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238]

Case Report

Unusual anatomy of maxillary central incisor with

two roots
T. S. Ashwini Shivakumar, Saleem Makandar, Ajay Kadam
Department of Conservative Dentistry and Endodontics, Maratha Mandals Nathajirao G. Halgekar, Institute of Dental Sciences and Research
Centre, Belgaum, Karnataka, India

A B S T R A C T
Introduction: Knowledge of root canal morphology is essential for successful endodontic therapy. Failure to recognize unusual root
canal anatomy may lead to unsuccessful endodontic treatment. Case Report: This case report describes the successful endodontic
treatment of the maxillary central incisor with unusual anatomy of two roots and two root canals. A 23-year-old male patient was
referred for dental consultation with discoloration of the maxillary right central incisor with periapical lesion, which revealed unusual
anatomy of root on radiographic examination, and was confirmed upon exploration. Discussion: As described by Vertucci, the
maxillary central incisor presents a single root and single root canal in 100% of the cases. However, few cases of maxillary central
incisors with two canals were reported in the literature, most of which were associated with developmental anomalies like fusion,
germination or dens invaginatus. Clinician should be aware of the unusual anatomical variations that should be detected by the
different diagnostic resources available.
Key words: Maxillary central incisor, spiral CT scan, two roots

Introduction

Case Report

Knowledge of root canal morphology is essential for

successful endodontic therapy.[1] Failure to recognize
unusual root canal anatomy may lead to unsuccessful
endodontic treatment.[2] Hence, it is important that
dentists consider the anatomical variations of root canal
systems.[3] Majority of the anatomical studies have found
that maxillary central incisors are single-rooted teeth
with a single canal.[4] The presence of an additional
root or root canal in the maxillary central incisor is
rare; however, few cases have been reported in the
literature.[1-13] This case report describes a maxillary
central incisor with unusual anatomy of two separate
roots, which was treated by conventional endodontic
treatment.

A 24-year-old male patient reported to the dental hospital

complaining of discoloration of the maxillary central
incisor. His medical history was non-contributory. Past
dental history revealed extraction of the right lateral
incisor 9 years back due to ectopic eruption on the
disto-palatal region. Clinically, enamel hypoplasia
and mild discoloration of the right central incisor was
observed [Figure 1]. Vitality tests show no response
with heat, cold or electric pulp tests (EPT). Radiographic
examination revealed periapical radiolucency with
presence of two roots superimposing over each other.
The tooth was diagnosed as having necrotic pulp with
chronic apical periodontitis. The mixed radiopaque
and radiolucent lesion measured approximately 5 mm
7 mm and was roughly triangular with ill-defined
borders [Figure 2].

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DOI:
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After rubber dam application, endodontic access was

gained. Two canal orifices, facial and disto-palatal,
were located with a DG-16 endodontic explorer using
endodontic loupes. It was difficult to negotiate the
disto-palatal canal initially due to presence of initial

Corresponding Author: Dr. T. S. Ashwini Shivakumar, Bauxite Road, Belgaum, Karnataka, India. E-mail: drashts2000@yahoo.co.in
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Ashwini, et al.: Maxillary central incisor with two roots

curvature at the cervical third of the canal. The access

cavity was extended on the disto-palatal aspect to
enhance accessibility and instrumentation. Working
length was determined using an apex locator (Propex
II, Dentsply mallifier, Ballaigues, Switzerland) and
confirmed with Radio Visio G raphy after coronal flaring
with Gates Glidden Drills #1, #2 and #3. Cleaning and
shaping of the root canals was performed using hand
instruments and with a passive step-back technique.
The facial canal was instrumented to a master apical file
size of 60 and disto-palatal canal to size of 40 ISO size
K-file. Intermittent irrigation was done with 3% sodium
hypochlorite solution and saline. Calcium hydroxide
with iodoform (metapex, Metabiomed, Horsham, USA
Co.) was used as an intracanal medicament. After 2
weeks, the root canals were irrigated and obturated with
gutta-percha and AH-Plus sealer using the cold lateral
compaction technique [Figure 3]. A spiral computed
tomography was performed with panoramic and axial
sections to verify the limits of the root canal filling and
bifurcation between the two canals at various levels
[Figures 4-9].

Figure 1: Pre operative photograph

Discussion
The present report demonstrates a rare case of central
incisor with two roots and two root canals that was
successfully treated by non-surgical endodontic
treatment. As described by Vertucci, maxillary central
incisor presents a single root and single root canal in
100% of the cases.[14] However, few cases of maxillary
central incisors with two canals were reported in
the literature, most of which were associated with
developmental anomalies like fusion, germination or
dens invaginatus.[13]
Various case reports have been mentioned that have
successfully been treated by non-surgical and surgical
means.[2,4,11,12,15] In the present clinical report, the two
roots were distinguishable, visible on the pre-operative
radiograph. Careful interpretation of the radiograph is
important in clinical endodontics.[16] The pre-operative
radiograph of dual-rooted maxillary central incisor
showed double radiolucent lines around the root
surface. This can be misinterpreted as fusion of central
incisor with another tooth or presence of retained root
stump. Presence of two roots was then confirmed with
angled radiographs and instruments.
According to a study by Brynolf with three to four
parallax radiographs, correct endodontic diagnosis was
obtained 90% of the time compared with one radiograph
80

Dental Hypotheses

Figure 2: Pre operative palatal view

Figure 3: Pre-operative peri apical radiograph

(74%).[1,17] Therefore, the clinician should take more

than one radiograph from different angulations. Tracing
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Ashwini, et al.: Maxillary central incisor with two roots

Figure 4: Post obturation periapical radiograph

Figure 5: CT scan image showing caronal 3rd

Figure 6: CT scan image showing middel 3rd

Figure 7: CT scan image showing apical 3rd

Figure 8: CT scan showing lateral view showing buccal root

Figure 9: CT sacn image showing disto palatal root

the outline of the root surface cautiously can also help

in the diagnosis.

root and also large buccal canal, step-back hand

instrumentation was preferred. Unusual morphology,
when encountered, may complicate conventional
treatment, as seen in one case report of treating two

Considering the acute curvature of the disto-palatal

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Ashwini, et al.: Maxillary central incisor with two roots

rooted maxillary central incisors, in which a great

caution was necessary.

Acknowledgment
The authors acknowledge with profound gratitude the
Principal and Head of Department of Conservative Dentistry
and Endodontics, Maratha Mandal Nathajirao G. Halgekar
Institute of Dental Sciences, Belgaum, for the support and
encouragement.

8.
9.
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11.
12.

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Cite this article as: Ashwini Shivakumar TS, Makandar S, Kadam A.

Unusual anatomy of maxillary central incisor with two roots. Dent Hypotheses
2012;3:79-82.
Source of Support: Gratitude the Principal and Head of Department of
Conservative Dentistry and Endodontics, Maratha Mandal Nathajirao G.
Halgekar Institute of Dental Sciences, Belgaum,
Conflict of Interest: None declared.

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