0099-2399/90/1609-0454/$02.00/0 JOURNAL OF ENDODONTICS Copyright 9 1990 by The American Association of Endodontists
Printed in U.S.A.
VOL. 16, No. 9, SEPTEMBER1990
CASE REPORT Apical Surgery on a Two-Rooted Maxillary Central Incisor Andrew E. Michanowicz, DDS, John P. Michanowicz, DDS, Josue Ardila, DDS, and Augusto Posada, DDS
This article presents a case of a two-rooted maxillary central incisor with previous endodontic therapy. One root canal was well filled and the other partially filled. A post was present in each root and the tooth had a crown. Surgery was performed and an amalgam retrograde filling was placed. A 6month postoperative radiograph shows repair.
Few cases have been reported of maxillary central incisors having two roots. After examining thousands of teeth, Vertucci (1) and Pineda and Kuttler (2) reported 100% of maxillary incisors having but one root and one canal. Case histories, however, have been reported of two-rooted maxillary central incisors by Sinai and Luspbader (3) and Mader and Konzelman (4). Other cases of fusion and two canals with one root have been reported by Mehlman (5), Wolfe and Stieglitz (6), and Todd (7). This report discusses the treatment
F~G 1. A radiograph showing a bi-rooted maxillary central incisor. A radiolucent area circumscribes both previously treated roots.
FIG 2. An immediate postoperative radiograph showing a retrograde amalgam seal in both apices.
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Vol. 16, No. 9, September 1990
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On June 4, 1988, the patient was premedicated with Phenergan and Motrin. The area was injected with 1:50,000 Xylocaine and a trapozoidal flap was reflected. The labial plate was eroded over both apices. The area was curetted and both root surfaces prepared with an inverted cone. The root preparations were filled with zinc-free amalgam (Fig. 2). Four interrupted sutures were placed and removed 5 days later. Healing was uneventful. A 6-month recall in December 1988 revealed the area to be repaired (Fig. 3). DISCUSSION This report presents a case in which a two-rooted maxillary central incisor had been previously treated, and a crown and post and core were present. Since a radiolucent area and a sinus tract were present, it was apparent that some form of retreatment was necessary. It was decided that attempts to remove the crown and posts might possibly result in fracture of the tooth, since two individual posts with a common core and crown were present. Apical surgery was decided upon as the treatment of choice to eliminate the possibility of fracture. Seltzer (8) mentions the presence of a post as indication for a retrograde filling. Dr. A. Michanowicz is director of Graduate Endodontics Research, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA. Dr. J. Michanowicz is in private practice in Pittsburgh, PA. Dr. Ardila is in private practice in Bucaramanga, Columbia, South America. Dr. Posada is in private practice in Bogota, Columbia, South America. FtG 3. A 6-month recall radiograph showing repair.
References
of a previously treated two-rooted maxillary central incisor utilizing a surgical approach. A 20-yr-old female in good health was referred for endodontic treatment of tooth 8. The patient had a full complement of teeth. The crown appeared to be unusually wide and was approximately 3 m m wider than the adjacent central incisor. A labial sinus tract stoma was evident in the attached gingiva. A radiographic examination revealed a single crown with two distinct roots, one mesial and one distal. The mesial root had a completed root canal filling and a post. The distal had a small amount of filling evident in the middle third of the root and also had a post. A radiotucent area approximately 5 m m x 9 m m circumscribed the apices of both roots (Fig. 1).
1. Vertucci F. Root anatomy of the human permanent teeth. Oral Surg 1984;58:588-99. 2. Pineda Y, Kuttler Y. Mesial distal and buccal lingual roentgengraphic investigation of 7,275 root canals. Oral Surg 1972;33:101-2. 3. Sinai I, Luspbader S. A dual maxillary central incisor. J Endodon 1984;10:105-6. 4. Mader C, Konzetman J. Double maxillary central incisor. Oral Surg 1980;50:99. 5. Mehlman E. Management of a totally fused central and lateral incisor with internal resorption perforating the lateral aspect of the root. J Endodon 1978;4:189-91. 6. Wolfe R, Stieglitz H. A fused permanent maxillary incisor endodontic treatment and restoration. NY State Dent J 1980;46:654-7. 7. Todd H. Maxillary right central incisor with two root canals. J Endodon 1976;2:227. 8. Seltzer Samuel. Endodontology. 2nd ed. Philadelphia: Lea & Febiger, 1968:369-70.
Printed in U.S.A.
VOL. 16, No. 9, SEPTEMBER1990
CASE REPORT Apical Surgery on a Two-Rooted Maxillary Central Incisor Andrew E. Michanowicz, DDS, John P. Michanowicz, DDS, Josue Ardila, DDS, and Augusto Posada, DDS
This article presents a case of a two-rooted maxillary central incisor with previous endodontic therapy. One root canal was well filled and the other partially filled. A post was present in each root and the tooth had a crown. Surgery was performed and an amalgam retrograde filling was placed. A 6month postoperative radiograph shows repair.
Few cases have been reported of maxillary central incisors having two roots. After examining thousands of teeth, Vertucci (1) and Pineda and Kuttler (2) reported 100% of maxillary incisors having but one root and one canal. Case histories, however, have been reported of two-rooted maxillary central incisors by Sinai and Luspbader (3) and Mader and Konzelman (4). Other cases of fusion and two canals with one root have been reported by Mehlman (5), Wolfe and Stieglitz (6), and Todd (7). This report discusses the treatment
F~G 1. A radiograph showing a bi-rooted maxillary central incisor. A radiolucent area circumscribes both previously treated roots.
FIG 2. An immediate postoperative radiograph showing a retrograde amalgam seal in both apices.
454
Vol. 16, No. 9, September 1990
Two-Rooted Maxillary Central
455
On June 4, 1988, the patient was premedicated with Phenergan and Motrin. The area was injected with 1:50,000 Xylocaine and a trapozoidal flap was reflected. The labial plate was eroded over both apices. The area was curetted and both root surfaces prepared with an inverted cone. The root preparations were filled with zinc-free amalgam (Fig. 2). Four interrupted sutures were placed and removed 5 days later. Healing was uneventful. A 6-month recall in December 1988 revealed the area to be repaired (Fig. 3). DISCUSSION This report presents a case in which a two-rooted maxillary central incisor had been previously treated, and a crown and post and core were present. Since a radiolucent area and a sinus tract were present, it was apparent that some form of retreatment was necessary. It was decided that attempts to remove the crown and posts might possibly result in fracture of the tooth, since two individual posts with a common core and crown were present. Apical surgery was decided upon as the treatment of choice to eliminate the possibility of fracture. Seltzer (8) mentions the presence of a post as indication for a retrograde filling. Dr. A. Michanowicz is director of Graduate Endodontics Research, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA. Dr. J. Michanowicz is in private practice in Pittsburgh, PA. Dr. Ardila is in private practice in Bucaramanga, Columbia, South America. Dr. Posada is in private practice in Bogota, Columbia, South America. FtG 3. A 6-month recall radiograph showing repair.
References
of a previously treated two-rooted maxillary central incisor utilizing a surgical approach. A 20-yr-old female in good health was referred for endodontic treatment of tooth 8. The patient had a full complement of teeth. The crown appeared to be unusually wide and was approximately 3 m m wider than the adjacent central incisor. A labial sinus tract stoma was evident in the attached gingiva. A radiographic examination revealed a single crown with two distinct roots, one mesial and one distal. The mesial root had a completed root canal filling and a post. The distal had a small amount of filling evident in the middle third of the root and also had a post. A radiotucent area approximately 5 m m x 9 m m circumscribed the apices of both roots (Fig. 1).
1. Vertucci F. Root anatomy of the human permanent teeth. Oral Surg 1984;58:588-99. 2. Pineda Y, Kuttler Y. Mesial distal and buccal lingual roentgengraphic investigation of 7,275 root canals. Oral Surg 1972;33:101-2. 3. Sinai I, Luspbader S. A dual maxillary central incisor. J Endodon 1984;10:105-6. 4. Mader C, Konzetman J. Double maxillary central incisor. Oral Surg 1980;50:99. 5. Mehlman E. Management of a totally fused central and lateral incisor with internal resorption perforating the lateral aspect of the root. J Endodon 1978;4:189-91. 6. Wolfe R, Stieglitz H. A fused permanent maxillary incisor endodontic treatment and restoration. NY State Dent J 1980;46:654-7. 7. Todd H. Maxillary right central incisor with two root canals. J Endodon 1976;2:227. 8. Seltzer Samuel. Endodontology. 2nd ed. Philadelphia: Lea & Febiger, 1968:369-70.
