Geminated Maxillary Lateral Incisor with Two Root Canals

Abstract

This paper reports a case of gemination in a maxillary lateral incisor with two root canals and crown-root dilaceration. A 16-year-old male patient was referred for endodontic treatment of the maxillary left lateral incisor and evaluation of esthetic and functional complaints in the anterior region. The patient reported trauma to the anterior primary teeth. There was no spontaneous pain, but the tooth responded positively to the vertical percussion test and negatively to the pulp vitality test. Clinical examination showed esthetic and functional alterations and normal periodontal tissues. CBCT imaging confirmed the suspicion of gemination and crown-root dilaceration and also revealed the presence of two root canals and periapical bone rarefaction. The root canals were instrumented with Reciproc R40 and 1% NaOCl irrigation and were filled by lateral condensation of gutta-percha and AH Plus sealer. The tooth was definitely restored with composite resin to recover esthetics. Continued follow-up over 6 months has shown absence of pain or clinical alterations as well as radiographic image suggestive of apical repair.

Diagnosis and treatment of a maxillary lateral incisor with two root canals. A case report.

“…Several case reports demonstrate that most root canals in lateral incisors are located in palatine and buccal. 19,20 In the present case, the use of 3.5x magnification and the flooding of the pulp chamber facilitated the location of the buccal canal entrance. Magnification has improved various endodontic procedures, leading to improve outcomes.…”

“…10,16 Although this anatomical variant is infrequent, 10,16,17 some case reports provide enough indications to note the presence of more than one root canal, which must be considered during the endodontic therapy to avoid untreated canals. 17,[19][20][21] The root anatomical variations in maxillary lateral incisors are attributed to specific developmental defects: fusion, gemination, "dens in dente", and palatal groove. 10,22,23 Therefore, identifying the aetiology of the abnormality is crucial to developing an appropriate treatment plan.…”

“…Clinically both the fusion and the germination show alteration in the shape of the crown. 19,24 "Dens in dente" is the invagination of the enamel organ within the dental papilla before proper calcification. Although a small fossa may appear on the palatal surface, the diagnosis is usually made by noticing a radiopaque image expanding the affected root to create the appearance of a tooth inside another tooth.…”

“…[10][11][12][13][14][15][16][17] In that sense, among maxillary teeth, the lateral incisors are typically described as singlerooted, with one canal, slightly flattened mesiodistally and with a disto-palatal orientated low curvature. 10,15,18 Although morphological root canal abnormalities of the maxillary lateral incisors are uncommon, [19][20][21] variations are frequently associated with "dens in dente", palatal grooves, gemination or fusion. 10,22,23 Besides, some reviews have informed a 3% incidence of two canals.…”

Investigation of Impacted Supernumerary Teeth: A Cone Beam Computed Tomograph (Cbct) Study

“…CBCT provides precise location of the impacted supernumerary teeth and allows accurate linear measurement of the distances from the anatomical structures and cortical plates. These advantages of CBCT enable correct and less invasive surgical planning with a less risk of damage ( 13 , 14 , 19 , 31 , 32 ). Initial diagnosis can be made using conventional techniques, but for further evaluation CBCT is recommended.…”