Case Report/Clinical Techniques
Maxillary Central Incisor with Type V Canal Morphology: Case Report and Literature Review Gareth Calvert, BDS, MFDS Abstract Introduction: It is widely accepted that the permanent maxillary central incisor almost invariably has a single canal. Methods and Results: This case reports a maxillary central incisor canal morphology that differs from this predominant form, a single-rooted permanent maxillary central incisor with 1 main canal that separated into 2 distinct canals in the apical third with 2 apical foramina. The presence of a superimposed mesioden was also established. Nonsurgical endodontic retreatment achieved an optimal result. Conclusions: There is greater variation in root canal morphology of permanent maxillary central incisors than population studies would suggest. (J Endod 2014;-:1–4)
Key Words Maxillary central incisor, mesioden, type V morphology
From the Department of Restorative Dentistry, Glasgow Dental School and Hospital, Glasgow, Scotland, United Kingdom. Address requests for reprints to Dr Gareth Calvert, Level 6, Glasgow Dental School and Hospital, 378 Sauchiehall Street, Glasgow G2 3JZ. E-mail address: [email protected]. nhs.uk 0099-2399/$ - see front matter Copyright ª 2014 American Association of Endodontists. http://dx.doi.org/10.1016/j.joen.2014.01.046
E
ndodontic treatment requires the clinician to have knowledge of pulpal anatomy to optimally negotiate and manage the root canal system. Numerous experimental techniques including injection molding, clearing, histologic sectioning, ground section, and stereomicroscopic examinations have been reported to provide such information on root canal morphology (1–6). In 1970, Altman et al (7) examined 20 extracted maxillary central incisors by histologic sectioning and concluded that 100% had 1 root canal. Later, Vertucci (8) examined 100 maxillary central incisors by clearing, again concluding that 100% had 1 root canal. He went on to describe the widely accepted root canal anatomy classification made more comprehensive by Sert et al (9, 10) in 2004. More recently, Turkish and Iranian populations studies have shown 2% have 1 root but 2 separate root canals (type IV) and 4% have 1 root with 2 canals converging apically (type III), respectively (10–14). Case reports describing the variation of both root and pulp canal anatomy are more abundant in the literature (15–38). The majority of cases report maxillary central incisors with 2 separate roots and, therefore, 2 root canals. However, Zaitoun and Mackie (32), Gondim (38), and Sheikh-Nezami and Mokhber (37) report 3 root canal systems, and Mangani and Ruddle (26) report up to 4 root canal systems. The population prevalence of supernumerary teeth in Caucasian permanent dentition ranges from 0.1%–3.8% (39–41) with a sex ratio of 2:1 in favor of males (42–44). Mesiodens that occur in the premaxilla between central incisors are most common (41, 45–49) and are known to cause dilacerations and delayed or abnormal root development of permanent teeth (43, 44). This case details endodontic retreatment of a symptomatic maxillary central incisor with a previously undiscovered type V root canal system adjacent to an unrelated mesioden.
Case Report A 53-year-old man was referred to the Department of Restorative Dentistry at Glasgow Dental School and Hospital, Glasgow, Scotland, because of pain associated with his right maxillary central incisor. Spontaneous low-level pain had been present for 1 year after endodontic treatment. At presentation, the coronal restoration was missing and was reported to have failed 3 weeks earlier. The patient was fit and well with no adverse medical conditions. Upon clinical examination, no coronal restoration was present in the right maxillary central incisor exposing the obturation material within the root canal system. No sinus tract was present; however, there was tenderness apically. Sufficient sound supragingival tooth tissue remained so that this tooth was restorable. A periapical radiograph of the tooth in question showed an inadequately obturated canal with an apical curvature and periapical radiolucency. An incidental finding included the superimposition of an inverted mesioden surrounded by a normal width of follicular space on top of the right maxillary central incisor apex (Fig. 1). Based on the results of the clinical and radiographic findings, the patient was diagnosed with symptomatic periradicular periodontitis and a mesioden. The treatment plan was endodontic retreatment of this tooth, an interim partial mucosal borne acrylic denture, and a definitive custom post core and crown. Using rubber dam isolation and a dental operating microscope, the obturation material was removed with ProTaper retreatment rotary files followed by Hedstrom files and eucalyptus oil (Dentsply Maillefer, Ballaigues, Switzerland). On visual inspection
JOE — Volume -, Number -, - 2014
Maxillary Central Incisor with Type V Morphology
1
Case Report/Clinical Techniques
Figure 1. Preoperative periapical radiograph of the upper right central incisor.
Figure 3. Immediate postoperative periapical radiograph.
of the root canal anatomy, a second canal in the apical third was identified. The additional canal and working length was then confirmed radiographically. The retreated canal was prepared to a ProTaper F4 master file, and the de novo canal preparation to a ProTaper F2 file (Dentsply Maillefer). Copious irrigation with 3% sodium hypochlorite solution was followed by 17% EDTA solution (Septodont, Saint-Maur-des-Fosses, France). Calcium hydroxide paste (Ultradent, South Jordan, UT) was
used as an intervisit dressing with a provisional resin-modified glass ionomer restoration. Obturation of the root canal systems used a warm vertical condensation technique. An F4 paper point precut to the canal bifurcation was placed in the apical portion of the retreatment canal to maintain its patency during obturation of the additional canal. Sparingly, AH Plus sealer (Dentsply DeTrey, Konstanz, Germany) was applied to a premeasured F2 gutta-percha (GP) cone (Dentsply Maillefer) and inserted to length in the additional canal. A System B (SybronEndo, Orange, CA) heated tip was introduced in a firm, fluid movement to the level of the bifurcation. Maintaining apical pressure, the tip was allowed to cool for 10 seconds and then reactivated to release and remove the excess GP coronal to the bifurcation. After retrieval of the paper point section with a Hedstrom file, visual inspection of the nonobturated canal confirmed its patency. Therefore, a premeasured F4 GP cone was coated with AH Plus sealer and introduced to length in the nonobturated retreatment canal. In a similar technique as before, the heated System B tip removed the GP coronal to the bifurcation, leaving the coronal and middle third unobturated ready for post preparation (Fig. 2). An immediate postoperative periapical radiograph (Fig. 3) shows both canals optimally obturated with a sealer puff mesially. Twelve months after definitive restoration by their general dental practitioner, the patient returned asymptomatic. Clinical examination revealed no signs or symptoms of persistent apical disease. A periapical radiograph shows periapical healing (Fig. 4).
Discussion
Figure 2. Intraoperative view of the canals obturated to the bifurcation.
2
Calvert
Twenty-four case reports from 15 different countries identify maxillary central incisors with more than 1 root and or canal (15– 38). Of these, 13 cases report associated tooth abnormalities, the most frequent being fusion/gemination (n = 10), dens invaginatus (n = 2), and enamel hypoplasia (n = 1). Gemination arises when JOE — Volume -, Number -, - 2014
Case Report/Clinical Techniques
Figure 4. Twelve-month follow-up periapical radiograph.
the tooth bud of a single tooth attempts to divide, presenting most often as 2 crowns either totally or partially separate with a single root and root canal (50). The most commonly affected teeth are the permanent maxillary incisors (51). On the other hand, fusion is described as the union of 2 or more separately developing tooth germs at the dentinal level, yielding a single large tooth (52, 53). It is often difficult to differentiate between this and gemination; therefore, current literature recommends the term ‘‘double’’ tooth (51, 54). Population studies using demineralization and staining techniques to examine maxillary central incisor root canal anatomy concluded that 1 main canal was present (8, 10, 11, 13, 14). Five case reports identify single-rooted maxillary central incisors with more than 1 canal; however, none of these report a type V morphology (16, 23–25, 37). Advances in dental imaging techniques such as cone-beam computed tomographic scanning may provide a clinical tool to examine root canal anatomy in greater population numbers and challenge the results of classic studies.
Conclusion This case describes the management of a maxillary central incisor with a type V root canal morphology, which was previously unrecorded in the literature. Case reports describe a greater variation in root canal anatomy of permanent maxillary central incisors than population studies would suggest.
Acknowledgments Thanks to William McLean for his contribution. The author denies any conflicts of interest related to this study.
References 1. Kuttler Y. Microscopic investigation of root apexes. J Am Dent Assoc 1955;50: 544–52. 2. Green D. Stereomicroscopic study of the root apices of 400 maxillary and mandibular anterior teeth. Oral Surg 1956;9:1224–32.
JOE — Volume -, Number -, - 2014
3. Green N. Microscopic investigation of root canal diameters. J Am Dent Assoc 1958; 57:636–44. 4. Kartal N, Yanıkoglu F. Root canal morphology of mandibular incisors. J Endod 1992;18:562–4. 5. Baisden K, Kulild C, Weller N. Root canal configuration of the mandibular first premolar. J Endod 1992;18:505–8. 6. Weine S. Three canals in the mesial root of a mandibular first molar. J Endod 1982; 8:517–9. 7. Altman M, Guttuso J, Seidberg H, et al. Apical root canal anatomy of human maxillary central incisors. Oral Surg Oral Med Oral Pathol 1970;30:694–9. 8. Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg 1984;58: 589–99. 9. Sert S, Aslanalp V, Tanalp J. Investigation of the root canal configurations of mandibular permanent teeth in the Turkish population. Int Endod J 2004;37:494–9. 10. Sert S, Bayirli GS. Evaluation of the root canal configurations of the mandibular and maxillary permanent teeth by gender in the Turkish population. J Endod 2004;30: 391–8. 11. Rahimi S, Shahi S, Yavari HR, et al. A stereomicroscopy study of root apices of human maxillary central incisors and mandibular second premolars in an Iranian population. J Oral Sci 2009;51:411–5. 12. Pineda F, Kuttler Y. Mesiodistal and buccolingual roentgenographic investigation of 7,275 root canals. Oral Surg 1972;33:101–10. 13. Kasahara E, Yasuda E, Yamamoto A, et al. Root canal system of the maxillary central incisor. J Endod 1990;16:158–61. 14. Calis¸kan MK, Pehlivan Y, Sepetc¸ioglu F, et al. Root canal morphology of human permanent teeth in a Turkish population. J Endod 1995;21:200–4. 15. Patterson JM. Bifurcated root of upper central incisor. Oral Surg Oral Med Oral Pathol 1970;29:222. 16. Todd H. Maxillary right central incisor with two root canals. J Endod 1976;2:227–9. 17. Heling B. A two-rooted maxillary central incisor. Oral Surg Oral Med Oral Pathol 1977;43:649. 18. Mader CL, Konzelman JL. Double-rooted maxillary central incisor. Oral Surg Oral Med Oral Pathol 1980;50:99. 19. Sinai IH, Lustbader S. A dual-rooted maxillary central incisor. J Endod 1984;10: 105–6. 20. Libfeld H, Stabholz A, Friedman S. Endodontic therapy of bilaterally geminated permanent maxillary central incisors. J Endod 1986;12:214–6. 21. Hosomi T, Yoshikawa M, Yaoi M, et al. A maxillary central incisor having two root canals geminated with a supernumerary tooth. J Endod 1989;15:161–3. 22. Michanowicz AE, Michanowicz JP, Ardila J, et al. Apical surgery on a two-rooted maxillary central incisor. J Endod 1990;16:454–5. 23. Al-Nazhan S. Two root canals in a maxillary central incisor with enamel hypoplasia. J Endod 1991;17:469–71. 24. Reid JS, Saunders WP, MacDonald DG. Maxillary permanent incisors with two root canals: a report of two cases. Int Endod J 1993;26:246–50. 25. Lambruschini GM, Camps J. A two-rooted maxillary central incisor with a normal clinical crown. J Endod 1993;19:95–6. 26. Mangani F, Ruddle CJ. Endodontic treatment of a ‘‘very particular’’ maxillary central incisor. J Endod 1994;20:560–1. 27. Beltes P. Endodontic treatment in three cases of dens invaginatus. J Endod 1997;23: 399–402. 28. Cabo-Valle M, Gonzalez-Gonzalez JM. Maxillary central incisor with two canals: an unusual presentation. J Oral Rehabil 2001;28:797–8. 29. Cimilli H, Kartal N. Endodontic treatment of unusual central incisors. J Endod 2002; 28:480–1. 30. Gonzalez-Plata RR, Gonzalez-Plata EW. Conventional and surgical treatment of a tworooted maxillary central incisor. J Endod 2003;29:422–4. 31. Genovese FR, Marsico EM. Maxillary central incisor with two roots: a case report. J Endod 2003;29:220–1. 32. Zaitoun H, Mackie IC. Management of a non-vital central incisor tooth with three root canals. Dent Update 2004;31:142–4. 33. Lin WC, Yang SF, Pai SF. Nonsurgical endodontic treatment of a two-rooted maxillary central incisor. J Endod 2006;32:478–81. 34. Sponchiado EC Jr, Ismail HA, Braga MR, et al. Maxillary central incisor with two root canals: a case report. J Endod 2006;32:1002–4. 35. Benenati FW. Endodontic treatment of a maxillary central incisor with two separate roots: case report. Gen Dent 2006;54:265–6. 36. Kremeier K, Pontius O, Klaiber B, et al. Nonsurgical endodontic management of a double tooth: a case report. Int Endod J 2007;40:908–15. 37. Sheikh-Nezami M, Mokhber N. Endodontic treatment of a maxillary central incisor with three root canals. J Oral Sci 2007;49:245–7. 38. Gondim E Jr, Setzer F, Zingg P, et al. A maxillary central incisor with three root canals: a case report. J Endod 2009;35:1445–7. 39. Stellzig A, Basdra EK, Komposch G. Mesiodentes: Incidence, morphology, etiology. J Orofac Orthop 1997;58:144–53.
Maxillary Central Incisor with Type V Morphology
3
Case Report/Clinical Techniques 40. Brabant H. Comparison of the characteristics and anomalies of the deciduous and the permanent dentitions. J Dent Res 1967;49:897–902. 41. Primosch R. Anterior supernumerary teeth-assessment and surgical intervention in children. Pediatr Dent 1981;26:204–15. 42. Mitchell L. Supernumerary teeth. Dent Update 1989;16:65–9. 43. Hogstrum A, Andersson L. Complications related to surgical removal of anterior supernumerary teeth in children. ASDC J Dent Child 1987;54:341–3. 44. Zilberman Y, Marlon M, Shteyer A. Assessment of 100 children in Jerusalem with supernumerary teeth in the pre-maxillary region. ASDC J Dent Child 1992;59:44–7. 45. Nasif MM, Ruffalo RC, Zullo T. Impacted supernumerary teeth: a survey of 50 cases. J Am Dent Assoc 1983;106:201–4. 46. Shapira Y, Kuftenic MM. Multiple supernumerary teeth: report of two cases. Am J Dent 1989;2:28–30. 47. Mckibben DR, Brearly LJ. Radiographic determination of the prevalence of selected dental anomalies in children. ASDC J Dent Child 1971;28:390–8.
4
Calvert
48. Liu JF. Characteristics of premaxillary supernumerary teeth: a survey of 112 cases. ASDC J Dent Child 1995;62:262–5. 49. Tay F, Pang A, Yuen S. Unerupted maxillary anterior super- numerary teeth: report of 204 cases. ASDC J Dent Child 1984;51:189–294. 50. Alvarez I, Creath CJ. Radiographic considerations for supernumerary tooth extraction: report of case. ASDC J Dent Child 1995;62:141–4. 51. Neville BW, Damm DD, White DK. Color Atlas of Clinical Oral Pathology. 2nd ed. Baltimore: Lippincott Williams & Wilkins; 1998:58–66. 52. Velasco LF, de Araujo FB, Ferreira ES, et al. Esthetic and functional treatment of a fused permanent tooth: a case report. Quintessence Int 1997;28:677–80. 53. Nunes E, de Moraes IG, Novaes PMO, et al. Bilateral fusion of mandibular second molars with supernumerary teeth: case report. Braz Dent J 2002;13: 137–41. 54. Soames JV, Southam JC. Oral Pathology. 3rd ed. New York: Oxford University Press; 1998:6–7.
JOE — Volume -, Number -, - 2014
Maxillary Central Incisor with Type V Canal Morphology: Case Report and Literature Review Gareth Calvert, BDS, MFDS Abstract Introduction: It is widely accepted that the permanent maxillary central incisor almost invariably has a single canal. Methods and Results: This case reports a maxillary central incisor canal morphology that differs from this predominant form, a single-rooted permanent maxillary central incisor with 1 main canal that separated into 2 distinct canals in the apical third with 2 apical foramina. The presence of a superimposed mesioden was also established. Nonsurgical endodontic retreatment achieved an optimal result. Conclusions: There is greater variation in root canal morphology of permanent maxillary central incisors than population studies would suggest. (J Endod 2014;-:1–4)
Key Words Maxillary central incisor, mesioden, type V morphology
From the Department of Restorative Dentistry, Glasgow Dental School and Hospital, Glasgow, Scotland, United Kingdom. Address requests for reprints to Dr Gareth Calvert, Level 6, Glasgow Dental School and Hospital, 378 Sauchiehall Street, Glasgow G2 3JZ. E-mail address: [email protected]. nhs.uk 0099-2399/$ - see front matter Copyright ª 2014 American Association of Endodontists. http://dx.doi.org/10.1016/j.joen.2014.01.046
E
ndodontic treatment requires the clinician to have knowledge of pulpal anatomy to optimally negotiate and manage the root canal system. Numerous experimental techniques including injection molding, clearing, histologic sectioning, ground section, and stereomicroscopic examinations have been reported to provide such information on root canal morphology (1–6). In 1970, Altman et al (7) examined 20 extracted maxillary central incisors by histologic sectioning and concluded that 100% had 1 root canal. Later, Vertucci (8) examined 100 maxillary central incisors by clearing, again concluding that 100% had 1 root canal. He went on to describe the widely accepted root canal anatomy classification made more comprehensive by Sert et al (9, 10) in 2004. More recently, Turkish and Iranian populations studies have shown 2% have 1 root but 2 separate root canals (type IV) and 4% have 1 root with 2 canals converging apically (type III), respectively (10–14). Case reports describing the variation of both root and pulp canal anatomy are more abundant in the literature (15–38). The majority of cases report maxillary central incisors with 2 separate roots and, therefore, 2 root canals. However, Zaitoun and Mackie (32), Gondim (38), and Sheikh-Nezami and Mokhber (37) report 3 root canal systems, and Mangani and Ruddle (26) report up to 4 root canal systems. The population prevalence of supernumerary teeth in Caucasian permanent dentition ranges from 0.1%–3.8% (39–41) with a sex ratio of 2:1 in favor of males (42–44). Mesiodens that occur in the premaxilla between central incisors are most common (41, 45–49) and are known to cause dilacerations and delayed or abnormal root development of permanent teeth (43, 44). This case details endodontic retreatment of a symptomatic maxillary central incisor with a previously undiscovered type V root canal system adjacent to an unrelated mesioden.
Case Report A 53-year-old man was referred to the Department of Restorative Dentistry at Glasgow Dental School and Hospital, Glasgow, Scotland, because of pain associated with his right maxillary central incisor. Spontaneous low-level pain had been present for 1 year after endodontic treatment. At presentation, the coronal restoration was missing and was reported to have failed 3 weeks earlier. The patient was fit and well with no adverse medical conditions. Upon clinical examination, no coronal restoration was present in the right maxillary central incisor exposing the obturation material within the root canal system. No sinus tract was present; however, there was tenderness apically. Sufficient sound supragingival tooth tissue remained so that this tooth was restorable. A periapical radiograph of the tooth in question showed an inadequately obturated canal with an apical curvature and periapical radiolucency. An incidental finding included the superimposition of an inverted mesioden surrounded by a normal width of follicular space on top of the right maxillary central incisor apex (Fig. 1). Based on the results of the clinical and radiographic findings, the patient was diagnosed with symptomatic periradicular periodontitis and a mesioden. The treatment plan was endodontic retreatment of this tooth, an interim partial mucosal borne acrylic denture, and a definitive custom post core and crown. Using rubber dam isolation and a dental operating microscope, the obturation material was removed with ProTaper retreatment rotary files followed by Hedstrom files and eucalyptus oil (Dentsply Maillefer, Ballaigues, Switzerland). On visual inspection
JOE — Volume -, Number -, - 2014
Maxillary Central Incisor with Type V Morphology
1
Case Report/Clinical Techniques
Figure 1. Preoperative periapical radiograph of the upper right central incisor.
Figure 3. Immediate postoperative periapical radiograph.
of the root canal anatomy, a second canal in the apical third was identified. The additional canal and working length was then confirmed radiographically. The retreated canal was prepared to a ProTaper F4 master file, and the de novo canal preparation to a ProTaper F2 file (Dentsply Maillefer). Copious irrigation with 3% sodium hypochlorite solution was followed by 17% EDTA solution (Septodont, Saint-Maur-des-Fosses, France). Calcium hydroxide paste (Ultradent, South Jordan, UT) was
used as an intervisit dressing with a provisional resin-modified glass ionomer restoration. Obturation of the root canal systems used a warm vertical condensation technique. An F4 paper point precut to the canal bifurcation was placed in the apical portion of the retreatment canal to maintain its patency during obturation of the additional canal. Sparingly, AH Plus sealer (Dentsply DeTrey, Konstanz, Germany) was applied to a premeasured F2 gutta-percha (GP) cone (Dentsply Maillefer) and inserted to length in the additional canal. A System B (SybronEndo, Orange, CA) heated tip was introduced in a firm, fluid movement to the level of the bifurcation. Maintaining apical pressure, the tip was allowed to cool for 10 seconds and then reactivated to release and remove the excess GP coronal to the bifurcation. After retrieval of the paper point section with a Hedstrom file, visual inspection of the nonobturated canal confirmed its patency. Therefore, a premeasured F4 GP cone was coated with AH Plus sealer and introduced to length in the nonobturated retreatment canal. In a similar technique as before, the heated System B tip removed the GP coronal to the bifurcation, leaving the coronal and middle third unobturated ready for post preparation (Fig. 2). An immediate postoperative periapical radiograph (Fig. 3) shows both canals optimally obturated with a sealer puff mesially. Twelve months after definitive restoration by their general dental practitioner, the patient returned asymptomatic. Clinical examination revealed no signs or symptoms of persistent apical disease. A periapical radiograph shows periapical healing (Fig. 4).
Discussion
Figure 2. Intraoperative view of the canals obturated to the bifurcation.
2
Calvert
Twenty-four case reports from 15 different countries identify maxillary central incisors with more than 1 root and or canal (15– 38). Of these, 13 cases report associated tooth abnormalities, the most frequent being fusion/gemination (n = 10), dens invaginatus (n = 2), and enamel hypoplasia (n = 1). Gemination arises when JOE — Volume -, Number -, - 2014
Case Report/Clinical Techniques
Figure 4. Twelve-month follow-up periapical radiograph.
the tooth bud of a single tooth attempts to divide, presenting most often as 2 crowns either totally or partially separate with a single root and root canal (50). The most commonly affected teeth are the permanent maxillary incisors (51). On the other hand, fusion is described as the union of 2 or more separately developing tooth germs at the dentinal level, yielding a single large tooth (52, 53). It is often difficult to differentiate between this and gemination; therefore, current literature recommends the term ‘‘double’’ tooth (51, 54). Population studies using demineralization and staining techniques to examine maxillary central incisor root canal anatomy concluded that 1 main canal was present (8, 10, 11, 13, 14). Five case reports identify single-rooted maxillary central incisors with more than 1 canal; however, none of these report a type V morphology (16, 23–25, 37). Advances in dental imaging techniques such as cone-beam computed tomographic scanning may provide a clinical tool to examine root canal anatomy in greater population numbers and challenge the results of classic studies.
Conclusion This case describes the management of a maxillary central incisor with a type V root canal morphology, which was previously unrecorded in the literature. Case reports describe a greater variation in root canal anatomy of permanent maxillary central incisors than population studies would suggest.
Acknowledgments Thanks to William McLean for his contribution. The author denies any conflicts of interest related to this study.
References 1. Kuttler Y. Microscopic investigation of root apexes. J Am Dent Assoc 1955;50: 544–52. 2. Green D. Stereomicroscopic study of the root apices of 400 maxillary and mandibular anterior teeth. Oral Surg 1956;9:1224–32.
JOE — Volume -, Number -, - 2014
3. Green N. Microscopic investigation of root canal diameters. J Am Dent Assoc 1958; 57:636–44. 4. Kartal N, Yanıkoglu F. Root canal morphology of mandibular incisors. J Endod 1992;18:562–4. 5. Baisden K, Kulild C, Weller N. Root canal configuration of the mandibular first premolar. J Endod 1992;18:505–8. 6. Weine S. Three canals in the mesial root of a mandibular first molar. J Endod 1982; 8:517–9. 7. Altman M, Guttuso J, Seidberg H, et al. Apical root canal anatomy of human maxillary central incisors. Oral Surg Oral Med Oral Pathol 1970;30:694–9. 8. Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg 1984;58: 589–99. 9. Sert S, Aslanalp V, Tanalp J. Investigation of the root canal configurations of mandibular permanent teeth in the Turkish population. Int Endod J 2004;37:494–9. 10. Sert S, Bayirli GS. Evaluation of the root canal configurations of the mandibular and maxillary permanent teeth by gender in the Turkish population. J Endod 2004;30: 391–8. 11. Rahimi S, Shahi S, Yavari HR, et al. A stereomicroscopy study of root apices of human maxillary central incisors and mandibular second premolars in an Iranian population. J Oral Sci 2009;51:411–5. 12. Pineda F, Kuttler Y. Mesiodistal and buccolingual roentgenographic investigation of 7,275 root canals. Oral Surg 1972;33:101–10. 13. Kasahara E, Yasuda E, Yamamoto A, et al. Root canal system of the maxillary central incisor. J Endod 1990;16:158–61. 14. Calis¸kan MK, Pehlivan Y, Sepetc¸ioglu F, et al. Root canal morphology of human permanent teeth in a Turkish population. J Endod 1995;21:200–4. 15. Patterson JM. Bifurcated root of upper central incisor. Oral Surg Oral Med Oral Pathol 1970;29:222. 16. Todd H. Maxillary right central incisor with two root canals. J Endod 1976;2:227–9. 17. Heling B. A two-rooted maxillary central incisor. Oral Surg Oral Med Oral Pathol 1977;43:649. 18. Mader CL, Konzelman JL. Double-rooted maxillary central incisor. Oral Surg Oral Med Oral Pathol 1980;50:99. 19. Sinai IH, Lustbader S. A dual-rooted maxillary central incisor. J Endod 1984;10: 105–6. 20. Libfeld H, Stabholz A, Friedman S. Endodontic therapy of bilaterally geminated permanent maxillary central incisors. J Endod 1986;12:214–6. 21. Hosomi T, Yoshikawa M, Yaoi M, et al. A maxillary central incisor having two root canals geminated with a supernumerary tooth. J Endod 1989;15:161–3. 22. Michanowicz AE, Michanowicz JP, Ardila J, et al. Apical surgery on a two-rooted maxillary central incisor. J Endod 1990;16:454–5. 23. Al-Nazhan S. Two root canals in a maxillary central incisor with enamel hypoplasia. J Endod 1991;17:469–71. 24. Reid JS, Saunders WP, MacDonald DG. Maxillary permanent incisors with two root canals: a report of two cases. Int Endod J 1993;26:246–50. 25. Lambruschini GM, Camps J. A two-rooted maxillary central incisor with a normal clinical crown. J Endod 1993;19:95–6. 26. Mangani F, Ruddle CJ. Endodontic treatment of a ‘‘very particular’’ maxillary central incisor. J Endod 1994;20:560–1. 27. Beltes P. Endodontic treatment in three cases of dens invaginatus. J Endod 1997;23: 399–402. 28. Cabo-Valle M, Gonzalez-Gonzalez JM. Maxillary central incisor with two canals: an unusual presentation. J Oral Rehabil 2001;28:797–8. 29. Cimilli H, Kartal N. Endodontic treatment of unusual central incisors. J Endod 2002; 28:480–1. 30. Gonzalez-Plata RR, Gonzalez-Plata EW. Conventional and surgical treatment of a tworooted maxillary central incisor. J Endod 2003;29:422–4. 31. Genovese FR, Marsico EM. Maxillary central incisor with two roots: a case report. J Endod 2003;29:220–1. 32. Zaitoun H, Mackie IC. Management of a non-vital central incisor tooth with three root canals. Dent Update 2004;31:142–4. 33. Lin WC, Yang SF, Pai SF. Nonsurgical endodontic treatment of a two-rooted maxillary central incisor. J Endod 2006;32:478–81. 34. Sponchiado EC Jr, Ismail HA, Braga MR, et al. Maxillary central incisor with two root canals: a case report. J Endod 2006;32:1002–4. 35. Benenati FW. Endodontic treatment of a maxillary central incisor with two separate roots: case report. Gen Dent 2006;54:265–6. 36. Kremeier K, Pontius O, Klaiber B, et al. Nonsurgical endodontic management of a double tooth: a case report. Int Endod J 2007;40:908–15. 37. Sheikh-Nezami M, Mokhber N. Endodontic treatment of a maxillary central incisor with three root canals. J Oral Sci 2007;49:245–7. 38. Gondim E Jr, Setzer F, Zingg P, et al. A maxillary central incisor with three root canals: a case report. J Endod 2009;35:1445–7. 39. Stellzig A, Basdra EK, Komposch G. Mesiodentes: Incidence, morphology, etiology. J Orofac Orthop 1997;58:144–53.
Maxillary Central Incisor with Type V Morphology
3
Case Report/Clinical Techniques 40. Brabant H. Comparison of the characteristics and anomalies of the deciduous and the permanent dentitions. J Dent Res 1967;49:897–902. 41. Primosch R. Anterior supernumerary teeth-assessment and surgical intervention in children. Pediatr Dent 1981;26:204–15. 42. Mitchell L. Supernumerary teeth. Dent Update 1989;16:65–9. 43. Hogstrum A, Andersson L. Complications related to surgical removal of anterior supernumerary teeth in children. ASDC J Dent Child 1987;54:341–3. 44. Zilberman Y, Marlon M, Shteyer A. Assessment of 100 children in Jerusalem with supernumerary teeth in the pre-maxillary region. ASDC J Dent Child 1992;59:44–7. 45. Nasif MM, Ruffalo RC, Zullo T. Impacted supernumerary teeth: a survey of 50 cases. J Am Dent Assoc 1983;106:201–4. 46. Shapira Y, Kuftenic MM. Multiple supernumerary teeth: report of two cases. Am J Dent 1989;2:28–30. 47. Mckibben DR, Brearly LJ. Radiographic determination of the prevalence of selected dental anomalies in children. ASDC J Dent Child 1971;28:390–8.
4
Calvert
48. Liu JF. Characteristics of premaxillary supernumerary teeth: a survey of 112 cases. ASDC J Dent Child 1995;62:262–5. 49. Tay F, Pang A, Yuen S. Unerupted maxillary anterior super- numerary teeth: report of 204 cases. ASDC J Dent Child 1984;51:189–294. 50. Alvarez I, Creath CJ. Radiographic considerations for supernumerary tooth extraction: report of case. ASDC J Dent Child 1995;62:141–4. 51. Neville BW, Damm DD, White DK. Color Atlas of Clinical Oral Pathology. 2nd ed. Baltimore: Lippincott Williams & Wilkins; 1998:58–66. 52. Velasco LF, de Araujo FB, Ferreira ES, et al. Esthetic and functional treatment of a fused permanent tooth: a case report. Quintessence Int 1997;28:677–80. 53. Nunes E, de Moraes IG, Novaes PMO, et al. Bilateral fusion of mandibular second molars with supernumerary teeth: case report. Braz Dent J 2002;13: 137–41. 54. Soames JV, Southam JC. Oral Pathology. 3rd ed. New York: Oxford University Press; 1998:6–7.
JOE — Volume -, Number -, - 2014
