Mahadevan Mageshwari, Paulaian Benin, Ravisankar Santhakumari Madhavankutty, Arvind Kumar Alexander, Nagaraj Neelamani Jaya
Conservative Dentist and Endodontist, Yash Dental, Adyar, Chennai, Tamilnadu, India.
Department of Conservative Dentistry and Endodontics, Rajas Dental College and Hospital, Tirunelveli, Tamilnadu, India.
Iran Endod J. 2023;18(2):104-109. doi: 10.22037/iej.v18i2.38146.
The knowledge of anatomical variations in the morphology of root canal systems can affect the successful diagnosis to deliver proper endodontic treatment. The current case report enlightens the endodontic management of an anomalous maxillary left central incisor with two roots/root canals, a C-shaped root canal configuration in a maxillary left lateral incisor identified by three-dimensional cone-beam computed tomography imaging as well as the successful aesthetic rehabilitation of maxillary fractured incisors. The chief complaint of patient was a history of trauma during his outdoor play and consequent broken upper front teeth. Tooth #9 was diagnosed with pulpal necrosis accompanied by asymptomatic apical periodontitis with two relatively dilacerated roots while the maxillary left lateral incisor (tooth #10) was diagnosed with necrotic pulp and asymptomatic apical periodontitis having a C-shaped canal. Endodontic treatment for teeth #9 and #10 were performed, followed by post and core fabrication. Tooth reinforcement was achieved with prefabricated un-polymerized glass fiber post for lateral incisor and Interlig Fiber for central incisor. Intentional root canal treatment of tooth #8 was considered to reduce labial inclination. The anomalous maxillary central incisor with two roots is an unexpected variant during endodontic treatment, and the presence of C-shaped canal in lateral incisors is extremely rare requiring careful diagnosis with radiographs, clinical examination along with additional aids; Three-dimensional (3-D) cone-beam computed tomography. 3-D imaging has added the advantages of appropriate identification of anomalous anterior teeth and careful location of additional root canal(s) during endodontic treatment.
了解根管系统形态的解剖变异会影响成功诊断,从而进行适当的牙髓治疗。本病例报告阐述了对上颌左中切牙双根/双根管的牙髓治疗、通过三维锥形束计算机断层扫描成像确定的上颌左侧切牙C形根管形态以及上颌骨折切牙的成功美学修复。患者的主要诉求是其在户外玩耍时曾受过外伤,导致上前牙折断。9号牙被诊断为牙髓坏死伴无症状根尖周炎,有两根牙根相对弯曲;而上颌左侧切牙(10号牙)被诊断为牙髓坏死和无症状根尖周炎,根管呈C形。对9号牙和10号牙进行了牙髓治疗,随后制作了桩核。侧切牙使用预制未聚合玻璃纤维桩,中切牙使用Interlig纤维桩进行牙齿加固。考虑对8号牙进行根管治疗以减少唇倾。上颌中切牙双根是牙髓治疗中意外出现的变异情况,侧切牙出现C形根管极为罕见,需要通过X线片、临床检查以及其他辅助手段(三维锥形束计算机断层扫描)进行仔细诊断。三维成像有助于在牙髓治疗过程中准确识别异常前牙并精确确定额外根管的位置。