Discussion:
The central incisor is typically considered a simple tooth to treat endodontically. Even though the canal space may be excessively wide or narrow due to a history of trauma, the presence of two root canals is rare but must be taken into consideration to avoid a negative outcome. Clinicians should be able to evaluate the case and prepare for anatomical anomalies (22).
Even though the case repot is weak of evidence (23), anatomical variabilities are always important to be reported since as mentioned before the main cause of endodontic failure is untreated anatomy (2)
After two years of follow-up the tooth presented no clinical or radiographic symptoms, and healing was confirmed. Nonetheless follow-up must continue until at least five years. It might be of a great interest also to evidence a three dimensional healing through a second CBCT image, but because of the age of the patient and the absence of other indications this might not be necessary.
In complex cases, treatment planning is fundamental after assessing all the necessary information. In particular, radiographic imaging is essential for the initial evaluation of an endodontic case. In the majority of cases, two-dimensional intraoral radiographs are adequate to assess intracanal anatomy. However, cases with anatomical irregularities or pathologies require the use of CBCT for three-dimensional imaging. CBCT imaging helps assess the anatomy of the canal system and the condition of the periapical tissues.
Although in many cases, irregularities in the number and shape of the roots are bilateral (24), in the present case, the contralateral central incisor (tooth #11) presented with no anatomical variations upon evaluation by CBCT. Thus, the abnormal anatomy of the central incisor was unilateral in this case.
In addition, the crown of the tooth was normal in shape and identical to the shape of the contralateral central incisor (25). Thus, developmental abnormalities such as gemination and fusion were ruled out.
This case report highlights the importance of treatment planning and meticulous evaluation of the initial internal anatomy of the root canal before initiating endodontic therapy. It is well known that the internal anatomy of each individual tooth is unique, and this must always be taken into consideration while treating a root canal space. Within the limitations of this report, it is important to highlight the ability of the root canal treatment to maintain, heavily compromised anatomically unique teeth.
References:
AAE Clinical Practice Committee. Guide to Clinical Endodontics. 6th ed. AAE. 2013.
Song M, Kim HC, Lee W, Kim E. Analysis of the Cause of Failure in Nonsurgical Endodontic Treatment by Microscopic Inspection during Endodontic Microsurgery. J Endod 2011; 37:11: 1516–9.
  1. Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Pathol 1984; 58: 589-9.
  2. Pineda F, Kuttler Y. Mesiodistal and buccolingual roent- genographic investigation of 7,275 root canals. Oral Surg Oral Med Oral Pathol. 1972; 33: 101–10. doi:
  3. Calişkan MK, Pehlivan Y, Sepetçioğlu F, Türkün M, Tuncer SS. Root canal morphology of human permanent teeth in a Turkish population. J Endod. 1995; 21: 200-4.
  4. Patterson JM. Bifurcated root of upper central incisor. Oral Surg Oral Med Oral Pathol. 1970; 29: 222.
  5. Heling B. A two-rooted maxillary central incisor. Oral Surg Oral Med Oral Pathol. 1977; 43: 649.
  6. Mader CL, Konzelman JL. Double-rooted maxillary central incisor. Oral Surg Oral Med Oral Pathol. 1980; 50: 99.
  7. Sinai IH, Lustbader S. A dual-rooted maxillary central incisor. J Endod. 1984; 10: 105–6.
  8. Libfeld H, Stabholz A, Friedman S. Endodontic therapy of bilaterally geminated permanent maxillary central incisors. J Endod. 1986; 12: 214–6.
  9. Michanowicz AE, Michanowicz JP, Ardila J, Posada A. Apical surgery on a two-rooted maxillary central incisor. J Endod. 1990; 16: 454–5.
  10. Al-Nazhan S. Two root canals in a maxillary central incisor with enamel hypoplasia. J Endod. 1991; 17: 469–71.
  11. Lambruschini GM, Camps J. A two-rooted maxillary central incisor with a normal clinical crown. J Endod. 1993; 19: 95–6.
  12. Gonzalez-Plata RR, Gonzalez-Plata EW. Conventional and surgical treatment of a two-rooted maxillary central incisor. J Endod 2003; 29: 422–4.
  13. Ravindranath M, Neelakantan P, Subba Rao CV. Maxillary lateral incisor with two roots: a case report. Gen Dent. 2011; 59: 68–9.
  14. Ghoddusi J, Zarei M, Vatanpour M. Endodontic treatment of maxillary central incisor with two roots. A case report. N Y State Dent J. 2007; 73: 46–7.
  15. Mangani F, Ruddle CJ. Endodontic treatment of a ”very particular” maxillary central incisor. J Endod. 1994; 20: 560–1.
  16. Genovese FR, Marsico EM. Maxillary central incisor with two roots: a case report. J Endod. 2003; 29: 220–1.
  17. Cabo Vale M, Gonzales JM. Maxillary central incisor with two root canals: an unusual presentation. J Oral Rehabil. 2001; 28: 797–8.
  18. Cimilli H, Kartal N. Endodontic treatment of unusual central incisors. J Endod. 2002; 28: 480–1.
  19. V Nagendrababu , B S Chong , P McCabe , et al. PRICE 2020 guidelines for reporting case reports in Endodontics: a consensus-based development. Int Endod J. 2020; 53: 619-626.  doi: 10.1111/iej.13285.
  20. Vertucci FJ. Root canal morphology and its relationship to endodontic procedures. Endodontic Topics. 2005; 10: 3–29.
  21. M Hassan Murad , Noor Asi , Mouaz Alsawas. New evidence pyramid. Evid Based Med. 2016; ;21:125-7. doi: 10.1136/ebmed-2016-110401
  22. Sabala CL, Benenati FW, Neas BR. Bilateral root or root canal aberrations in a dental school patient population. J Enodod. 1994; 20: 38–42. di: 10.1016/s0099-2399(06)80025-7
  23. Rajendran A., Sivapathasundharam B. Shafer’s Textbook of Oral Pathology, 7th ed. India: Elsevier; 2012.
Figure Legends:
Figure 1: PRICE flow chart
Figure 2: a. Preoperative radiograph b. Working length c. Obturation d. Obturation with temporary filling e. Two-year follow-up
Figure 3: CBCT slices from coronal (a.) to apical (e.)
Disclosure statement: The authors have no conflicts of interest to declare.
Written informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy