A maxillary central incisor presenting with more than one root or root canal is an exceptionally rare scenario considering the fact that most of the anatomic studies describe maxillary central incisor as a single rooted tooth with single canal. However, several case reports have shown the presence of up to four canals in maxillary central incisors. The aim of this article is to present a case report of maxillary central incisor with a rare anatomic variation, i.e. Vertucci’s type V root canal anatomy. Failure to locate and clean additional root canal system may lead to post treatment disease. Hence, an astute clinician should be aware of possible anatomic variations this tooth might present with.
The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.
Root canal anatomy is highly variable and complex. It has been studied using several techniques such as clearing, histological sectioning, microscopic/stereomicroscopic evaluation and ground sections; it provides valuable information in understanding complex internal root canal anatomy [
A 65-year-old female from Delhi, India (nationality: Indian; ethnicity: South Asian) reported to Department of Conservative Dentistry and Endodontics at Maulana Azad Institute of Dental Sciences in India with the complaint of pain in the upper front tooth. Medical history was insignificant. Root canal treatment was started by a private practitioner for tooth number 21 one week back. But the patient did not find any relief in pain.
On clinical examination, tooth number 21 was discolored, tender on percussion and the temporary restoration was missing. The external morphology of the crown was normal. Periodontal findings were within normal limits. Preoperative radiograph showed a single rooted left maxillary central incisor with one main canal bifurcating at apical third (Figure
Access opening was modified after rubber dam isolation under a dental operating microscope (DOM) (Carl Zeiss OPMI PROergo, Carl Zeiss Surgical GmbH, Oberkochen, Germany). Canal bifurcation was carefully negotiated using a precurved #10 K-file (Dentsply Maillefer, Ballaigues, Switzerland) (Figure
Access cavity was restored with a light-cured nanohybrid composite resin (Filtek Z250, 3M ESPE, St. Paul, MN) (Figure
The objective of this paper was to present a case report illustrating the endodontic management of a maxillary central incisor with Vertucci’s type V root canal anatomy. To the author’s knowledge, only one case report has been published till date which shows type V root canal anatomy in maxillary central incisor [
Vertucci’s type V root canal anatomy presents major endodontic challenge. To gain access to the apical third canal bifurcation, access opening needs to be carefully widened under the DOM to avoid root perforation. DOM is an indispensable armamentarium while managing complex root canal anatomy. It reduces the chances of mishaps, increases the chance of locating additional canals and offers greater precision [
Access cavity needs to be extended properly specially over the lingual shelf area to expose or uncover the second canal if present. Preoperative radiograph may indicate the presence of accessory root/root canal. A sudden break, narrowing or change in radiographic density of the root canal indicates presence of additional canal [
Although majority of studies suggest that maxillary central incisor is a single rooted tooth with single canal, a prudent clinician should always begin root canal procedure with an open mind and expect anatomical variations. It is highly recommended to use advanced armamentarium like DOM in managing teeth with complex root canal anatomy to provide much required precision in managing complex cases and increasing the ultimate success rate of endodontic treatment.
The authors have declared that no competing interests exist.
Consent was obtained by all participants in this study