ENDODONTIC TREATMENT OF UNUSUALLY LONG DISCOLORED MAXILLARY CENTRAL INCISOR: A CASE REPORT

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I.M.F. Abiodun-Solanke, D.M. Ajayi and A.O. Abu

Department of Restorative Dentistry, College of Medicine, University College Hospital, Ibadan, Nigeria.

Abstract

Background: Success in root canal treatment is achieved after thorough biomechanical preparation followed by complete obturation of the canal system together with prompt and adequate restoration. Therefore, the endodontic therapy requires specific and complete knowledge of the internal and external anatomy, and its variation in presentation. Such treatment may be performed in root canal systems that do not comply with normal anatomic features described in standard textbooks. This article presents a case of endodontic treatment in an unusually long discolored maxillary central incisor.

Case Presentation: A 31 year-old male patient was referred to conservation clinic for endodontic treatment of discolored left maxillary central incisor with associated history of recurrent swelling. Root canal therapy was performed and patient was found to have an unusually long working length of 29mm. This was then followed by enucleation of apical cyst without apical resection.

Conclusion: Though the patient presents a maxillary central incisor with canal length in the upper limit of some reported cases, it is unusual in our environment.

Keywords: Endodontic, Maxillary central, Unusually long, Treatment

Introduction

A broad knowledge of both the external and internal anatomy of teeth is of great importance for adequate endodontic treatment¹. Human dentition presents a variety of anatomical and morphological variations. However, the reported incidences of such variations in the maxillary central incisors are very few. Maxillary central incisor has one root and one canal but recently a few cases of dual–rooted maxillary central incisor have been reported in literature^1-5. Maxillary central incisors vary in root length with reported average length of 22mm to 23.8mm^6-8.

Weine⁹ in 1976 published a data for average tooth lengths in North Americans which were obtained from working lengths of his patients using the radiographic method. In an in-vitro study by Okpo and Akpata⁸ in 1986, the length of maxillary central incisor was reported to range from 20.0-28.0mm with a mean of 23.8mm. There is however a dearth of literature on length of maxillary central incisor among black Africans using clinical studies.

The following case report describes the endodontic management of a patient with an unusually long maxillary central incisor in our environment.

CASE PROFILE
A 31 year-old male was referred for the treatment of discoloured left maxillary central incisor. He noticed the discolouration of the tooth seven years before presentation, which could not be associated with any known cause. There was associated pain and swelling with pus discharge four years before presentation which subsided after medication. His medical history was unremarkable and non-contributory.

Clinical examination revealed a discoloured, mesiolabially rotated left maxillary central incisor.

Radiograph revealed a well circumscribed peri-apical radiolucency with sclerotic border in relation to left maxillary central incisor (Fig. 1). An assessment of periapical cyst was made and patient scheduled for root canal treatment followed by peri-radicular surgery for cyst enucleation.

The tooth was isolated with rubber dam. Access gained to the pulp chamber from the palatal surface a trianglar shaped cavity with apex pointing to the cingulum and base towards the incial edge. Canal was located and the pulp was already necrotic. A 25 mm ISO size 25 K file (Premier Dental Products Co, Canada, PA.) was placed in the root canal at full length without encountering any resistance, radiograph taken revealed that the file was short of the radiographic terminus by 4mm. Therefore, a size 31mm ISO size 25 Kfile was then placed in the root canal at 29mm using digital tactile sensation and the repeated working length radiograph showed that the file was at the radiographic terminus (Fig. 2). Biomechanical preparation of the root canal was carried out with serial K files ranging from ISO size 25 to ISO size 50 (Premier Dental Products Co, Canada, PA.) , using step back technique under continuous irrigation with 2.5% sodium hypochlorite solution(Reckitt Benckiser Ltd, Agbara, Nigeria). When preparation was completed, the canal was dried with paper points and a non-setting calcium hydroxide (Rite Dent Corp. Fl, USA ) dressing was placed within the canal and access cavity restored temporary with zinc phosphate cement (Prime Dental Manufacturing Inc,Chicago, Illinois). The Patient was recalled a week after. Tooth was asymptomatic and not tender to percussion, canal was dry and not foul smelling. After removing the non-setting calcium hydroxide dressing in the canal, the canal was reinstrumented and copiously irrigated and then dried with paper points. Thereafter, the master cone was selected, radiograph taken to ensure it is at the radiographic terminus (Fig. 3). The root canal system was obturated by lateral compaction of gutta- percha coated with a calcium hydroxide based sealer (Sealapex-Sybron/Keer USA) and acess cavity restored with zinc phosphate cement (Fig. 4).