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Root Canal Treatment of a 32-mm Length Maxillary Canine - A Case Report

Article  in  International Journal of Contemporary Medical Research · December 2017

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CASE REPORT www.ijcmr.com

Root Canal Treatment of a 32-mm Length Maxillary Canine - A Case

Report
Al-Dahman Yousef H.1,2, Al-Hawwas Abdullah Y.3, Al-Jebaly Asma S.4

walls on tooth #13. The tooth was sensitive to percussion and

ABSTRACT palpation and revealed no response to cold test. Periapical
Introduction: Permanent maxillary canines can present with radiographs have been taken (HELIODENTPLUS, Sirona,
an unusual length exceeding 31 mm. This case report describes Germany) and revealed normal periapical area and an
the root canal therapy of permanent maxillary canine with an irregular root morphology consisting of a very long root with
unusual length. an apparent length of 32 mm for tooth #13 [Figure 1]. Based
Case Report: A 52-years Saudi female patient was reported on the clinical and radiographic findings and according to
to endodontic postgraduate clinics of Riyadh College’s Dental
American Association of Endodontics consensus,13 the tooth
Hospital suffered from pain upon biting on tooth #13. Root
was diagnosed as necrotic pulp with symptomatic apical
canal treatment was performed, and the tooth was found to
have an unusual length of 32 mm. The use of an alternative
periodontitis.
reference point was made to correspond the working length Following the delivery of local anesthesia (2% lidocaine
with the available endodontic instruments. and 1:100,000 epinephrine) and isolation with rubber dam,
Conclusion: Successful root canal treatment in extremely removal of caries and access opening were made, and the
long teeth is suitable if modifications in treatment procedures access was enlarged using Gates‑Glidden drills (No. 2, 3,
are utilized. and 4).
Then, the estimated working length was 32 mm, but the
Keywords: Root Canal Anatomy, Maxillary Canine, Root
longest files available were only 31 mm in length. So, it was
Canal Treatment.
found that the use of a cingulum reference point would be
possible. By using the palatal cingulum as a reference point,
the overall working length could be reduced by 5 mm and the
INTRODUCTION
31 mm length files would be long enough for the appropriate
The knowledge of the anatomy of root canal system and its cleaning and shaping of the root canal system. The working
morphological variations play a significant role in all the length from this cingulum reference point was established
steps of endodontic treatment. Therefore, the clinician should using Root ZX II (J. Morita, Tokyo, Japan) electronic apex
have a thorough understanding of the detailed anatomy locator and confirmed radiographically [Figure 2].
of the root canal to be able to utilize the most appropriate The canal was prepared with hand files (Flexofiles,
treatment techniques and protocols and thereby increasing Dentsply‑Maillefer, Ballaigues, Switzerland) up to size #25
the percentage of success rate.1 and then instrumentation was achieved with ProFile rotary
Studies on dental anatomy report different mean lengths for files (Dentsply Maillefer, Ballaigues, Switzerland) up to size
different tooth types. In maxillary canines, they have been #25 0.04 to the full working length, then substracting of 5
associated with normal mean lengths of 26.5 mm2, 27.3 mm3, mm from the working length and instrumentation to size
and 26.8 mm.4 Moreover, varying lengths have been reported #40 0.06 using crown‑down technique. Copious irrigation
in several case reports which indicated lengths of 41 to 52 with 2.5% sodium hypochlorite (NaOCl) followed by 17%
mm for extracted maxillary canines.5-7 Additionally, reports ethylenediaminetetraacetic acid (EDTA) was carried out
of an unusual lengths include 33.5 mm8, 39 mm9, 39.5 mm10, during the instrumentation phase.
41 mm11, and even 47 mm.12
Treatment becomes more complex in such cases, because 1
Division of Endodontics, Restorative Department, Riyadh Colleges
there are no endodontic instruments longer than 31 mm of Dentistry and Pharmacy, 2Dental Department at Qassim Region,
commercially available. The present case report describes Ministry of Health, 3Endodontist, Head of Endodontic Division,
a nonsurgical root canal treatment of a maxillary cuspid a Dental Department, King Abdulaziz University Hospital, King
36-mm long with an emphasis on the alternative technique Saud University, Riyadh, 4Dental Intern, Qassim Private Colleges,
employed in root canal preparation and filling. Kingdom of Saudi Arabia
CASE REPORT Corresponding author: Yousef Hamad Al-Dahman, Division of
A 52‑years‑old Saudi woman with a non-contributing Endodontics, Restorative Department, Riyadh Colleges of Dentistry
medical history was reported to endodontic postgraduate and Pharmacy, Kingdom of Saudi Arabia, P. O. Box: 84891, Riyadh
11681, Kingdom of Saudi Arabia.
clinics of Riyadh College’s Dental Hospital, Riyadh, Saudi
Arabia for nonsurgical endodontic treatment of maxillary How to cite this article: Al-Dahman Yousef H., Al-Hawwas
right canine (number #13). The chief complaint was painful Abdullah Y., Al-Jebaly Asma S. Root canal treatment of a 32-mm
sensation on upper right canine upon biting. length maxillary canine - a case report. International Journal of
Clinical examinations revealed carious palatal and mesial Contemporary Medical Research 2017;4(11):2297-2299.

International Journal of Contemporary Medical Research 2297

ISSN (Online): 2393-915X; (Print): 2454-7379 | ICV: 77.83 | Volume 4 | Issue 11 | November 2017
Yousef H, et al. Root Canal Treatment

Figure-1: Preoperative radiograph. Figure-2: Working length determination. Figure-3: Postoperative radiograph.

The root canal was dried with sterile paper points (Maillefer, lengths in teeth with curved canals, which is in accordance
Dentsply, Ballaigues, Switzerland) and filled with cold lateral with the present case report.
compaction technique by gutta‑percha (Maillefer, Dentsply, Root canal treatment in teeth with such obstacle faced
Ballaigues, Switzerland) and AH26 sealer (Maillefer, during the treatment procedures could be compensated by
Dentsply, Ballaigues, Switzerland). The access cavity was using a 2.5% sodium hypochlorite solution with a greater
sealed with Coltosol temporary filling material (Coltosol® F, concentration of active chlorine when compared with the
Coltene, Switzerland), and the patient was referred to receive concentration of 1%.1
final restoration [Figure 3]. It is important to point out that Maillefer (Dentsply,
Ballaigues, Switzerland) produces the Vetinox series of
DISCUSSION
endodontic instruments, designed for veterinary use, with
A proper locating, cleaning, shaping, and obturating the root higher lengths, reaching 40 mm and even 60 mm.16
canal system is an adequate measure for long-term success The case reported here reveals that extremely long teeth can be
of root canal therapy. Therefore, failure of any of these successfully treated endodontically if suitable modifications
principles could compromise the treatment success end up in treatment procedures are utilized. A single-visit root canal
with post-treatment disease, pain, and/or complications of treatment is possible if the appropriate cleaning, shaping,
the treated tooth.1,14 and obturating materials are available.
It is widely known that the maxillary canines are the
CONCLUSION
longest teeth in the human dental arch. they are flattened in
the cervical region and should be flared to allow adequate Cases of extreme length can occur and in case it is not possible
instrumentation.15 The cleaning and shaping of maxillary to use another alternative technique, it could compromise
canines longer than 32 mm long is extremely difficult because the treatment by the risk of having to wear the coronary
of the size of the instruments commercially available.16 sound structure. The technique used in the present case not
In root canal treatment of teeth with this length, some only provided adequate cleaning, shaping, and obturation
modifications must he made in the treatment technique due to of the root canal, but also allowed the preservation of the
restrictions in length of files, endodontic burs, Gates Glidden remaining tooth structure. After seeing these case reports of
burs, sonic/ultrasonic instruments, obturating materials, and the maxillary canines which showed length measures that
spreaders.17 The use of an alternative reference point, located can reach the maximum measure of the longer endodontic
at the cervical limit of the access cavity, proved to be an instrument available or even go beyond, the availability
excellent approach in this case which allowed the use of a of longer endodontic instruments in the market becomes
standardized 31-mm length files for canal preparation, master evident.
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Volume 4 | Issue 11 | November 2017 | ICV: 77.83 | ISSN (Online): 2393-915X; (Print): 2454-7379
Yousef H, et al. Root Canal Treatment

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Source of Support: Nil; Conflict of Interest: None

Submitted: 29-10-2017; Accepted: 30-11-2017; Published: 08-12-2017

International Journal of Contemporary Medical Research 2299

ISSN (Online): 2393-915X; (Print): 2454-7379 | ICV: 77.83 | Volume 4 | Issue 11 | November 2017

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