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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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Year : 2006  |  Volume : 24  |  Issue : 4  |  Page : 204-208

Double-rooted primary canines: A report of three cases

Department of Pediatric Dentistry,Faculty of Dentistry, Ankara University, 06500 Besevler-Ankara, Turkey

Correspondence Address:
Ayse I Orhan
Ankara Universities Dib Hekimlidi Fakultesi, Pedodonti A.D. 06500-Besevler-Ankara
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-4388.28079

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This article reports three rare cases of birooted primary canines. In one of the three cases reported, the double-rooted primary canine was unilateral, which is a unique condition in the dental literature. One of the birooted primary canines was extracted for examination. Root canal morphology was examined using the clearing technique and three root canals were detected. The detection of birooted teeth requires a fastidious radiographic evaluation. Moreover, it should be kept in mind during endodontic therapy that the number of root canals might exceed the number of roots for these teeth.

Keywords: Endodontic therapy, morphology, primary teeth, root anomaly, root canal

How to cite this article:
Orhan AI, Sari S. Double-rooted primary canines: A report of three cases. J Indian Soc Pedod Prev Dent 2006;24:204-8

How to cite this URL:
Orhan AI, Sari S. Double-rooted primary canines: A report of three cases. J Indian Soc Pedod Prev Dent [serial online] 2006 [cited 2023 Jan 28];24:204-8. Available from: http://www.jisppd.com/text.asp?2006/24/4/204/28079

   Introduction Top

The single conical root is described in pedodontic and dental morphology texts as the normal, most common form of primary maxillary canine root.[1],[2] Birooted primary canines are an extremely rare dental anomaly, only a few cases of which have been reported since 1975.[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15] Although the etiology of this anomaly is unknown, an ingrowth of tissue from Hertwig's epithelial root sheath has been suggested as a possible cause.[4] This paper reports on three cases of birooted primary canines.

   Case Reports Top

Case 1

An 11-year 3-month-old Caucasian male was brought to our clinic for a routine dental examination. The child's medical history included no trauma, allergies or previous medical problems. An intra-oral examination revealed a mixed dentition with multiple carious lesions, amalgam restorations and missing teeth. Periapical radiographs revealed a double-rooted maxillary left primary canine [Figure - 1][Figure - 2]. A morphologic evaluation of the tooth revealed a normal shaped crown and an abraded incisal surface resulting from attrition [Figure - 3]. A radiographic examination clearly showed the succedaneous permanent canine root to have developed to two-thirds of its full length; therefore, the decision was made to extract the primary canine. Following extraction, the roots were examined and found to be bifurcated labially [Figure - 4]A, but connected palatinally by a hard tissue bridge, giving them the appearance of a single, wide root [Figure - 4]B. The mesial root was wider and longer than the distal root.

Radiological evaluation of the extracted tooth revealed the existence of two root canals, one in the mesial root and the other in the distal root [Figure - 4]C. The internal morphology of the birooted canine was evaluated using the clearing technique, as follows:

The pulp chamber was accessed with a file and the mesial and distal canals were located. The tooth was immersed in a 5% sodium hypochlorite solution for 6 h and in a 59% Hcl solution. Following decalcification, the tooth was rinsed in running water and dehydrated and black India ink was injected via the pulp chamber. The tooth was placed in pure alcohol for 4 h and immersed in methyl salicylate for clearing. The cleared tooth was examined under a stereomicroscope (Leica Microsystems AG, Wetzlar, Germany), revealing three different root canals - one each in the mesial, distal and palatinal directions [Figure - 5]A-C].

The mandibular left primary canine was found to be single-rooted, whereas the maxillary and mandibular right primary canines were missing and therefore the number of roots in these teeth could not be evaluated. Periapical radiographs of the patient's 9-year old sister showed normal, mixed dentition with no bifurcated primary canines.

Case 2

A 4-year 9-month-old Caucasian male was seen for a routine dental examination. Intra-oral examination revealed fully erupted primary dentition and interproximal carious lesions on the maxillary primary molars. Panoramic and periapical radiographs revealed a double-rooted maxillary right primary canine [Figure - 6][Figure - 7]. Clinical examination showed the crown of this tooth to be normal in shape and size [Figure - 8]. The patient's other primary canines were single-rooted and he had no siblings.

Case 3

A 6-year-old Caucasian male came to our clinic with the chief complaint of a toothache in the lower left quadrant. He was in primary dentition. Intra-oral examination revealed a deep carious lesion on the primary mandibular left second molar, as well as an amalgam restoration and multiple carious lesions on several other primary teeth. Panoramic and periapical radiographs incidentally revealed bifurcation of both maxillary primary canines [Figure - 9][Figure - 10]. Clinical examination showed the shape and size of their crowns to be normal [Figure - 11]. The mandibular canines were found to be single-rooted. The child's medical history was unremarkable and he had no siblings.

In cases 2 and 3, the parents were informed about these root anomalies and the patients were kept under close observation in order to examine the time and pattern of primary canine root resorption and eruption of permanent canine teeth.

   Discussion Top

As in all other birooted primary canines reported to date, root bifurcations in the three cases reported here were in the coronal third,[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15] indicating that biroot formation began between 9 and 10 months postnatally.[13] While double-rooted teeth are generally believed to be a result of enhanced expressivity of the gene initiating differential growth of Hertwig's epithelial root sheath,[13] the above data bring to mind the fact that trauma or other disturbances during morphodifferentiation may affect root form and size in later periods.[16] In the present cases, however, there was no history of trauma, nor were any double-rooted primary canines detected in the sibling of the one patient with a sibling. As a result, the birooted primary canines in the present cases could not be attributed to a specific cause.

A review of the dental literature revealed a tendency for this anomaly to occur more frequently in black and male children and bilaterally in the maxillary arch [Table - 1]. All three of the present cases were white males and all three of the anomalies were located in the maxillary arch. In our case 3, birooted canines were bilateral in the maxillary arch, which is the form commonly reported in the dental literature. In case 1, the birooted primary canine was located in the left maxillary arch; however, the maxillary right primary canine was absent and thus could not be evaluated. The mandibular right primary canine was also absent and the mandibular left primary canine was single rooted. In case 2, all four primary canines were present, but only the maxillary right primary canine was birooted. This unilateral case is unique in the dental literature [Table - 1].

Morphologic evaluation of the extracted canine in case 1 showed it to be similar to that of the case reported by Paulson et al .[9] The roots emanated from a long root trunk, they were bifurcated labially and connected on the lingual surface by a hard tissue bridge and the mesial root was wider than the distal root. While radiological evaluation of the extracted tooth in the first case indicated the existence of two root canals, a third canal was detected using the clearing technique, indicating that the number of root canals may exceed the number of roots. This finding must be taken into consideration during clinical procedures, especially endodontic therapy.

While birooted primary canines cannot be detected by routine intra-oral examination, they may easily be detected by examination of routine dental radiographs. This unusual root anatomy can lead to endodontic and extraction complications, as well as problems in permanent tooth eruption. It should be kept in mind during endodontic therapy that the number of root canals may exceed the number of roots.

   Acknowledgment Top

The authors wish to thank Dr. Semih BERKSUN for his technical support.

   References Top

1.Wheeler RC. Dental anatomy, physiology and occlusion. 5th ed. Saunders: Philadelphia; 1974. p. 43-79.  Back to cited text no. 1    
2.Sicher H, Dubrul EL. Oral anatomy. 6th ed. Mosby: St. Louis; 1975. p. 246-52.  Back to cited text no. 2    
3.Brown CK. Bilateral bifurcation of the maxillary deciduous cuspids. Oral Surg Oral Med Oral Pathol 1975;40:817.  Back to cited text no. 3  [PUBMED]  
4.Kelly JR. Birooted primary canines. Oral Surg Oral Med Oral Pathol 1978;46:872.  Back to cited text no. 4    
5.Krolls SO, Donahue AH. Double-rooted maxillary primary canines. Oral Surg Oral Med Oral Pathol 1980;49:379.  Back to cited text no. 5  [PUBMED]  
6.Chow MH. Bilateral double-rooted maxillary primary canines. An abbreviated case report. Oral Surg Oral Med Oral Pathol 1980;50:219.  Back to cited text no. 6    
7.Bimstein E, Bystrom EB. Birooted bilateral maxillary primary canines. ASDC J Dent Child 1982;49:217-8.  Back to cited text no. 7  [PUBMED]  
8.Bryant RH Jr, Bowers DF. Four birooted primary canines: Report of case. ASDC J Dent Child 1982;49:441-2.  Back to cited text no. 8  [PUBMED]  
9.Paulson RB, Gottlieb LJ, Sciulli PW, Schneider KN. Double-rooted maxillary primary canines. ASDC J Dent Child 1985;52:195-8.  Back to cited text no. 9  [PUBMED]  
10.Jones JE, Hazelrigg CO. Birooted primary canines. Oral Surg Oral Med Oral Pathol 1987;63:499-500.  Back to cited text no. 10  [PUBMED]  
11.Saravia ME. Bilateral birooted maxillary primary canines: Report of two cases. ASDC J Dent Child 1991;58:154-5.  Back to cited text no. 11  [PUBMED]  
12.Hayutin DJ, Ralstrom CS. Primary maxillary bilateral birooted canines: Report of two cases. ASDC J Dent Child 1992;59: 235-7.  Back to cited text no. 12  [PUBMED]  
13.Ott NW, Ball RN. Birooted primary canines: Report of three cases. Pediatr Dent 1996;18:328-30.  Back to cited text no. 13  [PUBMED]  
14.Winkler MP, Ahmad R. Multirooted anomalies in the primary dentition of Native Americans. J Am Dent Assoc 1997;128: 1009-11.  Back to cited text no. 14  [PUBMED]  [FULLTEXT]
15.Mochizuki K, Ohtawa Y, Kubo S, Machida Y, Yakushiji M. Bifurcation, birooted primary canines: A case report. Int J Paediatr Dent 2001;11:380-5.  Back to cited text no. 15  [PUBMED]  [FULLTEXT]
16.Sicher H. Orban's oral histology and embryology. 5th ed. Mosby: St. Louis; 1962. p. 48-51.  Back to cited text no. 16    


[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8], [Figure - 9], [Figure - 10], [Figure - 11]


[Table - 1]

This article has been cited by
1 Bi-rooted primary maxillary canines: A case report
Talebi, M., Parisay, I., Khorakian, F., Bagherian, M.
Journal of Dental Research, Dental Clinics, Dental Prospects. 2010; 4(3): 101-103
2 Bilateral bimaxillary Bi-rooted primary canines: Report of a case
Dhanpal, P., King, N.
Journal of Clinical Pediatric Dentistry. 2009; 34(2): 113-116


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