ANAHTAR KELİMELERSüt kanin, Çift köklü kanin

ÖZET

Süt dişlerinde daimi dişlerle karşılaştırıldığında boyut ve şekil anomalileri daha az görülür. Çift köklü süt kanin dişler ise çok nadir görülen bir dental anomalidir. Bu vaka raporunda iki vakada çift köklü maksiller süt kaninler bildirilmiştir. Her iki vakada da intraoral radyografik muayene sonu-cunda bilateral çift köklü maksiller süt kaninler olduğu görülmüştür. Radyograflarda belirgin mezial ve distal kökler izlenmiştir. Kaninlerin meziodistal genişlikleri normalden daha büyüktür. Ikinci vakada maksiller sol süt lateral ve kanin arasında süper-numere bir diş ve radyografik olarak mikrodontik bir daimi lateral olduğu görülmüştür. Çift köklü süt kaninlerin prevelansı maksillada mandibuladan daha yüksektir ve genellikle bilateral görülürler. Sık rastlanmayan bu kök anomalisi eksfoliasyon ve diş çekimi sırasında sorunlara yol açabilir. Çekim sıra-sında hekim, daimi diş germinin kazara çekilmesine engel olmak için daimi kaninin süt kaninin kökleri arasında sıkışmadığına emin olmalıdır.

KEYWORDSPrimary canine, Birooted canines

ABSTRACT

Primary teeth have fewer abnormalities with respect to size and morphology when compared to perma-nent teeth. Primary canines with bifurcated roots are an extremely rare dental anomaly. The present report describes two cases of birooted maxillary primary canines. In both of the cases intraoral radiographs demonstrated bilateral double-rooted maxillary pri-mary canines. The canines appeared to have distinct mesial and distal roots. The mesiodistal width of the canines was enlarged. A supernumerary tooth was detected between the maxillary left primary lateral and canine teeth and a microdontic permanent lateral in the second case. The prevalence of birooted pri-mary canines appears to be higher in the maxilla than the mandibula, and birooted primary canines seem often to occur bilaterally. This unusual root anatomy could lead to problems during exfoliation or extracti-on. During exodontic procedures, the clinician should make sure that the crown of the permanent tooth is not trapped in the interradicular area of the primary tooth as this could cause accidental removal of the developing permanent tooth.

Hacettepe Dişhekimliği Fakültesi DergisiCilt: 29, Sayı: 2, Sayfa: 24-28, 2005

Primary Maxillary Bilateral Birooted Canines: Report of Two Cases

Maksiller Bilateral Çift Köklü Süt Kaninler:2 Olgu Raporu

*Atilla Stephan Ataç , DDS, PhD **Ayşegül Çetingüç, DDS *Hacettepe University, Faculty of Dentistry, Department of Pediatric Dentistry**Hacettepe University, Faculty of Dentistry, Department of Pediatric Dentistry

OLGU RAPORU (A Case Report)

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INTRODUCTION

The dental literature contains many articles on dental anomalies. Most of these articles re-port anomalies of the permanent dentition, be-cause a smaller number of anomalies occur in the primary dentition than in the permanent dentition. Specifically, there are fewer primary radicular anomalies than of permanent radicular anomalies. It has been reported that the three-rooted mandibular molar frequency was occa-sional in the primary dentition and common in the permanent dentition.1 The incidence of two or three root canals in mandibular anterior teeth has also been documented. The incidence is re-ported to be as low as 1% and as high as 43%. The frequency of mandibular canines with two canals, have been reported to be between 19.3% and 31.2%. However, aberrations of maxillary anterior teeth are less frequently reported in the literature .2

Primary teeth have fewer abnormalities with respect to size and morphology when compa-red to permanent teeth. Few primary teeth have additional roots and those that do are usually primary molars.3 Maxillary primary canines are normally single rooted. Birooted primary cani-nes are very rare but cases have been reported in Japanese, Africans and Caucasians.1-6 Primary canines with bifurcated roots are an extremely rare dental anomaly.4,5 It should be noted that in all recently published reports, all canines are of a bilateral nature .5

Although the etiology of this condition is unk-nown, it has been suggested that it may be the result of an ingrowth of tissue from Hertwig’s epithelial root sheath4,5,6 which fuses to form a template for a birooted tooth.4

The purpose of the present case reports is to increase the awareness of morphological aber-rations of the maxillary primary canine and to emphasize the importance of radiographs taken from different angles. The present report descri-bes two cases of birooted maxillary primary ca-nines. A supernumerary tooth and a microdontic permanent lateral accompany the second case of birooted maxillary primary canines.

CASE REPORTS

PATIENT 1

A six year and seven months-old boy was bro-ught to the Department of Paediatric Dentistry, Hacettepe University Ankara, Turkey for routine dental care. Medical evaluation of the boy reve-aled no systemic disorders. An oral examination revealed multiple carious lesions, Class I canine and molar relationships. Intraoral radiographs demonstrated bilateral double-rooted maxillary primary canines (Figures 1 and 2). The canines appeared to have distinct mesial and distal ro-ots. The mesiodistal width of the canines was enlarged (Figures 3 and 4). All other dentition (primary and permanent) was normal. The time and pattern of the primary canine root resorb-tion and eruption of the permanent canine are being watched closely.

PATIENT 2

A six-year and three months-old boy was bro-ught to the Department of Paediatric Dentistry, Hacettepe University Ankara, Turkey for a routi-ne initial examination. The boy had no systemic disorders. Multiple carious lesions, Class I molar relationship, Class I canine relationship on the right side, and cusp to cusp canine relationship on the left side were observed during the intra-oral examination. In addition, a supernumerary

FIGURE 1

Maxillary left primary canine with two distinct roots

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tooth was detected between the maxillary left

primary lateral and canine teeth. Intraoral ra-

diographs revealed bilateral double-rooted ma-

xillary primary canines with distinct mesial and

distal roots (Figures 5 and 6). Due to the radiog-

raphic examination, the permanent left lateral is expected to be microdontic (Figure 7). The time and pattern of the primary canines, the left pri-mary lateral and the supernumerary tooth and also the eruption of the microdontic permanent left lateral, and the permanent canines are being watched.

DISCUSSION

The prevalence of birooted primary canines

appears to be higher in the maxilla than the

mandibula, and birooted primary canines seem

often to occur bilaterally.3 The etiology of teeth

with supernumerary roots is poorly understood.

FIGURE 3

Intraoral appearance of the birooted left primary canine with enlarged mesiodistal width

FIGURE 4

Intraoral appearance of the birooted right primary canine. The morphology of the crown is very much like a normal primary

canine

FIGURE 5

Bifurcated maxillary right primary canine

FIGURE 2

Maxillary right primary canine with mesial and distal roots

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Several authors have postulated theories for the

occurrence of this phenomenon. It has been de-

monstrated that bifurcation of roots may be re-

lated to an ingrowth of Hertwig’s epithelial root

sheath. Other researchers have suggested that

fusion or gemination may be related to the cli-

nical presentation of supernumerary roots.3 The

enamel organ plays an important part in root de-

velopment by forming Hertwig’s epithelial root

sheath, which moulds the shape of root and ini-

tiates dentin formation. These findings suggest

that, in this case a defect in the dental lamina

during the early stages of root formation could

be an etiological factor. Such abnormalities may

be genetically determined, or associated with

environmentally induced cellular changes.3

The dental anatomy of the primary birooted

canine reported in the dental literature has the

crown morphology of the primary canines, and

the root morphology of the primary mandibular

molars. The normal morphology for the primary

maxillary canine is that of a long, slender tape-

ring root that is more than twice the length of

the crown. The crown of the primary maxillary

birooted canine has approximately the same di-

mensions. The root orientation is like that of pri-

mary mandibular molars; primary birooted cani-

nes have a mesial and a distal root. For normal

exfoliation to occur, the permanent successor

must resorb the roots evenly. The anatomy of

the permanent canine may not lead to normal

exfoliation of the primary canine or eruption of

the permanent canine. This unusual root ana-

tomy could lead to problems during exfoliation

or extraction.6 During exodontic procedures,

the clinician should make sure that the crown

of the permanent tooth is not trapped in the

interradicular area of the primary tooth as this

could cause accidental removal of the developing

permanent tooth.1 These teeth may have to be

sectioned during extraction.6 The clinician also

should inspect extracted anomalous primary te-

eth to ensure that all roots have been retrieved.

Since it is not known whether these abnormal

root configurations affect the normal exfoliation

FIGURE 6

Maxillary left birooted primary canine. Roots show complete bifurcation in a mesiodistal direction

FIGURE 7

Radiological appearance of the microdont maxillary left permanent lateral and the supernumerary tooth between the

primary lateral and the primary canine

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CORRESPONDING ADRESS

Ayşegül ÇETİNGÜÇ, DDSHacettepe University, Department of Pediatric Dentistry

Tel: 90 312 305 22 80 Fax: 90 312 324 31 90 E-mail: aysegulcetinguc@yahoo.com

of the primary teeth, it is unclear whether these anomalous teeth present orthodontic problems.1 Observation of primary birooted canines during growth and development will help avoid prob-lems during successive stages of development and eruption.6

As stated previously, bifurcation of primary canines is an extremely rare condition. This ano-maly cannot be discovered by routine intraoral examination. It can often be detected by exami-nation of routine dental radiographs.5 As a result, this anomaly should be kept in mind and radiog-raphs should be taken before the extraction of a

primary canine.

REFERENCES

1. Winkler MP, Ahmad R: Multirooted anomalies in the primary dentition of Native Americans. J Am Dent Assoc. 1997; 128: 1009-1011.

2. Barkhordar RA, Nguyen NT. Maxillary canine with two roots. J Endod. 1985; 5(11): 224-227.

3. Mochizuki K, Ohtawa Y, Kubo S, Machida Y, Yakushiji M. Bifurcation, birooted primary canines: a case report. Int J Pead Dent. 2001; 11: 380-385.

4. Jones JE. Birooted primary canines. Oral Surg Oral Med Oral Pathol Oral Radiol Endo. 1987; 63(4): 499-500.

5. Saravia ME. Bilateral birooted maxillary primary canines: report of two cases. ASDC J Dent Child. 1991; March-April: 154-155.

6. Hayutin DJ, Ralstrom CS. Primary maxillary bilateral birooted canines: report of two cases. ASDC J Dent Child. 1992; May-June: 235-237.