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146 rev port estomatol med dent cir maxilofac. 2019;60(3):145-149

Tratamento endodôntico de incisivo central superior com dois canais
radiculares: caso clínico

r e s u m o

Palavras-chave: O objetivo do presente estudo foi relatar um caso clínico de tratamento do canal radicular
Tomografia computadorizada de um incisivo central superior com dois canais radiculares. O exame clínico evidenciou
Cavidade pulpar uma discreta variação no aumento da largura da coroa do dente 11 e apresentou respostas
Endodontia negativas nos testes de sensibilidade pulpar ao frio, percussão e palpação. O exame to-
Incisivo mográfico do dente 11 revelou a presença de dois canais radiculares e rarefação óssea na
Tratamento endodôntico região periapical, sugerindo o diagnóstico de uma possível necrose pulpar e periodontite
apical assintomática. Anestesia local e isolamento absoluto foram realizados, seguido de
acesso coronário à câmara pulpar com auxílio de microscópio cirúrgico. O comprimento de
trabalho foi estabelecido em 21 mm na porção distal e 20 mm na porção mesial do dente.
®
Os canais radiculares foram mecanicamente preparados com o sistema Wave One e obtu-
rados usando a técnica termomecânica híbrida com o cimento AH Plus . A paciente per-
®
maneceu assintomática durante os 12 meses de monitorização, sugerindo que o protocolo
terapêutico foi adequado e o tratamento bem sucedido. (Rev Port Estomatol Med Dent Cir
Maxilofac. 2019;60(3):145-149)
© 2019 Sociedade Portuguesa de Estomatologia e Medicina Dentária.
Published by SPEMD. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

symptoms in the region. Subsequently, all maxillary anterior
Introduction teeth were examined by inspection, pulp sensitivity, palpa-
Knowing the anatomical variations of the root canal systems tion, percussion and radiographic tests.
may influence the outcome of endodontic treatment. It is The clinical examination showed a discrete increase in the
common knowledge to dentists that maxillary central inci- crown width of tooth 11 and color change in the crown of tooth
1
sors have a single root canal in the majority of the cases. 12 (Figure 1).
However, the presence of multiple root canals has also been A cold spray (Endo-Frost; Coltene- Whaledent, Langenau,
reported, and the prevalence of a second root canal may be as Germany) was applied on the vestibular surfaces of the tooth
high as 2%. 2 for 5 s with the aid of a cotton swab to assess tooth vitality.
Due to their low prevalence, additional root canals in max- Both teeth responded negatively to the ice sensitivity, percus-
illary central incisors may be overlooked by clinicians, partic- sion and palpation tests.
ularly when the diagnostic steps are neglected or when The initial radiographic examination revealed an image
non-specific complementary examinations, such as conven- that suggested the presence of two root canals in tooth 11, in
tional two-dimensional radiographic imaging techniques, are addition to periapical bone rarefaction (Figure 2).
not performed. 3,4 Computed tomography was performed using the i-CAT
In order to overcome these limitations, computed tomog- cone-beam 3D Dental Imaging System (Imaging Sciences In-
raphy, more precisely cone-beam tomography, may be used as ternational, Hatfield, PA, USA) to study morphology and plan
an effective instrument for identifying dental anatomical vari- the endodontic treatment, with the following specifications:
ations, as it ensures three-dimensional precision for locating
roots and root canals. 3-5
The aim of this study is to report the root canal therapy of
a maxillary central incisor with two root canals, while empha-
sizing the clinical techniques available to approach these cases.

Case report

This present case reports the treatment of a 35-year-old fe-
male patient who sought the outpatient clinic with the chief
complaint of a swelling in the gum area above the maxillary
incisors. After anamnesis, the oral mucosa was clinically ex-
amined, and no alterations were observed in the palatal and Figure 1. Initial clinical photo
buccal faces of the reported region. The patient presented no