Endodontic retreatment of dentes geminati - case report

Abstract

Introduction: The shape of deciduous and permanent teeth can differ morphologically from that which is considered normal, partially or entirely. The variations in tooth shape can be hereditary or caused by a disease or trauma. Gemination, for example, means that two separate morphological units were created by division of the tooth germ. This is an extremely rare condition with a prevalence of 0.2 - 0.5%. Aim: A patient with symptomatic apical periodontitis of a previous endodontically treated tooth 21 was complaining of swelling and pain in the frontal area of maxilla. The basic features and specific appearance of geminated teeth were present - an enlarged mesio-distal diameter of the tooth crown, a groove on the incisal edge, a shallow or deeper groove on the vestibular and oral surface, which divides the tooth into two, usually unequal parts. Materials and Methods: Isolation of the tooth was made by OpraDam (Ivoclar Vivadent). For the mechanical debridement of this complex root canal system, we used H-files and rotary files Pro Taper Next till X3 file. Cleaning was done by passive ultrasonic activation and photon-induced photoacoustic streaming by Er-YAG laser of 5.25% NaOCl, 16% EDTA and 2% XX. After double application of Ca(OH)2 as an intracanal medicament for at least 1 week, the sinus track and symptoms were gone. The obturation technique was warm vertical condensation with System B and Obtura (SybronEndo). Conclusion: Dentes geminati are extremely rare and difficult to treat endodontically but after proper cleaning, shaping and obturation of this complex root canal system with 2 main root canals with huge isthmus between them and lateral canals we can expect healing.