Mandibular Incisors with Two Canals: A Case Series Highlighting Diagnostic and Clinical Challenges

Abstract

Mandibular incisors are traditionally described as having a single root and a single canal. Traditionally, it is considered the simplest tooth to treat endodontically. However, numerous studies have reported anatomical variations in the anterior teeth of the mandible. Mandibular incisors frequently exhibit anatomical variations, including the presence of a second root canal, which is often located lingually. This lingually placed canal is often overlooked by clinicians due to the narrow mesiodistal dimension of the tooth, superimposition on conventional radiographs, and limited understanding of the complex internal anatomy. The clinicians often fail to locate the lingual canal due to a lack of experience and understanding of root canal morphology, leading to continuing periapical pathology and eventual endodontic failure. Consequently, a thorough diagnostic approach is essential. The use of multiple angulated periapical radiographs, and where indicated, advanced imaging techniques, can greatly enhance the detection of canal bifurcations. In addition, carefully modified access cavity designs that extend slightly towards the cingulum improve the likelihood of locating the lingual canal orifice. The report emphasizes careful radiographic evaluation, modified access cavity design, and the use of magnification for identification and management of the lingual canal. This case series aims to describe the diagnosis and location of nonsurgical endodontic management of mandibular incisors with two canals, emphasizing the clinical and radiographic identification for successful treatment.

Keywords: Endodontic treatment, Two canals, Bifurcation