In this appointment, the location of the second orifice was detected with the aid of x2.5 magnification binocular loupes (Heine® HR, Heine Optotechnik, Herrsching, Germany) but we failed to negotiate this root canal.
Gutta-percha was removed from the coronal-third of the root canal using #2 and #3 Gates Glidden drills. Initially, the maxillary right lateral incisor was anesthetized (2% lidocaine with 1:80,000 epinephrine Daroupakhsh, Tehran, Iran) and after access cavity preparation, it was isolated with rubber dam. Overall, the final diagnosis was chronic apical abscess due to a previous faulty root canal treatment. 1) revealed periapical rarefaction extending to the distal aspect of the root of the right maxillary central incisor and a small supernumerary root. The maxillary right lateral incisor exhibited a periodontal pocket depth of 10 mm only in one point in the palatal side whereas in other areas and in the control teeth the probing depth was within the normal range. The maxillary right central incisor and canine (controls) reacted normally to thermal and electric tests, palpation and percussion. The maxillary right lateral incisor did not respond to thermal and electrical pulpal tests but was sensitive to palpation and percussion. The tooth had been restored with composite resin. A periodontist suggested a poor prognosis and recommended extraction of the tooth.Ĭlinical examination showed a swelling and a fistulous tract in the palatal aspect of the right maxillary lateral incisor with localized symptoms. A periodontal consultation done two months earlier yielded a differential diagnosis of a palatal groove or a root fracture. This paper reports a case of retreatment of a permanent maxillary lateral incisor with two separate roots and root canal, which was not recognized during two previous endodontic treatments.Ī 43 year-old female with a non-contributory medical and family history was referred to our private clinic with a history of a buccal abscess and fistula in the upper right lateral incisor region.ĭental history revealed root canal treatment done by a general practitioner 2.5 years ago and orthograde retreatment done one year ago by an endodontist due to persistent symptoms.
Negligence and lack of knowledge regarding variations in root canal morphology can lead to complications in the cleaning and shaping of the entire root canal system during endodontic treatment and subsequently unfavorable treatment outcomes. Few case reports exist about two rooted maxillary lateral incisors [ ] reported a 4.9% incidence for maxillary lateral incisors with two root canals in the Turkish population. ] reported that in the United States, 100% of the maxillary lateral incisors had only one root canal, while Caliskan et al. Practitioners should always be aware of the possible anatomical variations in the root canal system of teeth, which may be correlated to ethnicity [ Achieving a successful outcome in endodontic treatment requires comprehensive knowledge about the tooth anatomy and root canal morphology [
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