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A Successful Root Canal Therapy of a Maxillary Lateral Incisor With 2 Root Canals: A Case Report

Background: Complete debridement is the major key to successful non-surgical endodontic treatment in teeth with periapical lesions. The missed canals serve as a harbor for bacteria and the irritant factors that lead to treatment failure. Most anatomical studies found that the maxillary lateral incisor is a singlerooted tooth. Most cases reported about the maxillary lateral incisors with two roots are the result of fusion or gemination and are usually accompanied by an enlarged crown. However, a few studies reported that the crown dimensions were normal. Knowing this unusual anatomy helps clinicians to treat patients more efficiently with less chance of failure. Case Presentation: This case report describes successful endodontic management of an uncommon variation of the maxillary lateral incisor with two root canals. Based on the clinical and radiographic findings, pulp necrosis and symptomatic apical periodontitis were diagnosed. The tooth received root canal treatment. The patient was followed up for 6 months and clinical and radiographic examinations in the follow-up sessions showed improvement in the periapical condition and the tooth became asymptomatic. Conclusions: Due to the wide morphological variations in the root and the root canal system of the teeth, clinicians should have knowledge of any anatomical variation to minimize the risk of endodontic treatment failure following inadequate debridement of indistinguishable or inaccessible portions of the root canal system. *Correspondence to Razieh Salehi, Department of Endodontics, Dentistry School, Hamadan University of Medical Sciences, Hamadan, Iran. Tel: +98-8138381059 , Fax: +98-8138381085 , Email: r.salehi70510@gmail. com Background One of the most important objectives of the endodontic non-surgical treatment is to remove the infection from the root canal system and prevent re-infection of the root canal system. In fact, endodontic treatment can fail for some reasons, including misdiagnosis, persistence of root canal infection, incomplete debridement and root canal shaping, instrument fractures, and poor restoration. Therefore, it is very important to have knowledge of intradental anatomy in order to achieve a correct endodontic treatment (1). Most anatomical studies found that the maxillary lateral incisor is a single-rooted tooth (2). Although multiple case reports indicated significant variations in the tooth anatomy, most of the cases reported in the literature about the maxillary lateral incisors with two roots are the result of fusion or gemination and are usually accompanied by an enlarged crown. However, a few studies reported that the crown dimensions were normal (3). This study aimed to report a clinical case of endodontic treatment of a lateral maxillary incisor with two roots and two canals. Open Access Scan to access more free content A Successful Root Canal Therapy of a Maxillary Lateral Incisor With 2 Root Canals: A Case Report Received Aug. 28, 2019 Accepted Sep. 11, 2019 ePublished Sep. 29, 2019


Background
One of the most important objectives of the endodontic non-surgical treatment is to remove the infection from the root canal system and prevent re-infection of the root canal system. In fact, endodontic treatment can fail for some reasons, including misdiagnosis, persistence of root canal infection, incomplete debridement and root canal shaping, instrument fractures, and poor restoration. Therefore, it is very important to have knowledge of intradental anatomy in order to achieve a correct endodontic treatment (1). Most anatomical studies found that the maxillary lateral incisor is a single-rooted tooth (2). Although multiple case reports indicated significant variations in the tooth anatomy, most of the cases reported in the literature about the maxillary lateral incisors with two roots are the result of fusion or gemination and are usually accompanied by an enlarged crown. However, a few studies reported that the crown dimensions were normal (3). This study aimed to report a clinical case of endodontic treatment of a lateral maxillary incisor with two roots and two canals.
Open Access Scan to access more free content

AJDR Avicenna Journal of Dental Research
Case Report doi ◄ Due to the wide morphological variations in the root and the root canal system of the teeth, clinicians should have knowledge of any anatomical variation to minimize the risk of endodontic treatment failure following inadequate debridement of indistinguishable or inaccessible portions of the root canal system.

Case Presentation
An 11-year-old girl with a complaint of tooth sensitivity when chewing referred to Hamedan School of Dentistry for root canal treatment of the left maxillary lateral incisor ( Figure 1). Clinical examinations indicated normal dimensions of the lateral incisor crown on both sides. Moreover, there was no evidence of a developmental radicular palatal groove. In addition, the tooth did not respond to vital pulp tests and was sensitive to percussion. Radiographic examination showed caries in the mesial aspect of the crown. Actually, the mentioned tooth had abnormal root morphology with two separate roots (mesial and distal), whereas the contralateral tooth had normal morphology. Furthermore, radiolucency was seen around the mesial root ( Figure 2). Based on the clinical and radiographic findings, pulp necrosis and symptomatic apical periodontitis were diagnosed. Following a discussion with the patient and her parents and obtaining informed consent from the patient's parents, non-surgical root canal treatment was planned. After infiltration anesthesia with 1.8 mL of 0.2% lidocaine with 1:80 000 epinephrine, the tooth was isolated using clamp and rubber dam and access cavity preparation was done using high-speed diamond bur under water spray conditions. Then, the working length was measured by the apex locator (Root ZX, Morita, USA) and was confirmed by radiography. The canals were cleaned and shaped using the crown-down technique with Protaper System (Dentsply, Maillefer, Ballaigues, Switzerland) to size 40 for the distal root and 25 for the mesial root. It is notable that the canals were constantly irrigated with 5.25% sodium hypochlorite solution. Finally, after drying with a paper point, the canals were obturated with gutta-percha (Gapadent, China) and AH26 sealer (Dentsply-Maillifer, Ballaigues, Switzerland) by lateral condensation technique (Figure 3). Then, glass-ionomer cement (GC, Japan) was used as a temporary filling material and after the final radiography, the patient referred to the restorative department for the final restoration. The patient was followed up for 6 months and clinical and radiographic examinations in the follow-up sessions showed improvement in the periapical condition and the tooth became asymptomatic (Figure 4).   risk of endodontic treatment failure following inadequate debridement of indistinguishable or inaccessible portions of the root canal system. Hence, for managing cases with anatomical variation, modern diagnostic tools, recent endodontic techniques, and advancements in biomaterials to achieve high levels of success in endodontic treatment can be beneficial.

Conflict of Interest Disclosures
The authors declare that they have no conflict of interests.

Ethical Statement
Informed consent was obtained from the patient for being included in this study.

Authors' Contribution
Study concept and design: HK and FM; Analysis and interpretation of data: FM and RS; Drafting of the manuscript: RS; Critical revision of the manuscript for important intellectual content: FM, RS, and LG; Statistical analysis: LG.