Maxillary lateral incisors with two canals and two separate curved roots
A 25-year-old Indian female was referred by his general dentist for root canal treatment of the maxillary left lateral incisor (tooth 22). The general dentist referred the patient after observing its unusual root canal morphology with two separate curved roots in the pre-operative radiograph [].\nOn clinical examination, tooth 22 did not appear to have any coronal morphological variation and was identical to its left counterpart. No discoloration of the crown was evident. The tooth had mild tenderness to percussion; however, there was no evidence of swelling or sinus tract. The mucosa and the underlying alveolar bone were not tender to palpation. Gingival probing depths and tooth mobility were within physiologic limits. The tooth did not respond to electric and thermal pulp sensibility tests whilst the contralateral and adjacent teeth responded within normal limits. Patient reported a possible history of trauma 10 years back. The tooth was diagnosed with asymptomatic irreversible pulpits with chronic apical periodontitis.\nAfter administering local anesthesia of 2% lidocaine with 1:100,000 epinephrine, endodontic access cavity was done on the palatal surface by using a no. 2 round bur and E× 24 bur (non-end cutting tapered fissure; Mani, Tochigi, Japan) under rubber dam isolation. Clinical exploration with a DG-16 endodontic explorer (Hu-Friedy, Chicago, IL, USA) revealed two root canal orifices in a mesio-distal direction. Pulp extirpation was performed by using a barbed broach (Dentsply Maillefer, Ballaigues, Switzerland) and K-files (Mani Inc., Tochigi, Japan). The canal was thoroughly debrided with copious irrigation of sodium hypochlorite (2.5%) and 17% ethylene diamine tetra acetic acid (EDTA) followed by saline (0.9%). Coronal flaring of the root canal was done by using Gates-Glidden drills no. 1-4 (Mani Inc.). The working length was determined by using the apex locator (Propex; Dentsply Maillefer) and confirmed radiographically.\nBoth the root canals were cleaned and shaped up to a size 30 master apical hand nickel-titanium file (hand protaper F3 size) using a step-back technique. The canals were dried with sterile paper points (Dentsply Maillefer, Ballaigues, Switzerland), and calcium hydroxide paste (Calcicur; VOCO, Cuxhaven, Germany) was placed as an inter-appointment medicament. The access cavity was sealed temporarily with Cavit (3M ESPE AG, Seefeld, Germany). The patient was recalled after a week at which time the tooth was asymptomatic. The root canals were irrigated, dried and filled by cold lateral compaction of gutta-percha using a zinc oxide eugenol sealer (Kemdent; Associated Dental Products Ltd., Swindon, UK). The access cavity was restored with glass ionomer cement (Fuji IX; GC Corp., Tokyo, Japan), and a postoperative radiograph was taken [].