Endodontic treatment of maxillary lateral incisors with anatomical variations
A 12-year-old male was referred from the Department of Pediatric Dentistry for root canal treatment of the maxillary left lateral incisor. Upon clinical examination, the upper left lateral incisor showed mild tenderness to percussion and palpation. The tooth did not respond to electric and thermal pulp sensibility test while the adjacent teeth responded within normal limits. The periapical radiograph suggested two root canals in a bulbous root and a diffuse apical lesion (). From the clinical and radiographic findings, the maxillary lateral incisor was diagnosed as pulp necrosis and chronic apical abscess without sinus, for which root canal treatment was planned.\nAn access opening was made after rubber dam isolation. The main canal was wider and C-shaped. Another narrower canal was seen running towards palate under an operating microscope (). Along the dentinal map, the second canal was detected easily by extending the access cavity palatally. Working lengths were determined with an apex locator (Root ZX, Morita, Tokyo, Japan) and confirmed radiographically. Under copious irrigation with 5% sodium hypochlorite and 17% EDTA, the root canals were cleaned and shaped up to a size 35 with stainless steel K-files using the step-back technique and the circumferential filing technique. Obturation of the root canal was performed by cold lateral compaction of gutta-percha using an epoxy resin sealer (AH Plus) (). The access cavity was restored with composite resin (Filtek Z350 XT, 3M ESPE, St. Paul, MN, USA) and a postoperative radiograph was taken. The tooth was asymptomatic and the periapical lesion resolved over the subsequent six months ().