12 Endodontics
Endodontic management of a maxillary lateral incisor with an unusual root dilaceration diagnosed with cone beam computed tomography Dr. Mahmoud Mohammed Eid Mahgoub, Endodontic Microscope Center, Future University, Endodontic Specialist, Egypt Air Hospital mahmodmahgoub@gmail.com
Dr. Ahmed Abdel Rahman Hashem, Department of Endodontics, Faculty of Dentistry, Ain Shams University, Department of Endodontics, Faculty of Dentistry, Future University, Cairo, Egypt
Dr. Hany Mohamed Aly Ahmed, Department of Conservative Dentistry, School of Dental Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
Abstract Anterior teeth may have aberrant anatomical variations in the roots and root canals. Root di‑ laceration is an anomaly characterized by the dis‑ placement of the root of a tooth from its normal alignment with the crown which may be a con‑ sequence of injury during tooth development. This report aims to present a successful root canal treatment of a maxillary lateral incisor with unusual palatal root dilaceration (diagnosed with cone beam computed tomography) in which the access cavity was prepared from the labial aspect of the tooth to provide a straight line access to the root canal system which was instrumented using One‑ Shape rotary file system and precurved K‑files up to size 50 under copious irrigation of 2.5% NaOCl using a side‑vented irrigation tip. The canal was then obturated using the warm vertical compac‑ tion technique. Key words: Cone beam computed tomography, labial access cavity preparation, maxillary lateral incisor, root ca‑ nal treatment, root dilaceration.
Introduction
Republished from the Saudi Endodontic Journal Volume 7 / Issue 1 / April 2017
A full understanding of root and root canal mor‑ phology is a fundamental prerequisite for success‑ ful root canal treatment. 1 This includes absolute awareness of landmarks associated with normal and unusual morphology encountered in daily practice. 1 Maxillary anterior teeth are well known to have a straight single root that usually encases a single root canal; nevertheless, clinicians may still face a root/root canal configuration with an aber‑ rant morphology resulting in challenges even in ac‑ cessing the root canals. 2 According to the American Association of Endo‑
Dental News, Volume XXIV, Number II, 2017
dontists glossary of endodontic terms, dilaceration is defined as a deformity characterized by displace‑ ment of the root of a tooth from its normal align‑ ment with the crown which may be a consequence of injury during tooth development. 3 Common usage has extended the term to include sharply angular or deformed roots. 3 The prevalence of dilacerated roots in the human dentition varies in different population groups which can reach up to 16%,[4‑8] and the mandibular third molars usually show the highest prevalence among other tooth types which can reach up to 30.92%. 9 With the benefit of acquiring three‑dimensional (3D) information, cone‑beam computed to‑ mographic (CBCT) imaging has been increas‑ ingly used in the endodontic treatment of anomalous teeth, especially when conven‑ tional radiographs provide limited information and further details need to be identified. 10,11 This report aims to present a successful root canal treatment of a maxillary lateral incisor with unusual palatal root dilaceration diagnosed with CBCT.
Case report A 23‑year‑old male patient was referred for root canal treatment of an anomalous maxillary left incisor tooth (#22). His medical history was non‑ contributory, and the patient denies any history of trauma. On clinical examination, the tooth #22 showed a cervical carious lesion, gingival recession, and the tooth was tender to percussion [Figure 1a]. The tooth was previously treated by the referring dentist with an access cavity sealed with a tempo‑ rary filling material. The referring dentist reported the occasion of an accidental cervical labial perfora‑ tion during an attempt to prepare an access cavity from a palatal approach. A CBCT scan (J morita, Osaka, Japan) was per‑