Discussion:
The central incisor is typically considered a simple tooth to treat
endodontically. Even though the canal space may be excessively wide or
narrow due to a history of trauma, the presence of two root canals is
rare but must be taken into consideration to avoid a negative outcome.
Clinicians should be able to evaluate the case and prepare for
anatomical anomalies (22).
Even though the case repot is weak of evidence (23), anatomical
variabilities are always important to be reported since as mentioned
before the main cause of endodontic failure is untreated anatomy (2)
After two years of follow-up the tooth presented no clinical or
radiographic symptoms, and healing was confirmed. Nonetheless follow-up
must continue until at least five years. It might be of a great interest
also to evidence a three dimensional healing through a second CBCT
image, but because of the age of the patient and the absence of other
indications this might not be necessary.
In complex cases, treatment planning is fundamental after assessing all
the necessary information. In particular, radiographic imaging is
essential for the initial evaluation of an endodontic case. In the
majority of cases, two-dimensional intraoral radiographs are adequate to
assess intracanal anatomy. However, cases with anatomical irregularities
or pathologies require the use of CBCT for three-dimensional imaging.
CBCT imaging helps assess the anatomy of the canal system and the
condition of the periapical tissues.
Although in many cases, irregularities in the number and shape of the
roots are bilateral (24), in the present case, the contralateral central
incisor (tooth #11) presented with no anatomical variations upon
evaluation by CBCT. Thus, the abnormal anatomy of the central incisor
was unilateral in this case.
In addition, the crown of the tooth was normal in shape and identical to
the shape of the contralateral central incisor (25). Thus, developmental
abnormalities such as gemination and fusion were ruled out.
This case report highlights the importance of treatment planning and
meticulous evaluation of the initial internal anatomy of the root canal
before initiating endodontic therapy. It is well known that the internal
anatomy of each individual tooth is unique, and this must always be
taken into consideration while treating a root canal space. Within the
limitations of this report, it is important to highlight the ability of
the root canal treatment to maintain, heavily compromised anatomically
unique teeth.
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Figure Legends:
Figure 1: PRICE flow chart
Figure 2: a. Preoperative radiograph b. Working length c. Obturation d.
Obturation with temporary filling e. Two-year follow-up
Figure 3: CBCT slices from coronal (a.) to apical (e.)
Disclosure statement: The authors have no conflicts of interest to
declare.
Written informed consent was obtained from the patient to publish this
report in accordance with the journal’s patient consent policy