Restor Dent Endod.  2015 Feb;40(1):79-84. 10.5395/rde.2015.40.1.79.

Surgical endodontic management of infected lateral canals of maxillary incisors

• Jang JH
• Lee JM
• Yi JK
• Choi SB
• Park SH

• KMID: 2316928
• DOI: http://doi.org/10.5395/rde.2015.40.1.79

Abstract

This case report presents surgical endodontic management outcomes of maxillary incisors that were infected via the lateral canals. Two cases are presented in which endodontically-treated maxillary central incisors had sustained lateral canal infections. A surgical endodontic treatment was performed on both teeth. Flap elevation revealed vertical bone destruction along the root surface and infected lateral canals, and microscopy revealed that the lateral canals were the origin of the lesions. After the infected lateral canals were surgically managed, both teeth were asymptomatic and labial fistulas were resolved. There were no clinical or radiographic signs of surgical endodontic management failure at follow-up visits. This case report highlights the clinical significance and surgical endodontic management of infected lateral canal of maxillary incisor. It is important to be aware of root canal anatomy variability in maxillary incisors. Maxillary central incisors infected via the lateral canal can be successfully managed by surgical endodontic treatment.

Keyword

Apical ramification; Lateral canal; Root canal anatomy; Surgical endodontic treatment

MeSH Terms

Dental Pulp Cavity
Fistula
Follow-Up Studies
Incisor*
Microscopy
Tooth

Figure

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  Figure 1 Preoperative clinical and radiographic appearances. (a) Intraoral view of buccal sinus tract (arrow); (b) Periapical radiograph of the maxillary right central incisor with a gutta-percha cone tracing the sinus tract; (c) CBCT image of the labial bone resorption (arrow). Intraoperative photographs; (d) Loss of bone adjacent to the lateral canal (arrow); (e) Obturated canal with IRM (arrow). Postoperative clinical and radiographic appearances at follow-up; (f) At the 1 month follow-up, the labial fistula was resolved; (g) A 12 month follow-up periapical radiograph. Obturated lateral canal (arrow); (h) 18 month follow-up CBCT image showing formation of the alveolar bone (arrow) in the labial area of the maxillary right central incisor.

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  Figure 2 (a) Preoperative radiograph showing a maxillary left central incisor with a gutta-percha cone tracing the sinus tract; (b) Axial view of CBCT image showing the mesial bone loss in the middle third of the root (arrow); (c) Surgical confirmation of the lateral canal (arrow); (d) 1 month follow-up periapical radiograph. The obturated lateral canal was visualized (arrow).

Reference

1. Ida RD, Gutmann JL. Importance of anatomic variables in endodontic treatment outcomes: case report. Endod Dent Traumatol. 1995; 11:199–203.

2. Nair PN, Henry S, Cano V, Vera J. Microbial status of apical root canal system of human mandibular first molars with primary apical periodontitis after "one-visit" endodontic treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 99:231–252.

3. Adorno CG, Yoshioka T, Suda H. Incidence of accessory canals in Japanese anterior maxillary teeth following root canal filling ex vivo. Int Endod J. 2010; 43:370–376.

4. De Deus QD. Frequency, location, and direction of the lateral, secondary, and accessory canals. J Endod. 1975; 1:361–366.

5. Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Path. 1984; 58:589–599.

6. Weine FS. The enigma of the lateral canal. Dent Clin North Am. 1984; 28:833–852.

7. Iqbal MK, Gartenberg J, Kratchman SI, Karabucak B, Bui B. The clinical significance and management of apical accessory canals in maxillary central incisors. J Am Dent Assoc. 2005; 136:331–335.

8. Barthel CR, Zimmer S, Trope M. Relationship of radiologic and histologic signs of inflammation in human root-filled teeth. J Endod. 2004; 30:75–79.

9. Ricucci D, Langeland K. Apical limit of root canal instrumentation and obturation, part 2. A histological study. Int Endod J. 1998; 31:394–409.

10. Ricucci D, Siqueira JF Jr. Fate of the tissue in lateral canals and apical ramifications in response to pathologic conditions and treatment procedures. J Endod. 2010; 36:1–15.

11. Dammaschke T, Witt M, Ott K, Schäfer E. Scanning electron microscopic investigation of incidence, location, and size of accessory foramina in primary and permanent molars. Quintessence Int. 2004; 35:699–705.

12. Wada M, Takase T, Nakanuma K, Arisue K, Naqahama F, Yamazaki M. Clinical study of refractory apical periodontitis treated by apicectomy. Part 1. Root canal morphology of resected apex. Int Endod J. 1998; 31:53–56.

13. Rubach WC, Mitchell DF. Periodontal disease, accessory canals and pulp pathosis. J Periodontol. 1965; 36:34–38.

14. Harrington GW. The perio-endo question: differential diagnosis. Dent Clin North Am. 1979; 23:673–690.

15. Friedman S, Abitbol S, Lawrence HP. Treatment outcome in endodontics: the Toronto Study. Phase 1: initial treatment. J Endod. 2003; 29:787–793.

16. Setzer FC, Boyer KR, Jeppson JR, Karabucak B, Kim S. Long-term prognosis of endodontically treated teeth: a retrospective analysis of preoperative factors in molars. J Endod. 2011; 37:21–25.

17. Siqueira JF Jr. Aetiology of root canal treatment failure: why well-treated teeth can fail. Int Endod J. 2001; 34:1–10.

18. Song M, Kim HC, Lee W, Kim E. Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery. J Endod. 2011; 37:1516–1519.

19. Arnold M, Ricucci D, Siqueira JF Jr. Infection in a complex network of apical ramifications as the cause of persistent apical periodontitis: a case report. J Endod. 2013; 39:1179–1184.

20. Aryanpour S, Van Nieuwenhuysen JP, D'Hoore W. Endodontic retreatment decisions: no consensus. Int Endod J. 2000; 33:208–218.

21. Bell GW. A study of suitability of referrals for periradicular surgery. Br Dent J. 1998; 184:183–186.

22. Reit C, Gröndahl HG. Management of periapical lesions in endodontically treated teeth. A study on clinical decision making. Swed Dent J. 1984; 8:1–7.

23. Kvist T, Reit C. The perceived benefit of endodontic retreatment. Int Endod J. 2002; 35:359–365.

24. Torabinejad M, Corr R, Handysides R, Shabahang S. Outcomes of nonsurgical retreatment and endodontic surgery: a systematic review. J Endod. 2009; 35:930–937.

25. Kim HH, Min JB, Hwang HK. Apical foramen morphology according to the length of merged canal at the apex. Restor Dent Endod. 2013; 38:26–30.

26. Kim S. Prognostic factors influencing clinical outcome of nonsurgical endodontic treatment. J Korean Acad Conserv Dent. 2010; 35:436–444.

27. Ponce EH, Vilar Fernández JA. The cemento-dentino-canal junction, the apical foramen, and the apical constriction: evaluation by optical microscopy. J Endod. 2003; 29:214–219.

28. Green D. A stereomicroscopic study of the root apices of 400 maxillary and mandibular anterior teeth. Oral Surg Oral Med Oral Pathol. 1956; 9:1224–1232.

29. Vieira AR, Siqueira JF Jr, Ricucci D, Lopes WS. Dentinal tubule infection as the cause of recurrent disease and late endodontic treatment failure: a case report. J Endod. 2012; 38:250–254.

30. Kim S, Kratchman S. Modern endodontic surgery concepts and practice: a review. J Endod. 2006; 32:601–623.