Combined Endodontic and Surgical Management of Twin Rooted Maxillary Lateral Incisor with a Palatogingival Groove

A case of unusual anatomy in a maxillary lateral incisor is presented. A 20-year old female presented with failing endodontics. Clinical examination and radiographs revealed poorly obturated maxillary left lateral incisor with an untreated patent second root and a palatogingival groove. A decision was made to treat the tooth non-surgically. After removing gutta-percha from main canal, the orifice of second root could not be located from inside the chamber. After determining the position of this root to be mesial and palatal to main canal, gingival tissue was removed from mesio-palatal side and access was extended to include the cingulum and orifice was located mesio-palatally. This canal was mechanically prepared and both canals were filled with calcium hydroxide. Three weeks later when symptoms subsided, the canals were obturated using the warm vertical technique. However, patient returned after a month complaining of pain and pus discharge. The tooth was surgically retreated; the enucleation was performed without root end resection. Patient returned after two years and reported complete healing but with mild discoloration of crown which was treated with walking bleach technique.