Endodontic retreatment of a lower canine associated with a periapical lesion : case report of an unusual anatomy

Objectives: To describe the endodontic orthograde retreatment of a lower canine with a rare anatomy, affected by a symptomatic periapical lesion. Materials and methods: A 30-year-old Caucasian woman came to our office reporting severe pain and swelling located at the right mandible. A two-roots/two-canals configuration was discovered for the lower canine which sustained the periapical infection; a missed lingual canal was not recognized and treated at the previous primary endodontic therapy. A full pre-operative examination and diagnosis, the application of modern endodontic strategies along with the use of magnification technologies (like the Surgical Operating Microscope - SOM) and proper disinfection protocols were employed for endodontic re-treatment. Result and conclusions: Healing of the periapical infection was clinically and radiographically confirmed at a 9-month follow-up. Endodontists should know the anatomical variations of human teeth and be vigilant about them when approaching treatments. More than a single radiographic projection is recommended in the diagnostic phase. Careful procedures related to instrumentation, cleaning and filling of the entire root canal system enhance the potential for healing of apical lesions.