Comprehensive Treatment of the Infected Maxillary Lateral Incisor with an Accessory Root Muhammed Selim Yavuz, PhD, DDS,* Ali Keles ¸, DDS, † Mehmet Özgöz, PhD, DDS, ‡ and Fuat Ahmetog ˘lu, DDS † Abstract Rare anatomic anomalies may occur in the dentition and can affect treatment decisions and prognosis. Ac- curate diagnosis and therapy performed at the highest level can result in predictable success in these cases. This case report shows the clinical and radiographic findings and successful treatment (nonsurgical and sur- gical) of a combined apical and marginal periodontal inflammatory lesion of a maxillary lateral incisor with an accessory root. (J Endod 2008;34:1134 –1137) Key Words Accessory root, birooted incisor, endodontic treatment, incisor tooth, treatment M axillary lateral incisors usually have only one root; however, they may have root formation anomalies that can complicate root canal treatment (1). Accessory root formation anomalies of the maxillary lateral incisors are rarely seen (2, 3). They occur most commonly in mandibular canine, premolar, and molar teeth (especially the third molars); however, these anomalies can also be seen rarely in mandibular and maxillary incisor teeth (2–4). The identification of accessory roots is especially important in cases in which endodontic treatment or extraction of the tooth is necessary (5). If the tooth is asymp- tomatic and there is no clinical or radiographic sign of pathosis, intervention is not necessary. If, however, endodontic disease is present and any accessory roots present are not identified and treated, subsequent or continuing apical periodontitis would be the expected result (2). This case report shows the clinical and radiographic findings and successful treatment of a combined apical and marginal periodontal inflammatory lesion of a maxillary lateral incisor with an accessory root. Case Report A 25-year-old man was referred to our clinic with a history of recurrent swelling of the soft tissues of the lateral incisor region. The patient’s medical history was noncon- tributory. An intraoral examination revealed a sinus tract on the facial-attached gingiva overlying the apex of the maxillary lateral incisor tooth (Fig. 1). The patient had no pain or swelling, and the tooth did not respond to pulp tests. The periapical radiograph showed a separate accessory root, a large radiolucent area around the accessory root, and an expansion of the periapical periodontal space (Fig. 2). Periodontal probing revealed the existence of a 7-mm pocket on the distolingual aspect of the involved tooth. A diagnosis of pulp necrosis with chronic periradicular periodontitis was made, and the treatment decided on was to initially perform nonsurgical root canal therapy. The tooth From the Departments of *Oral and Maxillofacial Surgery, † Endodontics, and ‡ Peridontology, Atatürk University, Er- zurum, Turkey. Address requests for reprints to Dr Muhammed S. Yavuz, Atatürk University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, 25240 Erzurum/Turkey. E-mail ad- dress: mselimyavuz@gmail.com. 0099-2399/$0 - see front matter Copyright © 2008 American Association of Endodontists. doi:10.1016/j.joen.2008.06.010 Figure 1. Arrows show the sinus tract over the maxillary lateral incisor. Case Report/Clinical Techniques 1134 Yavuz et al. JOE — Volume 34, Number 9, September 2008