Maxillary lateral incisor with Vertucci’s type V root canal configuration

Aims: To describe and discuss the procedures adopted during the endodontic treatment of a maxillary lateral incisor with Vertucci’s type V root canal configuration.

Summary: A 30-year-old Caucasian male patient was referred for analysis of his left maxillary incisors, both compromised by a traumatic injury occurred seven days prior. His medical history was non-contributory. The root of tooth 21 presented a vertical root fracture, thus indicating its extraction. Tooth 22 showed no periodontal involvement or response to the cold sensitive test, but presented mild pain on both vertical percussion and apical palpation. The initial radiographic exam showed asymptomatic apical periodontitis, and suggested apical root fracture or apical root canal bifurcation. A cone-beam computed tomography (CBCT) was requested, and revealed no apical root fracture, but the presence of apical root canal bifurcation. The 12-month clinical and radiographic follow-up evidenced the partial success of the established therapy. Technological resources were relevant to the successful management of the complex case report described herein. However, patience, perseverance and clinical experience were also essential factors.

Key learning points:

• Vertucci’s type V classification is considered one of the rarest and most challenging root canal configurations among the existing anatomical complexities.
• This paper describes and discusses the procedures adopted during the endodontic treatment of a maxillary lateral incisor with Vertucci’s type V root canal configuration.
• Besides the technological resources, patience, perseverance, and clinical experience were essential for performing a predictable endodontic treatment in a tooth affected by a diagnosis posing a great difficulty such as that presented herein.