Root canal treatment of maxillary incisors with heterotopic alterations: clinical case report

Aim: Cleft lip and cleft palate are the most common congenital craniofacial malformations. Dentistry plays an important role in the treatment of these patients since this defect comes associated with dental problems. Those alterations can implicate the teeth dimensions, morphology, location, quantity and structure. The endodontic strategy in teeth with challenging locations in the dental arch is a distinctive and major challenge both for diagnostics and treatment. In many situations, technical complications may lead to failure. The aim of this study is to describe particular peculiarities of root canal procedure in a special case which the patient presented location and dental alterations in maxillary incisors. This condition requires some modifications on the conventional endodontic therapy. An incorrect dental position and the presence of orthodontic appliances can contribute to the overlapping images throughout the radiographic procedures. The endodontic treatment planning of the endodontic case was examined through periapical radiographs and cone beam computed tomography. The endodontic access cavity was developed by the buccal surface due to the encountered difficulties by the intrusion and palatal direction of the anterior dental elements in the maxillary arch. The following operative endodontic steps as chemico-mechanical preparation and obturation were performed and considered satisfactory. In the obturation proceeding was employed a biological controlled technique with active lateral condensation. Conclusion: The planning stage of the treatment based on careful clinical examination and adequate complementary diagnostics procedures is essential for the endodontic treatment success of teeth with heterotopic alterations