title: The clinical significance and management of apical accessory canals in maxillary central incisors.
abstract: BACKGROUND
  The maxillary central incisor is considered to be the least difficult subject for a clinical endodontic experience. However, the internal anatomy of maxillary central incisors can present a number of variations, including multiple accessory canals.
  
  
  METHODS
  This article highlights the clinical significance and management of accessory canals located in the apical one-third of maxillary central incisors. The authors present two case reports in which failure to detect the accessory canals led to root canal failure and subsequent surgical intervention. Another two case reports present the serendipitous discovery and nonsurgical management of accessory canals during the initial treatment of maxillary incisors.
  
  
  CONCLUSIONS
  It is important for the clinician to be able to detect the signs suggesting the presence of accessory canals in maxillary central incisors. Failure to do so may lead to a less-than-optimal endodontic treatment outcome.
authors.affiliation: Department of Endodontic, School of Dental Medicine, University of Pennsylvania, The Robert Schattner Center, Philadelphia 19104-6030, USA. miqbal@pobox.upenn.edu
authors.forename: Mian K
authors.initials: MK
authors.lastname: Iqbal
authors.forename: Jamie
authors.initials: J
authors.lastname: Gartenberg
authors.forename: Samuel I
authors.initials: SI
authors.lastname: Kratchman
authors.forename: Bekir
authors.initials: B
authors.lastname: Karabucak
authors.forename: Baokhoi
authors.initials: B
authors.lastname: Bui
mesh_terms: D000328:Adult; D003751:Dental Fistula / Q000209:etiology; D003786:Dental Pulp Cavity / Q000033:anatomy & histology*; D019232:Dental Restoration Failure; D005260:Female; D006801:Humans; D007180:Incisor / Q000033:anatomy & histology*; D008297:Male; D008437:Maxilla; D008875:Middle Aged; D006472:Oral Hemorrhage / Q000209:etiology; D018915:Root Canal Preparation / Q000009:adverse effects; D019227:Tooth Apex / Q000033:anatomy & histology*