The Twin-Rooted Anomaly: Endodontic Management of a Rare Case of a Maxillary Central Incisor With Two Roots

This case report describes the endodontic management of a maxillary central incisor with two roots, representing a rare anatomical variation. A 73-year-old female patient presented with a fractured tooth #21 with a carious crown. Pulp sensibility testing using cold spray elicited a sharp and prolonged painful response, consistent with a diagnosis of symptomatic irreversible pulpitis with normal apical tissues. Conventional periapical radiography suggested an unusual root morphology, which was further evaluated using cone-beam computed tomography (CBCT). CBCT imaging revealed a bifurcated root configuration with two distinct root canals and separate apical foramina. Root canal treatment was performed under dental operating microscope magnification using a crown-down preparation technique, followed by obturation with cold lateral compaction. Clinical and radiographic evaluation at the 1-year follow-up demonstrated a successful outcome. This case underscores the importance of careful diagnostic assessment and the judicious use of advanced imaging modalities for the detection and management of rare anatomical variations, even in teeth that typically exhibit simple root canal anatomy.