A 15-year-old female presented for root canal treatment of a symptomatic left maxillary central incisor. Although the internal anatomy of the maxillary central incisor is well known and usually presents with one root and a relatively simple root canal system, a second root with a separate root canal was located, treated and the patient’s symptoms were eliminated. The purpose of this case report is to describe the diagnosis and root canal treatment of a maxillary central incisor with two roots and two canals.

Keywords: anatomical variation, diagnosis, maxillary central incisor, multi-rooted tooth, root canal treatment