报道一例上颌侧切牙根管治疗术后腭根遗漏、钙化伴侧壁穿孔病例，探讨根管治疗规范及侧壁穿孔显微根管外科手术治疗方法。

患者，女，40岁，主诉左上前牙唇侧脓包1周，查体见22牙颊侧黏膜见瘘管口，舌窝见树脂补体，影像学检查示22牙单根双根管，颊根充填达尖，腭根遗漏且根尖1/3段无明显根管影像，根中1/3段远中根面处高密度充填物影像突破侧壁，外被半月形低密度透射区。复诊显微镜下寻及腭根根管口、疏通钙化并常规热牙胶充填，三氧化矿物凝聚体（MTA）充填穿孔处。显微根管外科手术清理侧壁穿孔外炎性软组织，MTA倒充填。

术后10 d瘘管消失，术后4和52个月X线片示根中1/3段远中根面高密度MTA阻射影，外围半月形透射影缩小，骨密度增高。

对于牙髓病学的根管治疗病例，术前应仔细阅读影像片，术后若发现低密度透射影像围绕侧壁根充物，则考虑侧壁穿孔，建议行MTA牙体内充填或并行显微根管外科手术封闭穿孔，密切观察。

To report a case of maxillary lateral incisor after root canal therapy with omitted and calcified palatal root canal as well as middle lateral wall perforation, and to investigate the standard of root canal treatment and the microsurgical treatment of lateral wall perforation.

A 40-year-old female complained of abscess on the labial side of her left upper anterior teeth for 1 week. Clinical examination revealed that maxillary left lateral incisor (tooth 22) showed fistula in buccal mucosa and resin complement in palatal lingual fossa. Radiograph showed that tooth 22 had single root with double root canal, there were two segments of high density in the root canal, the buccal root canal was filled to the apex, while the palatal root canal was missing and no obvious root canal image in 1/3 part of its apical segment. There was no low-density transmission image in the apical region. The high density in the middle 1/3 part of distal root broke through the lateral wall and was covered by a low-density semilunar transmission area. At the subsequent hospital visit, the palatal root canal was found under the microscope and dredged calcification, then root canal filling by warm gutta-percha obturation system were performed. MTA was applied to filled the perforations in the inner wall of pulp cavity. Conventional micro root canal surgery was used to clean up the inflammatory tissue outside the perforation, and MTA was used to fill the perforation.

Ten days after operation, the fistula disappeared. Follow-up X-ray after 4 months and 52 months showed high-density radiographs in the middle 1/3 part of distal root, the semilunar transmission area became smaller, and the bone density was higher.

For the case of endodontics root canal treatment, radiograph should be carefully read before operation. If the semilunar low-density transmission image around the lateral wall of root canal is found after the operation, the lateral wall perforation should be considered, MTA filling and sealing perforation or micro root canal surgery should be carried out together with closely observing.