Retreatment of badly decayed tooth with multiple mishaps

Fig. 1

A 32-year-old male patient presented to my clinic with a badly decayed prepared tooth no. 17, and he insisted on saving it rather than extraction & implant, which was an option.

At first, I’d like to highlight the importance of CBCT for the assessment of such cases to be able to put the best treatment plan for the patient and also to determine the cost of all procedures.

We requested CBCT, and we found 3 roots with 4 canals.

-MB Root had 2 root canals with an isthmus connection and separate apical foramina.

-Missed Mb2 Canal

- A ledge & unextended root canal filling material of the MB root canal

Fig. 2

We decided to do a gingivectomy on the distal side, remove all the caries, and remove the metal post to be able to assess the restorability of the tooth. 

But first we need to isolate the tooth as In endodontics, the rubber dam is not just an "option"; it is the standard of care. It serves as the primary barrier between a successful clinical outcome and a potential failure due to contamination or accident.

The use of a rubber dam serves three critical roles during root canal therapy:

Asepsis: It prevents saliva (and the millions of bacteria it carries) from entering the pulp chamber, ensuring the root canal system remains as sterile as possible during instrumentation.

Patient Safety: It acts as a safety net, preventing the accidental aspiration or ingestion of small endodontic files, irrigation solutions (like sodium hypochlorite), and debris.

Clinical Efficiency: By retracting the cheeks, tongue, and lips, it provides a dry, high-contrast field of view, allowing you to focus entirely on the tooth's internal anatomy.

Fig. 3

1^st & 2^nd XRAY : Here, we removed the metal post using ultrasonics, and then we removed all the gutta-percha.

scout the canals and bypassd the ledge

Taking working length

Catching the MB2 canal

Preparation for all canals

3^rd Xray : Intracanal medication to elevate the PH and to act as antibacterial

4^th  XRAY : Master cone fitting xray

5^th XRAY : Obturation of Mesials & DB Canal with WVC + Bio C Sealer

Then we decided to obturate the palatal canal with MTA apical plug.

“X-ray of plugger fit 2 mm short of the working length”

Fig. 4

1^st & 2^nd Xray : First MTA Apical plug

3^rd Xray : Obturation the rest of the canal with WVC + Bio C sealer

4^th Xray : Final Obturation

5^th Xray : Final Restoration

Fig. 5

MTA Apical PLUG, Clinically & Radiographically

Fig. 6

Final Obturation View, Clinically & Radiographically

Fig. 7

Final restoration :

• Flowable Composite Over orifices as Intra-Orifice barrier
• Ever X As Dentin replacement
• Core build-up composite

Clinical View explains the Preparation for the crown with sufficient ferrule

Xray view : after Emax Crown Cementation