Fig. 1

Pre-op x-ray and CBCT section


Fig. 2

Intra-op x-ray from the previous treatment


Fig. 3

Pre-op CBCT . In the sagittal views we can clearly see part of the root separate form the coronal part of the root


Fig. 4

Pre-op CBCT . In the coronal views it’s appreciable the distance between the apical two-thirds and the coronal one-third of the root



Fig. 5

Pre-op CBCT. Particular of the axial views


Fig. 6



Fig. 7

A correct access cavity improves the pulpal floor visibility

Fig. 8

Copious blood flow out of the mesio-buccal orifice


Fig. 9

After cleaning and shaping, we obtained a perfect control of bleeding. The picture shows the resorbable barrier beyond the apex, that will allow us to have a good apical control during the MTA apical plug .


Fig. 10

Map-One - Produits Dentaires SA


Fig. 11

MTA - Produits Dentaires SA


Fig. 12

MTA is extruded in the canal with MAP-ONE and well adapted with a micro brush .


Fig. 13

MTA apical plug and working length


Fig. 14

Post-op x-rays clearly show the apical plug and the complex endodontic anatomy: an strong apical curvature in the mesio -lingual canal and an apical delta in the distal canal


Fig. 15

Post-op CBCT. We decided to execute a CBCT in order to control the overfilling in the distal root , because in the 2D post-op x-rays the cement was close to the mandibular nerve.

The 3D exam confirms that the cement doesn’t invade the mandibular canal and the correct position of the MTA apical plug .


Fig. 16

The final x-rays evidence the endodontic anatomy, the root fragment and the MTA apical plug 


An accurate examination of the x-rays and of the CBCT can help the clinician to do a proper diagnosis in complex cases.

After understanding the problem, the sequence to be followed during the therapy is clear. The choice of MAP system has been useful to position MTA in a predictable, precise and correct fashion.


Rodríguez G, Patel S, Durán-Sindreu F, Roig M, Abella F. Influence of Cone-beam Computed Tomography on Endodontic Retreatment Strategies among General Dental Practitioners and Endodontists. J Endod. 2017 Sep;43(9):1433-1437

Wanderley VA, Neves FS, Nascimento MCC, Monteiro GQM, Lobo NS, Oliveira ML, Nascimento Neto JBS, Araujo LF. Detection of Incomplete Root Fractures in Endodontically Treated Teeth Using Different High-resolution Cone-beam Computed Tomographic Imaging Protocols. J Endod. 2017 Oct;43(10):1720-1724
Gaêta-Araujo H, Silva de Souza GQ, Freitas DQ, de Oliveira-Santos C. Optimization of Tube Current in Cone-beam Computed Tomography for the Detection of Vertical Root Fractures with Different Intracanal Materials. J Endod. 2017 Oct;43(10):1668-1673