Fig. 1

This patient come to my office with severe pain. On examination there was a grossly decayed 46 which was tender on percussion  & having no response to cold test . Xray  shows   a huge periapical lesion. A rct was planned.

Fig. 2

Rubber dam was placed  then all the caries was removed ,access was made . 

Fig. 3

There was a pulp stone in access which was removed by ultrasonic tips.

Fig. 4

Then access was packed with a teflon tape inside. Now time  to proceed for a pre endo build up ,where sectional metal matrix band was used  . Distal wall was made by  composites,after checking the proximal seal.


Fig. 5

Remove the retainer ,band and wedge  & give a temporary dressing & send the patient back . Due to time reasons I decided to stop the procedure and to continue the treatment in a second appointment.

Fig. 6

In the second appointment canal was negotiated and shaper with rotary sistem, four canals were find ,

Irrigation  done by  5.25 % NAOCL % 17 % EDTA  & normal saline as a neutral medium .

Activation of irrigants done by  PASSIVE ULTRASONIC AGITATION  by U files

Fig. 7

PLANO fron Style Italiano Endontics was used to organise Guttapercha in sequence as you can see in the pic.

Fig. 8

Obturation with  warm vertical compaction was performed

Fig. 9

Detail of the pulp chamber floor after the  canal obturation

Fig. 10

CORE BUILD UP was done by composites . Going to place an indirect overlay later on as a permanent prosthesis .

Fig. 11

Final xray shows the filling of the four canals and the buid up.


Endodontic therapy is a linear step by step procedure. from the diagnosis to the end all steps are important.


1. Cohen S, Burns RC. Pathways of the Pulp. 6th ed. St Louis: Mosby; 1994. p. 179-84.
2. Heydrich RW. Pre-endodontic treatment restorations. A modification of the ‘donut’ technique. J Am Dent Assoc 2005;136:641-2.
3. Hargreaves KH, Cohen S. Pathways of the Pulp.10th ed. St Louis: Mosby; 2010. p. 109.
4. Ingle JI, Bakland LK, Baumgartner JC. Ingle’s Endodontics. 6th ed.  Hamilton: BC Decker Inc.; 2008.
5. Omar H, El-Badrawy W, El-Mowafy O, Atta O, Saleem B. Microtensile  bond strength of resin composite bonded to caries-affected dentin with three  adhesives. Oper Dent 2007;32:24-30.