Fig. 1

Initial X-rays

When complete calcification of the coronal region was observed in the examined periapical film, a CBCT scan was requested from the patient to facilitate a more comprehensive examination

Fig. 2

It was determined that the position of the canal orifice began at a depth of 9.18 mm in the obtained tomography. The obtained findings indicate the presence of apical root resorption.

Fig. 3

Detection of the calcified part following access cavity preparation

After the identification of calcified area, it is tried to be advanced towards the canal orifice by using ultrasonic tips

Fig. 4

After the identification of calcified area, it is tried to be advanced towards the canal orifice by using ultrasonic tips

During the procedure, the stopper was removed to prevent interference with the working area while attempting to access the canal orifice. The stopper was reattached to the ultrasonic tip to check whether the desired length of 9.2 mm was reached. 

Fig. 5

Determination of the canal orifice position after 9.2 mm

Determination of the canal orifice position after 9.2 mm

Fig. 6

Reductions in working length can occur following canal shaping procedures. It has been reported that measuring the canal length after pre-flaring reduces the canal length deviations.

Preflaring procedure before the working length determination 

Preflaring process was made with file, the thickest part of which has a diameter of 0.8 mm.

The working length determination with Vdw 10 c pilot

Fig. 7

The working length determination with the apex locator and confirmed with X-ray

Glide path process with reciprocal file 

Following the glide path procedure, we completed the shaping process

After the completion of the shaping process, we carried out irrigation-activation procedures by applying our final irrigation protocol. Endo aspirator and paper points were used for the canal drying procedure

An apical plug was applied with MTA in the apical region due to the disruption of apical contraction. The MTA was placed in the root canal with MAP one system. It was advanced apically with the help of a pluger and gutta percha.

Fig. 8

Finishing X-ray


Conventional periapical radiographs and dental operating microscope could not provide sufficient information about the location of calcified canal orifices. The calcified area length was measured on CBCT then and placing a stopper on the ultrasonic tips. Therefore, the intraoperative use of CBCT was necessary and proved vital to successful positioning of calcified canal orifices.


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