Fig. 1

A patient came to my attention complaining about tenderness on chewing on the first lower left molar. To manage this casee 2 pre-operative radiographs with 2 different angulations were taken.

Pre-operative radiograph shows :

Short filling on the mesial system

Poor Obturation of the distal canal and wide apex

Peri-apical lesions related to each root

Fig. 2

A CBCT was also taken in order to make a better diagnosis.

Saggital cuts of CBCT scan shows improper seal of wide apex related to distal canals 

Poor shaping and Obturation related to mesial system.

Fig. 3

After the disassembling, the existing filling material was removed and the root canal system was shaped and cleaned.

The X-ray shows the master cone fitting.

Mesial system shows well fitted guttapercha to the full working length.

In the distal canal, a customized guttapercha point was cut by 2 mm sort of the apex to preform adequate MTA apical plug.

Fig. 4

The apical size of the distal canal, in fact, was larger than ISO .60, which is considered by some authors the cut off above which apical plug with bioceramics or MTA  is suggested to achieve apical seal.

Map one system was used as a carrier for increment placement inside the the canal.

Endo ice was applied to the customized guttapercha to harden the guttapercha to pack the MTA at the apical third.

Fig. 5

Post-operative radiograph shows the distal canal filled with a 4 mm MTA apical plug followed by thermo-plastized guttapercha. In the mesial canals, obturation was done using bio-ceramic sealer with hot-modified warm vertical compaction technique.

Fig. 6

12 months follow up radiograph  showing  the state of healing of the lesions and new hygienic crown 

Fig. 7

About the author

Mohamed Abdelkhalek

I'm a dentist was born and raised in Alexandri, I'm really passionate about endodontics and digital dentistry.
Proudly I'm providing elite services to my patient, also have been sharing knowledge with other colleagues inwebinars and local conference.
2012- 2017
University of Pharos
Dental derma dreams
Full time conservative dentist related
to micro-scopic and digital dentistry
• Advanced endodontic in Mazen dental clinic
Microscopic dentist
Digital dentistry
ADA certificate in endodontics


A correct pre operative assessment of the case, together with the knowledge of different filling materials, can increase the outcome of endodontic retreatments


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