Single session endo resto treatment of an upper second molar

Fig. 1

On radiological examination, there is no evidence of periapical lesions.

There is a radiolucent area beneath the amalgam restoration, indicating a potential infiltration or secondary decay.

Fig. 2

Pre operative picture

Fig. 3

After the anesthesia I did a multiple isolation on teeth 2.7, 2.6 and 2.5

Fig. 4

I removed the existing restoration and the decayed tissue,  then I started designing the access cavit with a diamond coated bur mounted on a turbine, until the pulp chamber floor was visible. Subsequently,  I refined the access with ultrasonic tips.

Fig. 5

From the picture in can be seen that there are 4 root canals in this tooth.

Due to the difficult scouting of MB1 with a #10 K-file, I did some coronal preflaring and refined the access cavity.

I then proceed to shape the root canals using martensitic files, following the sequence with a Crown-Down technique.

I established patency with a #.10 K-file, then I continued the shaping up to the working length.

Fig. 6

I shaped the root canal system with martensitic files and always did a visual gauging to determine the final size of the apical foramen, which was refined with dedicated rotary files..

To summarize: MB1 is prepared to size #30, MB2 to #20, DV to #25, and the palatal canal to #50.

It’s important to note that MB2 is confluent with MB1 at 16 mm.

Fig. 7

After shaping I did the final irrigation protocol using NaOCl, EDTA, and distilled water delivered by a polypropylene cannula and activating by ultrasonic tips according to the correct timing.

Fig. 8

The protocol I followed

Fig. 9

After that, I checked the fit of the gutta percha points

Fig. 10

Intra operative X-ray with gutta percha points. The confluence between MB1 and MB2 canal can be noted.

Fig. 11

I filled the root canal system with a hydraulic sealer and single cone technique

Fig. 12

Since the conditions were favorable, I cleaned the cavity and immediately proceeded with the post endodontic restoration that consisted in a direct composite restoration.

Fig. 13

The tooth after the restoration

Fig. 14

Post operative X-ray