Fig. 1

Tooth 46 was treated with a non-congruous root canal treatment and then became symptomatic.

The mesial canals were not shaped and the distal was half-treated.

Fig. 2

Once accessed the pulp chamber, it was noticed the presence of a hard, fully set calcium silicate based cement.

The removal was done using ultrasonic tips, but it was quite difficult gaining the canals.

No guttapercha was used, and the distal canal was filled partially filled with sealer.

A combination of Austenitic rotary files and ultrasonic tips was used to gain patency.

In the video, it is showed the process of removal of the calcium silicate cement. Even with the help of ultrasonic tips it is quite difficult to remove it

In the distal canal, the ultrasonic tips were alternated with austenitic rotary files.

In particular carefulness should be used when using ultrasonic or aggressive files in the canals as it is easy to create ledges.

Fig. 3

After gaining the apex, the working length was confirmed and a periodical Xray with mastercones was taken as well.

Fig. 4

The canals were sealed with a calcium silicate based cement and gutta-percha.

The tooth was then restored with fibre-reinforced resin.

Fig. 5

About the author;

Dr Roberto Careddu

I was born in Sardinia (Italy) and I graduated with Honors from the University of Cagliari (Italy). My endodontic journey started with a Master in Clinical Endodontics and continued with courses and univeristy programs in different countries. I recently completed my PhD at Trinity College of Dublin.

I live in Dublin, where I work as Endodontist in private practice and I am Clinical Supervisor in the Dublin Dental University Hospital.

I have authored scientific articles and I serve as an international conference speaker.

I am Member of the Faculty of Dental Surgery of the Royal College of Surgeons of Ireland,  Member of the Committee of the Irish Endodontic Society (IES) and the Irish representing for the European Society of Endodontology (ESE).


Calcium silicate based sealers are indeed easy to use and have many good characteristics, however, due to the difficulty in retreating them, they should be used carefully.


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Garrib M, Camilleri J. Retreatment efficacy of hydraulic calcium silicate sealers used in single cone obturation. J Dent. 2020 Jul;98:103370. doi: 10.1016/j.jdent.2020.103370

Baranwal HC, Mittal N, Garg R, Yadav J, Rani P. Comparative evaluation of retreatability of bioceramic sealer (BioRoot RCS) and epoxy resin (AH Plus) sealer with two different retreatment files: An in vitro study. J Conserv Dent. 2021

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