Fig. 1

Referral patient 32 years old women came in our office with pain on baiting on tooth 36. X-ray finding showed caries driven endodontic access with several iatrogenic errors like broken instrument in mesial root canal system, ledge, and perforation; missed canal in distal root; radiolucency around the root. CBCT was conducted for evaluation of anatomy.

Fig. 2

Lots of necrotic tissue and debris was found under the restoration and residual dentinal roof; pulp chamber was cleaned from all infected material.

Fig. 3

 Mesial canals were merging based on CBCT, fractured instrument was over the curvature, shaping was done from merging canal till the working length, fractured instrument was bypassed to preserve structure of the tooth. Treatment was done in two procedures, after cleaning and shaping MTA was placed to cover the perforation area with MAP system. On second visit canals were obturated with Neo sealer and gutta-percha. Patient was sent for restoration to referral doctor.

Fig. 4

 Follow up was done after 10 months, unfortunately patient doesn’t come back for follow up until she got problems on other teeth, she was assigned to do CBCT for implantation reasons. We can see positive dynamics on tooth 36.


Trends should be approached carefully so not to be trapped in failure. Skills of operator, armamentarium and proper knowledge should guide to proper access cavity design. To avoid iatrogenic errors in endodontic treatment it is necessary to follow rules of quality shaping. Never neglect anatomy of the tooth, take care of reasonable endodontic access cavity preparation, which gives you proper control over correct shaping and cleaning that can lead to successful endodontic outcome of tooth.


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