cone beam international magazine of cone beam dentistry

38 I I case report _ CBCT in endodontics using a parallel-cone technique and various projec- tions. The X-ray (Fig. 2) also revealed a deep amal- gam restoration extending into the pulp chamber, which had been infiltrated, and distal caries in the fused tooth. A deep carious lesion was also observed on tooth 46, but a simple filling was scheduled be- cause the tooth responded normally to cold and hot stimuli. In this case, the treatment plan was determined to be root-canal therapy for the pulpitis in the fused tooth and a direct restoration for the same tooth. In addition, dental hygiene sessions were scheduled for the patient because of generalised plaque and to avoid worsening of periodontal conditions in the area of the fused tooth. Direct restorations were also arranged with the general practitioner to avoid any other pulp implications in other teeth with marked infiltrated restorations. Initially, the treatment plan was targeted at the root-canal therapy of the fused tooth, which was urgent.Inordertoclarifytheanatomyofthiselement, a CBCT examination was also performed; it revealed two independent mesial roots (lingual and buccal) and a single distal root. The fused root in the middle involved two independent canals ending in the same area (Figs. 3 & 4). After anaesthetic with 1:100,000 lidocaine had been administered, the tooth was isolated with a rubber dam (KKD, Sympatic Dam). Because of the ab- normal anatomy, the use of a liquid photopolymeris- ing dam (DAM COOL, Danville Materials) was neces- sary to seal gaps completely and to avoid leakage of salivaintothetreatedtoothandsodiumhypochlorite into the patient’s mouth. An extended access cavity usinga1.2mmcylindricalburanda#2Start-Xultra- sonic tip (DENTSPLY Maillefer) was created to visu- alise all five orifices (Fig. 5). Once the surface was clean and canals were visible,negotiationwithhandfiles(K-Files)andPath- Files (DENTSPLY Maillefer) was performed to ensure patency of the canals. First #10 and #08 K-Files (if needed) were alternated along the canals with copi- ous irrigation with sodium hypochlorite and using 17% EDTA gel (B&L Biotech) until the #10 file was at theapex.Workinglengthwasmeasuredwithanapex locator (Root ZX, Morita). Afterwards #1–3 PathFiles were used until the #3 file reached working length in all five canals. Once patency had been confirmed, working length was also confirmed radiographically (Fig. 6). The next step was to shape the canals using reciprocating files (WaveOne, DENTSPLY Tulsa Dental Fig. 8_X-rays of the finished case. Fig. 9_After restoration. cone beam1_2014 Fig. 10_After restoration. Fig. 11_One-year recall X-ray. Fig. 8 Fig. 9 Fig. 10 Fig. 11 CBE0114_36-40_Krokidis 31.01.14 15:53 Seite 3