cone beam international magazine of cone beam dentistry

40 I I case report _ CBCT in endodontics cone beam1_2014 Specialties) with a single-file reciprocating tech- nique. Since the anatomy was slightly different, the shaping technique was changed. After the primary file (25.08, red code), apical gauging was performed with manual NiTi K-Files (ISO) to measure the apical restrictiondiameter.Forthedistalcanal,thelargefile was also needed. Throughout the procedure, irriga- tion with preheated 5.25% sodium hypochlorite was performed with 30g irrigating needles (NaviTip, Ultradent)andtheirrigantwasactivatedwithIrriSafe files (Acteon).15–17 Once the shaping had been com- pleted,apicaldiameterwasconfirmedthroughapical gauging, and cones were fitted. Irrigation with pre- heated and activated 17% EDTA solution (Vista Den- tal Products) was used to remove inorganic debris from the canals. Canals were then dried with paper cones and the roots were sealed with vertical con- densationofhotgutta-percha(Endo-␣2 B&LBiotech) withstandardisedgutta-perchaconesandPulpCanal Sealer. Back-filling was performed with warm liquid gutta-percha(SuperEndo-␤B&LBiotech;Figs.7&8). The treatment was completed with a direct compos- ite restoration (Figs. 9 & 10). All treatment was per- formed under clinical microscope (OMNI pico, Zeiss). The patient kept to her treatment plan and at- tended several recall appointments after the root- canal therapy. She also attended six-monthly oral hygiene appointments with the dental hygienist (Figs. 11–13). _Discussion Treatment planning for rare conditions such as fused teeth is fundamental to the success of each case. For this reason, clinicians must consider every parameter before starting treatment. In this case, a tooth extraction would have been the likely outcome withoutaCBCTexamination.Becausethefusedteeth complex did not involve any occlusal or periodontal problems, the extraction would have caused signifi- cantbiologicaldamageandheldsignificantfinancial implications. Once a treatment plan was in place, a CBCT scan was very helpful in determining the exact position of the canals and in designing the access cavity accord- ing to the exact anatomy, which was different from that of a normal single tooth. The single-file recipro- cating technique chosen for this case was adapted to the need of the tooth. Since the anatomy was complex, the direct use of a large file in the distal root might have failed. Had different diameters been established during apical gauging, the shaping tech- nique would have been changed and more files would have been introduced. For this reason the shaping technique was modified using more files for this particular root. _Conclusion In conclusion, this case demonstrates the impor- tanceoftreatmentplanning.Indesigningatreatment plan, all diagnostic methods should be considered. In thiscase,aCBCTexaminationresultedinasuccessful and predictable treatment._ Editorial note: A complete list of references is available fromthepublisher. Fig. 12_One-year recall. Fig. 13_Four-year recall. Fig. 12 Fig. 13 Dr Andreas Krokidis is a research associate at the National and Kapodistrian University of Athens in Greece.He can be contacted at andreaskrokidis@hotmail.com Dr Riccardo Tonini is in private practice in Brescia in Italy. cone beam_about the authors CBE0114_36-40_Krokidis 31.01.14 15:53 Seite 4