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| case report 16 laser 3 2016 tributory. The patient reported trauma to her upper teeth when she was 20 years old. After performing clinicalandradiographicexaminations,tooth11was diagnosed with pulp necrosis with internal root re- sorption and apical periodontitis. The tooth was slightly tender to percussion, periodontal probing depths were considered normal (< 3 mm), and there was no discoloration (Figs. 1 & 2). Approvalforthestudyprotocol(N_682/068)was obtained.Treatmentoptionswerediscussedandthe required consent obtained (Helsinki Declaration, re- visedinEdinburgh2000).Nofinancialincentivewas offered (i.e., patient was responsible for the usual root canal treatment fee). Under local anaesthesia (2 % lidocaine with 1:100,000 epinephrine, Scandonest, Saint Maur des Fossés, France) and rubber-dam isolation (Hy- genic Non-Latex Rubber Dam, Coltène/Whaledent, Germany), an access cavity was prepared with a high-speed carbide bur (SS White, Lakewood, NJ) and Zekrya Endo burs (DENTSPLY Maillefer, Ballai- gues, Switzerland). The working length (WL) was electronically established (Root Zx mini, Morita, USA)as1 mmshortofthebiologicalapexoftheroot and confirmed by radiography. No bleeding was noted from the root canal. Patency was confirmed withanISO#20K-fileandrootcanalpreparationwas performed with the Protaper system (DENTSPLY Maillefer,BallaiguesSwitzerland)uptoanF5(#50.05) instrument. Root canal irrigation was performed between each file with 3 ml of sterile saline solu- tion (Monoject 27G, Kendall-Covidien, USA). No chemical irrigants or inter- appointment dressings were used. For smear layer removal and root canal disinfec- tion, a previously reported laser-assisted protocol was adopted.42, 43 Following root canal preparation, the main canal was filled with distilled water and laser irradiation was performed with the 2,780 nm Er,Cr:YSGG laser (Waterlase MD; Biolase Technol- ogy, San Clement, CA) and radial firing Tip (RFT2 Endolase, Biolase Technology; calibration factor of 0.55)whichwas270 µmindiameter,withpanelset- tings of 0.75 W, 20 Hz (37,5 mJ), 140 µs pulse, 0 % waterand0 %air.Thetipwasplacedattheworking length and irradiation was performed, approxi- mately, at the speed of 2 mm/s until it reached the most coronal part of the canal. The irradiation pro- cedure was repeated four times: 2x with the canal filledwithdistilledwater(forsmearlayerandgran- ulation/pulp tissue removal) followed by 2x in dry conditions (to achieve deep dentine penetration and disinfection), with approximately 15 seconds between each irradiation. Afterward, a sterile cot- ton pellet was placed in the pulp chamber, and the accesscavitywassealedwithareinforcedzinc-ox- ideeugenolintermediaterestorativematerial(IRM, DENTSPLY). At the second appointment after seven days, the patient reported pain, tenderness to percussion and swelling upon questioning. Under local anaes- thesia and rubber dam isolation, the canal was re-accessed.Themaincanalwasfilledwithdistilled water and laser irradiation was performed using a 320 µm radial firing tip (RFT3 Endolase, Biolase Technology: calibration factor of 0.85), with panel settings of 1.25 W, 20 Hz (62.5 mJ), 140 µs pulse, 0 % water and 0 % air. The irradiation protocol was identicaltothefirstappointment. Afterirradiation, a final rinsing of sterile saline solution (3 ml) was performed, and the canal was dried with sterile pa- per points, checking for the absence of any suppu- ration or exudate. Filling was performed with a #50.05 auto-fit gutta-percha cone (DENTSPLY Maillefer, Ballaigues Switzerland) using a down pack-backfill technique (Calamus, DENTSPLY Maillefer) and a resin-based endodontic sealer (Topseal,DENTSPLYMaillefer).Bothdownpackmo- tion and gutta-percha injection were performed with low pressure and extreme caution due to the root weakness. Radiographic images were taken immediately (Fig. 3) and after one (Fig. 4), two (Fig. 5) and three years (Figs. 6 & 7). Over this follow-up period, the tooth remained completely asymptomatic and periapical healing was noticed. Fig. 1 Fig. 2 Fig. 3 Fig. 1: Clinical picture demonstrating aesthetic initial appearance of tooth 11. Fig. 2: Initial radiographic appearance of tooth 11 demonstrating an extensive apical radiolucency and internal root resorption. Fig. 3: Immediate post-operative radiograph of tooth 11. 32016