Orthograde Root Canal Treatment

Patient age 33
Patient sex Female
Tooth 26
Chief complaint My tooth is becoming unbearable! I can’t drink cold drinks without getting shocks and a lingering ache
Medical history Nothing of note
Dental history Patient has had previous composite resin restorative work over 4 years ago
Clinical evaluation Tooth that is tender to percussion & palpation. Elevated and heightened response to thermal stimuli

Image on right: Pre operative periapical radiograph of the tooth 16
Diagnosis Irreversible pulpitis and acute apical periodontitis
Treatment Planned Orthograde root canal treatment and permanent restoration
Alternatives Tooth extraction and space rehabilitation with dental implant, bridge, or partial denture
Prognosis Good
Treatment Orthograde root canal treatment over two visits
Chemomechanical debridement Instrumentation with k-files to produce a reproducible glide path, rotary NiTi to finish the preparation & irrigation with NaOCl. MAF X2 and X3 (ProTaper Next)
Dressing Ca(OH)2 for 2 weeks
Obturation With GP & AH Plus sealer. Warm vertical condensation technique
Orifice barrier GIC

Image on right: Pre obturation periapical radiograph of the tooth 16, checking cone length