Orthograde Root Canal Treatment

Patient age33
Patient sexFemale
Chief complaintMy tooth is becoming unbearable! I can’t drink cold drinks without getting shocks and a lingering ache
Medical historyNothing of note
Dental historyPatient has had previous composite resin restorative work over 4 years ago
Clinical evaluationTooth that is tender to percussion & palpation. Elevated and heightened response to thermal stimuli

Image on right: Pre operative periapical radiograph of the tooth 16
DiagnosisIrreversible pulpitis and acute apical periodontitis
Treatment PlannedOrthograde root canal treatment and permanent restoration
AlternativesTooth extraction and space rehabilitation with dental implant, bridge, or partial denture
TreatmentOrthograde root canal treatment over two visits
Chemomechanical debridementInstrumentation with k-files to produce a reproducible glide path, rotary NiTi to finish the preparation & irrigation with NaOCl. MAF X2 and X3 (ProTaper Next)
DressingCa(OH)2 for 2 weeks
ObturationWith GP & AH Plus sealer. Warm vertical condensation technique
Orifice barrierGIC

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