Clinical Case 4

by | Nov 26, 2019

Pre-operative radiograph of root canal re-treatment of LL6
Post-operative radiograph from distal horizontal angulation
Post -operative radiograph at perpendicular horizontal angulation

Primary RCT LL6

This patient was referred to me for symptomatic LL6 which needed cuspal coverage restoration. The tooth exhibited symptoms of irreversible pulpitis.



  • The patient had a history of TMJ disfunction.
  • Presence of pulp stones in the pulp chamber with reduced dimensions and considerable narrowing of root canals from calcification.
  • After a thorough consent process, the patient was treated over two visits purely as the patient was given frequent periods of rest during treatment.
First visit
The tooth was isolated with a rubber dam and access gained to the pulp chamber. The calcification/pulp stones present were removed using ultrasonics. All three canals were located, no cracks extended to the pulp chamber floor. An electronic Apex locator was used for working length determination. The patient struggled to open wide due to TMJ disfunction, hence the root canals were prepared to the length determined from using the electronic apex locator.The root canals were irrigated with NaOCl and prepared with NiTi rotary files. The canals were dressed with non setting calcium hydroxide.
Second visit
Patient was asymytomatic, the root canals were cleaned and shaped, irrigated with NaOCl and EDTA as final rinse and tooth obturated with gutta percha and bioceramic sealer using hydraulic condensation technique.
The root canals were sealed with flowable composite and restored with GIC. The patient has arranged an appointment for cuspal coverage restoration.