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Using pre-endodontic bonded buildup to manage isolation and clamp stabilization challenges

Dr. C. John Munce (Photo/Provided by CJM Engineering)
C. John Munce, DDS

C. John Munce, DDS

Tue. 16 April 2024


Tooth No. 14: Necrotic pulp with SAP and associated severe coronal breakdown presenting isolation and clamp stabilization challenges that were managed by pre-endodontic bonded build-up. Unusual root morphology made this an interesting case.

Complexities included:

  • Severe coronal breakdown and associated isolation challenges. Managed by slow-speed #6 round cariesectomy bur. Followed by bonded pre-endodontic reconstruction of the mesial wall.
  • Severe calcification of all canals. Managed by careful slow-speed round bur troughing to identify canal remnants on the chamber floor. The canals were further excavated by a series of decreasing-diameter deep narrow-shafted tiny slow-speed round troughing burs to a level where files could enter all four canal canals.
  • Unusual root morphology. Two separate palatal roots and two constricted buccal roots. Clarified by a pre-treatment CBCT scan.


At completion, to facilitate both a robust endodontic coronal seal and a durable build-up — and while still under rubber dam isolation protocol — composite was bonded directly over gutta percha from sub-orifice levels to the cavo-surface of the access cavity.

The referring doc, whose practice was associated with a periodontist, was advised that the depth of the excavated carious defect on the mesial would require crown lengthening to facilitate ideal restoration.

Photos/C. John Munce

Editorial note:

John Munce is a diplomate of the American Board of Endodontics, past president of the California State Association of Endodontists and founder and CEO of a clinical endodontic products company, CJM Engineering Inc. He is the primary author of the chapter, “Preparation for Endodontic Treatment” in the celebratory 50th anniversary 7th edition of “Ingle’s Endodontics”. He also co-authored a chapter on MTA repair of post perforations in Nadim Baba’s prosthodontics textbook, “Contemporary Restoration of Endodontically Treated Teeth”. Dr. Munce and his wife, Marianne, make their home in the mountains of the Idaho Panhandle town of Sandpoint.

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