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

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.

Completion

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.

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