Methodology

This case-series study presents three cases and is organized according to PRICE 2020 guidelines (7). An experienced endodontics specialist in the endodontics department of the Mashhad Dental Faculty performed all the treatment protocols conducted in the present study. Verbal and written informed consents were obtained from all patients participating, and all the Declarations of Helsinki were observed in the present study.

Case \RL 1

A 25-year-old man who was systematically healthy had been referred to the endodontics department due to toothache. Clinical examination and the patient’s history \RL showed signs of irreversible pulpitis in the mandible left the first molar. Nocturnal Toothache was also reported and pulp tenderness to cold and heat were positive. Extensive distal caries was shown in the clinic and pre-operative radiograph. Radiographic evaluation showed radix entomolaris along with S-shaped canals (Figure 1A). After a local anesthesia infiltration with 2% lidocaine and epinephrine 1:100,000 (Daroupakhsh, Tehran, Iran), the tooth was isolated with a rubber dam, and the distal access cavity was obtained with a high-speed diamond round bur No. 2 (Jota AG, RĂ¼thi, Switzerland) with continuous water spray under a dental operating microscope (Carl Zeiss, Meditec Inc., Dublin, CA, USA). The channels were negotiated with C-file #8 \RL and K-file \RL #10. An electronic apex finder was used to inspect the working length and it was confirmed by radiography (Figure 1B)\RL. All channels except radix were filed up to k-file #25 with tipper 0.04 and radix up to #20. (M3 Gold series, Dusseldorf, Germany). Irrigation was done with a 30-gauge needle (side vent needle) up to 2 mm from the working length. Chemomechanical Irrigation and shaping was completed by crown-down technique with M3 rotary files (UDG, Changzhou, China) up to size 25/04 under copious irrigation with 5.25% sodium hypochlorite and normal saline, alternately. After taking cone-fitting confirmation radiograph, all canals were dried with sterile paper points (META, Chugbuk, South Korea) and obturated with gutta-percha (META, Chugbuk, South Korea) and AH plus sealer (Dentsply DeTrey, Konstanz, Germany) using warm vertical technique by FastFill warm obturator (Fast Fill Obturation System, Eighteeth, china). Finally, Cavit (Cavisol, Tehran, Iran) was applied as a temporary restoration (Figure 1C). Follow-up was done 18 months later and the patient did not report any pain or discomfort. Clinical examination and radiograph showed an asymptomatic tooth with successful endodontic treatment (Figure 1D) <Figure 1>.