Methods (differential diagnosis, investigations, and
treatment method)
Upon obtaining informed consent, the treatment plan started with the
administration of local anesthesia using a buccal infiltration of 1.8 ml
of 2% lidocaine with 1:100000 epinephrine (Daroupakhsh, Tehran, Iran).
A rubber dam was placed to ensure an aseptic environment. The access
cavity was prepared using a high-speed diamond round bur No. 2 (Jota AG,
Rüthi, Switzerland) under continuous water spray, aided by a dental
operating microscope (Carl Zeiss, Meditec Inc., Dublin, CA, USA). The
access cavity was refined with a diamond fissure bur No. 2 (Jota AG,
Rüthi, Switzerland). Frequent irrigation with sodium hypochlorite and
saline enlarged the pulp chamber .Two canal orifices were identified and
explored with a #15 C-file (VDW, Munich, Germany). Coronal preflaring
was achieved using an SX instrument (M3, Changzhou, China). The working
length was determined using an apex locator (Root ZX, J. Morita, Japan)
and confirmed radiographically.The glide path was manually obtained
using C-pilot (VDW, Munich, Germany) numbers 6, 8, and 10, followed by
the use of rotary path files numbers 13, 16, and 19 with a 2% taper
(M3, Changzhou, China) throughout the working length.The SP1 gold rotary
system was utilized, with the S1 rotary file (UDG, Changzhou, China)
reaching the working length through a picking motion. Subsequently, the
canals were shaped using the M3 rotary system up to size 25/04. The
canals were irrigated with 20ml of 5.25% NaOCl and normal saline
throughout the instrumentation process.the activation of sodium
hypochlorite in the root canal was performed using sonic activation (SI)
with Endoactivator system (Dentsply Tulsa Dental Specialties) for 30
seconds per canal. The final irrigation of the root canal system was
performed using 17% EDTA. Master cone of size 25/04% for the buccal
canal and 30/04% for the palatal canal were selected (Figure 1. B).The
canals were thoroughly dried with sterile paper points (META, Chungbuk,
South Korea), and obturation was completed using Gutta-percha (META,
Chungbuk, South Korea) and AH-plus sealer (Dentsply DeTrey, Konstanz,
Germany) using the warm vertical technique by FastPackand and FastFill
(Eighteeth, china) warm obturator. Finally, Cavit (Cavisol, Tehran,
Iran) was applied as a temporary restoration (Figure 1. C).