case_images: PMC10155102_01
case_images: A) Pre-operative view of tooth #9 and tooth #10; B) Pre-operative periapical radiograph of tooth #9 and tooth #10; C) Working length radiograph of tooth #9; D) Mesio-labial and disto-palatal canal orifices in tooth #9; E) Post-obturation radiograph of tooth #9; F) Labial view of tooth #9 with Interlig  fibre placed in an inverted U-shape to form core reinforcement; G) Post-operative radiograph; showing post and core build-up of tooth #9, and tooth #10; H) Post and core build-up of tooth #9 and tooth #10; I) Post-operative view; showing rehabilitated maxillary incisors with full coverage zirconia crowns
case_images: IEJ-18-104-g001.jpg
case_images: PMC10155102_01_IEJ-18-104-g001.jpg
case_images: F1
case_images: Intraoral examination showed the presence of palatally curved coronal tooth structure in the maxillary left central incisor (tooth #9) (Figure 1A) and fractured maxillary left lateral incisor (tooth #10) with a groove running along the mesial surface (Figure 2E). Furthermore, a discrete radiolucent periapical lesion with a dimension of 6 mm * 6 mm was discovered; involving the root apices of tooth #9 and tooth #10 (Figure 1B). The working length was determined using an electronic apex locator (Woodpex III, woodpecker, China) and confirmed radiographically with 19 mm and 20 mm for the mesio-labial and disto-palatal canals, respectively (Figure 1C). Angelus, Brazil) was used for radicular reinforcement via inserting into the mesio-labial and disto-palatal canals; moulded into inverted U-shape for coronal reinforcement. (Figure 1F). An A2 shade flowable resin-based dental composite restorative material (Te Econom flow, Ivoclar Vivadent, Schaan, Liechtenstein) was used for the core build-up of tooth #9 (Figure 1H). Next, crowns were cemented with dual cure resin cement (Ultrafusion D/C; Prevest DenPro, India) (Figure 1I).
case_images: A) Pre-operative occlusal radiograph of tooth #9 and tooth #10; B) Working length radiograph of tooth #10; C) Post-obturation radiograph of tooth #9 and tooth #10; D) C-shaped canal orifice in tooth #10; E) Post-obturation clinical view of tooth #10; F) Pre-fabricated resin impregnated EverStick post (0.9 mm); G) Post space creation of tooth # 10; H) EverStick post in inverted U-shape to form core reinforcement; I) Radiograph after post and core build-up of tooth #10; J) Occlusal post-operative radiograph of teeth #7, #8, #9 and #10
case_images: IEJ-18-104-g002.jpg
case_images: PMC10155102_01_IEJ-18-104-g002.jpg
case_images: F2
case_images: Intraoral examination showed the presence of palatally curved coronal tooth structure in the maxillary left central incisor (tooth #9) (Figure 1A) and fractured maxillary left lateral incisor (tooth #10) with a groove running along the mesial surface (Figure 2E). In addition, an occlusal radiograph was taken to confirm the findings (Figure 2A). The working length was determined at 18 mm radiographically (Figure 2B). The C-shaped canal was obturated using cold lateral condensation technique, with AH-plus as the root canal sealer (Figure 2C-2E). The EverStick prefabricated post (0.9 mm) was selected and Stick Resin was used for moulding EverStick post into an inverted U shape (Figures 2F-2H). Then, it was inserted into the C-shaped canal for radicular reinforcement, and followed by using/light-curing of an A2 shade flowable resin-based dental composite material (Te Econom flow) for core build-up (Figure 2I). A follow-up of 6 months was recorded; showing considerable healing of periapical lesion examined by occlusal radiography (Figure 2J), and confirmed by CBCT (Figures 3D-3I).
case_images: A) Pre-operative periapical lesion dimensions; CBCT axial section of tooth #9 and tooth #10; B) CBCT coronal section of tooth #9 and tooth #10; C) CBCT sagittal section of tooth #9; D) Post-operative healing of periapical lesion; CBCT axial section of tooth #9 and tooth #10; E) CBCT coronal section of tooth #9 and tooth #10; F) CBCT sagittal section of tooth #9; G) CBCT coronal section of tooth #9; showing two roots; H) CBCT axial section of tooth #9; I) Pre-operative 3-D image of tooth #9 showing tooth structure palatally curved when compared to tooth #8; J) CBCT sagittal section of tooth #9 with palatally curved crown; K) CBCT axial section of tooth #10; showing a C-shaped canal; L) Post-operative 3-D image of teeth #7, #8, #9 and #10
case_images: IEJ-18-104-g003.jpg
case_images: PMC10155102_01_IEJ-18-104-g003.jpg
case_images: F3
case_images: The CBCT examination confirmed the presence of two roots in tooth #9 (Figures 3G and 3H) and acute curvature at the junction of cervical and middle thirds of tooth crown; forming an L-shaped curvature in the clinical crown (Figure 3J). The presence of the above-mentioned groove caused a C-shape canal formed in the lateral incisor (Figure 3K). The lesion in tooth #10 measured 7.5 mm long and 3.8 mm wide in relation to the sagittal section of tooth#10 (Figures 3A-3C). A follow-up of 6 months was recorded; showing considerable healing of periapical lesion examined by occlusal radiography (Figure 2J), and confirmed by CBCT (Figures 3D-3I).