Patient Demographics and Presentation: A 52-year-old female patient, with no significant medical history, presented with discomfort in the upper left quadrant. There were no contraindications to dental treatment (Tx). Clinical examination and radiographs revealed deep caries in tooth FDI #16, accompanied by gingival overgrowth on the mesial side, impeding proper access for endodontic treatment. 

Diagnosis and Treatment Plan: The diagnosis was irreversible pulpitis with symptomatic apical periodontitis in tooth #16. A treatment plan involving root canal therapy with an adjunctive gingivectomy procedure was formulated. 

Pre-Endodontic Gingivectomy:

• Procedure: A gingivectomy was performed using a diamond bur attached to a high-speed handpiece under local anesthesia.

• Objective: The goal was to remove the overgrown gum tissue on the mesial side, which was hindering access to the tooth for root canal treatment and for the placement of a sectional matrix. The procedure was executed with care to preserve as much healthy tissue as possible while ensuring adequate access.

Root Canal Therapy:

Access Opening:

• • A conservative access cavity was prepared using a high-speed dental handpiece with a round bur, straight fissure bur and tapered fissure bur.

  • Care was taken to follow the anatomical landmarks and to preserve tooth structure.

Pulpectomy:

• • Four canal orifices were located. 

  • The pulp chamber was accessed, and necrotic tissue was removed using K-files sizes #10, #15, and #20.

  • The procedure was performed under magnification to ensure thorough removal of pulp tissue.

Working Length Determination:

• • Radiographs were taken to accurately determine the working lengths of the canals.

Irrigation and Pulp Stone Removal:

• • Copious irrigation with sodium hypochlorite (NaOCI) was done to remove debris and disinfect the canals.

  • A pulp stone was encountered in one of the canals and was carefully removed without damaging the canal walls.

Cleaning and Shaping (Second Visit):

• • The canals were shaped using a series of Protaper files. The SX Protaper file was specifically used to gently widen the canal orifices.

  • The shaping process aimed to create a tapering canal conducive to effective obturation.

  • Canals were irrigated with sodium hypochlorite and with saline.

(Third Visit):

• • Gutta percha cones were initially inserted to confirm the working lengths.

Canal Disinfection and Drying:

• • Chlorhexidine gel was used as an intracanal medicament for its superior disinfecting properties and biocompatibility.

  • The canals were then dried using sterile paper points.

Obturation:

• • Gutta percha points were coated with a sealer and carefully inserted into each canal.

  • A plugger was used to compact the Gutta percha, ensuring a dense fill without voids.

Restorative Phase:

• • The access cavity was etched, and a bonding agent (3M) was applied.

  • Pulp space luxation was performed to create an optimal foundation for the composite restoration.

  • A sectional matrix was placed to aid in the reconstruction of the mesial wall using 3M flowable composite.

  • The cavity was completely filled with the composite, and care was taken to recreate the anatomical contours of the tooth.

Finishing and Polishing:

• • Finishing was performed using a flame-shaped bur followed by a series of finishing burs for precise contouring and smoothing.

  • An interdental strip was used to refine the proximal surfaces, ensuring proper contact and finish.

This case was done with Dr. Usman Gul at My Aesthetics Cosmetology.