SONDE (Sound of Dentistry)

Comprehensive Management of Extensive Root Defect in Maxillary Molar Using Pre-Endodontic Build-Up and Adhesive Onlay: A Case Report

2026-03-07T07:35:52+00:00

Background: Managing teeth with extensive root defects from secondary caries in failed restorations poses a significant clinical challenge, especially when restoration margins approach or extend beyond the gingival margin. Objective: To describe comprehensive endodontic and restorative management of a maxillary second molar with a severe root defect. Case Report: A 55-year-old woman presented with thermal sensitivity and a history of spontaneous radiating pain in the upper left posterior region. Clinical examination revealed a defective composite restoration with ICDAS 3, 2 root caries on tooth #17. Radiographs confirmed pulp involvement associated with an extensive defect on the distal surface of the root. The diagnosis was asymptomatic irreversible pulpitis with normal apical tissues. After local anesthesia and complete caries removal, a pre-endodontic build-up was performed using a sectional matrix system (Palodent® V3, Dentsply Sirona, USA) to reconstruct coronal walls and minimize contamination risk during root canal therapy. Biomechanical preparation was done with reciprocating NiTi instruments (Reciproc Blue®, VDW, Germany) followed by single-cone obturation with a bioceramic sealer. The final restoration was digitally designed using an intraoral scanner and CAD software. An indirect lithium disilicate adhesive onlay was selected to restore occlusal function. At follow-up, the tooth showed no symptomp and functionally stable. Conclusion: The integration of pre-endodontic build-up with indirect adhesive restoration offers a conservative and effective approach for managing posterior teeth with extensive root defects, preserving structural integrity and ensuring long-term clinical success.

Middle Mesial Canal Identification and Endodontic Management of the Mandibular First Molar with Five Canals: A Case Report

2026-03-26T05:58:37+00:00

Introduction: The middle mesial canal (MMC) is an anatomical variation occasionally encountered in mandibular first molars and often overlooked during endodontic treatment, potentially compromising clinical outcomes. This case report underscores the importance of recognizing and managing an MMC in five-canals mandibular molar. Methods: A 16-year-old male presented with lingering pain in the lower right posterior region. Clinical and radiographic findings led to a diagnosis of symptomatic irreversible pulpitis with symptomatic apical periodontitis in tooth #46. Canal exploration employed SLOB radiographic technique, magnification, ultrasonic troughing, and application of Krasner and Rankow’s laws. Five canal orifices were located—three in the mesial root, including a middle mesial canal, and two in the distal root. Canal preparation was achieved using Reciproc Blue instruments, coupled with passive ultrasonic irrigation for enhanced debridement. Obturation was performed with gutta-percha and a bioceramic sealer, chosen for its superior flowability and bioactivity. A full-coverage indirect overlay was placed to reinforce the remaining tooth structure. Results: At one-month follow-up, the patient reported complete resolution of symptoms, with radiographs showing well-obturated canals, intact periapical structures, and a functional restoration. Discussion: The presence of an MMC demands meticulous assessment and advanced visualization techniques. Knowledge of pulpal anatomy, effective instrumentation, and appropriate restorative choices are essential for long-term success. Conclusion: Successful endodontic outcomes depend on comprehensive canal identification, effective disinfection and obturation, and appropriate post-endodontic restoration.

Temporary Anchorage Devices in the Management of Malocclusion in Pediatric Patients: Scoping Review

2025-10-15T03:30:55+00:00

Introduction: Malocclusion is a prevalent developmental disorder in children that negatively impacts dental function, aesthetics, and craniofacial growth. Temporary Anchorage Devices (TADs) have been introduced as an alternative to conventional anchorage methods in pediatric orthodontics, aiming to overcome challenges such as inadequate anchorage and poor patient compliance. Methods: This scoping review was conducted to systematically investigate the clinical application, effectiveness, and outcomes of TADs in managing malocclusion among pediatric patients. Literature searches were performed in PubMed, Scopus, and EBSCOhost for studies published from 2014 to 2024 in accordance with PRISMA-ScR guidelines. Inclusion criteria were human studies focusing on pediatric patients treated with TADs; studies on animals, non-English languages, or published before 2014 were excluded. Study selection followed the Population, Concept, and Context (PCC) framework, and quality assessment was conducted using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Results and Discussion: A total of 7 studies met the criteria, including cohort studies, case series, case reports, and one randomized controlled trial. Most studies demonstrated that TADs provide absolute anchorage, increase flexibility in tooth movement, and reduce dependence on patient cooperation in complex cases. Conclusion: In conclusion, TADs represent a significant advancement in pediatric orthodontic care, enabling more predictable and effective management of malocclusion.

Keywords: Temporary Anchorage Devices, Pediatric Orthodontics, Malocclusion, Miniscrew

Internal Bleaching As An Esthetic Management For Discolored Non-Vital Tooth Post-Endodontic Treatment: Case Report

2025-10-18T14:58:04+00:00

Abstract

Background: Dental trauma may lead to pulpal necrosis, resulting in internal degradation of dental tissues and subsequent discoloration of the affected tooth. This discoloration is commonly associated with degradation of pulp remnants, penetration of obturation materials into dentinal tubules, or hemolysis of erythrocytes during endodontic procedures. Internal bleaching offers a minimally invasive and biologically conservative approach for esthetic rehabilitation in these cases.

Objective: To present a clinical case demonstrating the application of internal bleaching using the walking bleach technique for the esthetic management of a non-vital, endodontically treated maxillary central incisor.

Case Report: A 25-year-old female visited RSGM Unpad with a discolored maxillary left central incisor (#21) and worsen her appearance. The patient’s previous history of trauma five years ago. Clinical and radiographic examinations confirmed pulp necrosis, with asymptomatic apical periodontitis. Root canal treatment was performed using standar protocol. Two weeks post obturation, internal bleaching was initiated using the walking bleach technique with 35% hydrogen peroxide. The coronal seal was ensured using a 2 mm cervical barrier of resin-modified glass ionomer cement to prevent cervical resorption. After two bleaching sessions, a satisfactory shade match with adjacent teeth was achieved without any complications.

Conclusion: Internal bleaching with the walking bleach technique provides an effective, conservative, and predictable solution for managing discolored in non-vital teeth. The use of a proper cervical barrier and careful case selection are essential to minimize risks. This approach provides favorable esthetic results while preserving tooth structure.

Keyword: Internal bleaching, esthetics, non-vital tooth, tooth discoloration, endodontic

Esthetic Rehabilitation of a Non-Vital Discolored Tooth Through Endodontic Retreatment and Intra-Coronal Bleaching: A Case Report

2026-03-07T07:41:48+00:00

Background: Discoloration of non-vital anterior teeth is a common aesthetic concern, often associated with inadequate root canal treatment. A combined approach involving non-surgery endodontic retreatment and walking bleaching offers a conservative solution to restore both function and aesthetics.

Objective: To report the conservative management of a discolored non-vital anterior tooth using non-surgical endodontic retreatment and the walking bleach technique.

Case Report: A 24-year-old female presented with a complaint of anterior tooth discoloration persisting for the past two years, affecting her appearance. Patient experienced spontaneous pain five years earlier while undergoing orthodontic treatment. Six months earlier, the patient had undergone an incomplete root canal treatment, with radiographic examination revealing a non-hermetic obturation. Clinical examination revealed tenderness to percussion on tooth #11 and radiographic evaluation confirmed inadequate canal filling. According to the American Association of Endodontists (AAE) diagnostic criteria, tooth #21 was diagnosed as previously treated with symptomatic apical periodontitis. Non-surgical endodontic retreatment was performed with interim calcium hydroxide medication. The canal was obturated using the warm vertical compaction technique in combination with a bioceramic sealer to ensure tight seal. Bleaching was carried out using the walking bleach technique with 35% hydrogen peroxide. After the colour improved the tooth was restored with composite resin. Follow-up showed favourable aesthetic outcomes and patient satisfied with the result.

Conclusion: Non surgery endodontic retreatment combined with intra-coronal bleaching using 35% hydrogen peroxide is an effective and conservative approach for managing discoloration of non-vital anterior teeth with a history of inadequate treatment.

Aesthetic Rehabilitation of Maxillary Anterior Teeth Following Internal Bleaching with Direct Composite Veneers

2026-03-07T07:44:13+00:00

Background:

Intrinsic discoloration often present significant aesthetic challenges, particularly in patients with a history of an inadequate endodontic treatment. In such cases, a combining internal bleaching, endodontic therapy, and aesthetic rehabilitation is required to restore both function and appearance. This minimally invasive approach supports long-term aesthetic outcomes while preserving tooth structure.

Objective:

To present the management of intrinsic discoloration and anterior tooth asymmetry using internal bleaching, endodontic retreatment and direct composite veneers.

Case Report: A 24-year-old female came to the Department of Conservative Dentistry, Padjadjaran University presented with discoloration of tooth 21, which had undergone an inadequate endodontic treatment several years using a zinc oxide-based root filling material. Internal bleaching was performed using the walking bleach technique with 35% hydrogen peroxide. Meanwhile, on tooth 11 presented with a periapical abcess and root canal treatment was presented. After achieving a shade match, old composite restoration on teeth 11,21 were removed and replaced with new direct composite veneers. Additionally, both maxillary lateral incisors received direct composite veneers to correct tooth shape and achieve aesthetic balance.

Results:

The combination of internal bleaching and endodontic retreatment successfully eliminated the discoloration and resolved the infection. Composite veneers provided an aesthetically pleasing and balanced outcome.

Conclusion: Internal bleaching, when combined with endodontic therapy and direct composite veneers, offers a conservative and effective solution for managing complex anterior aesthetic cases. Addressing both discoloration and morphological imbalance can significantly improve the final aesthetic outcome.

Integrated Micro-Endodontic Surgical Management of a Persistent Periapical Lesion in a Maxillary Central Incisor: A Case Report

2026-03-07T07:50:02+00:00

Abstract:

Background:
Managing persistent periapical lesions in anterior teeth of adolescent patient presents a clinical challenge. While conventional root canal therapy remains the first line of treatment, certain cases may not respond adequately, especially when the lesion involves extensive bone destruction. In such scenarios, a surgical endodontic intervention becomes a vital alternative to preserve the affected tooth.

Case Report:

A 15-year-old female patient presented with tooth 11 previously treated endodontically. However, the CBCT revealed a periapical radiolucency associated with possible apical root crack and cortical bone perforation. Given the lesion’s extent and the limited prognosis of nonsurgical retreatment, a decision was made to perform a micro-endodontic surgical procedure. The procedure involved a submarginal Ochsenbein–Luebke flap, apical resection, curettage, root-end preparation, and retrograde obturation with mineral trioxide aggregate (MTA). To enhance healing, bone grafting and membrane placement were performed prior to wound closure. Histopathological analysis of the excised lesion confirmed a periapical cyst.

Objective:

This case underscores the critical role of accurate diagnosis using advanced imaging such as CBCT and highlights the value of a multidisciplinary approach in treating persistent lesions. The use of biocompatible regenerative materials like MTA and bone grafts can promote healing and maintains anterior aesthetics in adolescent patients.

Conclusion:

Micro-endodontic surgical management offers a predictable and conservative solution, especially for persistent periapical lesion in previously treated teeth, ensuring both functional preservation and aesthetic integrity.

Keywords: Apicoectomy, Bone graft, Cone-Beam Computed Tomography, Maxillary central incisor, Periapical cyst, MTA, Microsurgery.