| Patient age | 33 |
| Patient sex | Female |
| Tooth | 26 |
| Chief complaint | My tooth is becoming unbearable! I can’t drink cold drinks without getting shocks and a lingering ache |
| Medical history | Nothing of note |
| Dental history | Patient has had previous composite resin restorative work over 4 years ago |
| Clinical evaluation | Tooth that is tender to percussion & palpation. Elevated and heightened response to thermal stimuli |
Pre operative periapical radiograph of the tooth 16
| Diagnosis | Irreversible pulpitis and acute apical periodontitis |
| Treatment planned | Orthograde root canal treatment and permanent restoration |
| Alternatives | Tooth extraction and space rehabilitation with dental implant, bridge, or partial denture |
| Prognosis | Good |
| Treatment | Orthograde root canal treatment over two visits |
| Chemomechanical debridement | Instrumentation with k-files to produce a reproducible glide path, rotary NiTi to finish the preparation & irrigation with NaOCl. MAF X2 and X3 (ProTaper Next) |
| Dressing | Ca(OH)2 for 2 weeks |
| Obturation | With GP & AH Plus sealer. Warm vertical condensation technique. |
| Orifice barrier | GIC |
Pre obturation periapical radiograph of the tooth 16, checking cone length
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