PMC9900150_01
Treatment of tooth #10. A) Preoperative Photograph; B) Preoperative panoramic view; C) Preoperative periapical radiograph; D, E) CBCT images (sagittal sections); F, G) CBCT images (axial sections); H) Access Cavity using diamond bur and ultrasonic tip with methylene blue; I) Instrumentation; J) Supplementary sonic irrigation of a size 15, o2 taper tip of Endoactivator to NaOCl activation; K) Photodynamic therapy; L) Filling of the main canal and invagination; M) Clinical view following composite filling; N) Six-month follow-up; O) One-year Follow-up
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The tooth crown had a restoration but was free from caries and tooth discoloration (Figure 1A). Radiographic assessments using periapical (PA) image and panoramic view (OPG) revealed an atypical structure of pulpal anatomy, probably dens invaginatus, associated with a large periapical lesion and severe root curvature (Figures 1B and 1C). Cone-beam computed tomography (CBCT) was carried out using NewTom VGi (QR Verona, Verona, Italy) with exposure factors of 110 kV, 1-20 mA, 75-150 mum voxel, 6 cm2 field of view, and approximately one min reconstruction time (Figures 1D, 1E, 1F, and 1G). Then, following the rubber dam setting, two access cavities were prepared; one in dens in dent (mesial canal) and the other in the main canal (distal canal) (Figure 1H).  Tokyo, Japan) to estimate the working length (WL) followed by radiographic evaluation. The WL of the mesial canal (dens in dent canal) and distal canal (main one) were measured at 13 mm and 24 mm, respectively (Figure 1I). The canals were successfully enlarged manually to fit master K-file sizes #60 for dens in the dent canal and #15 for the main canal. Technology Co., Changzhou, China) was used for passive activation of NaOCl according to the manufacturer's recommendation (Figure 1J). To a better physical contact with the walls of the tooth canal system, efficient cleaning of the root canal surfaces, and better activation of NaOCl, an XP-Endo  Finisher file (FKG Dentaire, La-Chaux-de-Fonds, Switzerland) was used with supplementary sonic irrigation of a size 15, 02 taper tip of Endoactivator (Dentsply Sirona, Ballaigues, Switzerland). The root canal was irradiated by an infrared light-emitting diode (LED) with a wavelength of 630 nm and 2000 mW/cm2 intensity (Figure 1K). At the end of the session, a new PA radiograph revealed complete root filling (Figure 1L). A six-month (Figure 1M) and one-year (Figure 1N) recall radiographic images revealed progressive osseous healing. One-year clinical findings showed asymptomatic teeth, no sensitivity to percussion and palpation, no mobility, no attachment loss or recession, but complete healing of the sinus tract (Figure 1O).