Comprehensive knowledge of the entire root canal system is an essential prerequisite for successful routine endodontic treatments. The internal and external morphological configurations of roots and root canals are quite complex. Thus, several classifications have been put forth by researchers to appropriately understand the distinguishable features of root and root canal systems of multirooted teeth. Until now, the researchers have proposed new classification systems for a thorough understanding of the root canal systems, mainly concentrating on the root canal anatomy and anomalies. Moreover, with the advent of newer digital imaging systems, these classifications are more reproducible and relevant. They have further gained importance for the clinicians by acting as an aid in decision-making based on evidence-based dentistry. However, these classifications are primarily focused on the root canals, but none have assessed the anatomy of the pulp chamber floor. This review article delineates a novel Pawar and Singh molar pulp chamber floor classification© for the anatomy of maxillary and mandibular molars to ease the clinician's skills and further increase the prevailing literature for the benefit of researchers.

Introduction: Intracanal medicaments have been used during endodontic regenerative procedures to eradicate endodontic pathogens. Aims: The aim of our study was (1) to evaluate the antimicrobial efficacy of a novel antibiotic–steroid paste over the regularly used calcium hydroxide (Ca (OH)₂), double antibiotic paste (DAP), and modified triple antibiotic paste (M-TAP) and (2) to check the antimicrobial efficacy of irrigating solutions, Chlorhexidine (CHX), and sodium hypochlorite (NaOCl) against a 3-week-old Enterococcus faecalis (E. faecalis) biofilm. Materials and Methods: A total of 112 human extracted teeth were contaminated with E. faecalis for a period of 21 days. A novel antibiotic–steroid paste, Ca (OH) ₂, DAP, M-TAP, and a placebo were placed inside the canal, sealed, and incubated in an aerobic environment at 37°C. For irrigating solutions, each prepared sample was immersed in 1 ml of sterile saline for 1 min, followed by irrigating and immersion with 1.5% NaOCl and 2% CHX for 5 min. An antimicrobial assessment was performed at the end of 2 days and 7 days, with seven teeth from each group, for each time interval. Dentin debris collected was transferred to the respective medium for culture. After 24 h, colonies were counted using classical bacterial counting technique as colony-forming units. Results: Statistical analysis revealed that the novel antibiotic–steroid paste showed a statistically insignificant difference when compared to DAP, which had the highest antimicrobial properties. Conclusion: This novel functional paste has antimicrobial efficacy comparable with that of DAP.

Introduction: More than 41,000 root canal treatments (RCTs) are performed every day and about 25 RCTs are performed every week by an endodontist. The success rate of endodontic treatment ranges between 86% and 98%; however, the failure rates cannot be ignored which can range up to 20% of the treated cases due to a varied number of reasons including incorrect adoption of working techniques and usage of inappropriate materials. The present study aimed at comparing the practices of various levels of dentists toward RCT in their daily practice. Methodology: A cross-sectional, descriptive, questionnaire-based study was conducted among the dental practitioners who have completed the Masters of Dental Surgery (MDS) curriculum in India and postgraduate students in various dental colleges in India. The sample size was achieved to be 1601 at the completion of the study. The response rate for the study was 80.05%. All the dentists practicing RCT either in the clinic or in the college and willing to participate in the study were included in the study. A self-structured questionnaire was used as study tool. SPSS was used to analyze the data. Results: A total of 26.7% of the PG students (endodontists) used rubber dam. Majority of the dentists preferred hand instruments (62.36%) over rotary. Almost half (53.09%) of the postgraduates belonging to other branches reported to prescribe drugs. Conclusion: The present study showed a varied profile of the dentists with most of them following the basic protocols and techniques of international standards.

Aim: The aim was to compare and evaluate the efficacy of electrochemically activated water (ECA) against maleic acid, Mixture of tetracycline, acid and detergent. ie; 3% doxycycline, 4.25% citric acid, and 0.5% Tween 80 detergent (MTAD), Sodium hypochlorite (NaOCl), and saline as root canal irrigants in removing the smear layer. Materials and Methods: Twenty single canal mandibular premolars were randomly divided into five groups (n = 4), decoronated, prepared to working length, and instrumented till F3 using protaper gold rotary files. Each group was assigned a different irrigant. Saline-negative control and NaOCl-positive control. Teeth were sectioned and subjected to Scanning Electron Microscopic analysis. ECA was prepared using a custom-made apparatus having two chambers of capacity 50 ml each separated by a polymer membrane. About 40 ml of tap water was collected in each chamber. Two graphite electrodes were connected to the top of the compartments, linked to a power supply which initiates electrolysis, and the solutions obtained in anodic and cathodic compartments were collected. Statistical analysis was done using one-way ANOVA and Post hoc Tukey analysis. Results: NaOCl, maleic acid, and ECA had similar smear layer removal efficacy. MTAD was less efficient than the other irrigants tested. Saline did not remove the smear layer. Conclusion: Electrochemically activated water has promising smear layer removal efficacy and is comparable with conventional root canal irrigants.

Introduction: The present study was carried out with the objective of evaluation of efficacy of two root canal irrigants (LARGAL ULTRA and Biopure mixture of tetracycline, acid, and detergent [MTAD]) in smear layer removal and sealer penetration along the canal walls and to apprise any change in their efficacy when they were activated with two different types of lasers (neodymium-doped yttrium aluminum garnet [Nd:YAG] and erbium-doped yttrium aluminum garnet [Er:YAG]). The analysis was done with the help of confocal laser scanning microscope. Materials and Methods: The curved root canals (>20°) from 140 extracted human molars (negative control, n = 20) were prepared to size #25.06 with NaOCl irrigation. Teeth were divided into two experimental groups with sample size 60 each (Group I, II). Groups further divided into subgroups IA, IB, and IC and IIA, IIB, and IIC with sample size twenty each. Group IA, Largal Ultra irrigation without LAI; Group IB, Largal Ultra irrigation with Nd:YAG; Group IC, Largal ultra with Er:YAG; Group IIA, MTAD irrigation without LAI; Group IIB, MTAD irrigation with Nd:YAG; Group IIC, MTAD irrigation with Er:YAG. Teeth were obturated with gutta-percha and fluorescent dye labeled sealer. Transverse sections at 3 mm from root apex were examined with confocal laser scanning microscopy, and the percentage of sealer penetration into dentinal tubules was measured. Statistical Analysis: Analysis of variance calculated (e.g., one-way between-subjects ANOVA) and Tukey's test was performed for each mean comparison. Results: Difference between control and Group IIc (65.48 ± 0.57) was highest, followed by control and Group Ic (54.92 ± 0.57) and minimum between Group Ib and Group IIa (0.23 ± 0.57). Order of percent diffusion in the present study was: Group IIc > Group Ic > Group IIb > Group Ib ≈ Group IIa > Group Ia > Control (P <.001). Conclusions: It was inferred that, among the two irrigating solutions tested, Biopure MTAD is more proficient than Largal Ultra. Laser activation of final irrigating solution has been shown to allow better sealer penetration, with Er:YAG laser being more potent than Nd:YAG laser.

Background: According to recent approaches, the prevention of initial dental caries is achieved using certain noninvasive methods. One such method is the topical application of remineralizing agents. Various remineralizing products are commercially available, but their efficacy is uncertain. Aim: The aim of the study was to evaluate the remineralizing potential of MI, Reminpro, and Clinpro using scanning electron microscope (SEM) and energy dispersive X-ray (EDX). Methodology: Forty extracted human premolars were collected. The samples were decoronated and the crown portion was coated with nail varnish leaving behind a 3 mm × 3 mm window on the labial surface. The samples were soaked in demineralizing solution for 4 days to create an artificial lesion, followed by SEM-EDX analysis. The samples were then randomly divided into 4 groups Control, MI, Remin Pro, and Clinpro with ten samples each. The remineralizing agents were applied according to the group and subjected to pH cycling for 21 days which was followed by SEM-EDX analysis. Data obtained were statistically analyzed using SPSS IBM version 23 (ANOVA, post hoc-Tukey, and Paired-t-test). Results: Ca and P were increased after remineralization in all groups. Between groups, the increase was more for ReminPro, followed by Clinpro and MI. Conclusion: In this study, the remineralizing potential of Remin Pro was effectively more, followed by Clinpro and MI.

Background: The ambiguity in key influential factors such as minimal time for effective action, dilution, and need of drug carrier for intracanal medicaments necessitates a microbial analysis that aids in the potential selection of an intracanal medicament for ensuring optimal root canal disinfection. Aims: This study aims to evaluate the antimicrobial efficacy of octenidine hydrochloride (OHC) and gold standard calcium hydroxide (Ca(OH) ₂) as intracanal medicaments, both independently and along with chitosan (CTS) as medicament vehicle against the common resistant endopathogen – Enterococcus faecalis. Materials and Methods: A modified direct contact microbial test was used to evaluate the amount of surviving bacteria after predetermined contact time (2, 5, 20, and 60 min) and 5-fold serial dilution of the intracanal medicaments. The experiment was carried out under aseptic conditions and performed in triplicate to ensure reproducibility. Statistical Analysis Used: The results were analyzed by Kruskal–Wallis analysis of variance followed by pairwise comparisons by Mann–Whitney U-test. Results and Conclusions: The results showed that all the four medicament groups were able to show the maximum antimicrobial efficacy against E. faecalis at 60 min time interval and that the antimicrobial efficacy of OHC and Ca(OH) ₂ was at its peak when used alone. The study thereby concluded that the addition of CTS as a carrier did not enhance the antimicrobial efficacy of OHC or Ca(OH) ₂ against E. faecalis.

Context: Neoendo Flex and Mani Silk are recently launched nickel–titanium (NiTi) rotary files. Dentinal cracks and file separation remain a critical problem in the endodontic domain. Aim: The aim was to evaluate and compare the incidence of dentinal crack formation after root canal preparation with Neoendo flex and Mani silk files. Materials and Methods: Thirty-six extracted single-rooted premolars with straight, single root canals were selected for the study. The specimens were randomly assigned to three groups, with 12 samples in each group. The root canal preparation for the three groups was done with hand K-file, Mani Silk, and Neoendo Flex files, respectively, following which the specimens were horizontally sectioned at 3, 6, and 9 mm from the apex. Sectioned samples were viewed under a stereomicroscope to determine the presence or absence of dentinal cracks. The data were analyzed using one-way ANOVA and Chi-square test. Results: Hand K-files and Mani Silk files produced a lesser number of cracks than Neoendo Flex files; however, the difference was not statistically significant among the three file groups at 3 mm and 6 mm (P > 0.05). A statistically significant difference between the groups was seen at 9 mm, where Mani Silk files produced fewer cracks than K files and Neoendo Flex files (P = 0.007). Overall, Neoendo Flex significantly produced more cracks than Mani Silk and hand K-files (P = 0.0029). Conclusions: Both hand K files and NiTi rotary instruments may cause dentinal cracks. Neoendo Flex files tend to produce more dentinal cracks than Mani silk and K-file.

Objective: The objective of this study was to compare the effects of light and laser activation of in-office tooth bleaching systems on enamel microhardness and surface roughness. Materials and Methods: Twenty-five enamel slabs were divided into three treatment groups: light-activated bleaching, laser-activated bleaching, and control. The baseline data were recorded for enamel microhardness (Vickers microhardness [VMH]) and surface roughness (Roughness average, Ra). The specimens were cured for 10 min upon hydrogen peroxide application for the light-activated bleaching group and activated with a laser source, 8 cycles, 10 s per cycle for the laser-activated group. The changes in VMH and Ra at days 1, 7, and 28 were evaluated. Kruskal–Wallis, Friedman, Wilcoxon, and Mann–Whitney tests were used to analyze both VMH and Ra between the treatment groups at different time intervals. Results: There were a significant reduction in VMH values and significant differences between days 1, 7, and 28 against the baseline in the light-activated bleaching group (P = 0.001). The Ra values revealed significant differences in both light- (P = 0.001) and laser-activated (P = 0.033) groups. Conclusion: Light activation of a bleaching agent caused a reduction in enamel microhardness and an increase in surface roughness when compared to laser activation.

Context: Regenerative endodontics uses the concept of tissue engineering to restore the diseased immature tooth, allowing for continued development of the root to a healthy state. For regenerative endodontics, the use of human dental pulp stem cells (HDPSCs) with appropriate scaffolds and growth factors is imperative. Aims: The aim of the study was to evaluate the human dental pulp cell viability in two-dimensional (2D) and 3D fibrin glue scaffold to be used in regenerative endodontics. Subjects and Methods: Regenerative potential of HDPSCs was comparatively assessed usings 2D and 3D fibrin glue scaffold. 3D scaffold was made with different concentrations of fibrinogen. Cell morphology was studied under inverted phase-contrast microscopy, and cell proliferation was assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay at various time intervals. Statistical Analysis Used: Collected data underwent a two-way ANOVA test. The P value of the study was kept 0.05 according to the sample size. Results: Study revealed a significant increase in the proliferation of HDPSCs in fibrin glue precoated wells of 2D fibrin glue compared to preseeded cells on day 1 and day 3. The concentration of fibrinogen has a major role in cell viability in 3D fibrin glue scaffold. Homing of HDPSCs in the 3D scaffold improves with time. Conclusions: This study concludes that the concentration of fibrin glue has a significant role in HDPSC Viability in 3D scaffold.

Aims: To assess the effect of etidronic acid (EA) mixed with sodium hypochlorite (NaOCl) and two ethylenediaminetetraacetic acid-containing preparations (EDTA and SmearClear) alternated with NaOCl, as a final rinse, on root fracture resistance to a compressive force. Materials and Methods: Seventy-two premolar roots were randomly allocated to the following groups according to the irrigant solutions. For the EA group, 9% EA + 2.5% NaOCl were used throughout the assays (n = 21). The remaining groups received 2.5% NaOCl during and immediately after chemo-mechanical instrumentation. Intermediately, the roots received 17% EDTA (n = 19), or SmearClear (n = 16), or no irrigation (control) (n = 16) plus a final rinse with 2.5% NaOCl. The specimens were subjected to a vertical compressive force loaded at a crosshead speed of 0.02 mm/s parallel to the long axis of the root until fracture occurred. The results were compared statistically using the one-way analysis of variance for intergroup comparisons. Results: The negative control presented with the highest values, whereas the SmearClear presented with the lowest values, though no significant differences were found when comparing the different groups (P = 0.82). Conclusions: The use of EA + NaOCl or two EDTA formulations in association with NaOCl does not affect the fracture resistance of previously chemo-mechanically prepared roots.

Introduction: Enterococcus faecalis can be found in failed endodontic treatment (FET) even after performing primary endodontic treatment (PET). Calcium hydroxide (Ca(OH)₂) cannot fully eliminate this microorganism during PET. Brazilian green propolis (bee glue) was found to be more effective against E. faecalis when compared to Ca(OH)₂. A much less studied Malaysian geopropolis (MP) as well as Aloe vera (AV) is antibacterial but is unknown against E. faecalis. Objective: The objective of this study is to determine the antimicrobial effects of MP, AV, and MP + AV in comparison with Ca(OH)₂ against E. faecalis, as an intracanal medicament. Materials and Methods: Antimicrobial activity of MP, AV, MP + AV, Ca(OH)₂, and dimethyl sulfoxide was tested against E. faecalis using antimicrobial sensitivity testing, minimum inhibitory concentration (MIC), and minimum bactericidal concentration (MBC). The results were analyzed by Kruskal–Wallis test with Mann–Whitney post hoc test and repeated measures analysis of variance with Bonferroni post hoc test (P < 0.05). Results: For agar well-diffusion method, MP + AV gave maximum inhibition zone diameter (mean: 8.11 ± 0.015 mm), MP (mean: 6.21 ± 0.046 mm, Ca(OH)₂ (mean: 5.5 ± 0.006), and AV (mean: 5.05 ± 0.012) with P < 0.05. MIC for MP + AV was 2 mg/ml, MP at 8 mg/ml, Ca(OH)₂ at 8 mg/ml, and AV at 16 mg/ml. The MBC for MP + AV is at 4 mg/ml, MP at 16 mg/ml, Ca(OH)₂ at 16 mg/ml, and AV at 32 mg/ml. Conclusion: The combination of MP and AV consistently showed better antimicrobial activity compared to MP and AV alone against E. faecalis. The findings suggest that MP and AV used in combination may be an ideal intracanal medicament in FET and PET.

Aim: The aim is to evaluate the effect of different layer thickness on the amount of elution of monomers from two high viscosity bulk-fill composites after 24 h and 1 month storage in ethanol using high-performance liquid chromatography (HPLC) analysis. Materials and Methods: Forty-eight samples prepared from two high viscosity bulk-fill composite resins; Tetric EvoCeram Bulk Fill and x-tra fil were divided into three groups (n = 8) based on their layer thickness, i.e., Group 1 (2 mm), Group 2 (4 mm), and Group 3 (6 mm) and were then subdivided based on their storage period. The analysis of the eluates was performed using HPLC unit. Statistical analysis was performed using One-way ANOVA, independent sample t-test, and paired “t” test at a significance level of 0.05 (P < 0.05). Results: Increase in layer thickness resulted in increased amount of bisphenol A-glycidyl methacrylate (Bis-GMA) and urethane dimethacrylate (UDMA) elution for both composites, i.e., Group 3 > Group 2 > Group 1 and there was statistically significant difference among all the groups. Tetric EvoCeram Bulk Fill showed a statistically significant increase in amount of Bis-GMA and UDMA elution for all groups compared to x-tra fil. Furthermore, increase in storage period resulted in statistically significant increase in amount of Bis-GMA and UDMA elution for both composites, i.e., Group 1B > Group 1A, Group 2B > Group 2A, and Group 3B > Group 3A. The mean value of UDMA elution was higher when compared to that of Bis-GMA elution for both composites and there was statistically significant difference for all groups. Conclusion: Within the limitations of this in vitro study, it was concluded that increase in layer thickness resulted in increased amount of Bis-GMA and UDMA elution for both Tetric EvoCeram Bulk Fill and x-tra fil.

Aim: Evaluation of the impact of three different obturation techniques on the penetration depth and adaptation of a bioceramic root canal sealer(BioRoot RCS) to root dentin using scanning electron microscope and confocal laser scanning microscope. Materials and Methods: Recently extracted ninety mandibular premolar teeth of similar dimensions (±0.2 mm) with single canals and straight roots were segregated into three experimental groups (n = 30 each) based on the method of obturation used, i.e., lateral compaction technique, warm vertical compaction technique, and injectable thermoplasticized technique. After obturation, half of the root samples (n = 15) in each group were sectioned horizontally by hard tissue microtome at 3, 6, and 9 mm, respectively, from root apex for measuring sealer penetration depth with a confocal laser scanning microscope. Longitudinal sections of the samples (n = 15) were used for measuring the adaptation of sealers to radicular dentin using a scanning electron microscope. Statistical Analysis: Intergroup comparison of sealer penetration depth and adaptation to root dentin was analyzed using one-way ANOVA, and pairwise comparisons were made using Tukey's post hoc test. Results: Warm vertical condensation technique showed deeper root dentin penetration of the sealer. Better adaptation of the sealer to apical root dentin with minimal voids (P ≤ 0.05) was achieved with warm vertical condensation in comparison to the injectable gutta-percha method and lateral condensation obturating techniques. Conclusion: At all three root levels (coronal, middle, and apical), warm vertical condensation technique exhibited more sealer penetration with minimum gaps, whereas lateral condensation technique exhibited more gaps and less sealer penetration.

Context: Knowledge about dentin microstructure is essential for execution of clinical procedures which require adhesion of materials to dentin. Aims: To evaluate by scanning electron microscopy (SEM) the dentin ultrastructure after demineralization with 6 M and 12 M hydrochloric acid (HCl). Subjects and Methods: Twenty dentin segments were immersed in fixative solution and dehydrated in ethanol. After 24 h, segments were randomly divided into 2 groups (n = 10), demineralized with 6 M HCl (G6M) and 12 M HCl (G12M), and prepared for SEM analysis. Statistical Analysis Used: Based on photomicrographs and chemical composition (energy dispersive X-ray spectroscopy) of dentin, a descriptive analysis was conducted. Results: G6M samples revealed a demineralized surface with peritubular dentin exposure and small magnification of the dentinal tubules openings. The intertubular dentin was partially demineralized. Demineralization of G12M samples was more aggressive and at different depths, promoting erosion and “detachment” of dentin layers. Peritubular dentin was observed on the dentin surface. There was a large magnification of the dentinal tubules openings. In both groups, tubular structures showed a similar chemical composition to the intertubular dentin. Lamina limitans was not observed. Conclusions: Dentin demineralization is dependent on the HCl molarity and promotes exposure of peritubular dentin.

Objective: The aim of this study is to determine the role of clinical audit in improving endodontic treatment outcomes. Materials and Methods: An audit at the department of endodontics at dental specialty centre kingdom of Saudi Arabia was carried out. The audit was conducted by developing endodontics treatment and success predictors based on evidence, that can be measured for endodontic care. A total of 12 months' data was examined from the previous dental records. Ten clinical cards were which included root canal treatment were selected. The audit was carried out for a minimum of 50 teeth and a maximum of 200 teeth. The radiographs of record cards were studied and a single dentist completed the audit tool. Results: The vitality test was performed in 1.98% cases, intra-canal medicament was used and named in 3.96% cases, 3.96% the teeth were extracted due to endodontic failure. Further, in 6.93% of the cases that were identified had certain spaces but overall root canal filling was evaluated as satisfactory. Conclusion: The vitality test, type of intracanal medicament, and assessment of root canal filling were not done, but there was an overall performance of predictors for endodontic treatment.

Background: Cervical lesions requiring adhesive restoration may present with dentin hypersensitivity, but the effect of desensitizer treatment on microtensile bond strength (MBS) is inconclusive. Aim: The aim of the present study was to assess the influence of two types of dentin desensitizing treatment on bond strength to dentin. Materials and Methods: Thirty-six extracted human mandibular first premolars were used to obtain superficial buccal cervical dentin. The samples were assigned to two groups (18/group): etch-and-rinse (ERS) (Optibond^® Solo) and self-etch (Palfique) adhesive systems. Eighteen teeth in each group were randomly assigned to three desensitizer treatments (6/treatment); control (no desensitization), Gluma™ desensitizerand Novamin-containing toothpaste (Sensodyne repair and protect™). Bonded dentin-composite specimens were stored in artificial saliva for 2 weeks prior to scanning electron microscope (SEM) evaluation and MBS testing. Univariate analysis of variance and Tukey tests were performed (α = 0.05) for the data analysis. Results: The mean MBS with self-etch system (SES) was significantly higher than ERS system, irrespective of the dentin desensitizer regimen. SEM showed no hybrid layer or resin tag formation in the SES group. Tubular occlusion was observed in all specimens treated with desensitizer. Conclusion: Mild self-etch adhesive can be used on dentin treated with Gluma or bioglass-containing desensitizer without compromising the bond strength. Clinical Relevance: Dentin desensitizer such as in-office Gluma or at-home Novamin-containing toothpaste could be used without compromising the bond strength of mild self-etch adhesive systems.

Background: Homeopathy is one of the commonly used systems of complementary or alternative medicine. The present study was conducted with an aim to compare the antibacterial efficacy of two commonly used homeopathic medicaments acid benzoicum 30C (SBL Pvt Ltd) and silicea 6C (SBL Pvt Ltd) with that of calcium hydroxide (Deepti Ltd) as intracanal medicament against Enterococcus faecalis (ATCC-29212). Materials and Methods: The test organism used for the study was E. faecalis. Petri plates with 20 ml of sheep blood agar were inoculated with 0.1 ml of the microbial suspensions. The medicaments to be tested for antimicrobial efficacy against E. faecalis were divided into three groups: Group A (acid benzoicum), Group B (silicea), and Group C (calcium hydroxide). The antimicrobial activity of each medicament was measured and expressed in terms of the mean of the diameter of zone of inhibition (in mm) produced by each extract at the end of the incubation period. ANOVA and Tukey's honestly-significant difference posthoc test were used for the intergroup comparison. P < 0.05 was considered statistically significant. Results: Group A (acid benzoicum) showed the maximum zone of inhibition against Gram-positive E. faecalis (17.2 ± 0.65), and the difference between the groups related to the antibacterial activity was highly significant (P < 0.001). A statistically significant difference was observed between the three groups on the intergroup comparison (P < 0.001). Conclusion: In the present in vitro study, antimicrobial activity of the acid benzoicum extract was the highest followed by silicea extract and then calcium hydroxide.

Three-dimensional (3D) technology has gained wide acceptance in dentistry. It has been used for treatment planning and surgical guidance. This case report presented a novel treatment approach to remove and preserve the cortical bone and root-end resection during periapical surgery with the help of cone-beam computed tomography (CBCT), computer-aided design, and 3D printing technology. A 22-year-old male patient presented with a large periapical lesion in the right maxillary central and lateral incisors was referred for endodontic surgery. The data acquired from a preoperative diagnostic CBCT scan and an intraoral scan were uploaded into surgical planning software and matched. A template that could be used to locate root ends and lesion areas was virtually designed based on the data and was fabricated using a 3D printer. With the guidance of the template, the overlying cortical bone was precisely removed and preserved, and apicectomy was performed. The patient was clinically asymptomatic at a 6-month follow-up review. Six months after the surgery, the lesion was healing well, and no periapical radiolucency was observed on radiographic examination. The digitally designed directional template worked in all aspects to facilitate the periapical surgery as anticipated. The root ends were accurately located and resected. The surgical procedure was simplified, and the treatment efficiency was improved. This technique minimized the damage and reduced iatrogenic injury.

This clinical report describes the rehabilitation procedure of an upper central tooth with a coronal fracture without compromising the root. The treatment plan consisted of the reinsertion of the fractured fragment as a definitive cemented biological restoration. Due to the deficient remnant, a fiber-reinforced composite post was used. The objective of this clinical case was to report the biological behavior of the enamel and dentin of a biological restoration after dental trauma. Patient satisfaction with the treatment was achieved by continuing with the same tooth and biomimetizing the fracture line with conventional composites. Controls were conducted, and 1 year after dental trauma, no color changes in dental tissues and no inflammation in periodontal and soft tissues were observed.