Iranian Endodontic Journal

Abstract

This case report highlights the innovative application of Biodentine as an intraorifice barrier in the management of cracked teeth with radicular extension associated with endo-periodontal lesions. A 37-year-old female patient reported pain during chewing on tooth #36. Significant periodontal attachment loss was noted around the mesial root. The tooth was diagnosed with pulp necrosis. Upon endodontic access, a vertical crack extending into the mesial canal walls was observed. Root canals were identified and shaped using rotary instruments. Calcium hydroxide was placed as an intracanal dressing. After one week, the patient returned without inflammatory signs. The root canals were filled with gutta-percha and bioceramic cement. Biodentine repair cement was applied 2.0 mm beyond the orifice to seal and reinforce the area. The endodontic access cavity was restored with composite resin. Clinical and radiographic follow-ups at 12 months revealed significant periapical healing and the absence of inflammatory signs. A radiographic and computed tomography scan at 48 months confirmed substantial bone repair and continued tooth functionality. The intraorifice barrier with Biodentine demonstrated notable effectiveness, aligning with literature on its benefits. The protocol, integrating modern techniques and timely restoration, shows promise in managing cracked teeth with root extension, enhancing tooth preservation in complex cases.