Tooth 46: truss access

Performed by: Dr Stevan Kopanja



Female patient, 30 years old, came to my office with symptoms of irreversible pulpitis. Treatment was performed in 3 visits. First visit was pain menagment with pulpotomy, with preservation of dentin bridge between buccal and lingual wall, and pre-endo build up of distal wall. In second visit patient was asymptomatic and we finished endodontic treatment. In third visit we finished direct composite restoration, with cuspal coverage of distal cusps.


#1 pre operative radiograph    #2 pre operative: occlusal aspect


#3 initial opening

#4 truss access, preservation of dentin bridge. Space under dentin was cleaned using 5.25% NaOCl and ultrasonic. #5 pre-endo build up, sealing on distal subgingival margin


#6  after first visit, distal wall created, access closed with temporary filling                                                                         #7 contact zone created, soft tissue can heal until next visit


#8 obturation with AH+ and warm gutta percha

#9 radiograph after obturation, small isthmus in distal root    #10 radiograph after obturation, different angle


#11 endo access closed with glass-ionomer cement, tooth sandblasted with aluminium-oxyde

#12 cusp-by-cusp reconstruction of occlusal anatomy

#13 modeling of occlusal anatomy, one shade restoration

#14 immediate after polishing   #15 final look after polishing and occlusal adjustment



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