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10 I I case report _ calcified mandibular molar _Endodontics has evolved enormously over the last few decades. However, the basic principles from the past still apply today. The following case report givesanexampleofthemannerinwhichtheoldprin- ciplesareappliedwithnewertechniques,devicesand materials. _History and diagnosis A 37-year-old female patient was referred to our practice for a problem with her lower right second mandibular molar (tooth #31). She had no health is- sues, and was given an ASA score of 1. The referring dentistopenedthetoothbecauseofanacutepulpitis duetoanextensivecariouslesiondisto-lingually.She had difficulty locating the mesial canals because the pulp chamber was heavily calcified. She had placed calciumhydroxideupontheorificesofthecanalsand sealedthetoothwithacottonpelletandatemporary restoration. The patient had no clinical symptoms when she presented to our office for treatment. _Treatment and discussion A diagnostic radiograph (Fig. 1), which is essential in determining the treatment strategy, was taken to visualise the extent of the lesion and the anatomy of theroots.Thepatientwasthenanesthetisedbyalower alveolar nerve block with 4% articaine, 0.01mg/ml epinephrine (Septanest Special, Septodont). The temporary filling and cotton pellet were removed, exposing a large carious lesion. In order to facilitate the temporary restoration after treatment, an AutoMatrix (DENTSPLY Caulk) was placed. This also enabled better isolation. The tooth was then iso- lated with a rubber dam (Coltène/Whaledent; Fig. 2). Isolation, which is one of the fundamental prin- ciples in endodontics, is more than 100 years old. In 1864 already, Sanford C. Barnum developed the rub- berdam,whichwasgenerallyacceptedasanecessity in achieving good isolation and better prognosis.1 The first step in the treatment of a tooth […] is the adjustmentofrubberdamoverthediseasedtoothto precludethepossibilityoftheentranceofgermsinthe oral secretions into the pulp chamber. This should be theinvariablerule.2 However, a recent survey found that only 3.4% of general dental practitioners use the rubber dam in their endodontic routine.3 Visualisation and magnification can help clini- cians greatly in cases like the one presented here. Without the use of a surgical operating microscope (OM),itisverydifficulttolocatecanalsinthepresence ofagreatdealofcalcification.“Youcannottreatwhat you cannot see” is a quote that is regularly heard and that hits the nail right on the head. Fig. 1_Diagnostic radiograph. Fig. 2_Placement of rubber dam and AutoMatrix. Fig. 3_Calcified tissue in the pulp chamber. roots4_2010 Treating a calcified mandibular molar: Amodern-day protocol Author_ Dr Rafaël Michiels, Belgium Fig. 1 Fig. 3 Fig. 2