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Fig. 8_Obturation of the isthmus. Fig. 9_Pulp chamber after obturation and removal of excess sealer. Fig. 10_Final radiograph. Fig. 11_Final position. 12 I I case report _ calcified mandibular molar least a size 30 because I rinse with a 30-gauge irri- gation needle. That way, the NaOCl comes into direct contact with the apical dentine.5 This results in a sig- nificantly better removal of debris from the apical part of the root.6 In order to achieve a bigger apical diameter, a ProFile size 30.06 (DENTSPLY Maillefer) was taken to working length in the mesial canals and aProFilesize35.06inthedistalcanal.UtilisinganISO size 10 K-file, patency was maintained in all three canals throughout the entire treatment. Afterthecanalshadbeenshaped,theywererinsed with 10% citric acid, which was ultrasonically acti- vated three times for 20 seconds with an Irrisafe tip. During the third activation, the tip fractured and became stuck in the isthmus between the mesial canals. Cotton pellets were placed in the mesio- lingual and distal canal to prevent the instrument from falling into the canals during its retrieval (Fig. 5). Retrieval was done with another Irrisafe tip (Fig. 6). A final rinse was performed with 3% NaOCl, which was heated with a few bursts with System B (SybronEndo). Finally, cone pumping was performed with size 06 tapered gutta-percha cones. The lite- rature refers to cone pumping as manual dynamic irrigation that has proven to be more effective than regular irrigation.7 A confirmation radiograph was then taken with gutta-percha master cones (DENTSPLY Maillefer) in place (Fig. 7). The canals were dried with paper points (Roeko). Obturationwasperformedwithahybridtechnique inwhichcoldlateralcondensationwasusedtofillthe apical 4mm. Thereafter, the System B needle was taken 4mm short of working length into the canal. BackfillwasperformedwiththeElementsExtruderin smallincrementsof2mmeachtimetoreduceshrink- age. TopSeal (DENTSPLY Maillefer) was used as a sealer. During the backfill, I could see the isthmus beingobturatedwithgutta-percha(Fig.8),whichisa desirable result. Were tissue to have been left in the isthmus, it may have led to failure. After obturation, excess sealer in the pulp chamber was removed with 96% alcohol (Fig. 9). A temporary restoration was then placed with Fuji IX GP Fast A2 (GC Europe). Finalradiographs(Figs.10&11)weretakenandthe patient was sent home with instructions regarding possible post-operative discomfort and a prescrip- tion for 400 mg ibuprofen. _Conclusion In the past, there were several revolutions in the fieldofendodontics,suchasisolatingwiththerubber dam, cleaning with NaOCl and shaping with rotary instruments. Today, we still make use of these prin- ciples and are developing them further in order to make treatment easier and safer and to gain more favourable outcomes._ Editorial note: A list of references is available from the publisher. roots4_2010 DrRafaëlMichiels Parklaan119 2300Turnhout Leopoldplein14 3500Hasselt Belgium rafael.michiels@gmail.com www.ontzenuwen.be roots_contact Fig. 8 Fig. 9 Fig. 10 Fig. 11