# Print and Try Technique: 3D-Printing of Teeth with Complex Anatomy a Novel Endodontic Approach
## 2 Case Description
### Case 2
Treatment procedure: Root canal treatment was performed under local anesthesia, articaine hydrochloride with 1:100,000 articaine (Septodont, Saint-Maur-des-Fosses, France) and rubber dam (VISION rubber dam, ASA DENTAL, Bozzano, Italy) isolation. The access cavity was opened mimicking the preliminary design on 3D-model, under operative microscope. Ultrasonic tips were used to remove pulp calcifications and to finish the access cavity (Figure 8a). Figure 8: Main clinical steps of case 2. (**a**) Access cavity with US tips, (**b**) chamber irrigation with IririFlex®, (**c**) orifices enlargement with TruNatomyTM Orifice Modifier followed by the TruNatomyTM series, (**d**) working lengths X-ray control, (**e**) MB2 location and (**f**) filling with bioceramic sealer and single cone gutta-percha technique. After the Micro-Opener 10.04 use andchamber irrigation, (Figure 8b) the orifices were enlarged with a TruNatomy(tm) (Orifice Modifier 20.08 (TOM) (TruNatomy(tm), Dentsply Maillefer, Charlotte, VA, USA) (Figure 8c) (Movie 9). A temporary filling (Fuji IX, GC Italia, Milan, Italy) was placed following dressing with calcium hydroxide. At the second appointment a viscous chelator (GLYDE File Prep Intro Package, Dentsply Sirona, Charlotte, VA, USA) was employed to facilitate the negotiations of the canals and the displacement of the dentinal shaving to minimize the risk of blockages. The canal was progressively negotiated to full patency with a 10/.02 K-file. Working lengths were confirmed with an electronic apex locator (Root ZX mini, Morita, Tokyo, Japan) and a periapical X-ray (Figure 8d) as follows: MB1 was 27 mm long, MB2 merged with MB1 (Figure 8e), distal and palatal canals were respectively 30 and 28 mm long. TruNatomy(tm) (Glider 17/0.02 was used to obtain a rotary reproducible glide path with a mini-invasive approach, followed by TruNatomy(tm) (Small 20/ 04, as recommended for small canals. Afterwards, all the canals were prepared up to TruNatomy(tm) (Prime 26/.04. The irrigation protocol consisted of the following:10 mL of 5% sodium hypochlorite, used between each file of the TruNatomy(tm) (Series with sonic activation through a cordless unit with a flexible tip; 2 mL of 17% ethylenediaminettetraacetic acid (EDTA 17%, OGNA) for 60 min with sonic activation (EndoActivator(r) (r), Simit Dental, Maillefer, Charlotte, VA, USA) and a final rinse for 90 min with 5% sodium hypochlorite and 60 min of sonic activation (EndoActivator(r), Simit Dental, Maillefer, Charlotte, VA, USA). Between each solution change and at the end of the irrigation protocol a sterile saline solution, Sodium Chloride 0.9%, was used. Considering the anatomical complexity, the minimal preparation and the good result obtained with the mock obturation on the 3D-model, a single cone technique with TruNatomy(tm) (Contra-Percha Prime 26/.04 was chosen and combined with a bioceramic sealer (EndoSequence BC Sealer HiFlow, Brasseel USA(r), Savannah, GA, USA) which is flowable and can fill any irregularities or voids (Figure 8f) (Movie 10). The coronal anatomy was restored with a build-up, followed by an indirect composite overlay. A post-operative LCPA X-ray was taken (Figure 9a). Clinical and radiographic follow-up was scheduled at 6 months: the patient confirmed that the tooth had been clinically asymptomatic and periapical X-ray showed a smaller radiolucent area around the mesial buccal root (Figure 9b); closure of the existing sinus tract was observed too. The next follow-up has been planned at one year. Figure 9: (**a**) Post-operative X-ray was taken. (**b**) At 6 months review the periapical X-ray showed a smaller radiolucent area around the mesial buccal root.