# Print and Try Technique: 3D-Printing of Teeth with Complex Anatomy a Novel Endodontic Approach
## 2 Case Description
### Case 1
All these steps are reported in Movie 3. Treatment procedure: The actual endodontic treatment of the main canal 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 conservative design on the 3D-model. Operative microscope (Leica, Hamburg, Germany) and small-sized diamond burs (Komet, Lemgo, Germany) were used at this stage. The shaping was performed following the ProtaperGoldTM sequence (Dentsply Maillefer, Charlotte, VA, USA), to size F1 20/.08, to minimize root canal transportation (Figure 4a). The working length was 19 mm confirmed by an electronic apex locator (Dentsply Sirona, Charlotte, VA, USA). Irrigation was performed through a flexible plastic 30-gauge needle (IrriFlex(r), Produits Dentaires, Vevey, Switzerland) using 5% sodium hypochlorite solution (Niclor 5, OGNA, Pavia, Italy), followed by 17% ethylenediaminetetraacetic acid (EDTA 17%, OGNA, Pavia, Italy) (Figure 4b). Passive ultrasonic irrigation was carried out using  
Figure 3: (**a,b**) Customized bone and (**c**) tooth 3D-models were printed. (**d**) Main root canal therapy and invagination retrograde filling were performed on 3D-tooth model. a cordless ultrasonic unit with a flexible tip (EndoUltraTM, MICRO-MEGA(r), Besancon Cedex, France). Finally, the canal was filled with warm gutta-percha vertical technique using cordless units (Fast Pack and Fast Fill, Eighteeth, Shangai, China) (Figure 4c). The access cavity was restored with an adhesive composite restoration (Figure 4d). A final post-operative LCPA X-ray was taken (Figure 4e). (Movie 4). At the same appointment, a flap was opened (Figure 4f) and the granulomatous tissue extending above the invagination and the main canal foramen was surgically removed (Figure 4g,h). Figure 4: Main clinical steps of case 1. Orthograde approach: (**a**) shaping with rotary files, (**b**) irrigation with a plastic needle, (**c**) gutta-percha filling, (**d**) conservative coronal restoration and (**e**) periapical X-ray. Surgical approach: (**f**) Surgical flap design, (**g**) granulomatous tissue removal, (**h**) resulting invagination access exposure which was prepared with ultrasonic tips and irrigated with a plastic needle, (**i**) 3D-invagination filling with a putty bioceramic sealer and (**j**) periapical X-ray after palatal and buccal membrane positioning. The invagination was prepared with ultrasonic tips (KiS, Obitura Spartan Endodontics, Algonquin, IL, USA) and irrigated with a sterile saline solution (Sodium Chloride 0.9%, Fresenius Kabi, Bad Homburg, Germany) carried by a plastic needle. For the retrograde filling, a bioceramic sealer (EndoSequence BC RRM Fast Set Putty, Brasseler USA(r), Savannah, GA, USA) was delivered with a syringe (Figure 4i). A microsurgical mirror (BLACK ULTRAmicro B6183, Hahnenkratt, Koginbach Stein, Germany) (Figure 4h) was used to confirm under microscope magnification the retro-preparation and plugging stages. Palatal and buccal absorbable collagen membranes (Ossix(r) Plus, Sweden(r)Martina, Padova, Italy) were positioned prior to flap reapproximation and closure with an absorbable 5-0 suture (Movie 5). A post-surgical LCPA X-ray was taken (Figure 4j). One week later, no discomfort has been reported and primary tissue healing had been achieved, allowing sutures removal (Figure 5a). Clinical (Figure 5b) and radiographic follow-up (Figure 5c,d) showed a positive outcome, with soft tissue and bone healing progression.