UR4

Rewalling and Endodontic Management of a Maxillary First Premolar with Disto-occlusal Caries

Overview:

In this video, Jon demonstrates the advantages of pre-endodontic reconstruction, or "rewalling," on an upper right first premolar. He focuses on the benefits of bonding to fresh dentine prior to chemical irrigation and how building a four-wall reservoir facilitates more effective sodium hypochlorite management.

The Case & History:

A patient presented with symptoms of irreversible pulpitis associated with the upper right first premolar, specifically experiencing lingering pain triggered by hot and cold stimuli. Clinical examination revealed a deep disto-occlusal carious lesion. The patient was highly motivated to retain the tooth, and a single-visit endodontic treatment was proposed. Following the removal of the caries, a pink pulp was visible, indicating a high likelihood of significant haemorrhage upon access.

The Clinical Problem:

The clinician needed to decide whether to complete the root canal treatment before restoration or to rebuild the distal wall first. Jon highlights the challenge of bonding to dentine that has been compromised by endodontic irrigants like EDTA and sodium hypochlorite. By rewalling the tooth with a sectional matrix and a low-viscosity bulk-fill composite before access, the clinician creates a stable reservoir for irrigation, protects the tooth's structural integrity, and ensures an appropriate emergence profile for future restorative onlays.