A male elderly patient came with buccal mucosa swelling associated with tooth 46 and 47. Periapical radiograph confirmed the presence of periapical lesion and narrow root canals on both teeth. Challenging impediments were sensed upon negotiating most of the narrow root canals which were common in elderly patients. Glide path creation involved pre-flaring, K-file bending, watch winding movement, and very gentle strokes. After achieving patency, shaping, cleaning, and sealing phase can be performed.

Background: Dental hard tissue loss renders a tooth restorable or unrestorable. The treatment ranges from endodontic treatment to dental implant. Sometimes patients in need to restore their oral function and esthetics cannot afford those treatments due to a limited financial capability and time availability. Purpose: This case report presents a minimal invasive, single appointment, quick, and affordable alternative treatment to restore morphology, function, and esthetics. Case: A 40 years old male patient suffered enamel-dentin-pulp fracture on central incisor due to trauma. Eventhough the fracture involves pulp exposure, it remains vital. The tooth lacks sound tooth structure for ferrule effect. The patient wished to retain the tooth. Therefore, initial treatment plan comprised of reestablishing ferrule effect, root canal treatment, endodontic post, and porcelain crown. Nevertheless, due to financial and time constraint, patient refused the suggested treatment plan; thus, direct resin composite bridge was suggested. Case Management: Isolation is followed by calcium hydroxide capping of the exposed pulp. After application of etch and adhesive bonding to tooth 11, 21, and 22, nanohybrid resin composite was layered to fabricate the direct composite bridge, bonded to 11 and 21, with the following layering sequence: 1) palatal; 2) proximal; 3) body; 4) labial. The procedure took 1 hour to restore tooth morphology, function, and esthetics. Upon five years follow-up, the tooth remains asymptomatic. The direct resin composite bridge has been serving well. Conclusion: Direct resin composite bridges can be an affordable, quick, and minimal invasive treatment modality resulting in satisfactory esthetics, function, and longevity.

Introduction: Dental implants gained popularity as the treatment to replace grossly decayed teeth. However, with the increasing evidence and the difficulty to manage complications associated with dental implants, clinicians are pushed to opt for a more conservative approach. Case report: A male patient with a chief complaint of frequent food impaction in a severely decayed mandibular molar wished to retain his tooth. Upon thorough examination, the carious lesion extended to furcal area that rendered the distal root unsalvageable. However the mesial root can be retained; thus, hemisection was proposed. Management: Root canal treatment was carried out in the mesial canals. Then, the tooth was split mesio-distally.The distal root was extracted, and the mesial root was retained. Subsequently, the tooth was restored with PFM crown.Conclusion: Hemisection with subsequent prosthetic rehabilitation can be a viable alternative to retain severely decayed mandibular molar.

Clinical evaluation for a successful root canal treatment is assessed by various criteria, which are clinical, histopathological, and radiographical criteria. Therefore, failure of endodontic treatment can be described as a recurrence of clinical symptoms, with the presence of a periapical radiolucency or both. Failure factors in the treatment are frequently related to persistent infection. Conventional endodontic retreatment is indicated for symptomatic previously treated teeth or asymptomatic teeth with inadequately done initial endodontic treatment to avoid potential recurrence. Endodontic retreatment in elderly patients is a great challenge because the clinician has to reassure both the physical and psychological factors of the patient to determine whether to save a tooth or perform an extraction. Some difficulties may also be found in root canal retreatment, including finding the root canal hole or root canal blockage found in parts of the root canal that have not been repaired in the previous treatment. A 60-year-old female patient came with the chief complaint of recurrent pain, and subjective discomfort in the maxillary left central incisor. The patient had anxiety about the dental treatment. The tooth had a history of root canal treatment four months ago. The clinical examination showed a positive response to the percussion test. The radiographical analysis showed a root canal underfilling, 2-3 mm short of length from the apex. The tooth was diagnosed as a previously treated tooth with symptomatic apical periodontitis. Endodontic retreatment was performed based on the patient’s clinical condition and consent, followed by composite restoration. The clinical and radiographic re-evaluation after four weeks of follow-up revealed an excellent condition. This favorable result showed that a conventional retreatment plan of persistent pain on the previously treated tooth in an elderly patient led to progressive healing, and a longer follow-up was advised.