Co esponding au ho : Kun Ismiya in
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Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(01), 1440-1445
Publica ion his o y: Recei ed on 07 June 2025; e ised on 12 July 2025; accep ed on 15 July 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.1.2659
Abs ac
In oduc ion: Single isi endodon ic ea men has become a p ac ical and e icien app oach, especially o pa ien s
seeking as e and mo e con enien den al ca e. This me hod educes chai ime, minimizes he isk o in e -
appoin men con amina ion, and imp o es o e all pa ien sa is ac ion. In cases in ol ing lowe mola s wi h ex ensi e
co onal damage, immedia e es o a ion is essen ial o p e en ein ec ion and es o e unc ion. Endoc owns o e a
conse a i e es o a i e op ion by u ilizing he pulp chambe o e en ion, elimina ing he need o pos placemen ,
educing he isk o oo ac u e, p o iding a du able, es he ic, and ime-e icien solu ion o s uc u ally comp omised
pos e io ee h.
Desc ip ion o Case: A 21-yea -old emale p esen ed wi h a symp oma ic, ca iously exposed mandibula i s mola ,
which caused h obbing pain, especially a nigh . This oo h was diagnosed wi h pulpal nec osis and no mal apical
issues. Endodon ic he apy was pe o med in a single isi hen es o ed wi h a li hium disilica e endoc own one week
la e , ollowing adhesi e bonding p o ocols and p ope su ace condi ioning. The inal es o a ion was e alua ed
clinically and adiog aphically.
Discussion: Recen e idence suppo s single- isi endodon ics as a sa e and e ec i e op ion when p ope disin ec ion
p o ocols and case selec ion a e ollowed. Endoc owns p ese e emaining oo h s uc u e while achie ing high
ac u e esis ance, especially when bonded using dual-cu e esin cemen . The combina ion o bo h echniques
minimizes clinical ime and maximizes long- e m success.
Conclusion: This case illus a es ha combining single- isi endodon ic ea men wi h li hium disilica e endoc own
es o a ion p o ides a conse a i e, e icien , and du able ea men s a egy o non i al pos e io ee h.
Keywo ds: Single-Visi Endodon ics; Li hium Disilica e Endoc own; Adhesi e Res o a i e Den is y; Minimally
In asi e T ea men
1. In oduc ion
Single isi endodon ics (SVE) a e inc easingly a o ed as i s mo e cos -e ec i e ca e. The ise in popula i y o single
isi endodon ic has been also acili a ed by ad ances in endodon ic echnologies. The decision o pe o m oo canal
he apy in a single o mul iple isi s depends on a ious clinical ac o s, such as he p esence o pulpal in ec ion and
p eope a i e pain, which may in luence ea men ou comes [1]. This me hod in ol es comple e deb idemen ,
disin ec ion, and ob u a ion o he oo canal in one appoin men . Al hough his o ically deba ed, ecen sys ema ic
e iews sugges ha SVE and mul iple- isi p o ocols yield compa able ou comes in e ms o success a e, pos ope a i e
pain, and adiog aphic healing [2,3].
E icien Managemen o Nec o ic Mandibula Mola Using Single-Visi
Endodon ics and Endoc own: A Case Repo
Nadia Dwi Maha ani 1, 2, Dinsa Celia Pu i 1, Kun Ismiya in 1, * and Feb ias u i Cahyani 1
1 Depa men o Conse a i e Den is y, Facul y o Den al Medicine, Uni e si as Ai langga, Su abaya, Indonesia.
2 Facul y o Medicine, Uni e si as Nege i Su abaya, Su abaya, Indonesia.
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Indica ions o SVE include uncomplica ed i al ee h, physically o medically comp omised pa ien s, selec ed non i al
cases, pa icula ly hose p esen ing wi h a sinus ac , [3,4]. Single isi endodon ics may become a ea men op ion in
cases wi h no signi ican p e ea men complica ions, such as se e e pe iapical pa hology o complex canal ana omy,
whe e ubbe dam isola ion and sodium hypochlo i e i iga ion a e easible [5]. Con aindica ions o SVE include
complex canal ana omy (e.g., calci ied o cu ed oo s), acu e abscess wi h pus, pe sis en exuda e o bleeding , limi ed
mou h opening, TMJ diso de s, symp oma ic non i al ee h wi hou sinus ac , and la ge pe iapical lesions (>5 mm)[4].
As hese condi ion may inc ease he isk o pos ope a i e complica ions, such as pain o ailu e, based on e y low-
ce ain y e idence om 47 s udies wi h 5805 pa icipan s[5] .
Ad ancemen s in single- isi endodon ics, including nickel- i anium o a y sys ems, su gical mic oscopes, and CBCT,
enhance p ecision and e iciency. Ac i a ed i iga ion wi h sodium hypochlo i e, EDTA, and chlo hexidine, aided by
ul asonics, ensu es ho ough disin ec ion [4]. Elec onic apex loca o s minimize apical ex usion isks and ob u a ion
echnique wi h newe gene a ion o calcium silica e based seale , ha could enhance he o e all esul s o single isi
endodon ics [6]. A andomized clinical s udy e alua ed single- isi oo canal ea men in 100 pa ien s wi h
asymp oma ic single- oo ed ee h and apical pe iodon i is. A e 24 mon hs, 72 pa ien s showed signi ican
imp o emen s in bone densi y (p<0.01), wi h app oxima ely one- hi d achie ing clinical healing based on Pe iapical
Index sco es. Single- isi endodon ics demons a ed e ec i e pe iapical healing, compa able o s anda d mul i- isi
ou comes [7]. The clinical ou comes o single- isi endodon ic p ocedu es a e in luenced by e ec i e mic obial con ol,
case complexi y and p eope a i e condi ions, especially pos -endodon ic es o a ion signi ican ly impac long- e m
success[8].
Endodon ically ea ed oo h long e m su i al a es is de e mined by pos -endodon ic es o a ion, because i will
main ain and p o ec he exis ing oo h s uc u e, while es o ing es he ics, o m, and unc ion sa is ac o ily [9]. Pos -
e ained es o a ions possess se e al disad an ages such as weakening o he oo h s uc u e, oo ac u es, o in i s
applica ion in na ow and calci ied canals [10]. The pa adigm has shi om pos e ained es o a ion o adhesi e indi ec
ull es o a ion, such as o e lay and endoc own.
The e m endoc own was i s ound by Bindl and Mö mann in he yea 1999, and e med i as “ce amic monoblock
echnique. This monoblock concep is minimally in asi e den is y which acqui es mac omechanical e en ion om he
loo and walls o he pulp chambe and also mic omechanical e en ion om i s adhesi e cemen a ion [10]. This clinical
case epo aims o highligh he e ec i eness o single- isi endodon ics in achie ing success ul ea men ou comes,
while examining he es o a ion o a pos e io oo h wi h a conse a i e and es he ic endoc own as a pos -endodon ic
es o a ion, emphasizing i s indica ions and applica ions.
2. Desc ip ion o Case
A 21-yea -old emale pa ien p esen ed a Ai langga Uni e si y Den al Hospi al wi h a chie complain o a ca i y and
in e mi en noc u nal pain in oo h 36, p e iously managed wi h a empo a y illing and analgesics a a p i a e clinic
wo weeks p io . Clinical examina ion e ealed a non- i al oo h wi h deep ca ies pe o a ing he pulp chambe , no mal
pe iapical issues on adiog aphic assessmen , and no sys emic heal h issues o d ug alle gies. The ea men plan
in ol ed single- isi endodon ics ollowed by a li hium disilica e endoc own es o a ion o ensu e conse a i e and
es he ic es o a ion.
Figu e 1 P eclinical condi ion be o e ea men
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The p ocedu e commenced wi h pa ien p epa a ion, including a 30-second inse wi h 1% po idone-iodine and ubbe
dam isola ion. The empo a y illing was emo ed using a scale , ollowed by ca ies exca a ion and access opening. Roo
canal nego ia ion was pe o med wi h a C-Pilo #08 and #10 (VDW®STERILE C-PILOT® Files), wi h wo king leng hs
de e mined using an apex loca o (MB: 19 mm, ML: 19.5 mm, DB: 19 mm, DL: 19.5 mm). A mac o glide pa h was
es ablished wi h a P oGlide o a y ile (Den sply Si ona), and oo canal p epa a ion was comple ed using he c own-
down p essu eless echnique wi h P oTape Gold (Den sply Si ona) iles up o F2 (25/08) on all canals.
I iga ion echnique in ol ed sequen ial use o 2.5% sodium hypochlo i e (NaOCl) a e each ile change, ac i a ed by
sonic agi a ion (NSK TiMax S970, wi h Eddy ip) o enhance deb is emo al, ollowed by s e ile wa e inse and
ecapi ula ion wi h K-File #10. Final i iga ion consis ed o 2.5% NaOCl, s e ile wa e , 17% EDTA o emo e he smea
laye , and a inal s e ile wa e inse, all ac i a ed by sonic agi a ion.
Canals we e d ied using endo suc ion and pape poin s. Ob u a ion echnique employed he single-cone echnique wi h
F2 gu a-pe cha (25/08) and bioce amic seale (Ce aseal; Me abiomed), con i med adiog aphically. A empo a y illing
was placed, and he pa ien was scheduled o ollow-up.
Figu e 2 Ob u a ion adiog aph
One week la e , he empo a y illing was emo ed, and gu a-pe cha was educed 3 mm below he o i ice using a hea ed
plugge . A sel -e ch adhesi e (Single Bond Uni e sal Adhesi e; 3M ESPE) was applied o he o i ice, ai - hinned, and
ligh -cu ed. The o i ice seal ob ained wi h bulk ill lowable esin composi e (3M™ Fil ek™ Bulk Fill Flowable
Res o a i e) ollowed by ibe ein o ced composi e (E e X Pos e io ; GC) o c ea e a la pulp chambe loo .
A i s , he educ ion o he occlusal su ace o he oo h (1.5-2mm) was ca ied ou using a diamond wheel o ien ing i
pa allel o he occlusal su ace. Using a ound end diamond bu a high speed, he ce ical ma gins we e le elled in
cham e shaped main aining a 1.5 mm hickness uni o mly wi h he emaining co onal oo h s uc u e unde a cons an
cooling sys em h oughou he p ocedu e. The bu was aligned wi h he oo h's long axis, aiming o main ain a 7–10°
occlusal con e gence, ensu ing a smoo h ansi ion be ween he p epa ed co onal pulp chambe and access ca i y wi h
an app oxima e dep h o 3 mm. The walls and ma gins o he p epa a ion hen inished wi h ine inishing diamond bu .
Figu e 3 Endoc own oo h p epa a ion
Gingi al managemen is ob ained wi h size 00 gingi al e ac ion co d (Ul aco d, Den One Inc, USA), i was placed
wi hin he gingi al sulcus. Imp essions o he wo king model we e aken wi h hea y body pu y (3M™ Exp ess™ 2 Hea y
Body VPS Imp ession Ma e ial; 3M ESPE) and ligh body poly inyl siloxane (3M™ Imp in ™ 4 VPS Imp ession Ma e ial
(3M ESPE, Ge many) wi h wo s ep echnique imp ession o acqui ed well p ecision ma gin and wo king model.
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I e e sible hyd ocolloid o an agonis side. Bi e egis a ion o he pa ien ob ained wi h bi e egis a ion poly inyl
siloxane (3M™ Exp ess™ VPS Bi e Regis a ion Ma e ial). A empo a y bis-ac yl esin c own was placed, and a li hium
disilica e endoc own was ab ica ed.
A he nex isi , he empo a y c own was emo ed. Adequa e isola ion was achie ed using ubbe dam, hen
endoc own was ied in wi h y in pas e (G-CEM T y in Pas e; GC), e alua ing occlusion, p oximal con ac s, colo ,
ana omy, and ma ginal adap a ion. Once he adjus men had been e i ied, he endoc own was cemen ed using dual
cu ed adhesi e esin cemen (G-CEM Link Fo ce; GC).
P epa a ion o he es o a ion done by e ching he in aglio su ace o he p os hesis wi h 10% hyd o luo ic acid o 30
s, insed wi h wa e , and d ied wi h oil- ee ai sy inge. The in aglio su ace was hen applied wi h silane-based p ime
(G-Mul i P ime ; GC) o a minu e The oo h su ace was cleaned wi h a o a y b ush and pumice, ollowed by applica ion
o sel -e ch adhesi e (G P emio Bond; GC), b ushed ho oughly o 10 seconds, and d ied wi h maximum ai p essu e o
5 seconds, hen ligh cu ed o 10 seconds (LED 700mW/cm2). The endoc own was cemen ed wi h dual-cu e adhesi e
esin cemen , and ack cu ed o 2 seconds o an easie excess cemen emo al. Ligh cu e each su ace o ma gin o 20
seconds (LED 700mW/cm2). A e he cemen se , occlusion, ma ginal adap a ion, and p oximal con ac s we e e i ied.
Figu e 4 Applica ion o silane-based p ime on in aglio o endoc own
Follow-up isi s a one-week in e als con i med no pa ien complain s, no mal gingi al heal h, and s able es o a ion.
The success ul ou come, suppo ed by adequa e heal hy oo h s uc u e, accessible oo canals, and pa ien compliance,
indica ed a a o able p ognosis o he single- isi endodon ic ea men and endoc own es o a ion.
Figu e 5 Cemen ed endoc own in occlusal iew
3. Discussion
The case p esen ed in ol es a single- isi endodon ic ea men ollowed by an endoc own es o a ion o oo h 36 in
a 21-yea -old emale pa ien wi h a chie complain o a deep ca ious lesion and a his o y o spon aneous noc u nal pain.
The diagnosis o pulp nec osis wi h no mal apical issues was con i med h ough clinical and adiog aphic
examina ions, including nega i e esponses o i ali y es s and he absence o pe iapical adiolucency. The ea men
p o ocol, encompassing single- isi endodon ics wi h a c own-down p essu eless echnique, single-cone ob u a ion,
and an endoc own es o a ion, was execu ed success ully, esul ing in a a o able p ognosis. This discussion e alua es
he clinical app oach, i s alignmen wi h cu en endodon ic and es o a i e p inciples, and he implica ions o clinical
p ac ice.
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Single- isi endodon ic ea men was chosen due o he absence o pe iapical pa hology, low ca ies isk, and he
pa ien ’s coope a i e na u e, which a e c i ical ac o s o success in such p o ocols [6]. S udies ha e demons a ed ha
single- isi endodon ics can achie e compa able ou comes o mul iple- isi ea men s in non- i al ee h wi hou
pe iapical lesions, p o ided me iculous cleaning, shaping, and ob u a ion a e pe o med[5]. The use o he c own-down
p essu eless echnique wi h P oTape Gold iles acili a ed e icien canal p epa a ion while minimizing p ocedu al
e o s such as ledge o ma ion o apical anspo a ion [11]. This P oTape Gold sys em cha ac e ized by a con ex
iangula c oss sec ion and i e inishing iles (F1, F2, F3, F4 and F5) which ha e educed c oss sec ions wi h a U-shape
in o de o acili a e a highe deg ee o lexibili y. Acco ding o he manu ac u e , his design o he ins umen also
inc eases deb is emo al and lexibili y in he wo king pa o he ile [11]. The inco po a ion o sonic agi a ion wi h 2.5%
sodium hypochlo i e (NaOCl) and 17% EDTA enhanced he disin ec ion and deb is emo al, aligning wi h
ecommenda ions o op imizing canal cleanliness [12].
The choice o a single-cone ob u a ion echnique wi h a bioce amic seale was app op ia e gi en i s simplici y and
e ec i eness in achie ing a he me ic seal. Bioce amic seale s o e excellen biocompa ibili y, dimensional s abili y, and
he abili y o p omo e pe iapical healing, which a e ad an ageous in single- isi ea men s[13]. Radiog aphic
con i ma ion o he ob u a ion quali y, as e idenced by he absence o oids and p ope adap a ion o gu a-pe cha,
u he suppo s he e icacy o his app oach.
Endoc owns a e ecommended o ee h wi h calci ied canals, sho clinical c owns, and a loss o co onal oo h
s uc u e. Wi h ad ancemen s in adhesi e den is y, ee h wi h signi ican co onal damage can be es o ed using
endoc owns, which elimina e he need o pos s and u ilize he pulp chambe o e en ion. These es o a ions ely on
he “monoblock po celain echnique,” whe e pulpal walls o e mac omechanical e en ion, and adhesi e cemen a ion
p o ides mic omechanical e en ion [9]. No el ligh -cu ed adhesi e ma e ial, inco po a ing p ime s wi h 10-
me hac yloyloxydecyl dihyd ogen phospha e (MDP) monome , has been de eloped o combine wi h mic omechanical
e en ion o s onge chemical bonding [14].
In his s udy, endoc own ab ica ed using Li hium disilica e (LDS). LDS o e ing supe io lexu al and ac u e
esis ance, excellen aes he ics, and he abili y o be milled in o endoc owns. Some esea ch indica es LDS p o ides
g ea e ac u e esis ance and mo e a o able ( epai able) ac u es compa ed o pos -and-co e es o a ion, while
o he s udies ind no signi ican di e ence [15]
The single- isi endodon ic ea men and endoc own es o a ion o oo h 36 e ec i ely combined mode n echniques.
The c own-down p essu eless echnique wi h P oTape Gold iles, sonic agi a ion, and bioce amic seale ensu ed
op imal canal p epa a ion and ob u a ion. The li hium disilica e (LDS) endoc own, suppo ed by MDP-con aining
adhesi e p ime s, p o ided du able, aes he ic es o a ion wi h s ong e en ion. This case demons a es he e icacy o
chai side CAD-CAM echnology and LDS ma e ial. O e all, his app oach highligh s a s eamlined, pa ien -cen e ed
p o ocol o success ul clinical ou comes.
4. Conclusion
Single- isi endodon ics combined wi h a li hium disilica e endoc own o e s an e icien and minimally in asi e
solu ion o es o ing nec o ic mola s. Using c own-down p epa a ion, sonic i iga ion, bioce amic seale , and CAD-
CAM endoc own wi h MDP-based adhesi e, his app oach ensu es du abili y and es he ics, making i sui able o simila
cases.
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
The au ho s decla e ha he e is no con lic o in e es ega ding he publica ion o his documen .
S a emen o in o med consen
In o med consen was ob ained om pa ien included in he s udy.
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