Root Canal Treatment. with a mechanical treatment system. Clinical case

Transcription

1 Endo motor with MANI Silk File Root Canal Treatment with a mechanical treatment system Case file by Markus Ludolph, Dortmund/Germany. Focus of activities: Endodontics. Clinical case In January of 2016, a 31-year-old female patient presented at my dental office. Tooth 26 was sensitive to cold. The dentition was in good condition. The general medical history and the dental anamnesis were inconspicuous. The molars were sufficiently restored with composite fillings. An OPG showed a radiopaque shading which indicated a root filling. During the initial session on January 25, 2016, a sensitivity test and a percussion test were carried out. The former turned out positive, the latter turned out negative. To assure the diagnostics, an x-ray was taken (see picture on the right). The issue was discussed with the patient and we agreed to attempt a Kalsogen treatment (ZnO) in line of an EPD to provide a symptomatic relief. Radiograph of tooth 26, inconspicuous findings 1

2 This was successful until April 14, 2016, when the patient returned with the same symptoms. The patient had not returned for her recall appointment after the Kalsogen treatment. Another vitality test clearly showed a pulpitic discomfort. 1 Tooth 26 with rubber dam 2 Creation of an access cavity After application of a rubber dam, a vital extirpation was carried out under local anesthesia. The access cavity was created with a MANI Diamond Bur and with the aid of a surgical microscope. 2

3 3 Presentation of the canal 4 Probing the root canal MANI D-Finder in situ The orifices of the root canals are clearly visible under the surgical microscope. 5 Creation of a straight-line access In order to assess any calcifications or constrictions in the root canal, it is probed with a MANI D-Finder (ISO size 10) after the removal of the pulp tissue. The D-Finder works in the same way as a Pathfile (i.e. with a rounded tip and without cutting). 6 Preparation with MANI ISO 15 File Silk Complex #25, 0.08 Orifice Opener of the MANI system Once the patency of the root canals had been confirmed with the MANI D-Finder, a straight-line access was created with the Orifice Opener from the MANI Silk System. The system is composed of instruments for three different levels of difficulty and thus accommodates the different complexities of a root canal treatment. In this case, the set "Silk Complex" was selected which is suited to meet the challenges of extreme root canal geometries. Preparation with the MANI ISO 15 File up to the estimated working length After the creation of a straight line access, the root canal was prepared up to the estimated working length with the MANI ISO 15 File, in accordance with the manufacturer's instructions. 3

4 7 Electrometric measurement 8 Transmission of the measured values The MANI Micro Files (ISO 15), which are inserted into the MANI Endo Holder and have a connector for the electrometry system, were used for a first electrometric measurement. The electrometric values were transmitted to the microfiles for radiographic measurement. 9 Radiographic measurement 10 Radiographic measurement The radiographic measurement shows which root canal geometry is to be expected: Mesial canal: RP-mesial cusp, #15, 0.02/19 mm IAF #15, 0.02 Distal canal: RP-distal cusp, #15, 0.02/17 mm IAF #15, 0.02 Palatinal canal: RP-palatinal cusp, #15, 0.02/18 mm IAF #25, 0.02 (RP = reference point; IAF = initial apical file) 4

5 11 Preparation with a manual file 12 Preparation with the Endo Motor A manual file was used to extend the canal to size ISO 20, according to the manufacturer's instructions. Afterwards, the root canals were prepared with the system MANI Silk Complex (mesial #25, 0.04/19 mm, distal #25, 0.04/17 mm). The palatinal canal was extended to 18 mm with available files #40, A conventional endo motor was used for the extension with #40, Irrigation 14 Activation of the irrigation solution Irrigation with NaOCl 6 %, Navi Tip FX Ultradent Irrigation with NaOCl (6 %) and citric acid as well as the activation of the irrigation solution with the Endo Activator were intermediate steps in each case. After the canals had been prepared, irrigated according to the irrigation protocol and then dried, a master point radiograph was taken to determine the true working length (TWL). To do so, a gutta-percha cone was inserted into each canal without the use of sealer. 5

6 15 Master point radiograph 16 Insertion of the gutta-percha cone The master point radiograph shows that the palatinal gutta-percha cone does not completely reach the apex. Therefore, the canal was irrigated once more and an ISO 15 file was used to create patency of the canal slightly beyond the apex. Subsequently, the root canals were obturated in the one-point technique and the lateral condensation technique with gutta-percha cones in according lengths and sizes. 17 Trimming the gutta-percha cone 18 Compacting the gutta-percha cone Following the insertion and condensation of the cone, it was trimmed at the access of the canal and then compacted. To finalize the treatment, the cavity was cleaned and superfluous sealer was removed with a foam pellet. Next, the cavity was filled with a temporary composite filling material to prevent a re-infection of the root canals via saliva from from the oral cavity. 6

7 19 Final check by radiography For further information on this product, please visit our website at: The radiograph shows the striking complexity of the root canal system. Conclusion The presented case shows that even a difficult case with severely curved root canals and a wide lumen of the palatinal canal can be mastered readily with the MANI Silk System, leading to a precise result. The choice of the system components and the matching of the tapers facilitate an efficient preparation. Curved root canals always bear the risk of file fracture. On that account, several manufacturers have made efforts in the recent past to change material properties to keep the files as flexible as possible, letting the user master even complex and severely curved root canals. On the one hand, alloys with high flexibility are a blessing as they easily follow the root canal. On the other hand, the files Author Markus Ludolph Endo Clinic owner, Dortmund Markus Ludolph Dentist Am Oelpfad Dortmund/Germany with high flexibility may not be stable in their length over the course of the preparation which will lead to unsatisfying results. The system introduced here poses a good compromise: It is sufficiently flexible to follow severely curved root canals, at the same time, it is sufficiently stable to prevent any changes in the file geometry. These properties are obtained by only heat-treating that part of the file which is inserted into the curved root canal, instead of heattreating the complete file. The result of our presented case speaks in favor of this approach. Note: This case study is not an instruction leaflet. Please adhere to the instructions provided with the material and/or equipment. The responsibility for the treatment remains with the attending dentist. 7