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Dental Tribune United Kingdom Edition

17Endo TribuneApril 9-15, 2012United Kingdom Edition Technology designed the way you work New Dynamic Virtual Articulation Like using your physical articulator. Support for Occlusion Compass. KaVo PROTAR® evo, Whip Mix Denar® Mark 330, SAM® 2P, Artex® compatible and more to come. Next Generation Telescopes Full freedom for designing telescop- ic crowns. Support for attachment crowns and open telescopes. Add multiple bands, parametric attach- ments, and customized attach- ments. Great new features Dental System™ 2012-the future proof solution Model Builder Create lab models directly from TRIOS® and 3rd party intraoral scans. Support for implant models. Backing our users with technology, care and expertise TRIOS® integration Receive TRIOS® digital impressions instantly from dentists and start designing right away. 3Shape Communicate™ Upload 3D design visualizations with a single click. Share and discuss your cases with dentists. 2nd Generation Removable Partial Design Intuitively mimics the familiar workflow while significantly reducing production time. Digital Temporaries Create cost-effective temporaries without pouring a model using Virtual Preparation and Virtual Gingiva. D500 3D scanner 3Shape’s new D500 model with Dental System Standard provides the market’s best entry-level CAD/CAM solution for small to medium labs and can later be upgraded to extend the range of available indications. D800 3D scanner Two 5.0 MP cameras. Scans a single-die in 25 seconds, captures texture and scans impressions. Scan the QR code & sign up for our newsletter Meet us at Dentistry Show in March 2-3, Birmingham UK, NEC Booth M3 get to our clinic. When I first saw the X-rays (Fig. 2), I remembered a very similar case from several years ago with practically the same location of file separation. The separated files in the mesial canals were clearly visible. It was also noticeable that the distal ca- nal had not been treated to full length. Ultrasonic tips and the use of an operating microscope allowed me to retrieve the sepa- rated files and it was then time to reshape the canals and retreat the distal canal (Fig. 3). Owing to the combination of requirements for the treatment of this case— shaping and retreatment in one tooth—my instruments of choice were K3XF files. I started with 25.08, followed by 26.06 and con- cluded crown-down with 25.04. This gave access to the api- cal part, which was enlarged to 35.04 in the mesial and distal canals in order to prepare the apical portion of the root-canal system. The speed of the micro- motor for the shaping procedure was 500rpm and a sequence of push-and-pull movements—four to five strokes per canal—with each file was used in order to reach full working length. Figure 4 shows the obturation of the ca- nals, which was performed with RealSeal (SybronEndo) after both separated files had been re- moved and the root-canal system reshaped. The second case came as another referral. The patient was suffering from pain in her lower molar and was sent to the office in order to check the case and give the necessary treatment. The preoperative X-ray (Fig. 5) showed an api- cal lesion with an incomplete root-canal treatment. Because diagnostics found no sign of a root-canal crack, retreatment was my choice. However, we had to overcome two obstacles: the crown placed on the tooth and the fibre post inside the dis- tal canal. I decided to go through the crown without removing it in order not to place any tension on the distal canal. When analysing the anatomy, it appeared that the roots were fused. In such cases, avoiding any tension is recom- mended in order to avoid any cracks. Under the microscope and through the crown, I managed to remove the filling surround- ing the post. With the use of the ultrasonic WHAT, I managed to remove the fibre post itself to- gether with the previous filling from the access cavity. Using the K3XF after removal of the fibre post was a great help in reshap- ing the root-canal system, which appeared very convergent. The files displayed no sign of metal fatigue and the 25.06 was taken deeper into the canal com- pared with the standard K3 files. The extra flexibility and strength of the K3XF allowed me to per- form crowndown and final api- cal shaping. Obturation of the rootcanal system was performed with the Elements Obturation Unit (SybronEndo) and RealSeal material. The post-operative X- ray (Fig. 6) shows that the merg- ing canals had been cleaned, shaped and filled; and the same had been done for the fibre-post space. Conclusion In the two clinical cases present- ed here – both rather a challenge for root-canal retreatments – the final results were an endodon- tic success. This lends support to the fact that each challenge needs to be treated separately without fear or tremor from the initial pre-operative X-rays. Our fear shall control neither our judgment nor our choices! I would like to thank Yulia Vo- robyeva, interpreter and transla- tor, for her help with this article. DT Fig 4 Fig 5 Fig 6 About the author Dr Philippe Sleiman, Dubai Sky Clin- ic, Burjuman Business Tower, Level 21, Trade Center Street, Bur Dubai, Dubai, UAE phil2sleiman@hotmail.com