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April 1-7, 201314 Endo Tribune United Kingdom Edition T: 01613487848 E: ‘From 0 to 10 in three days.... I placed ten implants and completed four bone grafts. The great majority of the work done by me, but always with a guiding hand around to advise or step in if I wasn't happy.’ -Nick Millhouse Topics covered include: 12 days, approx one day per month including: 3 Surgical Days treating Live Patients 4 Restorative Days treating Live Patients 2 Phantom Head Days Restoring Implants 6 hours veri able CPD per course day Case Selection, Consent & Flap Design Aesthetics In Implantology CT Scans, Imaging & Treatment Planning Sinus Lifts, Bone Grafts & Augmentation Pink Porcelain or Bone Grafts Live Surgery ALL-ON-4 & Angled Implant Placement Single Tooth Implants Partial / Full Arch Bridgework Overdentures - Ball / Sockets / Bars Screw / Cement Retained Restorations Laboratory Techniques –The Importance of Excellent Communication Occlusion on Implants & Pricing Polices Starting April 2013 in Manchester & London ONE YEAR IMPLANT DENTISTRY COURSE Learn to place and restore dental implants under supervision Bene t from NobelClinician Interactive software training Learn‘All on 4’concept for the same day implants & restoration Keep valuable work in-house by increasing your treatment options Sponsored by: IN 21 YEARS WE HAVE HELPED OVER 500 DENTISTS LAUNCH THEIR IMPLANT CAREERS A Certi cate Course which can lead to a P.G. Dip Imp Dent with the British Academy of Dental Implantology (BADI) From £399 + VAT per day with Dr Göran Urde & Dr Paul Tipton I rrigation is a major step in endodontic treatment. A va- riety of chemicals are used to achieve what I like to con- sider the chemical preparation of the root canal system. Sodium hypochlorite (NaO- Cl) is a major component of the chemical preparation, mainly owing to its ability to attack the collagen component of the pulp tissue, and it is very cost- effective. However, one of the problems of using NaOCl is its safety, especially during its delivery inside the root canal system and the ability to limit its delivery strictly to root ca- nal space and nothing but the root canal space. Going beyond the limit of the root canal space causes serious problems, the grav- ity of which depends on the amount of NaOCl passing to the margins of the periodontal ligament or even attacking the periodontal ligament. A small amount can result in pain or discomfort after treatment, whereas a larger amount, especially in cases of large and\or open apices, can ac- cidentally be delivered inside the maxillary bone, travel via veins and arteries to primary anatomical organs and cause extensive, serious and very dangerous reactions. It is pos- sible that the majority of such incidents are treatable with steroids and antibiotics, as they are limited to muscle and bone inflammation and slight reversible necrosis. Sometimes we are not that lucky. Irrigating the last few millimetres in the root canal space is an important key to treatment success, and a cer- tain amount of NaOCl may be delivered into the maxillary sinus especially in the area of the maxillary second premolar and first molar. The case dis- cussed below was the result of accidental NaOCl delivery into the maxillary sinus. Case report The patient was referred to my office for a complaint re- garding the maxillary molar. After examining the patient and looking at her preop- erative X-ray, I saw nothing wrong with the existing root canal treatment, at least con- cerning the roots, but found a vague image in the sinus that I thought could be related to the maxillary molar and could be the cause of the problem. I asked my assistant to take a panoramic X-ray, which dem- onstrated a much larger prob- lem inside the sinus but at that point I did not realise the scale of the issue. Turning back to the patient, I went into some questions re- lated to the issue, such as “Do you have problems breath- ing through your nose on this side?”, “Can you describe to me the pain or discomfort you are having?”, “Can you tell me if anything unusual happened during your previous root ca- nal treatment?” and “What were the indications for this treatment several months be- fore?”. The patient, quite un- expectedly, told me that dur- ing the procedure she had, had a chlorine taste in her throat arising from her nose as if a liquid was dripping internally. Also, after the treatment was over and she was on her way home, a strange liquid with the same chlorine smell began dripping from her nose. Upon hearing that, I asked the patient to have a CBCT scan of the maxilla because it was necessary to establish the situation in the sinus. The patient was nervous and anx- ious, so I asked the radiology centre if they could capture the CBCT scan for her on the same day as a favour. A couple of hours later, the patient returned to my office and I took the time to examine the images. In the panoramic view, it was clear that half of the sinus was filled with in- flammatory tissue (Fig. 2); in the sectional views, I noticed that the posterior wall of the si- nus was non-existent in some places (Figs. 3–5). Potentially, it could be the position of the patient during the root canal procedure that made NaOCl stagnate on the posterior wall Irrigation for the root canal and nothing but the root canal Dr Phillipe Sleiman discusses chemical preparation of the canals Fig 1