Endo Tribune Middle East & Africa Edition

endo tribuneDental Tribune Middle East & Africa Edition | September-October 2015 4D BRAND PR MISE Q U A L I T Y S E L E C T I O N P E R F O R M A N C E Rely On Us for Quality, Selection and Performance. Henry Schein is a name you can trust. Our Brand Promise We provide the broadest selection of relevant products in the industry at the best possible value, to help you run your business more profitably. We stand behind all of our products with a 100% guarantee of satisfaction. Our products offer you maximum value without compromising on quality. We offer over 8,000 products you can trust to fulfill your needs—each bearing the Henry Schein Seal of Excellence— your guarantee of satisfaction. • Growing selection of value-priced products • All essential categories including diagnostics and infection control • High standards of quality and effectiveness Contact: Antonio Plata Phone: 631-843-5325 email: antonio.plata@henryschein.com 14ER3194 Dental Tribune_A4_Layout 1 12/2/14 4:15 PM Page 1 slightly widened with the Orifice Opener, ensuring that it could be easily detected in a further pro- cedure. The second MB root ca- nal could not be found with me- ticulous searching under loupes and the application of a decalci- fying solution (17% EDTA). After consultation and receiving the approval of the patient, it was decidedtoconducttheentirepro- cedure in at least two sessions. First, the root filling material in the MB and mesiopalatal (MP) root canals was removed us- ing rotating NiTi files, ProTaper D1, D2 and D3 files (DENTSPLY Maillefer), and manual H-files (DENTSPLY Maillefer). Further instrumentation of those canals was performed using WaveOne files (DENTSPLY Maillefer) with reciprocating motion: the MP ca- nal with black (#40) and the MB canal with red (#25). The work- ing length was determined and checked throughout the entire procedure using an electronic apex locator (RomiApex A-15, Romidan). The DP root canal was then ne- gotiated and a glide path was created approximately 1–1.5 mm shy of the apical foramen using #10 and 15 K-files. The coronal portion was flared successively with #3 and 2 Gates–Glidden drills. The same procedure was performed at the DB root canal. Clear visibility and straightline access were established for all four canals (Fig. 1). Two intra-oral radiographs were captured from two different hori- zontal angles with an inserted K- file in each root canal, but only one revealed all four root canals (Fig. 2), showing vague contours of the apical portion of the roots. A calcium hydroxide dressing was applied at the MP root canal and a paper point, soaked with a 2% solution of chlorhexidine (R4, Septodont), was left in the MB root canal. A cotton pellet with chlorhexidine was left in the pulp chamber and the cavity was then sealed with a tempo- rary filling material. In the second session, two weeks later, the DP and DB root canals were carefully prepared, apply- ing the same WaveOne tech- nique as used for the MP and MB root canals: the DP canal with WaveOne black (#40) and the DB canal with WaveOne red (#25). The working length was determined and checked using the same electronic apex locator. Throughout the entire endo- dontic procedure, 2.2% sodium hypochlorite and 10% citric acid solutions were used as irrigants, successively, in all four root ca- nals. Each of the four canals was finally irrigated with 40 ml of a 2.2% NaOCl solution, dried and obturated using Acroseal (Septo- dont) and a single gutta-percha cone with an adequate taper (DENTSPLY Maillefer; Fig. 3). The intra-oral, retro-alveolar radiograph captured post-treat- ment was of relatively poor qual- ity owing to superimposition and interference of the infrazygo- matic arch and adjacent bone structures, and failed to show the most important apical portions of the roots with the correct root canal fillings (Fig. 4). In agreement with the patient, a CBCT scan was obtained, pri- marily to check the treatment outcome, but also to document this extremely rare case with much more accurate and reli- able images. The small field of view (50 x 50mm) was recom- mended, and the data was ac- quired by SCANORA 3Dx (SORE- DEX) immediately after the treatment and at the six-month recall. The edited images (OnDe- mand3D, Cybermed) clearly visualized two distinctive pala- tal roots, their relation to the two buccal roots, the adjacent anatomic structures and, most importantly, the quality of the obturation of all four root canals (Figs. 5–9, arrows). Conclusion and key learning points A careful assessment of the inter- nal anatomy of the pulp chamber is essential for detecting all root canals. A maxillary second molar with two separate palatal roots is a rare anatomical variation and, according to our records, is de- tected only once in a decade. CBCT images provide more ac- curate and reliable information regarding roots and the root canal morphology than con- ventional radiographs are able to provide. Furthermore, con- cerning the treatment outcome, CBCT images enable a much more predictable and success- ful endodontic treatment proce- dure. Editorial note: This article is based on the work presented at the 16th congress of the European Society of Endodontology in Lis- bon in Portugal in 2013 and was published in cone beam – inter- national magazine of cone beam dentistry No. 02/2015. < Page 1D Fig. 1: Straight-line access to all four root canals of tooth #27 Fig. 4: Intra-oral radiograph of tooth #27 lacking periapical information Fig. 7: Axial view of the middle level, ax- ial view of the apical level, and sagittal detailed view of tooth #27 Fig. 2: Intra-oral radiograph indicating all four root canals of tooth #27 Fig. 5: Axial view of the middle level, ax- ial view of the apical level, and sagittal detailed view of tooth #27 Fig. 8: PAN detail, volume-rendered view and Multi-Planar Reformat view of treat- ment check-up of tooth #27 Fig. 3: Obturated root canal orifices of tooth #27 Fig. 6: Axial view of the middle level, ax- ial view of the apical level, and sagittal detailed view of tooth #27 Fig. 9: PAN detail, volume-rendered view and Multi-Planar Reformat view of treat- ment check-up of tooth #27 14ER3194 Dental Tribune_A4_Layout 112/2/144:15 PM Page 1

Endo Tribune Middle East & Africa Edition

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