Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2016-09-05, 09:33:59 | version 1.38.0
| case report canal preparation 22 roots 3 2016 From a distal Author: Dr Sam Alborz, USA Introduction Limited workspace is a common problem in end- odontic treatments. Before the arrival of pre-bend- ableNiTifiles,alotofRCT’sseemedtobealmostinex- ecutable due to severe constraints in the access area. Thefollowingthreecasesillustratehowmodernend- odontic instruments help specialists to enter a new era of canal preparation, particularly if the apex is comparatively hard to reach. Standardendodontictreatmentbeginswithplace- ment of a dental dam to isolate the working environ- ment, access to the canal via opening of the pulp chamber,andgaugingthecorrectworkinglengthus- ing a state-of-the-art electronic apex locator. How- ever, root canals often come in extraordinary shapes: an unusually curvy anatomy with hidden accessory canals or horizontal branches might pose a real chal- lengetothemostexperiencedofendodonticexperts. If the tooth is in a remote position or craniomandib- ularproblemsareaddedtothepicture,thetaskiseven moredifficult.Thankfullymodernendodonticsoffers practitionersawholerangeofcleverinstrumentsand dental materials that ensure an effective and reliable preparation and filling of the canal system. This is goodnewstoendo-specialistsgiventhatnotallcases allow standard procedures – or following the words of the old Bette Midler song: sometimes the world looks different ‘from a distal’. Case presentation Necrosis in S-shaped canals In our first case, a 23-year-old male patient was referred to our dental practice with chief complaint of pain in the lower left mandible. The radiograph showed deep caries approaching the pulp chamber and clinical testing revealed a diagnosis of irrevers- ible pulpitis with symptomatic apical periodontitis (Fig. 1). Further review of the radiographs showed thattooth18hadaverycomplexanatomyoftheme- sial roots: the canal system was almost S-shaped andtheapexthereforewouldbedifficulttoreach.In additiontothedistinctmesial-distalcurvaturethere was a significant faciolingual curvature associated with the mesial roots which was discovered during hand intrumentations. Yet, the difficult anatomy of the root canal system itself was not the only con- straining factor that considerably narrowed work space. To make things even more challenging, the patienthadasevereclassIIskeletalrelationship.To- gether with the posterior position of the offending tooth, this combination limited access to the canal openings even further. The insufficient interocclusal space did not allow a common NiTi 21 mm rotary instrument to fit into the canal. For this reason, a special NiTi file system by Swiss dental specialist COLTENE was used for canal preparation. The HyFlex EDM is a modular designed nickel titanium file system: in close cooperation with Case 1 (Figs.1–7) Fig.1: Initial situation. Fig.2: EDM File surface under the microscope. Fig.1 Fig.2 32016