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ePaper created 2016-09-05, 09:33:59 | version 1.38.0
| case report canal preparation 24 roots 3 2016 Abrupt canal curvature Our second case proved to be equally challenging: a 24-year-old female patient entered our referral practicewithanecroticpulpintooth18.Theopening waslimitedandonceagain,thetoothwaspositioned very distal with only limited space for instrumenta- tion. The root canals were highly curved with sudden sharp dilacerations (Fig. 8). After consultation, the patient agreed to root canal treatment. The dental dam was used to isolate the tooth andthecanalswereaccessedwitharounddiamond bur. The previous composite resin restoration was removedtofacilitatetheidentificationofpossible cracks. The dentin appeared to be intact, we then proceeded to shape the canals. We started to handfile all canals to a size 15 hand instrument to create a suitable mechanical glide path. In the fol- lowing sequence all files were pre-bent beginning with HyFlex EDM 10/0.05 (Fig. 9), followed by the EDM OneFile size 25 in a soft pecking motion. Thor- ough irrigation throughout the treatment helped clear the canals of any debris and necrotic tissue. Gauging the apices revealed ample enough room forasize30handfile,indicatingthatapicalenlarge- mentwaswarranted.Thedecisionwasmadetouti- lise EDM 40/0.04 finishing file on the distal canals. Duetotheabruptcanalcurvature,themesialcanals were shaped using a HyFlex CM 35/0.04. After copi- ous irrigation with NaOCI, EDTA and CHX under acoustic streaming the canals were dried and ob- turatedusingthewarmverticalcompactiontech- nique. Thanks to the flexible, fracture resistant files we were able to shape the canals very effec- tive and efficiently. The access was closed in the samemannerasincase1(seeFig.10,11).Without pre-bendable NiTi files, we would probably have been unable to perform root canal treatment on this tooth. Size 60 finishing files In our last case, a 37-year-old female patient presented with a necrotic pulp in the upper right central incisor with an evident vestibular swelling (Fig. 12). The pulp chamber was accessed using a surgicallengthfrictiongripsize2roundbur.Once working length was obtained the canal was hand filed to a size 15 hand instrument. Addition- ally, the HyFlex EDM Orifice Opener 25/0.12 was used to enlarge the coronal aspect of the canal. The apex was gauged, showing that a size 50 hand file was snug. As the canal was already very large coronally, we decided to use a size 60/0.02 EDM finishing file to shape the remainder of the canal and accomplish apical enlargement (cp. Fig. 13). Even the large size 60 EDM file proved its astonishing fracture-resis- Case 2 (Figs.8–11) Fig.8: Initial situation. Fig.9: HyFlex EDM Glidepath file. Fig.10: Post-op (clinical) situation. Fig.11: Post-op situation. Fig.8 Fig.10 Fig.11 Fig.9 32016