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ePaper created 2016-11-22, 09:52:12 | version 1.38.0
28 roots 4 2016 Stairs to the Apex Author: Dr Christophe Verbanck, Belgium Sometimes endodontic specialists have to go the extra mile to save teeth. Only with the proper endodontic instruments success can be ensured in the most challenging situations. This case shows how the aid of HyFlex CM-files can help to deal with multiple iatrogenic deformations after several previous temporary root canal therapies. The use of these pre-bendable NiTi-files help us to get the root canal preparation “back on track”. Endodontic intervention after a previous tem- porarytreatmentcansometimesposearealchal- lengeevenforthemostskilledendodontist.Some patients have a long history of unsuccessful root canal treatments. In a situation like this it be- comes quite difficult to shape the canal when the natural path of the root canal is almost com- pletely lost. The loss of dentin is often consider- able after several dentists have literally tried to “push their luck”. Iatrogenic damage An 18-year old male patient presented with a painfullowerrightfirstmolar.Afterthoroughexam- ination, both clinical and radiographic, tooth #46 was diagnosed to be the cause of his pain. On the pre-operative radiograph a (symptomatic) apical periodontitis could be recognized together with a leakytemporaryrestorationwithdecayunderneath. Twomesialandadistalcanalwerefilledwithcalcium hydroxide.Lookingevenmoreintodetailastepcould beobservedinthedistalrootcanal.Clinicalthetooth was painful on percussion and biting forces, there was no reaction to cold or warmth and no pockets couldbeprobedalthoughthegumwasinflameddue tothetemporaryrestorationanddecaythatwasleft behind. After further examination the patient explained the tooth had been treated in the recent past by no less than three different dentists. Recurring pain had forced him to seek treatment time and again after each provisional non-surgical root canal treatment (nsRCT). Apparently, each colleague had tried to work his or her way around the imperfect preparation of their predecessors leading to a root canal with the shape of a staircase. The absence of a good coronal seal lead to improper healing and thus caused a chain reaction of re-interventions whichresultediniatrogenicdamageoftherootca- nal walls. Re-shaping the root canal preparation Afterapplyingadentaldamthefirststepwastore- move the temporary filling and decay, the pulp floor was checked for perforations and all orifices were lo- cated. The canals were then scouted, patency was re- gained and with small hand files (K-flexofiles ISO 06 up to ISO 20) a manual glide path was established in all four root canals. After scouting it was clear that several steps, luckily without any perforation, were Fig.2: HyFlex CM Sequence. Fig.1: Pre-operative radiograph showing multiple steps in the mesio-buccal and distal canals. | case report canal shaping Fig.2 Fig.1 42016