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Endo Tribune Middle East & Africa Edition No. 1, 2017

January-February 2017 | No. 1, Vol. 7 ENDO TRIBUNE TheWorld’sEndodonticNewspaper MiddleEast&AfricaEdition PUBLISHED IN DUBAI FKG Dentaire SA 3D agility_ The One to Shape your Success Swiss Pavillion, Hall 8 Booth 8E17-8F10 7-9 February 2017 12-14 February 2017 Ultramed booth Free Workshops on Booth! Toothnotation: Upperrightfirstpermanentmolar ByProf.JamesPrichard,UK Patient Symptoms Severe pain (Visual Analogue Scale 9 out of 10). Poorly localized on the right hand-side. Always starting on the upper right hand side of the face. Pain radiates in to the ear and the cheek on the right hand-side. Pain is spontaneous and not responding well to over the counter analgesics (ibuprofen 400mg qds). Pain has been gradually getting worse over the last 48 hours. The patient was experiencing sleep disturbance and the pain came on in waves. Extreme sensitivity to cold stimulus, not so painfulwithhot. Examination Upper right first and second molars arerestoredwithamalgam. No pocketing or mobility and no tenderness to percussion. No tender- ness in the buccal or palatal sulcus. Sensibility testing with EndoFrost: UR7 +ve, UR6 ++ and triggered the patients’toothache. Pre-operativeradiograph Upper right first molar has a pin re- tainedrestoration,25%bonelossme- sially and distally, no obvious caries, a possible furcal radiolucency but no obvious peri-apical radiolucency at therootapices. The pulp chamber is reduced in size and the canals are not obviously vis- ible. The mesial root exhibits severe curvature in excess of 30 (Schneider 1971-Figure 1 [b]) towards the distal aspect. The sinus outline appears to belowandincloseapproximationto theroots. Diagnosis Acute irreversible symptomatic pul- pitisfromtheupperrightfirstmolar. Treatment Options Root canal treatment or extraction. The patient opted for root canal treatment. Treatment Anaesthesia was achieved with 1x 2.2 ml Lignospan (2% Lidocaine, 1:80,000 adrenaline) via buccal and palatal infiltration and isolation achieved with non latex dam (3M) and sealed with Oraseal (Optident) caulkingagent. Access was performed with a short tungsten carbide bur and the pulp chamberde-roofedwithasafeended tapered tungsten carbide bur (FKG). There was a pulp stone present in thechamberoverthepalatalrootca- nal (Figures 2 [a] and [b]) which was removed with a CAP 1 (Canal Access Preparation) ultrasonic tip (Acteon UK ) and 3 canals were immediately identified with a DG16 endodontic probe. Before canal shaping was performed thecoronal2/3rdswasexploredwith a size 10 K-flex file. Shaping was per- formedasfollows: “ScoutRace” (FKG Dentaire) sizes 10/.02; 15/.02 and 20/.02 (Figure 3) were used in an NSK Endomate (NSK) running at 1000 rpm to es- timated working length using 3% Sodium Hypochlorite-NaOCl (FKG) as the lubricant and irrigant. The ir- rigant was delivered with a 27G side vented Monoject needle attached to a3mlsyringe. Fig.1a Fig.1b ÿPageA2 7-9 February 201712-14 February 2017

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