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ePaper created 2017-06-21, 10:00:36 | version 1.38.0
| case report root canal preparation with NiTi fi les Fig. 10: Postoperative radiograph case 2 showing an obturated small lateral canal. Fig. 11: Follow-up four months later. Fig. 10 Fig. 11 recontamination. A bioactive 3-in-1 obturation ma- terial was applied in a special technique as described in the following case to ensure that all lateral and side canals were fi lled. The postoperative radiograph after the treatment most notably showed a lateral canal in the apical third as well as an isthmus between the main canals, which got both fi lled safely (Fig. 5). The result was a tight, durable seal of the whole root canal system, as the fi nal radiograph refl ected (Fig. 6). Case 2: 3-D obturation technique In our second case, a 65-year-old female patient was referred to our practice with chief complaint of pain in the right side mandible. The radiograph showed defects in two teeth: in tooth 45, an insuffi - cient former root canal treatment had led to a peri- apical lesion. In the neighbouring molar, a deep res- toration was clearly visible. Tooth 46 was therefore diagnosed with a necrotic pulp (Fig. 7). Again, the HyFlex EDM helped us to shape the canal effectively without transporting or changing the natural path of the root canal. After gaining access with the orifi ce opener, we once again used the HyFlex OneFile Fig. 13 Fig. 12: Pre-operative radiograph case 3, tooth 47. Fig. 13: HyFlex EDM 25/.12 Orifi ce Opener. Fig. 12 20 roots 2 2017 to get to the apex. A few fi nishing touches were provided with the help of a 40/.04 EDM fi le. Obturating all portals of exit turned out to be par- ticularly challenging in our second case, therefore a modifi ed three-dimensional obturation technique was applied using GuttaFlow bioseal. The 3-in-1 obturation material combines fl uid gutta-percha with a suitable sealer at room temperature and bioceramics in an au- tomix syringe (Fig. 8). This composition results in an easy to handle material with excellent fl ow properties and working times of 10 to 15 minutes. What we call three-dimensional obturation technique is, in fact, an effi cient and reliable way to fi ll even complex root canal structures. First, we warm the gutta-percha using system B heat source. For our purpose, we decrease the tem- perature to 130 degrees from the average 200 de- grees, as this totally suffi ces. Penetration depth is reduced to 3 seconds as well compared to the usual 5 seconds with a heat carrier to 4 millimetres from working length. This way the GuttaFlow does not set, but keeps a sticky consistency, which al- lows us to push it further down the canal with a plugger, if necessary. However, with our new technique the gutta-percha itself does not have to get inside the accessory canals, as the bioce- ramic sealer will already fl ow into any hidden ca- nals. In previous test settings, you can see that the modifi ed obturation technique allowed the sealer to advance deeper inside lateral canals in comparison to a traditional single cone tech- nique (Fig. 9). Inserting the obturation material with more speed also generates higher pressure: you do not have to reach the desired working length in one go, but can use another stroke until you reach the desired length. The sealer sets only around 2 minutes earlier than normal with the re- duced heat settings and fast penetration. Thanks to 3-D obturation, you let the sealer do its job in areas which are hard to reach, while it gets pushed further