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ePaper created 2017-09-12, 09:26:18 | version 1.38.0
| case report treating complex root canal anatomy 3D Endo Software, glide path management and WaveOne Gold: Setting the stage for treating complex root canal anatomy Authors: Peet J. van der Vyver & Farzana Paleker, South Africa/USA Introduction Radiographic imaging forms an essential part of the diagnosis, treatment planning and follow-up, in modern endodontics.1 Cone beam computed to- mography (CBCT) allows for the visualisation of root canal systems in three dimensions without the super- imposition of anatomic structures that occurs with conventional radiographs.2–4 CBCT units reconstructs the projection data to produce interrelational im- ages in the axial, sagittal and coronal planes.5 Due to the higher resolution of limited fi eld of the higher resolution of limited fi eld of view CBCT units (Fig. 1) their application in view CBCT units (Fig. 1) their application in endodontics has been expanded. endodontics has been expanded. High resolution CBCT im- High resolution CBCT im- ages are ideal for diag- ages are ideal for diag- nosis of periapical le- nosis of periapical le- sions, identifi cation of sions, identifi cation of root fractures and re- sorption lesions and for the evaluation of root the evaluation of root canal morphology, root canal morphology, root length and root curva- tures.6, 7 Dentsply Sirona recently launched 3D Endo Software that allows the clinician to perform pre-endodontic treatment plan- ning of simple and complex endodontic cases, using DICOM (Digital Imaging and Communi- using DICOM (Digital Imaging and Communi- cations in Medicine) data from a CBCT scan. cations in Medicine) data from a CBCT scan. The innovative software allows for the identi- The innovative software allows for the identi- fi cation of anatomical complexities, design of access cavities, working length measurement, and identifi - cation of canal curvatures before the actual proce- dure. In addition, the software also allows one to choose (from a preloaded database of endodontic fi le systems), a fi le or system that will most likely result in optimal canal preparation for that specifi c shape or diameter of a canal. The purpose of this article is to demonstrate the benefi t of the 3D Endo Software in a complex clinical case that required endodontic treatment. In addition, a different approach to glide path management and root canal preparation for canals that present with multi-planar anatomy will be discussed. Case report Preoperative evaluation The patient, a 25-year-old female, reported with irreversible pulpitis on her maxillary second left molar. The tooth was temporarily restored with Intermediate Restorative Material (IRM, Dentsply Sirona) and the patient complained about continuous food impac- tion between her maxillary left, fi rst and second molar teeth (Fig. 2). A periapical radiograph revealed that the temporary restoration was not sealing at the gingival margin (Fig. 3). Also, visible on the periapical radio- graph was evidence of possible curvatures in the me- siobuccal and distobuccal roots. It was decided, with the consent of the patient, to take a limited fi eld of view CBCT scan to explore the anatomy of this tooth. Fig. 1: Orthophos SL 3D (Dentsply Sirona) capable of taking limited fi eld of view images with a resolution of 80 µm in the endo mode, ideal for endodontic applications. 22 roots 3 2017