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ePaper created 2017-09-12, 09:26:18 | version 1.38.0
| case report treating complex root canal anatomy Fig. 8 Fig. 9 Fig. 8: Corrections made for the palatal root canal according to the canal config- uration that can be viewed in different planes in the software. Fig. 9: Corrections made for the mesiobuccal root canal according to the canal configuration that can be viewed in different planes in the software. was used in a rotary motion to expand the glide path in the palatal root canal (Fig. 23). Considering the sharp and severe curvatures in the two buccal canals, it was decided to convert the ProGlider instrument into a manual file to expand the glide path in these tortuous canals with more safety (Fig. 24). The manu- ally adapted ProGlider was used in a balanced force motion up to working length. In addition, to create more safety during the canal preparation of the two challenging buccal root canals, it was also decided to use the reciprocating WaveOne Gold Glider (Dentsply Sirona; Fig. 25), after the ProGlider instrument to fur- ther expand the glide paths. The WaveOne Gold Glider was used in 4–8 backstroke brushing motions from working length, in the two buccal root canal systems. Fig. 10: Corrections made for the distobuccal root canal according to the canal configuration that can be viewed in different planes in the software. Root canal preparation, irrigation, and obturation As mentioned before, WaveOne Gold files (Dentsply Sirona) were selected for root canal preparation. The Fig. 10 26 roots 3 2017 palatal canal was prepared with the reciprocating, Primary WaveOne Gold instrument (Fig. 26), and the two buccal root canals with the Small WaveOne Gold file up to working length (Fig. 27). After canal preparation, the canals were flooded with 17 % EDTA solution (Ultradent) and the solution activated for 1 minute with the EDDY Endo Irrigation Tip (VDW) driven by an air scaler (SONICflex LUX 2000L, KaVo). Thereafter, final disinfection was achieved by activating 3.5 %, heated sodium hypochlorite for three minutes, again activated with the EDDY Endo Irrigation Tip. The canals were dried with paper points and ob- turated using matching gutta-percha points, Pulp Canal Sealer (Kerr) and the Calamus Dual Obturation Unit (Dentsply Sirona). Figure 28 shows the final re- sult after obturation. Discussion According to the European Society of Endodon- tology’s position statement, the use of CBCT in en- dodontics should only be considered if additional information from the reconstructed three-dimen- sional images will potentially aid in the diagnosis and/or enhance the management of the tooth with an endodontic problem.8 A limited field of view CBCT scan should be considered as the imaging modality of choice for teeth with the potential for extra canals and suspected complex root canal morphology.9 The 3D Endo Software that was used in this case report not only allowed the operator to scroll through the tomographic slices in the coronal, axial and sag- ittal planes, but facilitated a 3-D image of the root canal anatomy prior to treatment. Only after visual- ising the severe curvatures and their projection in the buccal palatal direction was the complexity of this case realised. This information was vital for the treat-