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ePaper created 2017-09-12, 09:26:18 | version 1.38.0
treating complex root canal anatomy case report | Fig. 11 Fig. 12 Fig. 13 ment-planning phase of this case. According to the information obtained from the 3D Endo Software, the authors could select the ideal instruments for canal negotiation, glide path and canal preparation, irriga- tion and obturation. According to Tchorz (2017), the option to plan endodontic cases in 3-D before treat- ment is a significant gain for modern endodontics, and can help to prevent procedural errors, especially in complex cases.10 It is important to note that in this case report the working length measurements ob- tained from the 3D Endo Software and the apex lo- cator correlated with each other. However, it always advised to verify the software readings with an apex locator, as several parameters such as the access cav- ity design and position, the amount of coronal pre- flaring and the choice of reference point can have an influence on the working length measurement.10 The most challenging clinical aspect of this case was to negotiate the canals to pa- tency, to create reproducible micro glide paths, and to expand the glide paths to a level where the maximum safety could be secured before introduc- ing the root canal preparation instru- ments. The glide path preparations were managed with manual K-Files, K-Files in the reciprocating M4 handpiece followed by expanding the glide paths with the ProGlider and the WaveOne Gold Glider instruments. Fig. 14 In 2006, West recommended using K-Files with an initial watch winding motion to remove restricted dentine in very narrow canals, followed by a vertical in and out motion with a 1 mm amplitude and grad- ually increasing the amplitude as the dentine wall wears away and the file advances apically.11 Several authors have described the use of a small K-Files driven by a reciprocating hand piece for initial glide path preparation, especially in very constricted or curved canals.12, 13 The main advantages of using the reciprocating M4 hand piece is to reduce the glide path preparation time, hand fatigue, and to secure the canal in narrow, multi-planar root canals faster compared to the conventional manual technique.14 Securing the two multi-planar buccal root canal sys- tems in this case, with a size 08 K-File in the M4 re- ciprocating handpiece, facilitated further glide path enlargement. The ProGlider, a single file rotary glide path instrument was the first instrument used to expand the glide paths. This file is manufac- tured from M-wire NiTi alloy that shows more flexibility and resistance to cyclic fatigue compared to conven- tional NiTi alloy. It has a semi-active tip, size ISO 016 (D0) with a 2 % taper that progres- sively increase up to 8 % (D14; Fig. 29). The cross sec- tion of the ProGlider instrument is square and the file is used in a continuous rotary motion at 300 rpm and a torque setting of 2–4 Ncm.14 Considering the severe curvatures in different planes of the buccal root canal systems, the ProGlider instrument was first used in a manual mode up to working length in these two canals. It was also then decided to further expand the glide path in these canals by using the WaveOne Gold Glider, also a single, reciprocating glide path file designed for glide path enlargement. Here, a second glide path instrument was used be- cause the cutting envelope of the WaveOne Gold Glider is more than the ProGlider instrument (Fig. 30). Fig. 11: The software projects ISO size 06 instruments into the canals that allows the operator to visualise the internal anatomy of the root canals. Fig. 12: This software allows the operator to rotate the image in 3-D to alert the operator of the angle and direction of curvatures in the root canal systems. Note the sharp apical curvatures in different planes. Fig. 13: Master files from a preloaded database of endodontic file systems are selected and projected in the root canal systems. Fig. 14: The instruments can also be digitally rotated and visualise the root canal anatomy in 3-D. roots 3 2017 27