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ePaper created 2017-09-12, 09:26:18 | version 1.38.0
root canal preparation technique | Fig. 6: Vital first upper molar with irreversible pulpitis. Note the extremely long palatal root (approx. 31 mm), nevertheless we managed to seal a beautiful internal loop with a lateral canal, a sign of the proper chemical preparation under partial vacuum and Fig. 7 also well dried, allowing the sealer to be compacted inside. Fig. 7: A failing root canal treatment with apical infection and an internal resorption in the apical area. Fig. 8: The follow-up confirms a fast healing of both the apical area and the area of the resorption lesion. draw out all the fluids, residues and gases from all the root canal system. Once the system has been drained, the partial vacuum established inside the root canal system in its entirety can attract a fresh portion of irrigant for a faster and cleaner preparation of the root canal system. Clinical cases In the images above, we present some of the typi- cal cases demonstrating the cleanliness of the root canal system achieved as shown by the lateral and/ or accessory canals visualised upon 3-D warm verti- cal condensation (Figs. 3–6). The case of a failing root canal treatment with api- cal infection and an internal resorption in the apical area was referred to us (Fig. 7). After removing the previous filling, chemical preparation was performed, with the help of the partial vacuum inside the system the chemicals were able to clean the resorption area without an aggressive effect on the periodontal liga- ment; this has led to a truly three-dimensional obtu- ration. The 4-month follow-up image (Fig. 8) confirms a fast healing of both the apical area and the area of the resorption lesion. Conclusions Realising that a 100 % disinfection of the root ca- nal space remains unattainable, we continue to strive for perfection in our attempts to develop viable clin- ical protocols that would allow to lower the inflam- matory and/or bacterial load so that our patients’ bodies can heal. Based on the supporting research and testing as well as on a history of sustainably high treatment outcomes for both primary endodontic treatment and retreatment of vital and non-vital teeth, we would like to propose our irrigation protocol as a fast, safe, and, most importantly, evidence-based technique of chemical preparation. Fig. 6 Fig. 8 The Sleiman irrigation protocol requires 6 % (or 5.25 %, if the 6 % concentration is not available) NaOCl, 17 % EDTA, distilled water or normal saline. For the best results it is recommended to use a neg- ative pressure irrigation unit to introduce and re- move the solutions in order to benefit from the par- tial vacuum force; however, it must be said that using other introduction techniques in combination with the Sleiman sequence of irrigants will also improve chemical preparation results and lead to a cleaner root canal space. · Access cavity; manual files to locate orifices; man- ual files for initial scouting—NaOCl · H2O · Machine files for root canal preparation—EDTA · H2O · · H2O (cold for cryotherapy) · Drying the root canal system—EndoVac In between machine files—NaOCl The whole irrigation procedure should follow the ‘5 sec introducing solution + 3 sec pause’ guideline to achieve the best effect of the partial vacuum._ Editorial note: A complete list of references is available from the publisher. contact Prof. Philippe Sleiman Assistant and Professor Dental School Lebanese University profsleiman@gmail.com roots 3 2017 35