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Dental Tribune Middle East & Africa Edition | 5/2017 ENDO TRIBUNE A3 ◊Page A2 Fig. 8: 3-in-1 obturation material GuttaFlow bioseal Figs. 5 & 6: Postoperative radiographs, case 1 Fig. 7: Pre-operative radiograph of teeth 45 and 46, case 2 Fig. 9: In vitro comparison of single cone technique (left) to improved 3-D obturation (right) First, we warm the gutta-percha us- ing system B heat source. For our purpose, we decrease the tempera- ture to 130 degrees from the aver- age 200 degrees, as this totally suf- fices. 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 allows 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 bioceramic sealer will already flow into any hidden canals. In previous test settings, you can see that the modified obturation tech- nique allowed the sealer to advance deeper inside lateral canals in com- parison to a traditional single cone technique (Fig. 9). Inserting the obtu- ration material with more speed also generates higher pressure: you do not have to reach the desired work- ing length in one go, but can use another stroke until you reach the desired length. The sealer sets only around 2 minutes earlier than nor- mal with the reduced 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 down into the canal by the slightly melted guttapercha on top. The fine white line in the postoperative radiograph of tooth number 45 showed the ob- turated small lateral canal leading away from the main canal (Fig. 10). Moreover, in the follow-up session, we noted that healing of the affected teeth 45 and 46 had already taken place. The bioactive components of the obturation material further added to the regeneration process, as they stimulated the rebuilding of bone and dentine tissue, which was a favourable side effect to the actual sealing of the canal (Fig. 11). Case 3: Severe double curvature to finish off Last but not least, we come to the extraordinary S-shaped canal as mentioned in the introduction. With strong curves it is always good to know that NiTi files with a so-called “controlled memory” (CM) effect can be prebent like classic stainless steel files, but do not bounce back. Using their unique material properties, you can work comparatively stress- free, even under difficult conditions. This time, the patient with the rath- Fig. 10: Postoperative radiograph case 2 show- ing an obturated small lateral canal Fig. 11: Follow-up four months later Fig. 12: Pre-operative radiograph case 3, tooth 47 Fig. 15: Postoperative radiograph case 3 showing a severe double cur- vature in the mesial root Fig. 13: HyFlex EDM 25/.12 Orifice Opener Fig. 14: HyFlex EDM 10/.05 design and unusual cutting power. Whatever way you choose to reach the apex, prebendable NiTi files like the HyFlex EDM help you to follow the natural path of the root canal and quickly remove debris for chemical cleansing and long-term obturation of the various root canal structures. The extremely fracture resistant files are literally “cutting edge” technol- ogy, which make an excellent travel companion on virtually every road. er challenging canal anatomy was a 40-year-old female patient with complaints in her right side mandi- ble. In our analysis, the clinical diag- nosis revealed an irreversible pulpitis in tooth 47. The radiograph indicated that we needed to get around a very sharp angle in the mesial root (Fig. 12); endo specialists know how dis- tant molars are notorious for their winding root canal system! We used the following sequence to get to the length very quickly without straight- ening the canal at all: HyFlex EDM 25/.12, 10/.05 and the afore-mentioned HyFlex EDM One- File 25/~ (Figs. 4 , 13, 14). The flexible files can even find their way around tricky anatomies and are virtually unbreakable. They move perfectly in the centre of the canal, therefore I have never come across any perfora- tions or ledges during my numerous treatments so far. After using “CM”- treated NiTi files, they can be quickly regenerated by autoclaving and are ready for their next application until they reach the end of their life cycle by displaying an uneven, bent shape. As long as they are not unwound they can be re-used safely, otherwise they have to be discarded. After drying and successfully obtu- rating the canal, we were able to dis- miss the patient with a very prom- ising prognosis. The immediate postoperative radiograph showed the naturally formed, filled mesial canal with its striking double curva- ture at the end (Fig. 15). We are very glad that even in more challenging cases like the present one we can rely on the versatility of the latest genera- tion of rotary instruments. Conclusion The latest generation of nickel tita- nium files adapt easily to all shapes of root canals thanks to heir flexible Dr Alfredo Iandolo, Italy Dr Alfredo was awarded Doctor of Dental Medicine by the University of Naples Federico II in 2006. As Professor A.C. he has continued speaking on endodontic courses at his home university since 2014. Iandolo is a certified member of the ESE (European Society of Endodontics) as well as an active member of the SIE (Italian Society of Endodontics) and AIOM (Italian Academy of Microdentistry). As winner of the “Riitano Award” 2016 for best research in Endodontics Iandolo is a regular speaker at national and interna- tional congresses. The inventor of the Iandolo Gauging File (IG-File) and a new protocol in irrigation activation is widely published both nationally and internationally. Dr Alfredo Iandolo Via A. Ammaturo 126 B I-83100 Avellino, Italy iandoloalfredo@libero.it