Endo Tribune United Kingdom Edition

20 ENDO TRENDS Endo Tribune United Kingdom Edition | 9/2017 Irrigating the root canal: A case report By Dr Vittorio Franco, UK and Italy The patient reported on in this article is a student in dentistry and his par- ents are both dentists. They referred their son to a good endodontist, who then referred the case to me. As al- ways, peers are more than welcome in either of my practices, in Rome and London, so when I treated this case, I had three dentists watching me, a fu- ture dentist on the chair, placing a great deal of pressure on me. The 22-year-old male patient had a history of trauma to his maxillary incisors and arrived at my practice with symptoms re- lated to tooth #21. The tooth, opened in an emergency by the patient’s mother, was tender when prodded, with a moderate level of sensitivity on the respective buc- cal gingiva. Sensitivity tests were negative for the other central inci- sor (tooth #12 was positive), and a periapical radiograph showed ra- diolucency in the periapical areas of both of the central incisors. The apices of these teeth were quite wide and the length of teeth ap- peared to exceed 25 mm. My treatment plan was as fol- lows: root canal therapy with two apical plugs with a calcium sili- cate-based bioactive cement. The patient provided his consent for the treatment of the affected tooth and asked to have the other treated in a subsequent visit. was immediately evaluated using an electronic apex locator and a 31 mm K-type ﬁ le. The working length was determined to be 28 mm. After isolating with a rubber dam, I removed the temporary ﬁ ll- ing, and then the entire pulp chamber roof with a low-speed round drill. The working length As can been seen in the photo- graphs, the canal was actually quite wide, so I decided to only use an irrigating solution and not a shaping instrument. Root canals are usually shaped so that there will be enough space for proper ir- rigation and a proper shape for ob- turation. This usually means giv- ing these canals a tapered shape to ensure good control when obtu- rating. With open apices, a conical shape is not needed, and often there is enough space for placing the irrigating solution deep and close to the apex. I decided to use only some sy- ringes containing 5 per cent so- dium hypochlorite and EDDY, a sonic tip produced by VDW, for de- livery of the cleaning solution and to promote turbulence in the en- dodontic space and shear stress on the canal walls in order to remove the necrotic tissue faster and more effectively. After a rinse with so- dium hypochlorite, the sonic tip was moved to and from the work- ing length of the canal for 30 sec- onds. This procedure was repeated until the sodium hypochlorite seemed to become ineffective, was clear and had no bubbles. I did not use EDTA, as no debris or smear layer was produced. I suctioned the sodium hy- pochlorite, checked the working length with a paper point and then obturated the canal with a of 3 mm in thickness plug of bioactive ce- ment. I then took a radiograph be- fore obturating the rest of the ca- nal with warm gutta-percha. I used a compomer as a temporary ﬁ lling material. The symptoms resolved, so I conducted the second treatment only after some months, when the tooth #11 became tender. Tooth #21 had healed. I performed the same procedure and obtained the same outcome (the four-month follow-up showed healing). radiograph Dr Vittorio Franco is an endodontist who runs an endodontic referral prac- tice in Rome and a practice in London. An active member of the European Soci- ety of Endodontology, Franco is also the President-elect of the Italian Society of Endodontics.

Endo Tribune United Kingdom Edition

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