Endo Tribune Middle East & Africa Edition No. 2, 2018

Dental Tribune Middle East & Africa Edition | 2/2018 ENDO TRIBUNE A3 Single Visit Endodontic Treatment for Calcified Lower Centrals By Dr Mostafa Anwar, Egypt Single visit root canal treatment (RCT) is becoming more popular and achievable among patients nowa- days. Lots of reasons lie behind, such as new advances in tools and devices used for RCT, advanced techniques in activation of irrigation for proper disinfection, decreasing incidence of post-operative pain, lack of time due to work responsibilities by pa- tients who can’t come several times, an economically efficient solution for both dentist and patient, among others. This leads to a high demand for single visit treatment which is becoming a trend among patients, especially professionals. This case report shows how single visit treatment can be done easily, even in complex cases, as long as the proper tools, devices and equipment are available. First Contact with the Patient 57 years old female came to our den- tal clinic seeking for a smile makeo- ver due to protruded upper and an- terior teeth. The patient was advised to opt for orthodontic treatment at first, but refused due to special rea- sons. The patient decided to go for aesthetic treatment, which will be crowning the upper and lower ante- rior teeth. After performing a smile analysis and reviewing the required radiographs, the prosthodontist re- ferred the case to my clinic for doing RCT of the lower anterior teeth. An IOPA radiograph (Fig. 1) was taken us- ing CDRelite by FONA for the lower anterior region, but focusing on the lower centrals which seems to be the challenging case here, not to men- tion that the patient had a shallow floor of the mouth. Note that there is a Type III root canal morphology, according to Vertucci’s classification (1 canal coronally then 2 canals creat- ing dentin island, then rejoined to a single canal in the apical third of the canal), as shown in the figure, where this configuration will be noticed later in tooth 31. Fig. 1: Calcified Lower Central Incisors with Dentin island in tooth 41 Fig. 2: The bur showed no drop at the calcified pulp chamber. Fig. 3: The sharp explorer couldn’t locate the orifice. Fig. 4: The clamp is superimposing the two explorers. Fig. 5: Removal of the clamp for better radiograph interpretation. Fig. 6: Master Cone X-ray of the lower central incisors. tocol of 2.5% NaOCl, 17% EDTA and 2% CHX, with activation of irrigation using passive ultrasonic irrigation. Once the RCT of the above-mentioned teeth was done, negotiat- ing the canals of the lower centrals started. Newtron ultrasonic de- vice by Acteon and ET20 tip were used to locate the calcified canals and explore the floor of the pulp cham- ber but there was still no sign of the canal, although the tip was nearly 3 mm below the cervical line. So, I decided to go for canal negotiation guided by radiograph, where I take IOPA X-ray with 2 differently-sized sharp explorers placed in 2 differ- ent directions (Labial and Lingual) to decide where the ultrasonic tip will be directed. As the rubber dam was already in place, it was challenging to know if the proposed direction of the ultrasonic tip is in the right path or not, due to the superimposition of the clamp on the tip of the explorer. Here, I decided to remove the clamp while keeping the rubber dam sheet in place, tied by dental floss for bet- ter radiographic interpretation, as shown in Figures 4 and 5. Now, the procedure became easier. According to the radiograph taken (Fig. 5) I found that I have to trough in the middle, between the tips of the two sharp explorers. More troughing was done and the canals were nego- tiated and prepared, using 2Shape Rotary system till TS2 (25/6%). Dur- ing the mechanical preparation of the canals, the type III canals of each mandibular central joined and became a single canal. Then a mas- ter cone X-ray was taken before the obturation step and the clamp was put back in place again, as shown in Figure 6. In the next step, the teeth were ready for obturation, which was done us- ing TotalFill bioceramic sealer by FKG and gutta-percha cones of size 25/0.06. After obturation, a post-op- erative radiograph was taken to con- firm the quality of the RCT, as shown in Figures 7-8. Result The patient had her RCT of the lower anterior teeth completed in a single visit. Analgesics were prescribed for the patient in case of post-operative flare up. Then, she was referred to the prosthodontist who will further complete the treatment plan. She was satisfied with the RCT and was happy that all teeth were done in such a short time. Conclusion This clinical case shows that if we have enough knowledge of the lat- est dental trends and advanced equipment, we can provide our pa- tients the required treatment in one visit, even in the complex cases that would otherwise require multiple appointments. CDRelite helped diagnose the case correctly first, allowing to go through the next steps of the RCT quickly and smoothly. Moreover, the tools pro- vided in the FONA imaging software aided in getting more enhanced im- ages with minimal radiation dose, especially in this case where many radiographs were taken for diagnosis and treatment. Dr Mostafa Anwar BDS, DHHM, MDSc, PhD Researcher Assistant Lecturer of Endodontics – The British University in Egypt Certified Healthcare & Hospital Management Specialist-AUC Editorial Board Member – EC Dental Science Journal Endodontics Specialist – Whity Dental Center Practice Limited to Micro-Endodontics Fig. 7-8: Post-operative radiographs. Endodontic Treatment Before starting this treatment, it was planned that the Lower Laterals and Canines will be done first, then continue the treatment, leaving the lower two centrals for the last stage. This decision was confirmed during the access cavity step, where the two centrals showed calcification at the coronal third and no canal negotia- tion could be done, as illustrated in Figures 2 and 3 with the help of a clear radiograph. Using Univet Loupes of Magnifica- tion 5x, it was again confirmed that these two teeth will need more steps for RCT, so now the case was con- firmed radiographically and clini- cally under magnification. The deci- sion was taken and RCT was done for the lower laterals and canines on both sides using 2Shape files by Micro Mega for mechanical prepara- tion and using a standard rinse pro- The New Swiss Endo Academy Training Centre FKG Dentaire is proud to announce the opening of its new Training Centre in Dubai By FKG Dentaire FKG Dentaire SA (La Chaux-de- Fonds, Switzerland), leader in inno- vation and production of high-tech rotary Ni-Ti systems, is highly com- mitted in worldwide Continuing Education for dentists. After having set up its Training Cen- tre in 2014 (Swiss Endo Academy), based at the company’s headquar- ters, FKG Dentaire is proud to an- nounce a new Continuing Education Centre, located at its representative office, FKG Dentaire DMCC (Dubai, UAE). This Centre exhibits the latest gen- eration of high-end equipment (operating microscopes, phantom heads,...) and offers a real simulation laboratory, allowing general dentists and specialists, to enhance their clinical experience while exposed to the latest endodontics Ni-Ti sys- tems, more particularly to 3D Ni-Ti treatments range: the XP-Endo® se- quence. The centre of the Swiss Endo Acad- emy in Dubai has been inaugurated on February 5, just before the AEEDC congress, in the presence of the top management of the mother-compa- ny and the entire IMEA team of FKG Dentaire. FKG Dentaire DMCC Swiss Tower | Cluster Y | Office 1502 PO Box 450280 Jumeirah Lake Towers | Dubai | UAE T. +4971 445 222 40 E: mea@fkg.ch | W: www.fkg.ch www.facebook.com/FKGDentaireDMCC Lecture room with high definition projector Training table and center view Training set up with FKG Rooter S (Endo Motor), S-Apex (Apex Locator), Training kit and obturation devices Training table with 24 seats, monitors, FKG training kits, Endo motor and Apex Locator, Labomed Micro- scopes, Phantom Heads, Surgery LED lights, Dental Stools

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