PUBLISHED IN DUBAI www.dental-tribune.me September-October 2018 | No. 5, Vol. 8 The new Swiss Endo Academy Training Centre FKG Dentaire is proud to announce the opening of its new Training Centre in Dubai SUBSCRIBE NOW https://me.dental-tribune.com/e-paper/ issn 2193-4673 Vol. 13 • Issue 4/2017 roots international magazine of endodontics 42017 By FKG Dentaire FKG Dentaire SA (La Chaux-de-Fonds, Switzerland), leader in innovation and production of high-tech rotary Ni-Ti systems, is highly committed 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 genera- tion of high-end equipment (operat- ing microscopes, phantom heads,...) and offers a real simulation labora- tory, allowing general dentists and specialists, to enhance their clinical experience while exposed to the lat- est endodontics Ni-Ti systems, more particularly to 3D Ni-Ti treatments range: the XP-Endo® sequence. research Photodamage of dental pulpa stem cells during 700 fs laser exposure case report Apexiﬁcation treatment with MTA REPAIR HP interview Understanding sonic-powered irrigation 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 | JLT | Dubai | UAE Tel.: +4971 445 222 40 Email: firstname.lastname@example.org Web: www.fkg.ch FB:www.facebook.com/FKGDentaireIMEA AD Training table with 24 seats, monitors, FKG training kits, Endo motor and Apex Locator, Labomed Microscopes, Phantom Heads, Surgery LED lights, Dental Stools 3D agility_ The One to Shape your Success 3D anatomical root canal preparation Exclusive Adaptive Core™ Technology Remarkable cyclic fatigue resistance 3D efﬁciency_ Optimal Cleaning while Preserving Dentine 3D cleaning and biofilm removal Enhanced irrigation and debridement Unique expansion capacity FKG Dentaire SA www.fkg.ch Discover our products on the booth Droguerie Tamer S.A.L
2 ENDO TRIBUNE Dental Tribune Middle East & Africa Edition | 5/2018 Internal resorption treatment using MTA-based endodontic sealer Clinical Case Report By Dr. Fábio Duarte da Costa Aznar, Brazil Male patient, 32 years old, pre- sented with clinical classiﬁcation of pulp necrosis of dental elements 11 and 12 (Fig. 1), associated with the presence of internal resorp- tion, being subjected to endodontic treatment on both elements. He re- ported a history of dental trauma in childhood, and had previously un- dergone an urgent intervention in element 21 by another professional, due to edema and pain in the api- cal region. Due to the presence of ﬁstula in this region, it was traced and found to originate from dental element 21 (Figs. 2 and 3). After the initial approach of the patient, he was anesthetized and absolute isolation was prepared. Afterward, the coronary access was made, during which the pulp necro- sis of both teeth was clinically iden- tiﬁed. A crown-down disinfectant penetration was done, using NaOCl at 5% as an irrigating agent, with od- onometry performed by the X-ray method (Fig. 4) due to the infeasi- bility of using a foraminal locator in these anatomical conditions, which could inﬂuence its precision. The preparation was done by the step- back preparation technique, using K Files (Maillefer/Switzerland) and NaOCI 2.5% as an irrigating agent, seeking to dilate the whole root canal formation. With each change of instrument, ultrasonic irrigation was done with smooth inserts (Ir- risonic/Helse/Brazil) using the PUI and CUI concept (Fig. 5). As a com- plement to the intra-canal decon- tamination process, two ﬁfteen-day exchanges of calcium hydroxide were done (Ultracal/Ultradent/ USA), also aiming at analysis of the quality of cleaning obtained in the area of resorption by the radiopac- ity of this medication (Fig. 6). chanical technique (Figs. 7 and 8), through the use of GutaConden- sor (Maillefer/Switzerland), cones of TP gutta percha (Dentsply/Bra- zil), and Fillapex MTA-based sealer Angelus/Brasil) (Fig. 9). After the thermocompaction, the cut of the obturation, vertical condensation with the use of CLC, cleaning of the pulp chamber, and immediate pro- visional restoration were done (Fig. 10). The sealing of the ramiﬁcations and resorptive areas was observed radiographically, as well as the pres- ence of silent postoperative. The obturation was done using thermome- the Tagger Hybrid The proservation was done after three months. It demonstrated re- sorption of the Fillapex sealer and new bone formation in the apical region of both teeth (Fig. 11). Dr. Fábio Duarte da Costa Aznar Specialist in Endodontics HRAC(Centrinho)/USP/Bauru Master’s Campinas Coordinator of the Program of Specializa- tion in Endodontics FACESC/Chepecó-SC, FAIPE/Goiânia-GO & GOE-Macapá in Endodontics SLMandic/ Fig. 1: Initial radiographic as- pect of teeth 11 and 21. Fig. 2-3: Tracing of ﬁstula of dental element 21. Fig. 4: Odontometric radiog- raphy. Fig. 5: Complementation of the cleaning process using ultra- sonic irrigation. Fig. 6: Radiographic aspect of the intracanal ﬁlling with Cal- cium Hydroxide. Fig. 7-8: Wearing down of the cone and technique of thermomechanical obturation. Fig. 9: Fillapex M.T.A.- based endodontic sealer. Fig. 9: Final radiography. Fig. 10: Proservation after 3 months. Interview: “Endodontic treatment is an invaluable therapeutic technique” By DTI From 4 to 7 October, the world of endodontics will be meeting in the South Korean capital of Seoul for the 11th International Federation of En- dodontic Associations (IFEA) World Endodontic Congress (WEC). In light of the event, which has attracted den- tal professionals from all around the world for many years, Dental Tribune Online spoke with IFEA WEC 2018 Chairperson Dr Andy Euiseong Kim. Dr Kim, how would you de- scribe your experience as chairperson of the IFEA WEC 2018 Seoul local organising committee? First of all, it is my great honour and privilege to act as chairperson of the local organising committee. I’ve learnt so much while preparing for this gathering. I would like to express my sincere appreciation to everyone for the support they’ve shown us so constantly. I feel so blessed, and it could not have been done without that cooperation and support. Second, I have been pleased to see Ko- rean dentists demonstrating their ex- cellent capability. They perform ex- cellent endodontic treatment, even in poor environments, and all the techniques of endodontic treatment are controlled under the govern- ment-led health insurance system. I can conﬁrm that these researchers are conducting world-class research. Finally, it has been a valuable experi- ence to feel the unity of the members of the Korean Academy of Endodon- tics. The theme of this year’s meet- ing is “Endodontics: The ut- most values in dentistry”. Can you explain what is behind this and how you identify with it? Endodontic treatment is an invalu- able therapeutic technique that can keep natural teeth healthy. The reach of its use depends on the country, and I have felt sorry that endodontic treatment has been more neglected than other ﬁelds, given its impor- tance. We have various difﬁculties, especially with the limited choices for dentists, because of the govern- ment’s medical insurance system. With this point of view, we came to the idea of going back to the basics and asked ourselves a fundamental question: what is most important for national oral health? A fancy build- ing may be nice to look at, but it will not last long if the groundwork is not done properly. Likewise, our efforts to keep our natural teeth healthy for the long term should never be under- estimated. Why do you think meetings such as IFEA’s WEC are impor- tant for the endo community? This is an absolutely necessary meet- ing. The American Association of Endodontists meeting, the European Society of Endodontology meeting and the WEC of IFEA are the standard meetings of international endodon- tic societies, but while the meetings arranged by the ﬁrst two associations are locally constrained, the IFEA gath- ering is the only academic congress that covers international endodontic treatment. Membership of IFEA con- tinues to increase, and 36 countries have enrolled in IFEA as member countries. It is natural that there’s level of dif- ference depending on the country, and I believe everyone will level up through this kind of meeting. By do- ing so, we can contribute to the posi- tive development of human beings, which is IFEA’s primary value. Also, the meeting promotes fellowship among endodontists and exchange of experiences and ideas. We will maximise synergy in our ﬁeld by sharing information with one an- other. What are your expectations/ hopes for the meeting, and what are you most looking forward to personally? I am so excited about the meeting. The largest number of participants of all of past IFEA WECs will come to Korea from 70 countries all over the world. Personally, I am thrilled to meet endodontists from all over the world. I know that it will be a wonder- ful experience to meet participants from far away and from closer to home. Furthermore, I hope that IFEA will continue to grow into a global organisation representing the whole world.
4 ENDO TRIBUNE Dental Tribune Middle East & Africa Edition | 5/2018 Diagnosis and Outcome in Endodontics in the 3D Imaging era Professor Francesco Mannocci, specialist in endodontics and restorative dentistry, discusses how 3D Imaging is streamlining the endodontic workﬂow. may be. The ﬁnal 3D representation can be rotated 360° and allows us to determine the working length, ana- lyse the natural shape of the canal and select the appropriate ﬁles using the integrated ﬁle database. In root canal treatment, there is al- ways a need for strict infection con- trol to prevent bacteria getting into lesions and creating infection that can lead to failures. A tight coronal seal is especially important to pre- vent bacteria penetrating the tooth at a later stage. if the tooth is particu- larly damaged it is more difﬁcult to achieve an adequate coronal seal and makes the tooth more prone to failure through bacterial infection. CBCT imaging plays a vital role in such cases, as these teeth are likely to be more prone to small cracks and fractures, which are difﬁcult to detect using traditional scanning methods. IN CONCLUSION | CBCT is essential: • In diagnosing external/internal resorption. • In diagnosing traumatic injuries of teeth. • In the assessment of endodontic outcomes in the context of clinical trials. • For pre-surgical assessment. • In detecting small radiolucencies in teeth with deep caries. • As a pre-treatment radiograph before the endodontic treatment of molars, lower incisors and retreatment of premolars. • For looking more closely at the loss of tooth structure and the success of root canal treatment. AD Complex cases, nothing left to hide? The ﬁrst CBCT based software designed to improve endodontic treatment planning for more predictability. 3D Endo™ Software By Dentsply Sirona In recent years, a team at King’s Col- lege London has completed a num- ber of clinical trials highlighting the importance of CBCT (Cone Beam Computed Tomography) in diagno- sis and outcome assessment in en- dodontics. As endodontists, we are all now familiar with the beneﬁts of using CBCT scans to identify where the problems are within the tooth. We use this technology to help us view trauma such as tooth fracture or examine where a root canal treat- ment has failed. It is well known that the presence of radiolucencies at the apex of a root is symptomatic of endodontic infec- tion such as granulomas or cysts. in the majority of endodontic cases, the assessment of outcomes is reliant on the detection of these apical radiolu- cencies or exposing any change in their size. A radiographic technique (CBCT) demonstrates far better sensitivity and speciﬁcity at detecting radiolu- cencies than traditional periapical radiographs. With periapical radio- graphs, it has been demonstrated that the number of roots cannot be seen clearly, so we are not just miss- ing radiolucencies at the apex of the root, but missing entire root canals. it is important to remember that the radiation dose delivered to the pa- tient must also be considered, when assessing treatment modalities. A periapical radiograph delivers 0.14% of annual background radiation, ris- ing to 0.2% with panoramic, whilst a conventional CT scan delivers 39%. A small ﬁeld of view CBCT scan de- livers barely 1%, which although around 7 times higher than a tradi- tional scan, is in fact, much less than taking a long-haul ﬂight, say from Paris to Tokyo, that delivers 4 times this radiation dose. Preserving the vitality of the pulp helps to preserve the structure of the tooth. indirect pulp capping works better than direct pulp capping and we can use CBCT to help determine when indirect capping is likely to be a success or failure. indirect pulp capping guided by CBCT can help avoid the loss of tooth structure, sig- niﬁcantly improving the success rate of this procedure and potentially in- creasing the chances of survival for the tooth. We can now also use CBCT in the actual design of root canal treat- ment, effectively planning access to the pulp chamber, and 2017 sees the launch of 3D endo, a new soft- ware by Dentsply sirona, which will improve individual treatment plan- ning using CBCT. This software will help us to visualise the direction and position of the canal and the ideal shape of the access cavity. 3D endo enables the user to isolate the tooth being treated and locates the oriﬁce and apex of the canals. This makes it possible to add more points to the computer image, resulting in more precise tracking of each individual canal, no matter how curved they