Endo Tribune Middle East & Africa No. 2, 2018
Understanding sonic-powered irrigation / Single Visit Endodontic Treatment for Calcified Lower Centrals / Rotary vs Reciprocation: “How Do I Choose?”
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DTMEA_No.2. Vol.8_ET.indd
www.dental-tribune.me
Published in Dubai
March-April 2018 | No. 2, Vol. 8
Understanding
sonic-powered irrigation
SUBSCRIBE NOW
www.me.dental-tribune.com/e-paper/
Vol. 13 • Issue 4/2017
issn 2193-4673
roots
international magazine of
endodontics
4
2017
By Dr Vittorio Franco, Italy
Thoroughly irrigating the entire root
canal system—including isthmi
and lateral canals—is important for
success of endodontic treatment.
Research has shown that sonic activation of irrigants offers significant
improvement in cleaning efficacy,
since it removes considerably more
debris and smear layer than needle
irrigation. Besides cleaner root canals, it increases the effectiveness
of disinfectant solutions to support
long-term success. We spoke with
leading Italian endodontist Dr Vittorio Franco about his daily irrigation
protocol, passion for endodontics
and experience with EDDY, a sonicpowered irrigation tip.
What do you like most about
endodontics?
Nothing is clearly visible in endodontics, so one has to constantly adapt
one’s strategy. In the end, one must
discover the anatomy, understand
the difference between one’s imagination and reality, and find a good
treatment solution. Many recent
dental studies have confirmed the
importance of retaining the natural
dentition and thus of endodontics
as opposed to implantology. Now is
the right time to be an endodontist.
We now have more possibilities for
preserving natural teeth and that is a
wonderful thing.
Why is proper rinsing so
important, and how can one
see when the canal has been
cleaned properly?
I think that the cleaning of the canal
is the most important aspect of an
endodontic procedure. Of the three
major steps, shaping and obturation
are less important than eliminating
bacteria from the root canal. The
main purpose of endodontic treatment is to clean the canal. Otherwise, root canals can become a good
environment for bacteria to grow
in. If the dentist retains vital tissue
that will then become necrotic, it
will facilitate bacterial growth. The
main reason for retreatment is the
presence of an infection due to poor
cleaning in the first place.
There are many published studies
on the time required for proper irrigation. We have many variables
to consider—contact time, refreshment of the solution, amount of tissue/bacteria, volume, temperature,
shear stress and so on—so we cannot standardise this process and final result. There are studies that say
one needs 30 minutes to achieve the
complete elimination of bacteria, but
they did not consider activation possibilities. If you ask me how I decide
when irrigation has been sufficient,
from my point of view, the only clinical way to determine whether the irrigating solution is working is from
seeing bubbles in the solution. That
means that the solution is reacting
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
with something inside the root canal system—obviously if there is no
communication like a large foramen
or perforation.
If bubbles stop being produced, the
clinician can stop cleaning the canal
ÿPage A2
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Remarkable cyclic fatigue resistance
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Optimal Cleaning while Preserving Dentine
3D cleaning and biofilm removal
Enhanced irrigation and debridement
Unique expansion capacity
FKG Dentaire SA
www.fkg.ch
[2] =>
DTMEA_No.2. Vol.8_ET.indd
2
endo tribune
Dental Tribune Middle East & Africa Edition | 2/2018
◊Page A1
How does EDDY work,
and how long does
the activation need?
because the sodium hypochlorite is
probably no longer reacting. There
may still be something inside the
canal, but the solution has achieved
its best result. That would be my only
suggestion.
I use EDDY in the same way as passive ultrasonic irrigation, applying
three to four cycles of 30 seconds for
each canal. I help the EDTA to contact the dental surface with EDDY for
15–20 seconds. After this, I activate
every sodium hypochlorite rinse for
30 seconds. The number of cycles depends on the kind of canal. If I think
that there is some necrotic tissue or
a complicated anatomy, I use more
than three cycles. If it is an easy case, I
still use three cycles of activation.
What is your irrigation
protocol?
I start with 5 per cent sodium hypochlorite, which I use for the entire
shaping procedure. At the end, I use
17 per cent EDTA, activate it and remove it quickly. Then I use sodium
hypochlorite again and activate it
up to four times depending on the
case. For necrotic cases, I wait until
I see the reaction of the irrigant and
the substrate. After removal of the
sodium hypochlorite, I use 95 per
cent ethanol to dry the canal. I do not
use citric acid and chlorhexidine, but
prefer EDTA to remove the smear
layer.
How did you activate
the irrigant before you began
using EDDY?
I tried all activation tools before
EDDY, as irrigation activation has
been one of my favourite methods
ever since I was introduced to it. Before EDDY, I used passive ultrasonic
activation and still use it sometimes
in my Italian practice. Now, I use
EDDY for most of my cases.
How important is it to have
a flexible tip?
EDDY is quite different from passive ultrasonic tips. With EDDY, one
can combine two different things.
First, one has an activation protocol
that some studies have shown is at
least as good as passive ultrasonic
activation. Second, one has a gentle
mechanical action on the canal walls.
This is why I love EDDY. One can
work on the wall and the shear stress
Would you recommend
EDDY?
Absolutely. It is a great solution, being inexpensive, easy to use and effective. One can effectively promote
the contact of the irrigant with the
dental tissue. This is one of the main
ways in which the irrigating solution
should work. One can achieve a very
impressive shear stress so that is one
of the best ways to activate the solution and clean the canal.
EDDY, a sonic tip produced by VDW.
seems to be impressive when using
it. It is also very safe.
What do you think about
the polyamide material from
which EDDY is made?
EDDY requires an air scaler.
Should this be an obstacle
to making the switch
to this device?
It works very well. It is a very good
material for working after shaping,
as one cannot damage the canal wall.
Also, the possibility of tip fracture is
low if one works inside the canal.
How did you learn about
EDDY?
I tried everything in terms of activation. The manufacturer asked me to
test it before its impending launch
in Italy and I was happy to do so. At
first, I tried it with great care—and
it instantly proved to be effective. I
inspected the walls of the canal and
was impressed by the level of the
cleanness of the walls. With EDDY,
one can work in all canals, and some-
Dr Vittorio Franco is an Italian endodontist who uses EDDY, a sonic-powered irrigation
tip. (Photograph: Vittorio Franco)
times I like to work only with the tip
in large and wide canals. I do not use
a shaping instrument, but just one
file for length determination and
then continue with EDDY. One can
also remove debris and the smear
(Management of Endodontic Failure)
(Management of Endodontic Failure)
PRICE:
4,400 AED (1198USD)
TIME & LOCATION:
Thursday - Friday 05 - 06 July 2018
CAPP Training Institute, Dubai, UAE
Thank you very much for the interview.
Endo Micro Surgical Retreatment
Endo Non-surgical
and Surgical Retreatment
Dr. Antonis Chaniotis, Greece
layer easily by activating the solution through the device. Every dentist will appreciate how EDDY works
under the microscope.
Honestly, buying an air scaler is not
a high-cost investment. As a general
practitioner, one can use an air scaler
for a number of applications, including prophylaxis, endodontics, periodontics and minimally invasive
therapy. Personally, I use it for bone
surgery. It is not as expensive as a
piezoelectric surgery unit or a laser. I
think that the cost benefits of EDDY
and an air scaler are fantastic.
CONTACT:
Email: events@cappmea.com
Mob: +971 50 2793711
CAPP designates this activity for 14CE Credits
| 09:00 – 18:00
COURSE OUTLINE:
DAY 1 - To understand the rational behind non surgical retreatment approaches and the
aitiology of initial root canal treatment failure. To present an evidence based framework
for the safe and effective dissasembly of non obturation and obturation materials.
DAY 2 - To understand the factors related to the long term outcome of non surgical
endodontic retreatment and to develop a rational diagnostic and decision making
framework. To appreciate the importance of magnification and illumination for the
management of complicated non surgical retreatment cases.
Prof. James Prichard, UK
PRICE:
4,400 AED (1198USD)
TIME & LOCATION:
Saturdy - Sunday 07 - 08 July 2018
CAPP Training Institute, Dubai, UAE
CONTACT:
Email: events@cappmea.com
Mob: +971 50 2793711
CAPP designates this activity for 14CE Credits
| 09:00 – 18:00
COURSE AIMS:
DAY 1 - To understand the rational behind micro surgical retreatment approaches and
acquire basic surgical knowledge.
DAY 2 - To understand the importance of magnification in endodontic microsurgery
and acquire basic microsurgical skills.
14 CE
Credits
14 CE
Credits
Est.
14 CME
HAAD
Est.
14 CME
HAAD
Est.
12 CME
DHA
Est.
12 CME
DHA
[3] =>
DTMEA_No.2. Vol.8_ET.indd
A3
endo tribune
Dental Tribune Middle East & Africa Edition | 2/2018
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 nowadays. 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 patients 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.
Fig. 1: Calcified Lower
Central Incisors with
Dentin island in tooth 41
Fig. 2: The bur showed no
drop at the calcified pulp
chamber.
First Contact with the Patient
57 years old female came to our dental clinic seeking for a smile makeover due to protruded upper and anterior teeth. The patient was advised
to opt for orthodontic treatment at
first, but refused due to special reasons. The patient decided to go for
aesthetic treatment, which will be
crowning the upper and lower anterior teeth. After performing a smile
analysis and reviewing the required
radiographs, the prosthodontist referred the case to my clinic for doing
RCT of the lower anterior teeth. An
IOPA radiograph (Fig. 1) was taken using CDRelite by FONA for the lower
anterior region, but focusing on the
lower centrals which seems to be the
challenging case here, not to mention 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 creating 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. 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 negotiation could be done, as illustrated in
Figures 2 and 3 with the help of a
clear radiograph.
Using Univet Loupes of Magnification 5x, it was again confirmed that
these two teeth will need more steps
for RCT, so now the case was confirmed radiographically and clinically under magnification. The decision was taken and RCT was done
for the lower laterals and canines
on both sides using 2Shape files by
Micro Mega for mechanical preparation and using a standard rinse pro-
Fig. 3: The sharp explorer
couldn’t locate the orifice.
Fig. 4: The clamp is
superimposing the two
explorers.
tocol of 2.5% NaOCl, 17%
EDTA and 2% CHX, with
activation of irrigation
using passive ultrasonic
irrigation.
(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 negotiated and prepared, using 2Shape
Rotary system till TS2 (25/6%). During the mechanical preparation
of the canals, the type III canals of
each mandibular central joined and
became a single canal. Then a master cone X-ray was taken before the
obturation step and the clamp was
put back in place again, as shown in
Figure 6.
Once the RCT of the
above-mentioned teeth
was done, negotiating the canals of the
lower centrals started.
Newtron ultrasonic device by Acteon and ET20
tip were used to locate
the calcified canals and
explore the floor of the pulp chamber 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 different 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 better radiographic interpretation, as
shown in Figures 4 and 5.
Now, the procedure became easier.
According to the radiograph taken
Fig. 5: Removal of the
clamp for better
radiograph interpretation.
In the next step, the teeth were ready
for obturation, which was done using TotalFill bioceramic sealer by
FKG and gutta-percha cones of size
25/0.06. After obturation, a post-operative radiograph was taken to confirm 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
Fig. 6: Master Cone X-ray
of the lower central
incisors.
have enough knowledge of the latest dental trends and advanced
equipment, we can provide our patients 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 provided in the FONA imaging software
aided in getting more enhanced images 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
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-deFonds, 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 headquarters, FKG Dentaire is proud to announce a new Continuing Education
Centre, located at its representative
office, FKG Dentaire DMCC (Dubai,
UAE).
This Centre exhibits the latest generation of high-end equipment
Lecture room with high definition projector
Training table and center view
(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 systems, more particularly to 3D Ni-Ti
treatments range: the XP-Endo® sequence.
The centre of the Swiss Endo Academy in Dubai has been inaugurated
on February 5, just before the AEEDC
congress, in the presence of the top
management of the mother-company and the entire IMEA team of FKG
Dentaire.
Training set up with FKG Rooter S (Endo Motor),
S-Apex (Apex Locator), Training kit and obturation
devices
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
Training table with 24 seats, monitors, FKG training
kits, Endo motor and Apex Locator, Labomed Microscopes, Phantom Heads, Surgery LED lights, Dental
Stools
[4] =>
DTMEA_No.2. Vol.8_ET.indd
Dental Tribune Middle East & Africa Edition | 2/2018
A4
ENDO TRIBUNE
Rotary vs Reciprocation: “How Do I Choose?”
By Dr John West, USA
As a practicing endodontist and a
clinical endodontic educator for
more than 30 years, the most frequent question I am asked about
technique is: “Is it predictable?”
While every dentist wants his or her
endodontic treatment to be easier,
more efficient, simpler, and profitable, in the end, it is predictability that
trumps all considerations.
When I am asked the question “Rotary vs Reciprocation: How Do I
Choose?” my answer is “Rotary and
Reciprocation,” because the predictability of both methods is similar;
they are just different in sequence,
purpose, and motion. This article
should help to explain these 3 critical distinctions of Rotary vs Reciprocation so that the clinician is aware
of these differences, understands
his or her options, and makes the
best choice for his or her particular
practice and patient needs. It is an
invitation to be self-educated about
your best way to produce endodontic preparations that can be easily
obturated.
The Greatest Variable
In all of dentistry, the greatest variable is always the clinician. While
product and operatory infrastructure play a significant role, the
answer to rotary vs reciprocation
depends mostly on technique, and
technique depends on the clinician’s
skill, care, and judgment.
Q: How Do I Choose?
A: Take the Challenge
Here is a simple and revealing test
for each clinician to determine his or
her own preferred “Rotary vs Reciprocation” choice. Speak to your local
Dentsply Sirona sales representative
and explain to them that you want
to do this “challenge” test: Purchase
enough Rotary files (ProTaper Next®
or ProTaper Gold™) and enough Reciprocation files (WaveOne® Gold) to
treat 10 endodontic patients with Rotary and 10 endodontic patients with
Reciprocation. You could treat every
other patient alternately with Rotary
and Reciprocation, or you could treat
10 patients in a row with Rotary and
then 10 with Reciprocation. Reverse
the order if you prefer. You can use
this same telltale test for comparison
with your current preferred system.
Take good notes about what worked
and did not work. Your answer for
Rotary vs Reciprocation will be right
in front of you!
Closing Comments
Using predictability as your critical
benchmark distinction, your own
testing will reveal your best choice
of “Rotary vs Reciprocation.” The result: clinical confidence, consistency,
and control. The marketplace has
actually already answered the question of Rotary vs Reciprocation. The
market’s answer: “Rotary and Reciprocation.” Those clinicians who have
done their own in-house, controlled
homework and testing will be happy
with their answers. Now it’s your
turn!
WaveOne® Gold
Now with WaveOne® Gold Glider
Surf the canal
with confidence
Dr. West is a co-inventor of the ProTaper® and WaveOne® Gold endodontic
shaping systems.
WaveOne® Gold offers you the simplicity of a one-file
shaping system combined with higher flexibility* to respect
the canal anatomy. Now available with a corresponding glide
path file to optimize your shaping preparation. Experience
the feeling of confidence throughout your treatment.
References
http://www.dentistrytoday.com/
articles/63-articlesmagazine/
Endodontics/10376-rotar.
*compared to WaveOne
© 2017 Dentsply Sirona, Inc.
Rx Only
Dr John West, USA
Founder and Director of the Center for Endodontics, Dr. John West, is recognized as
one of world’s premier educators in clinical & interdisciplinary endodontics
ST8/ B EN W1G0 ADV 000 / 02/2017 – updated 09/2017
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