Endo Tribune Middle East & Africa No. 2, 2024
Introducing Clinical Endodontics Symposium: An addition to 37th Int’l Dental ConfEx in Dubai / High-end technology for simplicity / X-Smart Pro+: “Ensuring safety while going much faster”
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DTMEA_No.2. Vol.14_ET.indd
PUBLISHED IN DUBAI
www.dental-tribune.me
Vol. 14, No. 2
Introducing Clinical Endodontics
th
Symposium: An addition to 37 Int’l
Dental ConfEx in Dubai
By CAPP Events & Training
Centre for Advanced Professional Practices (CAPP) has announced the inauguration of the
Clinical Endodontics Symposium
(CES) as a standalone sub-event
within the esteemed CAD/CAM Digital & Oral Facial Aesthetics 37th Dental ConfEx. Scheduled to take place
on 15-16 November 2024, at the
prestigious Madinat Jumeirah Arena
& Conference Center, this symposium promises to be a transformative
experience for all attendees.
CES marks a significant milestone in the landscape of dental conferences, offering a dedicated platform for the exploration of
cutting-edge advancements in Clini-
cal Endodontics. Bringing together a
consortium of leading experts, researchers, and practitioners, CES
aims to delve deep into the latest
techniques, technologies, and trends
shaping the practice of endodontics
today.
At CES, participants can anticipate a dynamic programme featuring insightful presentations, interac-
tive discussions, and hands-on workshops. From innovative root canal
treatments to advancements in diagnostic tools, the symposium will
cover a wide spectrum of topics essential to modern endodontic practice. Moreover, attendees will have
the opportunity to gain invaluable
insights into the seamless integration of digital technologies in endodontic procedures, revolutionizing
patient care and treatment outcomes.
One of the key highlights of CES
is its collaborative environment, fostering networking opportunities and
knowledge exchange among peers.
This symposium offers a unique platform to engage with like-minded individuals, share experiences, and
stay at the forefront of the rapidly
evolving field of endodontics.
In conclusion, the Clinical Endodontics Symposium (CES) promises
to be an event, redefining the standards of excellence in Clinical Endodontics. We invite you to join us at
the CAD/CAM Digital & Oral Facial
Aesthetics 37th Dental ConfEx and be
a part of this transformative journey
towards a brighter future for endodontic practice.
For more information and registration details, please visit www. cappmea.
com/clinicalendo-2024.
CAPP Events & Training
Web: www.cappmea.com/courses
Mob: +971502793711
E-mail: events@cappmea.com
[2] =>
DTMEA_No.2. Vol.14_ET.indd
CASE REPORT
A2
Endo Tribune Middle East & Africa Edition | 02/2024
High-end technology for simplicity
By Adj Prof. Philippe
Sleiman, Lebanon
Since nickel–titanium (NiTi) files
were introduced into root canal therapy, engineers have been seeking
the perfect design and combination
for optimal root canal therapy. Heat
treatment and twisting of NiTi was a
major breakthrough in this field. It
opened up the era of heat treatment
for rotary files, and now almost all
files in the market are heat-treated,
creating great flexibility, but putting
aside cutting efficiency, cutting
being the major task for rotary files
in shaping root canals.
The Traverse and now ZenFlex
file systems (both Kerr) are produced
using a novel heat treatment that
combines cutting efficiency and flexibility in one file and in the necessary
places. This new technology in heat
treatment adds value to our daily
work, as ultimately what matters is
the treatment that we offer to our
patients. Safety and cutting efficiency are apparent when using
these files, allowing me to use a
rather simplified approach for treating the complex root canal anatomy.
In this article, I will demonstrate this
approach with reference to several
cases.
The orifice opening is done with
the 25/.08 Traverse file, which has a
maximum flute diameter of 1 mm.
This is a file that I use in almost all of
my cases. In straight canals, it goes as
deep as it can and, in curved canals,
is limited to working above the curve.
In straight canals, ZenFlex offers
a wide range of sizes, from 20 to 55,
in both .04 taper and .06 taper. After
using the ZenFlex for some time, the
dentist can evaluate the size that he
or she likes to use according to his or
her experience and preferences and
can use one ZenFlex file to finish the
shaping.
In this first example, the patient
was referred for treatment of a sinus
tract of the anterior maxilla (Fig. 1).
A gutta-percha cone was placed inside the fistula, showing the way to
the infection site. This was a straight-
5
forward case, prepared using the
25/.08 Traverse file in the upper part
of the root canal, followed by a
10 K-File (Kerr) to determine the
working length and then a 40/.06
Traverse file taken to working length.
Naturally, treatment involved complete chemical preparation and 3D
sealing of the root canal space (Fig. 2).
The next example was also a
straightforward case. This was a
maxillary lateral incisor with a necrotic pulp and a slightly resorbed
apex. A 55/.06 ZenFlex file was used
in a single-file technique to treat this
canal (Fig. 3).
In molars and narrow canals, a
simple sequence is required in order
to perform shaping. It can start with
the 25/.08 Traverse file, taken to just
above the curve, especially in mesial
canals. Using a K-File, the dentist can
determine the working length using
an apex locator and use this length
for preparation with rotary files. The
K-File is also used to achieve patency.
The second rotary file is the 13/.06
Traverse file, taken to working length,
followed by the 20/.06 and 25/.06
ZenFlex files, also taken to working
length. If the dentist is following an
apical enlargement regime, a 30/.04
ZenFlex file can be used for the apical
area (Fig. 4).
Maxillary second molars are in
my opinion one of the most challenging teeth to treat because of
their position and unpredictable
anatomy. In this example case, the
patient was referred for irreversible
pulpitis (Fig. 5). Looking at the preoperative radiograph, we can see the
curvature of especially the mesial
and palatal root canals. The sequence used was as described before, starting with the 25/.08 Traverse
orifice opener as deep as it goes and
just above the curve, followed by a
8 K-File for working length determination and the 13/.06 Traverse file
used to working length in all canals.
During the use of the 13/.06
Traverse file, I did not feel much resistance, so I decided to go ahead
with the .06 taper sequence. The next
file was the 20/.06 ZenFlex, followed
1
2
Speed 650 Torq 300
4
3
Sleiman sequence
Fig. 4: Technical card for small to medium canals.
by the 25/.06 ZenFlex file. Personally,
I believe in apical enlargement, and
for that reason, I used the 30/.04
ZenFlex file as the final enlargement
file in this case. I used a medium cone
as the master cone and achieved 3D
sealing of the system (Fig. 6).
Of course, I performed complete
6
chemical preparation, according to
my sequence, during the procedure.
In very narrow canals, the .06
taper ZenFlex file will be replaced by
the .04 taper one, in order to reduce
taper lock, which occurs when a large
file is trapped inside a single or a
double canal curve. This can create a
great deal of torsional stress and
bending stress on the same spot,
leading to severe damage of the file
and even to le separation. The sequence is use of the 25/.08 Traverse
► Page A3
[3] =>
DTMEA_No.2. Vol.14_ET.indd
CASE REPORT
A3
Endo Tribune Middle East & Africa Edition | 02/2024
◄ Page A2
file in the straight part of the canal,
followed by 8 and 10 K-Files, taken to
working length. The 13/.06 Traverse
file opens the way for the 20/.04
ZenFlex file, which is followed by the
25/.04 ZenFlex file and additionally
the 30/.04 ZenFlex file for apical enlargement (Fig. 7). A medium or
fine-medium cone can be adapted
as the master cone.
In this example case, the patient
was referred by his treating dentist,
who had penetrated deep into the
roots in trying to find the canals and
was not successful, but fortunately
no perforation had occurred (Fig. 8).
Under the microscope and using ultrasonic tips, the canals were made
accessible. On the radiograph, we
can see that the canals, especially the
mesial ones, are narrow and have
small curves, particularly apically.
The real challenge in this case was
maintaining the original shape of the
canal. For those reasons, the sequence with the .04 taper was chosen. Treatment was initiated with the
25/.08 Traverse orifice opener, followed by a 8 K-File for working
length determination. The 13/.06 Traverse file was used all the way to the
end of the working length, followed
by the 20/.04 and 25/.04 ZenFlex files,
both taken to working length.
For apical enlargement, the 30/.04
ZenFlex file was used.
A medium cone was used as the
master cone in the distal root, and
fine-medium cones were used in the
mesial root. A full sequence of irriga-
tion was used during the treatment,
and the system, which included a
deep isthmus between the mesial
roots, was lled in multiple levels from
the middle to the apex, achieving
beautiful 3D obturation (Fig. 9).
Editorial note: This article was first
published in roots international magazine of endodontics, Vol. 18, Issue 2/2022.
Author
Adj Prof. Philippe Sleiman is an
assistant professor at the Faculty of
Dental Medicine of the Lebanese
University in Beirut in Lebanon and
Adj Prof. at the UNC Adams School
of Dentistry at the University of
North Carolina in Chapel Hill, North
Carolina, in United States. He can
be contacted at profsleiman@gmail.
com.
7
Fig. 7: Technical card for narrow canals.
8
9
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register at
www.roots-summit.com
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DENTAL EXPERTS
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Juan Mesquida
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of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.
Tribune Group GmbH designates this activity for 18.5 continuing education credits. This continuing education activity has been planned and implemented in accordance with
the standards of the ADA Continuing Education Recognition Program (ADA CERP) through joint efforts between Tribune Group GmbH and Dental Tribune International GmbH.
[4] =>
DTMEA_No.2. Vol.14_ET.indd
INTERVIEW
A4
Endo Tribune Middle East & Africa Edition | 02/2024
X-Smart Pro+: “Ensuring safety
while going much faster”
By Dental Tribune
International
In February in the UAE, Dentsply
Sirona held the second Dentsply
Sirona World Dubai, attracting almost 1,200 participants from 50
countries. At the event, the company’s X-Smart Pro+ made its market
premiere in the Middle East. The
device is a portable tabletop endodontic motor with an apex locator
and was developed to optimise the
performance of Dentsply Sirona’s
and VDW’s endodontic file systems. In this interview, endodontic
expert and key opinion leader
Prof. Simone Grandini from Italy
talks about the features and benefits of the unit.
Prof. Grandini, the X-Smart
Pro+ endodontic motor boasts an
integrated apex locator and a high
torque range of up to 7.5 N cm,
alongside a touch screen interface.
How do these features enhance
the user experience and accuracy
in endodontic procedures compared with conventional endodontic motors?
This engine is not so different
from others at first glance; however, there are numerous small de-
Prof. Simone Grandini reported on his experiences with the new X-Smart Pro+ endodontic motor at this year’s Dentsply Sirona World Dubai. (Images: Dentsply Sirona)
tails that make X-Smart Pro+ a special motor. For example, various file
systems can be used with it. Even
though many of my peers tend to
work with file systems with which
they are familiar and achieve good
clinical results with these, they appreciate the opportunity to try out
new files. The endodontic motor
can be programmed for each system, allowing the torque and rotation speed to be set manually. This
is not possible with all motors.
The features you mentioned
have proved themselves in everyday clinical practice. We want simplicity and good functionality in
one device. X-Smart Pro+ meets
this need.
X-Smart Pro+ offers both rotation and reciprocation modes,
optimising the performance of
Dentsply Sirona’s endodontic file
systems. Could you explain how
these file motions differ in practice and what advantages each
provides to endodontists in terms
of efficiency and safety during
root canal treatments?
X-Smart Pro+ is the first endodontic motor to be offered by both Dentsply Sirona
and VDW.
In endodontics, we have been
working with different modes of
canal preparation for a long time.
Incidentally, the reciprocating
preparation method was described
in 1985 already. The instrument rotates alternately clockwise and anticlockwise, allowing the instrument to continuously advance api-
cally. This movement pattern ensures that the file is centred in the
canal. For us as dentists, this makes
it possible to prepare the canal with
just one instrument. However,
when we have cases that necessitate working in a way that is particularly gentle on the dentine, this is
better achieved with continuously
rotating files. It is therefore very
important to have both rotation
and reciprocation available in order
to decide on a patient-specific
basis which motion will achieve the
best results.
X-Smart Pro+ claims to maintain apex locator precision during
active shaping by employing
Dentsply Sirona’s proprietary
Dynamic Accuracy technology.
Can you discuss how this technology influences the safety and
precision of reaching the apex,
especially in comparison with
manual files and other endodontic motors in the market?
This technology allows for reliable and direct length determination while shaping using an apex
locator as precise as the conventional manual method of measurement. Another important capability is that this integrated apex locator constantly updates the working
length, addressing the concern of
measuring a working length that is
changing throughout the procedure. This makes it easy to keep the
file on target while shaping, ensuring safety while going much faster.
To accommodate future treatment options and a wide range of
file systems, X-Smart Pro+ is designed with upgradeable firmware. In your opinion, how important is this feature for dental
professionals in terms of longterm investment and adapting to
evolving endodontic techniques
and technologies?
This is very important. The development of files never stands
still, as the industry continues to
pursue improvements in preparation. The aim is to further increase
the success rate of endodontic
treatment, which is currently
around 90%, depending on the
pulpal and periapical conditions of
the tooth at the time of treatment.
Editorial note:
More information about Dentsply
Sirona’s X-Smart Pro+ can be found at
dentsplysirona.com.
)
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