Endo Tribune Middle East & Africa No. 3, 2016
FKG Dentaire SA expands its range of 3D instruments with the introduction of the XP-endo® Finisher R / Getting to the 00.00 point
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DTMEA_No.3. Vol.6_ET.indd
www.dental-tribune.me
PUBLISHED IN DUBAI
May-June 2016 | No. 3, Vol. 6
ENDO TRIBUNE
FKG Dentaire SA expands its range of 3D instruments
with the introduction of the XP-endo® Finisher R
The World’s Endodontic Newspaper Middle East & Africa Edition
By FKG
FKG Dentaire SA continues it’s
marketing of innovative instruments, after the introduction of the
revolutionary XP-endo® Finisher
in 2015. The range of instruments
designed for 3D cleaning of the root
canal is now enriched by the XP-endo® Finisher R (XP-FR), targeting the
removal of filling material.
Made of a unique and highly
flexible NiTi alloy that can expand
100 fold compared to standard instruments, XP-FR reaches areas of
the canal walls impossible to reach
with traditional files.
After initial filling material is removed, regardless of the instrumentation technique used, residual material is always present particularly
in curved or oval canals.
Like with the XP-endo® Finisher
the exclusive FKG MaxWire™ alloy
(Martensite-Austenite) gives to the
instrument the ability to expand
and contract so as to contact difficult
to reach areas, especially in curvedand oval-shaped canals.
With its ISO 30 diameter, the XPFR is slightly stiffer than the XP-endo® Finisher enabling it to eliminate
Gutta-percha and sealer.
Moreover, the XP-FR features
unparalleled resistance to cyclic fatigue, due to its small core size and
zero taper. The instrument is easy
to use and intended for all dentists
keen to enhance the long-term success of their retreatment procedures.
The XP-FR is available in sizes 21
and 25 mm, packed in a sterile blister
of 3 instruments.
XP-FR L21 - ISO 30 (M Phase)
XP-FR L21 - ISO 30 (A Phase)
FKG MaxWire
S1.XB0.00.0AE.FK - XP-endo Finisher R, ISO 30, 21 mm, Sterile
XP-FR L25 - ISO 30 (M Phase)
Contact Information
FKG Dentaire SA
Crêt-du-Locle 4
CH-2304 La Chaux-de-Fonds
Switzerland
T. +41 32 924 2244
info@fkg.ch
www.fkg.ch
XP-FR L25 - ISO 30 (A Phase)
S1.XB0.00.0AD.FK - XP-endo Finisher R, ISO 30, 25 mm, Sterile
The XP-FR is available in sizes 21 and 25 mm. Packed in a sterile blister of 3 instruments.
3D generation_
Long-term success
for your endodontic treatments
FKG Dentaire SA
www.fkg.ch
[2] =>
DTMEA_No.3. Vol.6_ET.indd
2
endo tribune
Dental Tribune Middle East & Africa Edition | 3/2016
Getting to the 00.00 point
By Prof. Philippe Sleiman, Lebanon
Anatomy and nature still teach us
on a daily basis. Root canal treatment, while it is becoming a routine
procedure, surprises and sometimes
bad cases still occur. In this article, I
will present two unusual case reports
from my own practice.
Case 1
The first is a clinical case that in my
experience posed rather a challenge.
The patient was referred to my office
suffering from paraesthesia of his
lower lip on the one side after a root
canal treatment had been performed
on his mandibular second molar.
The preoperative radiograph (Fig.
1), which was sent by his dentist,
showed a well-performed root canal
treatment that did not explain the
clinical manifestations, but looking
closely at the apical part one could
observe that the obturation material lay in proximity to the apex of
the mandibular canal. Immediate
retreatment was required. Unfortunately, the material that had been
used was the plastic carrier Thermafil (DENTSPLY), and it was extending into the nerve, causing the inflammation, and the inflammation
was causing pressure on the nerve.
The Thermafil was removed from
the canals—never an easy thing to
do—using K3XF files (Sybron -Endo;
Fig. 2) and without any solvent in
order to avoid any more damage to
the nerve in case of leakage. I set the
Elements Adaptive Motor (Kerr Endodontics; Fig. 3) to K3XF mode, first
using a 25.06 file in the softened part
of the gutta-percha with the System
B plugger. I was very careful not to
push the carrier further inside the
nerve and not to damage the plastic
carrier and lose the grip. The second
file used was the 25.04 K3XF to remove more gutta-percha and to liberate the carrier.
The instrument was used to hold the
Fig 7
carrier and to remove it from the canal (Fig. 4). Once the Thermafil had
been removed and the exact working length had been determined using the Apex ID apex locator (Axis,
SybronEndo, Fig. 5), the canals were
shaped following the SM sequence
in TF Adaptive mode to the working
length, and I used the EndoVac irrigation system (SybronEndo, Fig. 6) with
cold physiological saline in order to
reduce the inflammation by cooling
down the roots. All of the canals were
irrigated with the cold saline for at
least 20 minutes. The reason I used
this technique was to immediately
lower the in flammation inside the
mandibular canal, which is not well
innervated. Reducing the inflammation inside and around the nerve can
take a while and I needed to lower it
as soon as possible. The canals were
kept empty with a cotton pellet inside the access cavity and a hermetic
seal on top. I asked immediately for
a CT scan (i-CAT, Imaging Sciences
International) to be taken in order
to study the case. To my surprise, I
found that the position of the mandibular canal was different from the
contralateral one and that it was in
contact with the apex of the second
molar where the root canal treatment was performed (Fig. 7).
sealer at the end too. Carefully adjusted master cones were placed
inside the canals with a very tight
tug back. The correct amount
of sealer was applied in order
to avoid any excess and gentle
warm obturation was performed
with the Elements Obturation
Unit (SybronEndo). The integrity
of the obturation was checked
with a CBCT scan (Figs. 9 & 10).
Six months later, a conventional
radiograph was performed (Fig.
Fig 1
Fig 2
Fig 3
Fig 4
The patient was prescribed antiinflammatories and kept under observation. Several days later, his lip
was normal in function, but there
was still some of loss of sensibility.
Thirty days postoperatively, another
CT scan was taken (Fig. 8) in order to
check the inflammation inside the
nerve itself, but during this time we
continued to irrigate the canals with
cold physiological saline at intervals
of three days.
Until the patient reported the slow
return of sensitivity, I decided to
seal the canals, and it was for me
the moment of truth, since I knew
that I needed to seal the canals to the
00.00 point and place a small puff of
Fig 8
Fig 5
Fig 6
11) in order to follow up on the case;
the patient was doing very well with
a completely functional and sensitive lip. The final radiograph showed
a sealed root canal space and none of
the sealer inside the mandibular canal remained. The conclusion of this
case is that we will never know the
reason for such a difference in the
position of the mandibular canal between the right and left of the mandible, and that we need to respect
the 00.00 point of the length of the
roots—nothing more and nothing
less. And the most important conclusion is that nature and the human
body have a truly amazing healing
power once the cause of inflammation has been eliminated.
Case 2
In the second clinical case, the patient presented at the office with
problems biting on his molar, with a
fistula on the buccal side of his mandibular first molar. The preoperative
radiograph showed an acceptable
root canal treatment performed in
accordance with recommendations
(Fig. 12).
Studying the radiographs in detail,
we could obviously see that something was not right in the apical area
of the mesial canals. A closer look
indicated some kind of pathology
Fig 9
Fig 10
in the coronal part of the distal canal
and possibly a cervical resorption or
an internal resorption that might explain the fistula in this area.
Again K3XF files were used to retreat
the case, with the proper irrigation
technique using the Endo Vac. A
50.04 file or the ML3 file in TF Adaptive mode was used to shape the last
3 mm of the canals. Adequate master cones were prepared with a very
strong tug back placed 0.5 mm short
of the working length.
My choice was the Elements Obturation Unit in order to perform the
sealing of the root canal system. The
choice of the plugger was made, selecting the largest plugger to reach
5 mm from working length in each
canal, in order to generate hydraulic
pressure and to seal in 3-D during the
down-pack or the first wave of obturation. Manual pluggers were also
adjusted to reach 5 mm and 10 mm
from the working length. Medium
viscosity was chosen for the cartridge with a large opening and the
extruder was set to two arrows or fast
injection. The sealer was placed on
the cones and inserted into all four
ÿPage 3
[3] =>
DTMEA_No.3. Vol.6_ET.indd
Dental Tribune Middle East & Africa Edition | 3/2016
3
endo tribune
◊Page 2
formed by the endodontist to complete the root canal treatment, but it
should be concluded with a hermetic
seal on top of it.
The article was published in Roots
Magazine 1/2016
Fig 11
canals, the first wave of condensation was performed in the canals one after another, and
the manual plugger that reached 5 mm from
working length was used thereafter in order
to control the apical plug. Sealer was placed
inside the canal, the preheated cartridge was
inserted very slowly with no pressure applied
on the needle, since it should reach 7 mm
Irrigatys
By DTI
With endodontic treatment, there is
the risk of superinfection. The French
laboratory ITENA Clinical claims to
have solved this problem with its
revolutionary Irrigatys handpiece.
This two-in-one device is used for
both irrigation and agitation of the
cleaning solution inside the root canal. To achieve this, the laboratory
put a perforated metal tip at the top
of the handpiece to deliver the cleaning solution in an oscillating movement.
A removable tank allows the root canal to be treated successively using
sodium hypo chlorite and EDTA. The
irrigation line directs the cleaning solution through the metal tip.
The patented technology, achieved
after six years of research, optimises
the results of a very complex procedure, according to the company.
Ambidextrous, light and flexible, the
device has excellent ergonomics,
providing intuitive handling. Irrigatys recharges on a charging station
that can be fixed to the chair.
Irrigatys is available with all of its accessories in a starter kit. The metal
tips are available in two sizes, 17 mm
and 21 mm, to cover all clinical cases.
Fig 12
from the working length, 5 mm was injected
into each canal, manual pluggers were used to
condense this part and final filling of the root
canal system was performed, also followed by
hand plugging. The hydraulic force generated
with this technique is sufficient to seal lateral
and accessory canals and, of course, the resorption in the distal canal that appeared in
Fig 13
the final postoperative radiograph (Fig. 13).
The root canal system has a very complex
anatomy and this is not often apparent on
radiographs. Performing a partial root canal
treatment and placing one cone is not the
gold standard in root canal treatment. Sealing the root canal system is the final step per-
Prof. Philippe Sleiman
Advance American Dental Center
Abu Dhabi and Dubai, UAE
profsleiman@gmail.com
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