Interview: “Today’s solutions from FKG cater to the very diverse patient and dentist population in the Middle East” / Using digital software for effective root canal therapy / A new endo-resto approach in digital dentistry
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DTMEA_No.3. Vol.13_ET.indd
PUBLISHED IN DUBAI
www.dental-tribune.me
Vol. 13, No. 3
“Today’s solutions from FKG cater to
the very diverse patient and dentist
population in the Middle East”
An interview with Didier Devaud
By Dental Tribune MEA
Swiss company FKG Dentaire
designs and manufactures endodontic products, working with the
best universities in the world to develop innovative solutions. In order
to anticipate and respond to the
needs of users, the company seeks
to be close to its markets and for
that reason works with carefully selected distributors all over the
world and has training centres in La
Chaux-de-Fonds in Switzerland,
Oslo in Norway and Dubai. In this
interview, Dental Tribune Middle
East & Africa speaks with CEO
Didier Devaud about the company,
its operations in the Middle East
and plans for the region, and how it
meets the needs of customers in
the Middle East.
Can you tell us a little bit
about your background and how
it led you to your position as CEO
at FKG?
Endodontics has long been a
passion for me, both in terms of innovation opportunities and commercial strategy. After leading marketing and clinical operations
worldwide for Dentsply Sirona’s
endodontics business, I joined FKG
two years ago as chief commercial
officer and became CEO last
November. FKG has always had a
strong manufacturing and technology background, designing and
manufacturing the most advanced
NiTi file systems; however, it has
lacked commercial presence and
impact. This is the reason for my
Didier Devaud, CEO at FKG Dentaire. (Image: FKG Dentaire)
appointment, considering my
background and experience in the
field.
Could you explain FKG’s mission and core values and how
they guide the company’s operations and decision-making?
FKG’s core values are , and our
mission is to make endodontics
safe and easy with innovative,
high-quality and less invasive solutions. How do we do this? First, we
don’t copy, but we aim to come
The headquarters of FKG Dentaire located in La Chaux-de-Fonds, Switzerland.
(Image: FKG Dentaire)
forth with truly novel approaches
that preserve the natural tooth
anatomy by removing as little dentine as possible while providing
enough space for disinfection. We
design and manufacture our own
machines and processes and perform control quality from the very
start to the last . This enables us to
stand on our own, and FKG is further differentiated through our
minimally invasive designs, cutting-edge products and Swiss
quality based on centuries of manufacturing experience
originating from the
watchmaking industry.
FKG has a reputation for innovation in
the dental industry.
Would you tell us
about some of the recent products or technologies that FKG has
introduced?
Recently, we have
completed our portfolio
with R-Motion, our reciprocation technology
that has up to 200%–
300% better cyclic fatigue compared with past designs. We also
updated our XP-endo Rise product portfolio with a glide path file,
shaping file and finishing file, providing a complete minimally invasive solution with a unique faceted
tip profile that follows the root
canal anatomy while cutting optimally. We also introduced the
Rooter X3000—the fastest endodontic motor in the market—
which is ideally suited for all endodontic procedures, from glide
path creation to retreatment.
day’s solutions from FKG cater to
the very diverse patient and dentist
population in the Middle East who
want to preserve teeth. These
products are the strongest on the
market and won’t fracture inside
the canal like copycat designs from
me-too companies. FKG also offers
continuing education and the clinical evidence to support the benefits of the products we offer. FKG’s
TotalFill, for example, has hundreds
of studies supporting its use,
whereas competing bioceramic
sealers have at the most just a few.
What is FKG’s current presence in the Middle East, and
what are the company’s plans for
expanding its operations in the
region?
We currently have our Middle
East headquarters in Dubai, where
we have offices as well as a stateof-the-art training facility with 20
chairs for training on simple to very
advanced endodontic procedures.
Since the easing of COVID restrictions, we have been able to restart
our training programmes, collaborating with prestigious universities
like the University of Birmingham in
the UK and some of the best known
endodontists in the region.
We have gained substantial
business through our partners in
the Middle East, notably through
government tenders thanks to our
quality and education. We are also
one of the very few companies
solely focused on endodontics, .
Our plan is to continue expanding
commercially and to enlarge our
education by establishing training
centres in other countries, for instance in Egypt, where we have a
strong partner.
Can you discuss any specific
goals or targets that FKG has set
for its operations in the region
over the next few years?
Sure. FKG’s goal globally is to
double its sales in the coming five
years, and the Middle East is one of
the key and largest regions for our
company. We aim to more than
double our sales in the Middle East
establishing new training centres
and partnering with new distributors that focus on endodontics and
with universities that teach best
practices in minimally invasive endodontic treatment.
How does FKG tailor its products and services to meet the
specific needs and preferences
of customers in the Middle East?
Customers in the Middle East
are demanding in terms of both
product quality and education, as
they are core to an evolving profession. The past practices of drilling a
big hole in the tooth or spending
hours manually accessing and
shaping a canal are obsolete. To-
Looking ahead, what role do
you see the Middle East playing
in FKG’s overall growth strategy,
and how is the company positioning itself to capitalise on opportunities in the region?
The Middle East is one of the
regions where we historically established a regional headquarters
and training facility and is core to
our strategy of expansion. Dentists
from all around the world come to
the yearly AEEDC Dubai congress
and to be trained in our centre in
Dubai. We are ideally positioned,
having some of the best distribution companies in the region, for
which FKG’s portfolio ideally complements their own. We aim to continuously innovate our designs and
already have some innovations in
the pipeline that will fuel growth in
the region for years to come. We
are not focused on the short term,
but envision success in the long
term.
[2] =>
DTMEA_No.3. Vol.13_ET.indd
ENDO TRIBUNE
A2
Endo Tribune Middle East & Africa Edition | 03/2023
Using digital software for effective
root canal therapy
By Prof. Adj. Philippe Sleiman,
Lebanon
Introduction
Root canal anatomy is often
complex. Traditional 2D radiographs can give us an idea about
the anatomy and its complexity or
indicate whether we are dealing
with a retreatment or calcification,
but only 3D vision can provide the
necessary accuracy. In this article, I
will be sharing with you cases with
different scenarios for which I used
the DTX Studio Clinic dental imaging software (DEXIS) to create a
digital model and a road map for
me to follow clinically.
Case 1
This patient attended in an
emergency owing to sharp pain in
a second maxillary molar. This was
confirmed upon clinical examination. A standard radiograph was
taken (Fig. 1), showing a very complex anatomy and calcified pulp
chamber. The history of this tooth,
as described by the patient, was
that an inlay had been placed on it
and discomfort developed after a
while that had lasted several years
untreated. On check-up, he had
been told that everything was fine.
I asked for an i-CAT scan to be
taken in order to better understand
what was going on. Studying the
horizontal view of the 3D image,
the level of calcification in the pulp
chamber compared with the pulp
chamber of the first molar could be
seen clearly (Fig. 2).
The endodontic mode in the
new DTX Studio Clinic software allows the addition of many views
and sections and adjustment of the
thickness of the sections in order to
check the level of calcification. An
additional benefit is that it allows
tracing of the internal anatomy of
the roots, individually and together. When tracing the root canals, a colour can be selected for
each canal. This is of great benefit
for visualising the internal anatomy
(Fig. 3).
With this software, a 3D model
of the tooth with the canals traced
with their approximate working
lengths can be visualised, giving us
an idea of what to expect (Fig. 4).
For ex- ample, in this case, the average working length was around
27 mm for this second maxillary
molar with four canals and this kind
of anatomy—I call these cases a
double espresso because they are a
bit of a challenge. For example, the
distal canal had a sharp curve like a
hook at the apex. All this data can
help in choosing a file sequence for
the shaping and cleaning of the
root canal system. Traverse and
ZenFlex files (Kerr Dental; Fig. 5)
were used to shape the canals. In
the distal root, the 30/.04 file was
not used in the last 2mm, in order
to avoid any misshaping of this
area. The irrigation was performed
according to the Sleiman sequence
of irrigation (published in roots
magazine 1/2014). 3D obturation of
the canals was performed with the
elements IC obturation system
(Kerr Dental; Fig. 6). Obturation was
completed, and the immediate
postoperative radiographs showed
that all the canals were filled and
sealed (Figs. 7a–c).
Case 2
The same patient had a fistula
in the buccal area at the furcation
level of his mandibular molar, resulting from occlusal contacts
being too high and not being ad-
1
2
Case 1—Fig. 1: Pre-op radiograph, showing a very complex root canal system and a calcified pulp chamber.
Fig. 2: Horizontal cross section taken from the i-CAT scan (DEXIS) showing total calcification of the root canal orifice at the level
of the cemento-enamel junction, in comparison with the first molar.
▶ Page A3
3
Fig. 3: Endodontic mode in DTX Studio Clinic tracing the anatomy of the canals and providing an approximate working length in different colours for each canal. Four separate roots are shown.
4
Fig. 4: 3D reconstruction of the canals in different colours, showing the detailed length segment by segment for each canal.
[3] =>
DTMEA_No.3. Vol.13_ET.indd
ENDO TRIBUNE
A3
Endo Tribune Middle East & Africa Edition | 03/2023
◀ Page A2
justed after placing the inlay on the
maxillary molar (Fig. 8). This had
caused activation of substance P
that then created the calcification
in the maxillary molar and the irreversible inflammation of the mandibular molar— micro-trauma effects.
Using the endodontic mode in
DTX Studio Clinic (Fig. 9), each slide
and cut were examined, searching
for the reason for the fistula of the
mandibular molar. A possible cause
of the fistula may have been the
complex of lateral canals seen in
the coronal part of the distal root
(Fig. 10). Root canal therapy was
initiated using the Traverse and
ZenFlex files in the same sequence
as that used for Case 1, and 3D obturation with elements IC was performed (Fig. 11).
5
6
Fig. 5: The Sleiman sequence of shaping using the Traverse and ZenFlex files. Fig. 6: Elements IC for obturation with the continuous wave compaction technique and backfilling.
7a
7b
7c
8a
8b
Figs. 7a–c: Immediate post-op radiographs showing 3D filling of the root canal system at different angulations. Case 2—Figs. 8a & b: Pre-op radiograph showing the calcified pulp chamber and radiolucency in the
furcation area (a). The fistula facing the coronal part of the root canal (b).
Case 3
The third case highlights the artificial intelligence incorporated
into DTX Studio Clinic, one feature
of which is automatic tracing of the
mandibular canal. In this case, it
was a very helpful feature to have.
The patient was suffering from irreversible pulpitis of a mandibular
third molar. He wanted to save the
tooth at any cost because did not
want to have an implant (the molar
was an abutment tooth for a
bridge). The radiograph showed
the roots of the molar overlapping
the mandibular canal (Fig. 12). A 3D
radiograph was taken, and on this,
the software traced the mandibular
canal over- lapping the molar in the
panoramic view. The endodontic
mode revealed that the canal bypassed the buccal area, slightly
touching the mesiobuccal canal
(Figs. 13–15). The radiograph taken
immediately after the root canal
therapy, performed through the
crown, showed complete obturation of all the canals (Fig. 16).
Conclusion
Using digital imaging software
can significantly improve the outcome of root canal therapy by providing
additional
information
about the complex anatomy of the
root canal system. Modern dental
imaging software such as DTX
Studio Clinic allows visualisation of
the complexity of the root canal
system with great accuracy—I liken
it to a map which I can follow during
treatment. This map makes endodontic treatment more predictable and effective.
Editorial Note: This article was
published in roots international
magazine of endodontics vol. 19,
issue 1/2023.
9
10
11a
11b
Fig. 9: Endodontic mode in DTX Studio Clinic in different sections for analysis of the case. Fig. 10: Horizontal view of just 0.5 mm in thickness showing a complex system of
lateral canals in the coronal part of the distal canal. Figs. 11a & b: Bone reconstruction with DTX Studio Clinic showing a bone defect in the coronal area (a). Immediate
post-op radiograph showing the lateral canals filled in the coronal part of the distal canal (b).
▶ Page A4
[4] =>
DTMEA_No.3. Vol.13_ET.indd
ENDO TRIBUNE
A4
Endo Tribune Middle East & Africa Edition | 03/2023
◀ Page A3
Prof. Adj. Philippe Sleiman
is an assistant professor at
the Faculty of Dental Medicine of the Lebanese University in Beirut in Lebanon and
an adjunct professor at the
Adams School of Dentistry of
the University of North Carolina at Chapel Hill in the US. He can be contacted at
profsleiman@gmail.com.
12
13
15
14
16
Case 3—Fig. 12: Pre-op radiograph, showing the intimate relationship between the mandibular canal and the molar. Fig. 13: Tracing of the trajectory of the mandibular canal. Fig. 14: Endodontic mode of DTX Studio
Clinic showing different sections of the area and the relation between the mandibular canal, traced by the software, and the roots of the molar. Fig. 15: 3D reconstruction showing that the nerve bypassed the buccal
area and only touched the middle part of the mesial canal. Fig. 16: Immediate post-op radiograph.
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DTMEA_No.3. Vol.13_ET.indd
ENDO TRIBUNE
A5
Endo Tribune Middle East & Africa Edition | 03/2023
A new endo-resto approach in
digital dentistry
By Dr Simona Chirico, Prof
Massimo Mario Gagliani, Italy
Introduction
The endodontic treatment of
severely compromised teeth and
their restoration represent an everyday challenge in the clinical
dental practice. The advent of increasingly high-performance endodontic instruments, CAD/CAM
technologies by chairside systems
and the related materials drastically reduced the rehabilitation
times of these teeth, allowing the
treatments to be performed in a
single visit.
This procedure might be an interesting alternative to the usual
one; it discloses a new way of thinking in which restorative preparation and digital impression, has
made before the endodontic treatment; in fact, right after a complete
removal of carious tissues or damaged restorations, the clinician
should orient the whole preparation, except the access cavity, to
seal dentin and prepare the tooth
for the indirect restoration. At the
end of this phase a digital impression should be taken and addressed to the milling procedure;
during this period the root canal
treatment might be accomplished
and, at the end, the restoration
could be cemented, sometimes
without removing the rubber dam.
Inclusions criteria consist in:
•
Carious lesions with pulp involvement (need endodontic
treatment);
•
•
•
•
Carious lesions that have
caused the loss of at least one
cusp (need indirect restoration);
Inappropriate
endodontic
treatment (need endodontic
retreatment);
Presence of apical lesions
(need endodontic treatment/
retreatment)
Willingness of the patient to
undergo a long appointment;
Exclusions criteria consist in:
•
Invasion of the supracrestal
attachment during the margins preparation;
•
Acute or chronic periapical abscess;
•
Temporomandibular
disorders (TMD);
•
Vertical root fracture
The potential advantages of this
procedure should be summarized:
•
Immediate Dentin Sealing before theusage of irrigating
solutions might guarantee a
better sealing by the adhesive
systems
•
The access cavity might be
better controlled during the
shaping and sealing steps
•
Adverse effects on adhesion
process generated by any kind
of sealer might be avoided
•
The single visit procedure reduces time for patient and clinician
•
In a single visit procedure, the
restoration might enhance the
overall sealing of the endodontic space
The use of COLTENE endodontic instruments, which have features suitable for this procedure, is
clearly recommended to obtain a
conservative shaping of the root
canal system.
The use of the resin composite
CAD/ CAM block BRILLIANT Crios,
as a material for partial indirect restorations, guarantee excellent performances both for mechanical resistance and aesthetics, with the integration of this with the surrounding tissues.
The luting of the restorations
can be accomplished either with
the BRILLIANT EverGlow composite
in a paste or flow composition,
making the steps of removing the
material and its polymerization
easier.
Case 1
A female 38-year-old patient
had an emergency appointment
due to pain and high sensitivity of
heat and cold in the fourth quadrant. After carrying out the physical
and radiographic examination, the
presence of a large carious lesion
with pulp involvement first lower
molar, which had an old composite
restoration, was clinically and radiographically assessed. A poor
oral hygiene and gingivitis in the
acute phase was also detected
(Figs. 1, 2). Since the patient was
pregnant and would have given
birth after 3 weeks, a single session
procedure was encouraged and the
new protocol "endo-resto approach in digital dentistry" was
chosen.
Fig. 1: Radiographic evaluation of
tooth 46
Phase 1
Isolation and cavity preparation
After applying the rubber dam
to isolate the fourth quadrant, the
removal of the old restoration to
evaluate the extent of the carious
extension
was
accomplished
(Fig. 3). Later a full toilette of the
dentine was completed, the margin
relocation performed and the cavity refined for proceed with the
endodontic treatment (Fig. 4). All
the margins were perfectly visible
and the contour of the future endocrown should not be modified by
the root canal treatment procedures. The root canal system at this
time should be already prepared
(Fig. 4).
Phase 2 – Impression
In this case, to give a little rest
to the patient, the rubber dam was
removed but most of the time it
should be left in place during the
digital impression procedure.
A part of teflon was placed in
the bottom of the pulp chamber,
for a height of about 1.5 mm. This
tool was used to simulate the subsequent covering of the floor with
the flow, after finishing the endodontic treatment. Once the correctness of the canal closure was
verified, the chair-side digital protocol started with the use of CEREC
Primescan. After selecting the
tooth (46), the type of restoration
(inlay/onlay) and the material to be
used (Coltene - BRILLIANT Crios),
the impressions of the upper and
lower hemiarchs and the bite were
recorded (Figs. 5-7).
Fig. 2: Clinical evaluation of tooth 46
In this way the milling machine
was able to produce the endocrown, during the execution of the
endodontic treatment.
Once this procedure was completed, the margin preparation of
46 was drawn (Fig. 8), ready to be
restored with an endocrown, and
the final project previewed (Fig. 9).
When everything was finished, the
process continued with the milling
of the BRILLIANT Crios A2 HT composite block (Figs. 10, 11).
Phase 3
Endodontic treatment
The root canal shaping was carried out with the Hyflex EDM instruments - Shaping set medium
25 mm, alternating the use of
CanalPro sodium hypochlorite at
each step (Figs. 12, 13). After completing the root canal instrumentation and drying the canals using
Paper Points Greater Taper .04
COLTENE paper cones, GuttaFlow
bioseal root canal cement was applied and closed by vertical hot
condensation with Hyflex EDM
Gutta-percha points (Figs. 14-16).
▶ Page A6
Fig. 3: Initial removal of the old restoration on tooth 46 to assess
the extent of the carious lesion.
Fig. 4: Tooth 46 with completed and finished cavity.
Fig. 5: Digital impression (lower hemiarch).
Fig. 6: Digital impression (upper hemiarch).
Fig. 7: Digital impression (buccal bite).
Fig. 8: Drawing of the preparation margin to accommodate the endocrown.
Fig. 9: Preview of the endocrown of 46.
Fig. 10: Preview of the milling phase.
Fig. 11: BRILLIANT Crios A2 HT block.
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DTMEA_No.3. Vol.13_ET.indd
ENDO TRIBUNE
A6
Endo Tribune Middle East & Africa Edition | 03/2023
◀ Page A5
Phase 4 – Restoration
After the endodontic treatment
(Fig. 17), a layer of BRILLIANT EverGlow Flow (Fig. 18) was applied to
the bottom of the pulp chamber
(Fig. 19). Once the milling of the
block was completed (working time
about 9 minutes), a try-in check was
done. Afterwards, the endocrown
was finished and polished (Figs. 20,
21). We continued with the conditioning phases of the restoration,
carrying out, in the order: sandblasting (Fig. 22), application of the
adhesive ONE COAT 7 UNIVERSAL
(Fig. 23).
After applying the rubber dam
again, isolating the fourth quadrant, the conditioning of tooth 46
was performed: etching (Fig. 24),
ONE COAT 7 UNIVERSAL adhesive
(Figs. 25, 26).
At this point, the luting of the
endocrown took place using the
heated composite BRILLIANT EverGlow A2/B2 (Figs. 27, 28). After removing all the excesses, the polymerization took place for a time of
90 seconds per surface (occlusal,
buccal, lingual). Post luting polishing was performed using the DIATECH
ShapeGuard
Composite
Polisher Kit (Figs. 29, 30).
After removing the rubber
dam, a post-luting clinical check of
the endocrown was performed
(Fig. 31). The execution time of this
new protocol “endo-resto approach in digital dentistry” was
2 hours and 30 minutes.
Ten days after the endo-resto
treatment, the patient will undergo
a clinical and radiographic evaluation to assess the integration of the
restoration with the surrounding
tissues. (Figs. 32, 33).
Case 2
A male 62-year-old patient had
an emergency appointment due to
pain and high sensitivity of heat and
cold in the third quadrant. After carrying out the physical and radiographic examination, the presence
of a large carious lesion with pulp
involvement first lower molar, which
had an old amalgam restoration,
was clinically and radiographically
assessed (Figs. 34, 35). The patient
was offered to treat this tooth in a
single visit with the new protocol
"endo-resto approach in digital
dentistry”, which he accepted.
Phase 1
Initial digital impression
The session began immediately
with the digital impression, concerning the left lower arch, the
upper one and the buccal bite
(Figs. 36-38). It is important to start
with the impression because, after
having prepared the tooth under
the rubber dam and recorded the
new impression, the software is
able to match and recognize the
two components.
Phase 2
Isolation und preparation
After applying the rubber dam
to isolate the third quadrant
(Fig. 39), the amalgam was removed and the mesial margin was
relocated. Then, the cavity was prepared, according to the endocrown, and the pulp chamber was
opened according to the endodontic treatment (Fig. 40).
Phase 3 – Final digital impression and procedures
Before the digital impression,
teflon was applied on the pulp
floor, with the aim of simulating the
thickness of the subsequent layer
▶ Page A7
Fig. 12: Hyflex EDM files.
Fig. 13: CanalPro (NaOCl 3 %).
Fig. 16: HyFlex EDM Guttapercha Points.
Fig. 17: Endodontic treatment completed.
Fig. 18: BRILLIANT EverGlow Flow.
Fig. 19: Layer of flow applied to the bottom of pulp chamber.
Fig. 20: Resin composite endocrown at the end of characterization
and polishing.
Fig. 21: Resin composite endocrown at the end of characterization
and polishing.
Fig. 22: Sandblasting.
Fig. 23: Application of adhesive ONE COAT 7 UNIVERSAL.
Fig. 24: Etching.
Fig. 25: Application of the universal adhesive.
Fig. 26: ONE COAT 7 UNIVERSAL.
Fig. 27: BRILLIANT EverGlow A2/B2.
Fig. 28: Luting of the endocrown.
Fig. 29: DIATECH ShapeGuard Polishers.
Fig. 30: Endocrown after polishing and finishing.
Fig. 14: ROEKO Paper Points
Greater Taper 0.04.
Fig. 15: GuttaFlow bioseal.
[7] =>
DTMEA_No.3. Vol.13_ET.indd
ENDO TRIBUNE
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Endo Tribune Middle East & Africa Edition | 03/2023
◀ Page A6
Fig. 31: Clinical view of the endocrown of 46, after removing the
rubber dam.
Fig. 32: Clinical evaluation of endocrown integration.
Fig. 33: Radiographic evaluation of the integration of the restoration and endodontic treatment.
Fig. 34: Clinical evaluation of tooth 36.
Fig. 35: Radiographic evaluation of tooth 36.
Fig. 36: Digital impression (mandibular arch).
Fig. 37: Digital impression (maxillary arch).
Fig. 38: Digital impression (buccal bite).
Fig. 39: Isolation of the third quadrant.
Fig. 40: Tooth 36 after cavity preparation and removal of the pulp.
Fig. 41: With the use of a probe, the thickness of the teflon was measured, which must be between 1 and 2 mm, in order to emulate the
flow layer after the endodontic treatment.
Fig. 42: Applied teflon.
Fig. 43: Digital impression of tooth 36 after the application of rubber dam and cavity preparation.
Fig. 44: Drawing of the dental preparation margin to accommodate
the endocrown.
Fig. 45: Preview of the endocrown of 46.
Fig. 46: Preview of the milling phase.
Fig. 47: BRILLIANT Crios A2 HT block.
Fig. 48: Hyflex EDM files.
Fig. 49: CanalPro (NaOCl 3%).
Fig. 51: GuttaFlow bioseal.
Fig. 52: HyFlex EDM Guttapercha Points.
Fig. 50: ROEKO Paper Points
Greater Taper 0.04.
▶ Page A8
[8] =>
DTMEA_No.3. Vol.13_ET.indd
ENDO TRIBUNE
A8
Endo Tribune Middle East & Africa Edition | 03/2023
◀ Page A7
Fig. 53: Endodontic treatment completed.
Fig. 54: BRILLIANT EverGlow Flow.
Fig. 55: Layer of flow applied to the bottom of pulp chamber.
Fig. 56: Resin composite endocrown after characterization and polishing.
Fig. 57: Resin composite endocrown after characterization and polishing.
Fig. 58: Sandblasting.
Fig. 59: Application of ONE COAT 7 UNIVERSAL.
Fig. 60: Application of the universal adhesive.
Fig. 61: ONE COAT 7 UNIVERSAL.
Fig. 62: BRILLIANT EverGlow A2/B2.
Fig. 63: Luting of the endocrown.
Fig. 64: DIATECH ShapeGuard Polishers.
Fig. 65: Endocrown after polishing and finishing.
Fig. 66: Clinical evaluation of endocrown integration.
Fig. 67: Radiographic evaluation of the integration of the restoration and endodontic treatment.
of flow that will be applied at the
end of the endodontic treatment
(Figs. 41, 42).
Once the correctness of the
canal closure was verified, the
chair-side digital protocol continued. Tooth 36 was cut out from the
previous scan, and the preparation
under rubber dam was recorded,
with the adjacent teeth as reference (Fig. 43).
Once this procedure was completed, the margin preparation of
36 was drawn (Fig. 44), ready to be
restored with an endocrown, and
the final project previewed (Fig. 45).
When everything was finished,
I continued with the milling of the
BRILLIANT Crios A2 HT composite
block (Figs. 46, 47) and then the
endodontic treatment.
Phase 4
Endodontic treatment
The root canal shaping was carried out with the Hyflex EDM in-
struments - Shaping set medium
25 mm, alternating the use of
CanalPro sodium hypochlorite at
each step (Figs. 48, 49). After completing the root canal instrumentation and drying the canals using
Paper Points Greater Taper .04
COLTENE paper cones, GuttaFlow
bioseal root canal cement was applied and closed by vertical hot
condensation with Hyflex EDM
Gutta-percha points. (Figs. 50-52).
After the endodontic treatment
(Fig. 53), a layer of BRILLIANT
EverGlow Flow (Fig. 54) was applied
to the bottom of the pulp chamber
(Fig. 55).
Phase 4
Endcrown luting procedure
Once the milling of the block
was completed (working time
about 11 minutes), the endocrown
was tried in, finished and polished
(Figs. 56, 57). We continued with
the conditioning phases both of
the restoration and the tooth. For
the first one it consisted in: sandblasting (Fig. 58), application of the
universal adhesive ONE COAT 7
UNIVERSAL (Fig. 59). For the second one: etching, ONE COAT 7 UNIVERSAL adhesive (Figs. 60, 61).
At this point, the luting of the
endo-crown took place using the
heated
composite
BRILLIANT
EverGlow A2/B2 (Figs. 62, 63). After
removing all the excesses, the polymerization took place for a time
of 90 seconds per surface (occlusal,
buccal, lingual). Post luting polishing was performed using the DIATECH ShapeGuard Composite Kit
(Figs. 64, 65).
After removing the rubber
dam, a post-luting clinical and radiographic check of the endocrown
was performed (Figs. 66, 67). The
execution time of this new protocol
“endo-resto approach in digital
dentistry” was 2 hours and
20 minutes.
Dr Simona
Chirico
is a dentist who
graduated from
the University of
Milan in 2016
and later pursued a Master's
degree in Restorative and Aesthetic
Dentistry at the University of Bologna,
which she completed in 2021. She has
been actively involved in Restorative
Dentistry, Endodontics, and Digital
Dentistry since 2017, and currently runs
a private practice in Milan and Desio
(MB). Additionally, she serves as the
scientific coordinator for "Dentistry33 Edra".
Prof. Massimo
Gagliani
has been actively practicing
Restorative Dentistry and Endodontics
since
1990. He began
his career as a Researcher at the University of Milan in 1992 and was later
promoted to Associate Professor in the
same institution in 2000. He is a member of major international and national
societies for Restorative & Endodontics
and was one of the five founders of the
Digital Dental Academy (DDA). His research work has been widely published
in major international journals. Since
2014, he has served as the Scientific
Coordinator for Editorial Group Edra.
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