Endo Tribune Middle East & Africa No. 3, 2024
Clinical Endodontics Symposium (CES) unveils speaker lineup for November event / A second chance
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DTMEA_No.3. Vol.14_ET.indd
PUBLISHED IN DUBAI
www.dental-tribune.me
Vol. 14, No. 3
Clinical Endodontics Symposium (CES)
unveils speaker lineup for November event
By CAPP Events & Training
CAPP Events & Training is thrilled
to introduce the Clinical Endodontics
Symposium (CES), a groundbreaking
addition to the CAD/CAM Digital &
Oral Facial Aesthetics 37th Dental
ConfEx. Taking place on 15-16 November, at the Madinat Jumeirah
Arena & Conference Center in Dubai,
CES promises an immersive experience for all attendees.
This symposium gathers leading
experts, researchers, and practi-
tioners to explore cutting-edge
techniques, technologies, and trends
shaping modern endodontic practices.
Expect a vibrant programme
filled with insightful presentations,
interactive discussions, and hands-on
workshops covering a wide range of
topics essential to contemporary
endodontic practice. From innovative root canal treatments to diagnostic tool advancements, CES will
delve deep into the forefront of endodontics.
Attendees will engage with likeminded individuals, share experiences, and stay ahead in this rapidly
evolving field.
Speaker Lineup:
•
Prof Federico Foschi (Ireland):
Modern Endodontics at a Glance
•
Dr Antonis Chaniotis (Greece):
Management of Splitting Root
Canal Systems
•
Prof Gianluca Gambarini (Italy):
Simplifying Endodontic Proce-
•
•
•
dures While Increasing Treatment Quality
Prof Damiano Pasqualini (Italy):
How to be Successful in Modern
Surgical Microendodontics
Dr Mohamad Zaafrany (Egypt):
Coming Soon
Hands-On Courses:
Dr Antonis Chaniotis (Greece):
Management of Root Canal
Blockage and Apical Periodontitis
•
Prof Damiano Pasqualini (Italy):
Modern Surgical Microendodontics
For registration and more information, visit www.cappmea.com/
clinicalendo-2024.
CAPP Events & Training
Web: www.cappmea.com/confex2024
Mob: +971502793711
E-mail: events@cappmea.com
AD
THE
RACE
ACE
LEGACY
SAFE. EFFICIENT. SOFT CONTROL.
www.fkg.ch/race-evo
[2] =>
DTMEA_No.3. Vol.14_ET.indd
CASE REPORT
A2
Endo Tribune Middle East & Africa Edition | 03/2024
A second chance
By Dr Philippe Sleiman,
Lebanon
Introduction
As dentists, we frequently encounter the need to reevaluate previous root canal treatments. This
necessity may arise due to issues
such as coronal leakage or inadequate prior procedures. Fortunately, our immune system plays a
crucial role in maintaining a delicate balance against bacterial aggression. Sometimes, this balance
remains undisturbed, bacterial activity being confined to the apical
area and there being no visible
symptoms. However, a decline in
our immune response or changes
in dental restorations, such as fillings or crowns, can disrupt this
equilibrium, leading to clinical
manifestations.
True endodontic retreatment
presents various challenges, depending on factors such as the
quality of the initial treatment, the
materials used for obturation, the
presence of ledges or separated instruments, intricate root canal
anatomy, and the use of fibre-reinforced or metal posts. When approaching retreatment, it is helpful
to divide the process into stages,
addressing each challenge systematically from the coronal portion
towards the apex. By tackling obstacles individually, we can effectively manage the procedure, ensuring all aspects are addressed
and our ultimate goal is achieved. If
a metal or fibre-reinforced post is
present, careful consideration must
be given to the remaining thickness
of the dentinal walls. Ultrasonic instruments are invaluable for removing hard materials, and in
high-risk scenarios, microsurgery
may be warranted.
In this article, I will focus on a
simplified technique for removing
gutta-percha, utilising nickel–titanium rotary files and demonstrate
by way of clinical cases. Additionally, I will discuss the limitations of
this approach and when it is necessary to employ alternative techniques based on specific obstacles
encountered during retreatment.
For retreatment, I utilise the
Traverse and ZenFlex files (Kerr
Dental). Specifically, I employ the
4
25/.08 Traverse orifice opener of 17
mm in length, alongside the 35/.06,
30/.06 and 25/.06 ZenFlex files
(Fig. 1). These files boast a unique
variable heat treatment, sharp cutting edges and a design of the
flutes, making them ideal for both
initial endodontic procedures and
retreatment.
In a step-by-step approach, this
sequence is designed for the removal of previous gutta-percha
from within the root canal. Firstly,
using the 25/.08 Traverse file at a
speed of 800 rpm, a small pecking
motion is applied. Typically, two or
three motions are sufficient to establish an entry point and remove
the coronal portion of the gutta-percha. The file is allowed to
reach its maximum depth without
additional pressure. Subsequently,
the 35/.06 ZenFlex file is employed,
following the same gentle picking
motion. Each movement extends
2–3 mm, lasts only a couple of seconds and is repeated around three
times.
The 35/.06 file is succeeded by
the 30/.06 file and, if necessary, the
25/.06 file to ensure complete removal of gutta-percha from the
canal. Should an obstacle be encountered, particularly in mesial
canals with severe curvatures,
switching to the 4% taper ZenFlex
files is advised. The same crowndown technique and file sizes are
maintained throughout the procedure. I employ a comprehensive sequence of irrigation, which has
been previously published.1
Case 1
The patient was referred owing
to discomfort of his mandibular
teeth that had started to become
painful and develop throbbing
pain. Upon clinical and radiographic examination, the patient
was advised that the problem concerned a mandibular first molar
and premolar. The previous root
canal therapy had not been up to
standard and appeared to have involved single cone obturation (Fig.
2). The patient was presented with
a treatment plan that included retreatment of both the premolar
and molar and eventually the replacement of both crowns.
1a
1b
1c
1d
Figs. 1a–d: Retreatment sequence. 25/.08 Traverse file (a). 35/.06 ZenFlex file (b). 30/.06 ZenFlex file (c). 25/.06 ZenFlex file (d).
I proceeded through the
crowns for both teeth in the same
session. As described earlier, I used
the 25/.08 Traverse file (17 mm in
length) and followed with the
35/.06, 30/.06 and 25/.06 ZenFlex
files up to the working length. In
this case, I added the 35/.04
ZenFlex file as an apical enlargement file. 3D obturation was done
using the elements IC (Kerr Dental)
for both teeth.
A year later, I recalled the patient for follow-up (Fig. 3). I observed that the healing of both
teeth was almost complete, showing beautiful root canal system obturation and multiple exits. The
crown on the molar had been replaced, but unfortunately the
crown on the premolar had not and
exhibited some kind of internal
build-up. I advised the patient that
2
this might risk the success of the
treatment for the premolar.
Case 2
The patient was referred for retreatment of a first mandibular
molar. The initial radiograph
showed a cast metal post in the distal canal, a separated instrument in
one of the mesial canals and a ra-
3
Case 1—Fig. 2: Initial periapical radiograph. Fig. 3: One-year follow-up periapical radiograph.
5
Case 2—Fig. 4: Initial periapical radiograph. Fig. 5: Immediate post-op periapical radiograph. Fig. 6: One-year follow-up periapical radiograph
6
► Page A3
[3] =>
DTMEA_No.3. Vol.14_ET.indd
CASE REPORT
A3
Endo Tribune Middle East & Africa Edition | 03/2024
◄ Page A2
9
7
Case 3—Fig. 7: Initial periapical radiograph.
10
Fig. 9: Immediate post-op periapical radiograph. Fig. 10: One-year follow-up
periapical radiograph.
8
11
Fig. 8: Pre-op CBCT scan.
Fig. 11: Eighteen-month follow-up periapical radiograph.
diolucency at the apex (Fig. 4). The
patient was informed that in order
to retreat his molar, I would need to
remove his old crown and the metal
post to give me access to the root
canals to retreat them and that the
alternative would be microsurgery
on the mesial root, but this would
require that I cut a long section of
the root in order to achieve a hermetic seal inside the canal because
of the separated file and the part of
the canal that had not been treated.
The patient opted for the first
choice.
The first steps were cutting the
crown and removing it and then
proceeding with a delicate cutting
of the metal post piece by piece
and vibration with ultrasonics for
safe removal. This gave me access
to the gutta-percha under it. I used
the same sequence of Traverse and
ZenFlex files, and in the distal root
and mesiobuccal root, I managed
to go all the way to the working
length, but in the mesiolingual
canal, I stopped where the separated file was located. Here I used
#6, 8, 10 and 15 K-files in order to
bypass the file and was fortunate to
be able to retrieve it from inside the
curvature. Full cleaning and shaping were performed, followed by
3D obturation with the elements IC
(Fig. 5). The one-year follow-up
showed great healing (Fig. 6).
Case 3
The last case I would like to discuss in this article has been one of
my most challenging retreatments.
The patient was referred from
abroad for retreatment of a maxillary molar, as she insisted on saving
her tooth. From the radiograph, I
could clearly see a separated instrument in the mesial root, but the
anatomy was very suspicious
(Fig. 7). Looking at the CBCT scan
given to me by the patient—for
which I would have preferred a
higher resolution—I observed
three different exits for the mesial
root and a very unusual anatomy
(Fig. 8). Studying the whole case, I
also saw a ramification on the palatal root in the apical area. I explained to the patient that I would
do my best to save her tooth. I used
the same sequence of Traverse and
ZenFlex files in the distal and palatal canals up to the full working
length, and for the mesial root, I
reached the separated file and
began the very delicate task of bypassing the separated file and negotiating the very complex root
canal system. The immediate postoperative radiograph showing the
3D obturation of the mesial complex and the palatal ramification
was most satisfying (Fig. 9). Radiographs taken at the one-year (Fig.
10) and 18-month follow-ups (Fig.
11) showed good healing. Radiographs taken at different angulations showed the complexity of the
mesial root.
Conclusion
In conclusion, opting for a second chance in treatment is always
preferable. Understanding the potential and limitations of our tools
and abilities is crucial for achieving
success.
References
1. Wang HH, Sanabria-Liviac D,
Sleiman P, Dorn SO, Jaramillo DE.
Smear layer and debris removal from
dentinal tubules using different irrigation protocols: scanning electron microscopic evaluation, an in vitro study.
Evidence-Based Endodontics 2017; 2:5.
Editorial note: This article was first
published in roots international magazine of endodontics, Vol. 20, Issue
1/2024.
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.
[4] =>
DTMEA_No.3. Vol.14_ET.indd
SINGAPORE
SAVETHEDATE
29-30 AUGUST 2025
Organiser
Co-Organiser
www.capp-asia.com
JOIN US IN MARINA BAY SANDS
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