Endo Tribune Middle East & Africa No. 5, 2016
Endo meets 3D / “Find it - fix it - and leave it alone”
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www.dental-tribune.me
Published in Dubai
September-October 2016 | No. 5, Vol. 6
ENDO TRIBUNE
Endo Meets 3D
Dentsply Sirona Develops New 3D Endo Software for
Better,
Safer Middle
and Faster
The World’s Endodontic
Newspaper
East &Endodontics
Africa Edition
By Dentsply Sirona
Dentsply Sirona announces the introduction of another integrated
solution to the market: a new 3D imaging software to improve the planning and workflow of endodontic
procedures.
With the largest
research and development
platform in the industry, Dentsply
Sirona is committed to its mission
of empowering dental professionals
to provide better, safer, faster dental
care.
York/Salzburg:
Dentsply Sirona
has developed yet another innovation in endodontics: 3D Endo is
the first CBCT-based software that
enables endodontic treatments to
be preplanned and optimized on
the basis of imaging data from the
ORTHOPHOS units. This new advancement is also the first software
project to combine the know-how
and experience of Dentsply Sirona’s
market leading engineers, scientists
and software developers in both its
endodontics and digital radiography
units. Based on 3D data and its specific visualization, the practitioner
is able to case-specifically recognize
the demands on the root canal treatment tooth, analyze the natural
shape of the root canal and select the
appropriate files using the integrated file database. As a result, the endodontic treatment is more efficient
and safer, as well as with significantly
improved patient communication.
Since, with the help of a planning
report or demonstrative capabilities
directly in the software, the practitioner can clearly explain the initial
situation and the appropriate treatment to the patient. Dentsply Sirona
plans to introduce this software in
the coming months upon the receiving the necessary regulatory approval.
For years, Dentsply Sirona has been
collaborating and creating integrated solutions in the area of endodontics. Back in 2014, WAVEONE® by
Maillefer and RECIPROC® by VDW,
both leading reciprocal file systems,
were first integrated into the TENEO
treatment centers and more recently
into the SINIUS centers, which considerably improved the workflow of
the Endo function. Now, with new 3D
Endo software, Dentsply Sirona will
offer an even more comprehensive
integrated approach to endodontics
which will be available on the market
this fall.
“Dentsply Sirona is working to shape
the future of endodontics worldwide
by continuously striving for better
patient outcomes and by empowering dental professionals with worldclass innovative solutions, education
programs and clinical procedures.
This new software is yet another way
in which our platform will redefine
endodontic care for dental professionals and patients by setting new
treatment standards in efficacy, safety and simplicity,” says Dominique
Legros, Group Vice President, Dentsply Sirona Endodontics.
ÿPage 2
3D generation_
Long-term success
for your endodontic treatments
FKG Dentaire SA
www.fkg.ch
[2] =>
2
endo tribune
Dental Tribune Middle East & Africa Edition | 5/2016
◊Page 1
“Using our new software in combination with our ORTHOPHOS units
will provide practitioners the best
image quality at the lowest dose and
significantly improve their endodontic workflow. By working collaboratively with the Endodontics team,
we were able to best identify and address an unmet need and develop an
easy to use, integrated solution for
our customers,” says Dr Stefan Hehn,
Group Vice President, Dentsply Sirona Imaging.
Dentsply Sirona as The Dental Solutions Company
As a result of the recent merger,
Dentsply Sirona is the world’s largest
manufacturer of professional dental
products and technologies. As The
Dental Solutions Company, Dentsply Sirona’s comprehensive solutions
offering includes leading products
and brands across consumables,
equipment, technology and specialty products. With the broadest clini-
cal education platform and an unparalleled commitment to R&D in
dentistry, the company’s vision is to
deliver innovative dental solutions
to improve oral health worldwide.
“This new software collaboration is
further evidence that Dentsply Sirona is truly better together,” says
Jeffrey T. Slovin, CEO of Dentsply Sirona. “Our unrelenting commitment
to customers and to continuously introduce innovations and end-to-end
integrated solutions will drive better,
safer and faster dentistry around the
globe.”
“Find it, fix it, and leave it alone”
By Prof. Philippe Sleiman, Lebanon
This three-part principle, though
originating in the field of osteopathy,
can find great application in modern
endodontics, where we deal with
routine root canal treatment, as well
as with cases in which a patient is in
a compromised state of health for
which the solution may be a routine
root canal treatment, and anything
more than that would be overtreatment.
Initially, we need to find the problem,
by analysing the clinical situation
and identifying what is going wrong.
This task is truly difficult. Making the
correct diagnosis based on:
- the patient’s account; here, we need
to listen to our patient, to learn about
his or her local problem, where it is
located and what triggers it ·
- the patient’s history, that is overall
health, any diseases and/or conditions, systemic medication, etc.
- the proper use of the appropriate
diagnostic tools, including pulp testing, response to cold and hot, the bite
test, radiographs and CBCT scans;
additionally, the latest software can
help us in reading and analysing
the data that we have, including in
3-D—I recall the words of my radiology professor, reminding us to study
radiographs and be attentive to every small detail, not just look at them
- the logical connection between the
patient’s account and history, the
clinical findings and the imaging
data—sometimes, putting the pieces of the puzzle together can be fast;
sometimes, it may take longer.
Once the diagnosis has been established, the choice of treatment modality and selection of the best tools
to perform the treatment follow. At
this stage, focusing first and foremost on the patient’s health, it is important to choose the most effective
and efficient treatment that would
be as minimal as is practical and sufficient. The rest should be taken care
of by Mother Nature.
Case presentation
Case 1
The first case that I would like to pre-
Fig 5
sent was a referral patient. Sitting
back in the chair, the patient started
giving his account: over the previous
six months, he had twice travelled
to somewhere in Asia for surgery on
his left-sided submandibular lymph
nodes (Fig. 1), which had apparently
been swollen. Each time, pathology
tests were clear of any cancer-specific markers. CT scanning and conventional radiographic assessment
were conducted, with no findings
recorded.
Having shared this, the patient reported that he felt his lymph node
becoming swollen again, and he was
anxious about it. His account was
taken very seriously. Additionally, he
reported that two of his mandibular
premolars were aching, since root
canal treatments had been started at
a different clinic, but the dentist had
been unable to finish them. With the
patient’s permission, a new CBCT
scan was obtained, and I asked the
patient to wait for an hour to give me
time to study it.
Judging by the general view first and
then going into local details, I realised the two mandibular premolars
were indeed in need of endodontic
retreatment. However, knowing
from clinical experience that premolars may have various clinical manifestations, I continued looking for
other sources of potential problems,
but without disregarding the premolars as the culprits (Fig. 2).
Analysing the CBCT sections, trying
different filters and settings, looking at the mandibular molar with a
large filling, and studying the bone
around it, my eye caught something
unusual. There was a small abscess
migrating towards the internal angle
of the mandible (Fig. 2) and creating
an area of bone erosion (Fig. 3). This
could be the pathology causing the
patient’s suffering, in addition to the
two mandibular premolars.
At this point, one might be happy
with the diagnostic findings and race
to treat the problems affecting the
mandibular dentition. However, still
unsatisfied with the overall findings,
I turned to analysing the maxilla,
Fig 1
Fig 2
Fig 3
where I found that the second molar
had internal decay and cervical internal resorption, creating an infection
pathway into the maxillary sinus
(Fig. 4).
I explained the situation to the patient and proposed retreating the
two mandibular premolars, as well
as conducting primary root canal
treatment on the mandibular molar
and the maxillary molar. The patient
agreed, and the four treatments were
performed in one session, using the
TF Adaptive system (Kerr) for shaping and EndoVac (Kerr) for chemical
preparation according to the “A” sequence of irrigation protocol,2 followed by 3-D obturation of the root
canal system using the Elements Obturation Unit (Kerr; Fig. 5). Antibiotics were prescribed for the patient to
help his body combat the submandibular infection. Although I prescribe systemic antibacterial medication very rarely, I did so in this case
because it was not clear what had
happened with the lymph nodes and
if they were still functional based on
the immediate postoperative radiographs of the mandibular molar (Fig.
6) and the maxillary molar (Fig. 7). A
minor postoperative reaction (moderate pain, no swelling) was observed
and had completely resolved a week
later.
Fig 4
Case 2
The next clinical case is somewhat
similar and involved an extra-oral
sinus tract (Fig. 8). A middle-aged female patient was referred to the office with an extra-oral fistula in the
posterior submandibular area. According to the patient, she had had
no pain or swelling and the fistula
had appeared several weeks before
she presented to the clinic.
At first, she thought it was a skin
problem, but then realised that there
was pus draining and the opening
was growing larger. Upon consulting with a dermatologist, who said
the problem was most probably of
dental origin, the patient consulted
her dentist, who had previously
placed an implant for her. The dentist thought the infection was associated with her third molar and not the
implant, and suggested extraction of
the tooth. The patient wanted to retain the tooth and hence sought an
endodontic consultation regarding
this option.
A new CBCT scan (i-CAT, Imaging
Sciences International; Fig. 9) confirmed that the third molar had an
internal sinus tract, which had created the fistula. This could all be solved
by root canal treatment on the mo-
lar, followed by a crown and followup treatment, with a good prognosis
for overall long-term success. The
patient was happy to hear that and
requested treatment as soon as possible.
The root canal was treated (Fig. 10),
using the TF Adaptive system for
shaping and EndoVac for chemical preparation according to the “A”
sequence of irrigation protocol, followed by 3-D obturation of the root
canal system using the Elements
Obturation Unit (Fig. 5). Follow-up
records were taken (Figs. 11 & 12),
with radiographic control to check
for bone healing and external facial
photographs to compare. The patient was extremely satisfied that
her molar could be preserved.
Conclusion
These clinical examples illustrate
the importance of diagnosis as the
main piece of the puzzle the importance of “finding it”. Today, the stateof-the-art approach in endodontics
requires the use of sophisticated
equipment and software to complement the expertise and experience
ÿPage 3
[3] =>
3
endo tribune
Dental Tribune Middle East & Africa Edition | 5/2016
◊Page 2
Fig 9
Fig 6
Fig 10
Fig 7
Fig 8
Fig 11. 6 weeks later
of the operator. Only all this in con- Fixing the problem requires the
cert allows us to put the pieces of the most biological approach to root
puzzle together.
canal treatment, putting our clinical
The patient’s subjective account can experience to work to provide the
lead us or sometimes mislead us. best treatment for our patients. Once
We should keep in mind that most we are sure we have done the best we
of our patients do not know how can to eliminate all kinds of aggresanatomy works or that pain can be sive conditions and disease, we need
referred from a distant area in the to let nature take care of the healing
mouth. That is where the objective process.
history and adequate analysis of the
diagnostic and clinical findings lead The author would like to thank Yulia
the way.
Vorobyeva 1Sleiman,
interpreter
and
A5_EN_MEA_TF Adaptive ADV.pdf
25.07.16
14:30
C
M
Fig 12. 6 weeks later
translator, for her help with this article.
Prof. Philippe Sleiman is an endodontist at the Vilafortuny clinic and training centre in Dubai in the UAE, the
Advanced American Dental Center in Abu Dhabi in the
UAE and the American Dental Clinic in Dubai. He can be
contacted at profsleiman@gmail.com
References
[1] “Find it, fix it, and leave it alone”—
an axiom attributed to Dr Andrew
Taylor Still, the founder of osteopathy, and recorded by his students
and followers.
[2] Published earlier in Sleiman, P.,
“‘A’ sequence of irrigation”, Roots International, 1 (2014), 14–7.
.
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www.KerrDental.ae
K
TF Adaptive is the endodontics file system that adapts its movement
to give you more control during your procedure.
The Adaptive Motion Technology and the motor’s exclusive algorithm allow the instrument to switch between
reciprocation and rotation, depending on the amount of pressure placed on the file. Reducing the risks of file
breakage and apical extrusion, and improving your patients’ comfort.
To give you more confidence during your canal preparations.
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