Endo Tribune U.S. No. 7, 2011
Case study: Retreatment of a lower molar / Products
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[1] =>
ENDO TRIBUNE
The World’s Endodontic Newspaper · U.S. Edition
July 2011
www.endo-tribune.com
Vol. 6, No. 7
Case study: Retreatment
of a lower molar
By Konstantinos Kalogeropoulos, DDS
Endodontics is all about preserving the natural dentition. There is
no better implant than the natural
tooth, given the fact that it can be
treated and restored effectively and
predictably. Many factors, such as
root perforation, affect the prognosis
of endodontic treatment.1
Today, perforations can be managed predictably with the use of MTA
cement as sealing material.2
The purpose of this article is to
illustrate the endodontic retreatment
of a mandibular first molar with perforation in the coronal third of the
mesiolingual root canal, aided by the
use of magnification provided by the
dental operating microscope (OM).
Case report
A 61-year-old male patient, with a
non-contributory medical history,
was referred by a general dentist
for retreatment of a mandibular first
molar. The tooth was tender to percussion. Periapical radiolucency was
evident in both roots and the furcation area.
A previous root canal treatment
had been performed more than 10
years ago. The canal filling was short
in length and the remains of a screw
post were present in the mesiolingual
canal (Figs. 1, 2). The treatment plan
was to restore the tooth with a cast
dowel and porcelain-fused-to-metal
(PFM) crown.
After local anesthesia had been
administered, a rubber dam was
placed and the temporary filling
removed. The fragmented post was
removed by means of ultrasonic tips
under magnification (G6, Global Surgical). Owing to the vicinity of the post
to the furcation, care was taken not to
remove dentin distal to the post.
The root-filling material apical of
the post and from the orifices of the
other root canals was also removed
with ultrasonic tips. Observation
under high magnification revealed
a small perforation of the root canal
wall where the post was placed (Fig.
3). The patient and the referring
dentist were informed that the tooth
was to be retreated and the perforag ET page 2B
Fig. 1
Fig. 2
Fig. 3
Fig. 5
Fig. 4
Fig. 6
[2] =>
2B
Clinical
Endo Tribune | July 2011
ENDO TRIBUNE
f ET page 1B
tion defect sealed with MTA cement
(DENTSPLY Maillefer).
A copious amount of irrigation (2.5
percent NaClO) was used throughout
the treatment. The root canals were
flared with a combination of GatesGlidden burs and rotary NiTi instruments. Under high magnification, an
additional root canal space was found
in the distal root (Fig. 4). Remnants of
the previous root canal filling material were removed with a combination
of hand files and rotary instruments,
and patency was achieved with small
stainless-steel hand files. Working
length was calculated with an apex
locator (Root ZX mini, J. Morita) and
PathFile (DENTSPLY Maillefer) rotary instruments were used for preflaring.
The mesial root canals were
instrumented to 40/.04 and the distal to 50/.04 with rotary instruments
(BioRace, FKG). The smear layer was
removed through one-minute irrigation with 17 percent EDTA (Ultradent). Passive ultrasonic irrigation
was performed with 2.5 percent
NaClO and ESI needles (EMS), three
times for one minute each in every
canal.
The canals were dried and
Ca(OH)2 was placed with a Lentulo
spiral (DENTSPLY Maillefer) as an
intra-canal medicament. Cavit G (3M
ESPE) was used as temporary filling
material. The patient was given oral
and written post-operative instructions and was told to return after 15
days.
At the second appointment, the
anti-microbial irrigation regimen was
repeated and the canals were dried
with sterile paper points. Gutta-percha points were placed in the canals
and a master-cone radiograph was
taken (Fig. 5). The sealer used was
AH Plus (DENTSPLY DeTrey). The
continuous wave of condensation
technique was applied during obturation with System B (SybronEndo)
at 4 mm from the apical terminus of
the canal, and back-filling was done
with thermo-plasticised gutta-percha
using the Obtura III Max (Obtura
Spartan).
Care was taken not to accidentally push sealer into the perforation
site. The mesiolingual root canal was
back-filled to a level apical of the
perforation (Fig. 6). After obturation,
white MTA, delivered with the MTA
gun (both DENTSPLY Maillefer), was
used to seal the perforation site.
As requested by the referring den-
Tell us
what
you
think!
The World’s Endodontic Newspaper · U.S. Edition
Publisher & Chairman
Torsten R. Oemus
t.oemus@dental-tribune.com
Chief Operations Officer
Eric Seid
e.seid@dental-tribune.com
Group Editor & Designer
Robin Goodman
r.goodman@dental-tribune.com
Editor in Chief Endo Tribune
Frederic Barnett, DMD
BarnettF@einstein.edu
International Editor Endo Tribune
Prof. Dr. Arnaldo Castellucci
Fig. 7
Fig. 8
tist, no post space was left in the
distal root canal, as he wished to create his own space to place an intraradicular post (Fig. 7). Cavit-G was
used as temporary filling material.
The patient was referred back to the
dentist for the final restoration and
was told to return after a six-month
period for a recall examination.
At the recall appointment seven
months later, the radiograph showed
no evident radiolucency in the periradicular tissues of the tooth (Fig.
8). However, it also revealed that the
new post had not been placed at the
adequate length. The general dentist
was contacted and reassured me that
a new dowel and PFM crown would
be placed.
terials have not yet been proven to
enhance overall success rates in endodontics.3 Root perforations can affect
prognosis in a negative way.1 Nevertheless, the OM allows clinicians to
work with great precision even under
the most demanding circumstances,4
and MTA greatly enhances success
when treating perforations in the furcal area.2
In addition, the use of ultrasonics
under magnification facilitated the
removal of the post despite its small
size. Passive ultrasonic irrigation
removed debris and necrotic tissue
effectively from the mesial isthmus
area, allowing obturation material to
fill it, as can be observed in the final
X-ray (Fig. 8). ET
Conclusion
A complete list of references is available from the publisher.
Advances in technology and bioma-
ET About the author
Dr. Konstantinos Kalogeropoulos is a
post-graduate endodontics resident at
the University of Athens Dental School.
He has published in national and international scientific journals and presented a large number of oral presentations
and posters at endodontic congresses.
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dental-tribune.com
Online Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Account Manager
Humberto Estrada
h.estrada@dental-tribune.com
Marketing Manager
Anna Wlodarczyk-Kataoka
a.wlodarczyk@dental-tribune.com
Marketing & Sales Assistant
Lorrie Young
l.young@dental-tribune.com
C.E. Manager
Julia Wehkamp
j.wehkamp@dental-tribune.com
International C.E. Sales Manager
Christiane Ferret
c.ferret@dtstudyclub.com
Dental Tribune America, LLC
116 W. 23rd St., Suite #500
New York, NY 10011
Tel.: (212) 244-7181
Fax: (212) 244-7185
Published by Dental Tribune America
© 2011 Dental Tribune America.
All rights reserved.
Dental Tribune America makes every effort
to report clinical information and manufacturer’s product news accurately, but cannot
assume responsibility for the validity of product claims, or for typographical errors. The
publishers also do not assume responsibility
for product names or claims, or statements
made by advertisers. Opinions expressed by
authors are their own and may not reflect
those of Dental Tribune America.
info@athensendo.gr
www.athensendo.gr
Dr. Konstantinos Kalogeropoulos
73–75 Deinokratous Str.
11521 Kolonaki
Athens
Greece
Do you have general comments or criticism
you would like to share? Is there a particular topic you would like to see more articles
about? Let us know by e-mailing us at
feedback@dental-tribune.com. If you would
like to make any change to your subscription
(name, address or to opt out) please send us an
e-mail at database@dental-tribune.com and
be sure to include which publication you are
referring to. Also, please note that subscription
changes can take up to six weeks to process.
Managing Editor/Designer
Implant, Endo & CAD/CAM Tribunes
Sierra Rendon
s.rendon@dental-tribune.com
Editorial Advisory Board
ET
Corrections
Endo Tribune strives to
maintain the utmost accuracy in its news and clinical reports. If you find
a factual error or content that requires clarification, please report the
details to Managing Editor
Sierra Rendon at s.rendon@
dental-tribune.com.
Frederic Barnett, DMD (Editor in Chief)
Roman Borczyk, DDS
L. Stephen Buchanan, DDS, FICD, FACD
Gary B. Carr, DDS
Prof. Dr. Arnaldo Castellucci
Joseph S. Dovgan, DDS, MS, PC
Unni Endal, DDS
Fernando Goldberg, DDS, PhD
Vladimir Gorokhovsky, PhD
Fabio G.M. Gorni, DDS
James L. Gutmann, DDS, PhD (honoris causa),
Cert Endo, FACD, FICD, FADI
William “Ben” Johnson, DDS
Kenneth Koch, DMD
Sergio Kuttler, DDS
John T. McSpadden, DDS
Richard E. Mounce, DDS, PC
John Nusstein, DDS, MS
Ove A. Peters, PD Dr. med dent., MS, FICD
David B. Rosenberg, DDS
Dr. Clifford J. Ruddle, DDS, FACD, FICD
William P. Saunders, Phd, BDS, FDS, RCS Edin
Kenneth S. Serota, DDS, MMSc
Asgeir Sigurdsson, DDS
Yoshitsugu Terauchi, DDS
John D. West, DDS, MSD
[3] =>
Products 3B
ENDO Tribune | July 2011
Roydent Dental
announces launch
of 2Seal easymiX
Roydent
Dental
Products
announced recently the release of
2Seal easymiX Root Canal Sealer.
2Seal easymiX is an easy-to-use,
auto-mix epoxy resin sealer. The
double chamber syringe guarantees a consistent, ideal mix ratio
with less waste.
“We are excited to offer this
solution to our customers,” said
Nancy Connor, Roydent’s sales
and marketing manager. “2Seal
easymiX is a safe and ideal way
for doctors to achieve one-handed
dispensing and precise placement
in the canal. It is also extremely
radiopaque and biocompatible.”
This sealer is so versatile it may
be used with any obturation method
— warm, heated or cold techniques,
the company says.
Additionally, the new mix tip
is designed with 360° Flex, which
rotates 360 degrees for easy maneuvering enabling doctors to place the
(Photo/Provided by
Roydent Dental Products)
sealer directly in the root canal system at any angle.
2Seal easymiX is available from
any authorized Roydent Dental Products distributor.
For more information on Roydent
Dental Products, please call customer care at (800) 992–7767 or visit
roydent.com. ET
ProPack SC single-patient kit
SybronEndo, the leader in innovative endodontic products, is excited to
announce the availability
of the ProPackTM SC. ProPack single patient kits
contain virtually all the
consumables required for
a root canal — including pre-sponged hand
files and rotary NiTi files,
lubricant, paper points
and obturation material
— all with color coded,
step-by-step instructions.
Designed to provide
general
practitioners
with convenience and
ease of use, ProPack eliminates much
of the guess work and hassle of ordering, stocking and finding the right
materials for root canal procedures.
ProPack SC is the first of the ProPack system to launch and is packaged
with Soft-Core® obturation. Available
in packages of six, designed to treat
most anterior or posterior cases.
“Since most root canals are not
prescheduled, I need to be prepared
on the spot. With ProPack, I know I
have all the products I need in one
(Photo/Provided by SybronEndo)
convenient kit and I’m ready to go,”
said Dr. Tony Soileau, Lafayette, La.
To learn more about ProPack,
visit sybronendo.com. To order, call
SybronEndo at (800) 346-3636, contact your local representative or your
authorized SybronEndo dealer.
SybronEndo is dedicated to the
preservation of natural dentition while
eliminating patient pain. The company
aims to provide clinicians with the safest and most efficient products that set
industry standards.
AD
[4] =>
4C
Industry Opinion
Endo Tribune | May 2011
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