Dentsply Sirona reports back on ‘Endodontics Live: Part 2’, a Dentistry Live session which showed root canal treatment of a patient whose lower premolar had two roots and two canals.
Every endodontic case is different. This was certainly true for Sagi Shavit as he joined Dentistry Live to present ‘Endodontics Live: Part 2’. The session showed live root canal treatment in real time from the Campbell Academy in Nottingham, sponsored by Dentsply Sirona.
Sagi was introducing what he described as ‘an unusual case; an interesting tooth with a very unusual configuration’. This was a male patient with a two-rooted lower premolar with two canals.
Root canal morphology plays a decisive role in determining the success of endodontic treatment. A lower premolar with two canals is rare. To add to the mix, Sagi showed the live audience that when he aspirated one canal the hypo was coming back up through the other. This indicates it was highly likely that the two canals were actually connected at some point.
Case presentation
With the tooth isolated under rubber dam and some initial flaring already done with WaveOne Gold Primary and Small files, Sagi proceeded to take the audience step by step using a microscope through this particularly interesting case.
A glide path was created using a 10K file and the working length determined using a ProPex Pixi Apex Locator.
Then proceeding with a WaveOne Gold Small file, Sagi demonstrated the brushing motion he recommends to prepare and shape the canals. He highlighted the importance of IRI (irrigate, recapitulate, irrigate). This is the process used during RCT to ensure the root area is cleaned out thoroughly and free of debris.
Sagi then turned to locating where the two canals joined using a GP point inserted in the buccal canal and a 10K file in the lingual which indicated they were meeting about 3mm from the apex.
Activation
Activated irrigation is a method to agitate and improve the flow of irrigating fluids. These are used for cleaning and disinfecting the root canal system. In this case Sagi was using the SmartLite Pro EndoActivator from Dentsply Sirona. It uses an elliptical motion to activate the EDTA to remove any organic material such as pulp, shavings and minerals adhering to the canal walls.
The canals were then dried with sterile paper points to avoid re-infecting the canals. They were then obturated using AH Plus Bioceramic Sealer.
Bioceramic sealers seal the root canal by chemically bonding to dentine and releasing calcium ions. Sagi explained the reasons why he highly recommends the use of bioceramics. They are very radiopaque so they show up clearly on radiographs. The latest bioceramic sealers are very easy to handle. They are highly biocompatible and are not affected by moisture in the canals.
The final treatment stages were to obturate and seal the coronal part of the tooth using composite. Here Sagi demonstrated why he prefers to deliver composite using a hand plugger for better adaptation to seal the canals.
Once the lower premolar was sealed with the composite and light-cured, a post-op X-ray was taken and the case was complete. A crown was to be fitted at a later date.
Simplifying endodontics
In the Q&A session that followed the Dentistry Live broadcast, Sagi was asked why so many dentists approach RCT with trepidation.
‘What makes endo daunting is using the wrong materials’ was the reply.
He explained why endodontics requires a thorough education on the anatomy of the root canal system and the use of appropriate instrumentation, irrigation systems and materials.
His top tips for successful endodontic management:
- Always use a microscope
- Take advantage of the upcoming endo treatment training courses through the Dentsply Sirona Academy
- Choose a straightforward and easy to use file system such as WaveOne Gold – the ideal file system for everyone from endodontic specialists to those just starting out in endodontic practice.
You can watch Sagi’s session on demand at dentistry.co.uk/webinars/live/ if you are a Dentistry CPD member.
To be kept up to date with any new webinars from Dentsply Sirona register on their website and sign up to their mailing list: Dentsply Sirona UK: Dental products and technologies.
Find out more about Dentsply Sirona’s broad range of endodontic file systems and products here.
