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Case #1:
When difficult becomes easy –
Managing extreme curvature and calcified
root canal system. Tooth #20
Clinician: Murat Ayik, DDS, Dallas, TX
Chief complaint: #20 extremely tender on
touching and biting.
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Exam/diagnosis: Tooth No. 20 did not respond to vitality
test and was very tender to percussion and palpation on the
area. Radiographically, a calcified root canal system and severe apical curvature was noted (Fig. 1). There was a periradicular lesion associated to tooth #20.
Pulpal diagnosis: #Pulpal Necrosis, Symptomatic apical
periodontitis
12 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Treatment options: Root canal treatment,
no treatment or extraction.
Treatment: 1x1.8 ml carpule (36 mg) 2% Lidocaine,
1:100.000 epinephrine (0.018 mg) was administered via Inferior alveolar nerve block. After rubber dam placement, access
was made. Main canal was located using the round #4 bur
from the Endo Access Kit and ProUltra® Endo Tips (2-5).
The exploration of all systems was completed with #10 and
#15 Lexicon® K-files and copious irrigation of 6.15% sodium
hypochlorite. The glide path management was done in two
steps; we first secured the working length prior to the curvature, creating a smooth and reproducible path, by removing
the coronal and middle third resistance. This step allowed us
to negotiate the most complex anatomy with less fatigue.
The glide path was refined to length with PathFile® rotary
files #13, #16, and #19.
Working length was determined using a ProMark® Apex
Locator. Patency was confirmed with a #10 Lexicon® K-file.
The glide path was refined to length with PathFile® rotary
files #13, #16, and #19. The orifices were opened with the SX,
and subsequently all canals were instrumented with ProTaper
Gold® Files. The master apical size was F2. After shaping was
completed, the EndoActivator® was used to agitate the
6.15% NaOCl. After rinsing out the NaOCl with sterile water,
the canals were irrigated with QMix® 2-in-1 which was also
activated. All canals were dried with paper points.
Obturation was completed using GuttaCore® cross-linked
gutta-percha core obturators to take advantage of the hydraulics and create a dense, three-dimensional seal on the
areas where a heat source could not be delivered within a
few millimeters of the apex (Fig. 2).
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