Joseph Sabbagh explains how root canal treatments can be used in everyday practice using GenENDO and BioRoot Flow instruments.
Root canal therapy (RCT) is a common endodontic procedure that aims to preserve a tooth through a proper cleaning, shaping and obturation of the root canal system. When performed correctly, the success rate of vital endodontic treatments varies between 88.6 and 90.3% (Ricucci et al, 2011) while for retreatments it is between 65.5% and 77.6% (Stueland H et al, 2023).
Recent innovations in endodontics are revolutionizing root canal treatment by incorporating advanced imaging, precision instruments and improved disinfection methods, making treatment easier and more predictable. 3D imaging, particularly cone beam computed tomography (CBCT), enables detailed visualization of complex canal morphologies and guided access, enhancing diagnostic accuracy, treatment planning, and maximizing tooth preservation and clinical outcomes (Peters and Arias, 2022).
The cleaning and shaping of a root canal system is based on the use of flexible nickel-titanium (NiTi) files, with simplified sequences, improved alloys together with apex locators and enhanced rotary motors, facilitating efficient shaping of curved canals by minimizing procedural errors. This allows for subsequent steps, including coronal eruption, creation of a reproducible slide path, determination of working length, and biomechanical preparation and decontamination of the root canal system.
What is the goal of root canal treatment?
Ultimately, the procedure aims to achieve effective occlusion, ensure the longevity of the restoration and preserve as much of the natural tooth structure as possible (ESE, 2006).
The dental community has come to understand that adequate endodontic treatment does not mean enlarging the canals, but rather proper decontamination of the root canal system combined with three-dimensional sealing. Various techniques using gutta-percha, delivered in different ways, are used for the occlusion phase.
The warmvertical technique, described by Schilder in 1972, was considered the gold standard in endodontics. Although it shows good clinical results, this technique is complex and involves many steps.
Recent development in biomaterials has led to a new class of products called bioceramics, based on calcium silicate (CSCs). They can be used as cements in restorative dentistry to maintain pulp vitality or as sealants in endodontics (Dong and Xu, 2023).
In addition to excellent physical and chemical properties, CSCs play an important role in endodontic therapy due to their biocompatibility and bioactivity when in contact with pulp tissues (Haridas et al, 2024).
During the occlusion stage, the use of a bioceramic sealer combined with a single gutta-percha cone made this phase easier and more predictable.
The following clinical case report details the root canal treatment of a molar using a simplified GenENDO NiTi Revo-S+ instruments (Septodont), combined with obturation of the root canal systems using a recent bioceramic sealant, BioRoot Flow (Septodont).
Case report
Clinical signs and symptoms
A 35-year-old patient presented to the dental clinic with severe spontaneous pain located in the lower left posterior quadrant. The pain persisted for three days and intensified with hot stimuli.
A periapical radiograph revealed a large composite restoration with secondary caries in the mesial box on tooth #36 (mandibular first molar) with an enlarged periodontal ligament space around the mesial root and no evidence of periapical radiolucency. No swelling or sinus tract was visible.
Diagnosis
The cold spray vitality test elicited a prolonged pain response. Based on clinical and radiographic findings, the tooth was diagnosed with acute irreversible pulpitis. A non-surgical root canal treatment was planned.
Procedure and treatment
After local anesthesia (Septanest, 1:200,000, Septodont, Saint-Maur des Fossés, France) an endodontic access cavity was performed using a round diamond and Endo Z tungsten carbide. Four canal mouths were identified: mesiobacterial (MB), mesioglossal (ML), distoparial (DB), and apostolic (DL). The working field was isolated using an elastic latex barrier secured with a Softclamp (Kerr, Orange, USA) to prevent possible contamination of the gingival fluid or accidental ingestion of the instrument.
A GenENDO K-File 010 (Septodont) was used to detect canal patency. The final working length was determined using an apex locator and confirmed radiographically. The MB and ML canals had separate crests, while the distal canals were wide and merged into a single foramen.
Conformation
Cleaning and shaping began using a crown-down technique with rotary files GenENDO Revo-S+ SC1, SC2, SU (Septodont). 25 diameter, .04 and .06 taper. Coronary flaring of the channels was done using it GenENDO Revo-S+ SC1 instrument (25/.06) down stroke, widening the coronal third to remove any interference and straighten the stroke.
Channel configuration was done using it GenENDO Revo-S+ SC2 instrument (25/.04) up to the apex removing dentin from the walls. Followed by final configuration with the GenENDO Revo-S+ SU (25/.06) for even taper and optimal preparation, using one center down and one up stroke with selective wall mount, working length finish.
Irrigation
Copious irrigation with 3.5% sodium hypochlorite was performed throughout the instrumentation, and the canals were irrigated with EDTA to remove the smear layer. Recheck of channel patency was routinely ensured using a GenENDO K-File 010 between each instrument.
In the absence of swelling and complete drying of the canals, the modern endodontic strategy recommends obturation of the canal system during the same session. After the final irrigation, the canals were dried using one or two paper points to prevent excessive drying. BioRoot Flow, a newly introduced bioceramic sealant, was injected into each canal under low pressure.
A single cone technique, using a gutta-percha master cone, previously calibrated and confirmed radiographically, was inserted into each canal. The gutta-percha points were then cut using a heat cutter and compressed with an endo-plug. A Teflon bead was placed in the access cavity and covered with a temporary cement.
Follow up and result
At a one-month follow-up, the patient reported no pain or discomfort. Clinical examination showed no sensitivity. The tooth remained functional and symptom-free.
Discussion
Endodontic treatment of mandibular molars can be difficult due to the variations and complexities in root canal morphology. In this case, the presence of four channels required careful exploration and negotiation. The use of magnification, electronic apex position, and simplified rotary instruments enhanced the accuracy of canal shaping. The occlusion phase was done with a bioceramic sealer and a single cone of gutta-percha, which is increasingly used in endodontics.
Successful root canal treatment depends on adequate diagnosis, canal disinfection and hermetic obturation. Early intervention prevented the progression of periapical disease and preserved the natural tooth structure, avoiding extraction.
Conclusion
This case highlights the importance of comprehensive diagnostic and clinical protocols in the endodontic treatment of mandibular molars. With proper technique and patient compliance, even complex molars can be managed predictably, resulting in long-term tooth retention and functional restoration.
Learn more about GenENDO and BioRoot Flow.
This article is sponsored by Septodont.
