Dentsply Sirona reports back in “Endodontics Live: Part 2,” a Dentistry Live session that showed root canal treatment of a patient whose lower premolar had two roots and two canals.
Every endodontic case is different. That was certainly the case for Sagi Shavit as he joined Dentistry Live to present ‘Endodontics Live: Part 2’. The session featured live root canal treatment in real time from Campbell Academy in Nottingham, sponsored by Dentsply Sirona.
Sagi was presenting what he described as “an unusual case. an interesting tooth with a very unusual configuration.” This was a male patient with two-rooted lower premolars with two canals.
Root canal morphology plays a key 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 channel, hypoglycemia returned from the other. This indicates that it was very likely that the two canals were actually connected at some point.
Case presentation
With the tooth isolated under a rubber dam and some initial flare-up already done WaveOne Gold Primary and Small files, Sagi proceeded to lead the public step-by-step using a microscope through this very interesting case.
A slide path was created using a 10K file and the working length was determined using a ProPex Pixi Apex Locator.
Then, moving on to a WaveOne Gold Small file, Sagi demonstrated the brushing motion he recommends for preparing and shaping the canals. He emphasized the importance of IRI (irrigation, recapitulation, irrigation). This is the procedure used during RCT to ensure that the root area is thoroughly cleaned and free of debris.
Sagi then turned to locating where the two canals joined using a GP point inserted into the buccal canal and a 10K file on the tongue that showed they met about 3mm from the apex.
Activation
Activated irrigation is a method of agitating and improving the flow of irrigation fluids. These are used to clean and disinfect the root canal system. In this case Sagi was using the SmartLite Pro EndoActivator by Dentsply Sirona. It uses an elliptical motion to activate the EDTA to remove any organic material such as pulp, filings and metals adhering to the canal walls.
The canals were then dried with sterile paper points to prevent re-contamination of the canals. They were then blocked using AH Plus bioceramic sealer.
Bioceramic sealants seal the root canal by chemically bonding with dentin and releasing calcium ions. Sagi explained why he strongly recommends using bioceramics. They are very radiolucent, so they show up clearly on x-rays. The latest bioceramic sealants are very easy to handle. They are highly biocompatible and are not affected by moisture in the canals.
The final stages of treatment were the occlusion and sealing of the coronal part of the tooth using composite material. Here Sagi showed why he prefers to deliver composite material using a hand stopper for a better fit to seal the canals.
Once the lower premolar was sealed with the composite and light-cured, a postoperative radiograph was taken and the case was completed. A crown was to be placed later.
Simplifying endodontics
In the Q&A session following the Dentistry live broadcast, Sagi was asked why so many dentists approach RCT with trepidation.
“What makes endo scary is using the wrong materials” was the reply.
He explained why endodontics requires thorough training in the anatomy of the root system and the use of appropriate instruments, irrigation systems and materials.
His top tips for successful endodontic management:
- Always use a microscope
- Take advantage of the upcoming endotherapy training courses through Dentsply Sirona Academy
- Choose a simple and easy-to-use file system like 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 Dental CPD member.
To keep up to date with any new webinars from Dentsply Sirona, sign up to their website and join their mailing list: Dentsply Sirona UK: Dental products and technologies.
Learn more about Dentsply Sirona’s wide range of endodontic file systems and products here.
