Dental News - Endodontic treatment and the magic lamp

Dr Anne Heinz

Mon. 30. January 2023

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Sensitive or traumatised patients require special attention, whether they are adults or children. Sometimes both the clinician and the patient share a common anxiety when it comes to root canal therapy—mostly out of fear of the unknown. To reduce this fear, it helps to break established habits and to ensure a smooth treatment process by employing state-of-the-art endodontic assistance systems. The following case report demonstrates how fears can be successfully reduced and how to trust the miraculous genie of the magic lamp.

When a child enters the Dentiland dental practice for the first time, he or she is reminded not of a dentist’s practice but rather of a fairy tale castle. This way, we break through familiar stereotypes to put children in a trance. It is important for children to be taken seriously and to be treated sympathetically in an environment in which they feel comfortable. Besides providing a feel-good atmosphere in child-oriented treatment rooms, our approach focuses on high-quality treatments. When it comes to a demanding and time-consuming treatment such as the root canal therapy of primary teeth, we are fortunate to have systems available which both simplify treatment and save time. The dental dam has already become standard in some paediatric dental practices, but mechanical preparation and the use of a microscope are still rare. With ritualised behavioural guidance and by using an endodontic motor such as the CanalPro Jeni (COLTENE; Fig. 1), successful treatment is not a question of magic, even if the name suggests so.

Fig. 1: The CanalPro Jeni fully automated endodontic motor. (Image: COLTENE)

Who else has a friend like me?

Like a car’s navigation system, the Jeni reliably navigates through the prevailing anatomy of the root canal. A preprogrammed sequence of nickel–titanium (NiTi) files is simply selected on the touch screen. Complex algorithms control the variable movements of the files used at millisecond intervals during this process. Blocking of the file or wrong turns are virtually impossible with the digital navigation aids: the software recognises obstacles immediately and sends an acoustic signal when irrigation of the canal is recommended to rinse debris from the prepared canal. The dentist must always advance with the contra-angle handpiece from the coronal to the apical direction. This approach requires a little trust initially, but makes treatment extremely reliable and efficient, particularly for practice teams.

With COLTENE’s motor, fixed file sequences and key work steps can be automated quite easily. Newcomers in particular will benefit from the intuitive operation of and software-supported analysis of the canal profile by this fully automated endodontic motor.

Five simple steps

The following patient case illustrates how easy endodontic treatment can be using the Jeni. The patient was a 6-year-old boy who attended Dentiland in spring this year with complaints concerning his upper jaw. Intra-oral diagnostics confirmed the need for treatment of tooth #64 (Fig. 2), and Type II early childhood caries was diagnosed. After detailed counselling, the patient and his parents consented to root canal therapy. The endodontic treatment in this case followed the five classic steps:

infection control;
preparation;
irrigation and drying;
obturation; and
restoration.

Initiating the trance: after anaesthesia and application of the dental dam, four NiTi files were used in the Jeni endodontic motor with integrated apex localisation. First, the 25/.12 HyFlex EDM orifice opener (COLTENE) was used to prepare the access cavity and expand it coronally. It was not necessary to create a glide path. The three subsequent files were able to follow the natural profile of the canal in an optimal manner. The actual preparation was performed with the 20/.05 HyFlex EDM file and 25/~ HyFlex EDM OneFile (Figs. 3 & 4). During this process, the preset Jeni mode moves the files steadily in the apical direction. As soon as the beep recommends irrigation, the instruments are withdrawn from the root canal and then reinserted deeper than before. This procedure is repeated until shortly before the apex is reached. In this case, the files accomplished the working length in a single pass. Finally, the apical third was prepared with a 40/.04 file, which was also quickly inserted to the working length.

Fig. 2: Pre-op radiograph of tooth #64. (Image: Dr Anne Heinz)

Fig. 3: The 20/.05 HyFlex EDM file. (Image: COLTENE)

Fig. 4: The 25/~ HyFlex EDM OneFile. (Image: COLTENE)

Fig. 5: Sequence selection by touchscreen. (Image: COLTENE)

Fig. 6: Post-op radiograph. (Image: Dr Anne Heinz)

The parameters for the various file systems from COLTENE have been saved in the software of the endodontic motor (Fig. 5). Alternatively, using the Doctor’s Choice program, individual sequences of up to eight files can be saved.

Overall, the affected tooth was prepared quickly and reliably with the aid of the fully automated co-pilot—a true blessing, since compliance during treatment, supported by a reduced treatment time through a reliable workflow, is important, particularly with (young) anxious patients. In combination with a child-friendly and relaxing environment, this set-up eliminates much of the original trepidation, even in the case of an endodontic treatment. After extensive irrigation of the canal with sodium hypochlorite and drying of the canals with the appropriate paper points, the canals were filled with calcium hydroxide and a ceramic paediatric crown was inserted adhesively for restoration. After checking the occlusion and articulation, the patient was discharged satisfied and pain-free (Fig. 6).

Conclusion

Efficient, fast and reliable restoration is particularly important for children. The Jeni’s state-of-the-art assistance systems guide the practice team step-by-step through the preparation process by adjusting the movement of the files.

Editorial note:

This article was published in roots—international magazine of endodontics, issue 2/2022.