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Irrigating the root canal: A case report

Post-operative radiograph (Image: Dr Vittorio Franco, UK and Italy)
Dr Vittorio Franco, UK and Italy

Dr Vittorio Franco, UK and Italy

Mon. 22. January 2018

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The patient reported on in this article is a student in dentistry and his parents are both dentists. They referred their son to a good endodontist, who then referred the case to me. As always, peers are more than welcome in either of my practices, in Rome and London, so when I treated this case, I had three dentists watching me, a future dentist on the chair, placing a great deal of pressure on me.

The 22-year-old male patient had a history of trauma to his maxillary incisors and arrived at my practice with symptoms related to tooth #21. The tooth, opened in an emergency by the patient’s mother, was tender when prodded, with a moderate level of sensitivity on the respective buccal gingiva. Sensitivity tests were negative for the other central incisor (tooth #12 was positive), and a periapical radiograph showed radiolucency in the periapical areas of both of the central incisors. The apices of these teeth were quite wide and the length of teeth appeared to exceed 25 mm.

My treatment plan was as follows: root canal therapy with two apical plugs with a calcium silicate-based bioactive cement. The patient provided his consent for the treatment of the affected tooth and asked to have the other treated in a subsequent visit.

After isolating with a rubber dam, I removed the temporary filling, and then the entire pulp chamber roof with a low-speed round drill. The working length was immediately evaluated using an electronic apex locator and a 31 mm K-type file. The working length was determined to be 28 mm.

As can be seen in the photographs, the canal was actually quite wide, so I decided to only use an irrigating solution and not a shaping instrument. Root canals are usually shaped so that there will be enough space for proper irrigation and a proper shape for obturation. This usually means giving these canals a tapered shape to ensure good control when obturating. With open apices, a conical shape is not needed, and often there is enough space for placing the irrigating solution deep and close to the apex.

I decided to use only some syringes containing 5 per cent sodium hypochlorite and EDDY, a sonic tip produced by VDW, for delivery of the cleaning solution and to promote turbulence in the endodontic space and shear stress on the canal walls in order to remove the necrotic tissue faster and more effectively. After a rinse with sodium hypochlorite, the sonic tip was moved to and from the working length of the canal for 30 seconds. This procedure was repeated until the sodium hypochlorite seemed to become ineffective, was clear and had no bubbles. I did not use EDTA, as no debris or smear layer was produced.

I suctioned the sodium hypochlorite, checked the working length with a paper point and then obturated the canal with a of 3 mm in thickness plug of bioactive cement. I then took a radiograph before obturating the rest of the canal with warm gutta-percha. I used a compomer as a temporary filling material.

The symptoms resolved, so I conducted the second treatment only after some months, when the tooth #11 became tender. Tooth #21 had healed. I performed the same procedure and obtained the same outcome (the four-month follow-up radiograph showed healing).

Editorial note: A complete list of references are available from the publisher. This article was published in roots - international magazine of endodontology No. 04/2017.

One thought on “Irrigating the root canal: A case report

  1. The ultimate reason why root canals fail is bacteria. If our mouths were sterile there would be no decay or infection, and damaged teeth could, in ways, repair themselves. So although we can attribute nearly all root canal failure to the presence of bacteria, I will discuss five common reasons why root canals fail, and why at least four of them are mostly preventable.

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Henry Schein One unveils natively embedded voice workflow at 2025 GNYDM

Henry Schein One's new suite of artificial intelligence-powered products promises to make a substantial impact within the dental industry. (Image: romanslavik.com/Adobe Stock)
Henry Schein

Henry Schein

Fri. 28. November 2025

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AMERICAN FORK, Utah, US: Following the announcement of its collaboration with Amazon Web Services, Henry Schein One has unveiled its embedded artificial intelligence (AI) and automation workflows. This includes Voice Notes, which helps practices close revenue gaps through clean claims and modernise more effectively.

“Our goal isn’t piecemeal AI and automation; it’s natively embedded AI with a purpose,” Dr Ryan Hungate, chief clinical and strategy officer at Henry Schein One, said in a press release. “We’re seamlessly building it into every part of the practice. From the first phone call to the final payment, AI is already embedded through multiple points within the Henry Schein One ecosystem—helping dental teams save time, increase accuracy and improve margins.”

Start with cleaner claims and sharper intake

Henry Schein One’s newly launched Forms workflow captures insurance data from a simple photograph of the patient’s card, making record entry faster and more accurate. “The new Forms save our front office teams significant time, allowing them to focus on patients. Our patients appreciate how easy the forms are and the time they save during their visits. As partners, Henry Schein One helped us deliver a win–win–win for our team member experience, patient experience and operational efficiency,” said Matt Hall, chief experience officer at dental support organisation Smile Brands. “Building the forms for scale, while allowing customisation, is seamless and powerful. Features like automatic field-level write-back, ID capture or optical character recognition and intuitive user experience for patients ensure our offices receive the most accurate patient data so we can best serve them. We’ve successfully rolled them out across all our practices on Dentrix Ascend.”

To further streamline pre-appointment workflows, Eligibility Pro extracts real-time benefits from insurance portals and adds the coverage details to the patient’s record. This allows front office teams to have accurate eligibility information before the appointment starts.

Deliver smarter care chairside

Once the patient is in the chair, Detect AI, powered by VideaHealth, helps teams diagnose with greater confidence. This dental AI platform, cleared by the US Food and Drug Administration, identifies dental caries and bone loss directly on radiographs, helping patients clearly understand clinical findings and treatment recommendations. The new Detect AI Impact Panel takes this a step further by increasing patient understanding, trust and, ultimately, treatment acceptance.

Document hands-free

The new Voice Notes maps chairside conversations into accurate clinical records using generative AI to transcribe and summarise in real time. This reduces administrative burden and frees teams to focus on patient care. A recent Yale University study found that the proportion of clinicians who reported burn-out decreased by 13 percentage points within 30 days of adopting an AI scribe solution.

Keep every conversation connected

The new Ascend Phones software ties patient communication directly to the record, giving teams instant context to allow them to answer questions confidently. A call pop displays key details as soon as the phone rings, while AI-powered summaries capture conversation notes and sentiment automatically—creating consistent, high-quality interactions.

Support every role, any time

Rounding out the newest workflow enhancements is Claire, a multilingual 24/7 support assistant available by chat or phone. Henry Schein One is the only company connecting every part of the dental journey—forms, eligibility, imaging, treatment planning, documentation and claims—to truly monitor practice performance and protect profits.

Looking to the future

Henry Schein One will continue to lead the industry with its next wave of AI-enabled solutions, including predictive tools for scheduling and case acceptance, AI-driven assistants that support documentation and coding for cleaner claims, and unified analytics dashboards that provide a complete view of clinical and operational performance. “Henry Schein One isn’t just talking about the future of dentistry; they’re building workflows that are intuitive, allowing AI to make a real impact today for clinicians,” said Dr Jason Mann, co-founder and chief dental officer at Providence Dental Partners.

To explore how embedded AI can support your practice, visit Henry Schein One at Booth 4021 during the Greater New York Dental Meeting, from 30 November to 3 December. Join the company for daily happy hour at 4:30 p.m. until 2 December.

For more information about Henry Schein One and its range of innovative products, visit the company website.

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