Dental News - Irrigating the root canal: A case report

Irrigating the root canal: A case report

Post-operative radiograph (Image: 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.

Fig. 1: Pre-operative radiograph

Fig. 2: Intraoperative radiograph of apical plug of tooth #21.

Fig. 3: Post-operative radiograph.

Fig.4: EDDY in action.

Fig. 5: Intraoperative radiograph of apical plug of tooth #11 (after 6 months from the first treatment).

Fig. 6: Post-operative radiograph.

Fig. 7: Four months follow-up radiograph.

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”

Dr. Rusznak, Root Canal Ashburn VA says:

October 10, 2019 at 2:49 am

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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The NSK Blue Prize has been created to honour individuals and organisations whose work has advanced dental medicine through scientific discovery, clinical innovation, education or community healthcare. The award recognises achievements that have delivered meaningful benefits for patients and society and seeks to encourage future breakthroughs in oral healthcare. The foundation hopes that the prize will become one of the world’s most respected honours in dentistry and ultimately be regarded as the field’s equivalent of the Nobel Prize.

The name “Blue” reflects the foundation’s symbolic colour, representing the Earth, the sea, the sky and life itself. It was chosen to express values shared by all humanity—values that transcend borders, cultures and scientific disciplines—and to reinforce the global importance of dental medicine and its contribution to human health and dignity.

Eligible contributions include work in basic dental science, clinical and translational research, and technological innovation, as well as projects that deliver significant public health benefits. Rather than focusing solely on academic achievement, the selection process also considers how research has improved or has the potential to improve lives through better prevention, enhanced treatment and reduced health inequalities.

Each year, up to three laureates will receive a prize of JPY 10 million (€54,167.4^*), together with a commemorative trophy and certificate. Winners will also be invited to Japan to attend the award ceremony and present a lecture, helping to share their research with the wider international community.

Recipients will be selected by an independent international committee made up of respected experts chosen for their research achievements, integrity and ethical standards. The selection process is governed by the principles of independence, transparency and academic excellence and is intended to ensure that decisions remain free from commercial or organisational influence.

Nominations for the inaugural NSK Blue Prize opened on 1 July and will remain open until 20 December. Researchers and organisations from around the world are encouraged to participate. Through the prize, the foundation seeks to showcase outstanding achievements that will shape the future of dental science and oral healthcare for generations to come. Further information about the prize can be found on the NSK Nakanishi Foundation website.

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^* Calculated on the OANDA platform for 13 July 2026.