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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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ClearCorrect launches new digital solutions globally

The expanded Virtuo Vivo workflow can be connected to all ClearCorrect workflows. (All images: ClearCorrect)

Mon. 22. April 2024

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ROUND ROCK, Texas, US: ClearCorrect recently unveiled a new suite of products and features aimed at supporting clinicians in their provision of orthodontic care and in their practice efficiency. This launch includes improvements to the ClearCorrect digital workflow, helping dentists to advance their digital orthodontic treatment. Upgrades to the Virtuo Vivo scanning workflow and ClearCorrect Sync mobile app optimise efficiency, streamlining record collection, case submission, and case review and management. A new version of ClearCorrect’s treatment planning tool, ClearPilot, has also been released, offering enhanced features and improved set-up control and accuracy.

Expanded Virtuo Vivo workflow

The expanded Virtuo Vivo workflow supports all ClearCorrect workflows, including new aligner orders, new retainer orders and case revisions, giving clinicians maximum flexibility and empowering them to do their best work. Virtuo Vivo also now offers a fast scanning feature for ClearCorrect cases.

The latest integrations of ClearCorrect with intra-oral scanners, including the expanded Virtuo Vivo workflow, make it easy for clinicians to delegate operational steps in the intra-oral scanning process to their staff.

ClearCorrect Sync 2.0

Clinicians can further simplify their workflows with the latest version of the ClearCorrect Sync app, digitising their operations for greater efficiency in practice management. The app now has an expanded range of features that enable clinicians to start, review and manage cases easily:

  • View all cases from the Doctor Portal.
  • Receive notifications for cases that need attention.
  • Access case details, such as shipment tracking.
  • Access the Doctor Portal and ClearPilot directly in the app.

ClearCorrect Sync 2.0 offers clinicians a seamless digital end-to-end experience, streamlining the collection and submission of records and the review and management of cases.

ClearPilot 8.0

ClearPilot 8.0 gives clinicians greater control and an improved user experience. The latest version of the software empowers clinicians in their treatment planning with advanced editing tools. Bite jump editing allows the position of the jaw to be adjusted in order to more accurately visualise potential treatment outcomes when using advanced techniques. Tilt/cant positioning allows adjustment of the 3D model’s position to more accurately reflect the jaw position and match the patient’s facial lines. Multiple interproximal reduction editing applies and distributes interproximal reduction values among several teeth at once. The user interface of ClearPilot 8.0 has also been improved with a keyboard shortcut guide, enhanced visualisation and optimised utility for a better user experience.

 

Florian Kirsch, head of the orthodontic business unit and Connected Customer Solutions at the Straumann Group.

Florian Kirsch, head of the orthodontic business unit and Connected Customer Solutions at the Straumann Group.

“This launch is about transforming smiles and lives. I am excited to witness the positive impact that ClearCorrect’s digital workflow and practice growth offering will have on clinicians, their staff and their patients,” said Florian Kirsch, head of the orthodontic business unit and Connected Customer Solutions at the Straumann Group.

Practice growth offering

ClearCorrect’s practice growth offering provides a comprehensive suite of marketing, education and business resources to empower clinicians and their staff to offer ClearCorrect with confidence and to grow their practices. These resources include a patient marketing kit, a patient conversion kit, and practice growth education and guides.

The partnership that elevates

Dr Mostafa Altalibi, chief orthodontist at the Canadian dental practice Transforme Ortho.

“As an orthodontist, ClearCorrect has been my trusted ally in crafting countless smiles, each one a testament to its power and reliability. Now, with the launch of the new software, I cannot wait for even more precision and efficiency that it will bring to my treatments, enabling me to do more, in less time and with less effort,” said Dr Mostafa Altalibi, chief orthodontist at the Canadian dental practice Transforme Ortho.

Created by dentists for dentists and aspiring to be the world’s most customer-centric aligner brand, ClearCorrect carefully listens to the needs of clinicians, swiftly responding with solutions they need to reach their practice goals, ultimately changing patients’ lives. With a foundation clinicians can trust, along with comprehensive continuing education options, ClearCorrect is proud to offer a partnership that helps clinicians build a thriving practice. ClearCorrect is committed to the empowerment of clinicians, development of their staff and elevation of their practices.

ClearCorrect is backed by the Straumann Group, which encompasses brands with a history of over 70 years of research and innovation. This support enables the creation of cutting-edge products featuring advanced technology and fully integrated digital workflows. These products are complemented by outstanding service, support and educational offerings.

To date, the company has supported partners across more than 60 countries and transformed over a million smiles. Together with clinicians, ClearCorrect looks forward to creating healthier, more confident smiles around the world.

More information about clearCorrect’s products can be found here.

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