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January-February 2018 | No. 1, Vol. 8
XP-endo® Shaper Plus sequence, 25 mm (K-File 10 + K-File 15 + XP-S + XP-F): S1.XB0.00.SAD.FK
42017
rootsinternational magazine of endodontics
issn 2193-4673 Vol. 13 • Issue 4/2017
researchPhotodamage of dental pulpa stem cells during 700 fs laser exposure
case reportApexification treatment with MTA REPAIR HP
interviewUnderstanding sonic-powered irrigation
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XP-endo® Shaper Plus sequenceFKG Dentaire presents its new single file sequence
By FKG
A new generation of Swiss-made in-struments enables safer and more ef-fective root canal treatments, thanks to unique 3D extension capabilities.
The XP-endo® Shaper Plus sequence, launched by leading Swiss endodon-tic firm FKG Dentaire SA, solves a common problem for dentists: how to treat complex root canal systems without causing damage to the dentinal structure. FKG combined unique Adaptive Core™ technology with 3D design to create instruments that can easily adapt to the canal anatomy to clean once impossible-to-reach areas. The result is enhanced debris removal and irrigation for a
more gentle, conservative treatment compared to instrumentation using traditional NiTi files.
“The main problem with conven-tional files is their lack of flexibility, which means that dentists can’t re-move all the debris, but sometimes end up taking off too much healthy dentin,” says Thierry Rouiller, CEO of FKG Dentaire.
“But that all changes with this XP-endo® generation of instruments.”
The patented MaxWire® alloy reacts to the body’s temperature, making the tools highly flexible compared to instruments of the same final size. A small, free-floating adaptive core de-
signed in 3D allows the instruments to expand and progress with agility along the canal while resisting to cy-clic fatigue.
• The XP-endo® Shaper (XP-S) per-forms 3D debridement of the canal while respecting its natural shape.
• The XP-endo® Finisher (XP-F) achieves 3D cleaning and biofilm re-moval, including in areas impossible to reach with traditional files.
• The instruments are delivered in a sterile blister pack destined for single patient use, thus maximising safety.With the XP-endo® Shaper Plus se-quence, dentists have the most ad-vanced Swiss precision tools at their fingertips to perform a complete, minimally invasive root canal in-strumentation.
References FKGXP-endo® Shaper Plus sequenceXP-endo® Shaper Plus sequence, 21 mm (K-File 10 + K-File 15 + XP-S + XP-F): S1.XB0.00.SAC.FK
FKG Dentaire SAwww.fkg.ch
Dental Tribune Middle East & Africa Edition | 1/2018 ENDO TRIBUNEA2
The tooth was submitted to endo-dontic therapy, and after the initial approach with the patient, anesthe-sia was given, followed by preparing absolute isolation. Subsequently, the coronary access was performed, where it was possible to clinically verify the presence of pulp necrosis and perforation. A disinfecting pen-etration of root canals (crown-down) was performed using as irrigator agent NaOCl to 5%, and the odon-tometry determined by the use of foraminal locator. The preparation was carried out by Reciproc system (VDW/Germany), and as irrigator agent was employed NaOCl 2.5% as-sociated with ultrasonic activation
performed with straight inserts (Ir-risonic/Helse/Brazil).
Next, the drilling was treated, with its cleaning and the regularization, em-ploying ultrasonic diamond insert (E7D/Helse/Brazil). As a complement to the intra-channel decontamina-tion process and the furcation re-gion, a biweekly exchange of Calci-um Hydroxide (Ultracal/Ultradent/USA) was held, observing remission of all symptoms.
The obturation was performed using the thermomechanical Hybrid Tag-ger technique (Fig. 3), by employing GutaCondensor (Maillefer/Switzer-
land), TP gutta-percha cones (Dent-sply/Brazil) and MTA-based sealer Fillapex (Angelus/Brazil) (Fig. 4). Af-ter thermo compaction, the obtura-tion cutting was performed, as well as vertical condensation using cold pusher; and again the region of the perforation was cleaned and filled with Calcium Hydroxide.
After 15 days, again, we proceeded to seal the drilled region, and ini-tially verified the proper possibility of drying the area. The filling of the drilled region was carried out with the use of MTA Repair HP (Angelus/Brazil), previously prepared as rec-ommended by the manufacturer,
and it was inserted using an MTA Ap-plicator (Angelus/Brazil). Clinical and radiographic criteria were used to de-termine the correct filling using the material (Figs. 4 and 5); and the glass ionomer cement (Vitremer/3M/USA) used for the protection of the sealed region (Fig. 6). After the tem-porary restoration, radiographically it was observed proper sealing of furcation region by MTA Repair HP, as well as no postoperative complica-tions.
Follow up was conducted after two months, observing bone neoforma-tion in the furcation region and ab-sence of symptoms (Fig. 7).
Prof. Dr. Fábio Duarte da Costa Aznar, BrazilHe is a specialist in En-dodontics HRAC (Cen-trinho)/USP/Bauru. Doctor of Applied Dental Sciences - Den-tal School by Bauru Q
University of São Paulo.Additionally, Prof. Dr. Fábio is the Co-ordinator of Specialization Course in Endodontics Facoph/Bauru-SP, FACESC/Chapecó-SC, FAIPE/Goiânia-GO, GOE/Macapá-AM, Funorte/Ji-Paraná-RO.
Figs. 4-5: Clinical and radiographic appearance of drilling filling with MTA Repair HP. Fig. 6: Drilling region protection sealed with glass ionomer cement.
Fig. 7: Follow-up X-ray after two months.
Drilling treatment using the new MTA Repair HPClinical Case Report
By Prof. Dr. Fábio Duarte da Costa Aznar, Brazil
Female patient, 47 years old, present-ed with a clinical picture of extensive iatrogenic perforation of the furca-tion region of the dental element 36 (Figs. 1 and 2), associated with radio-graphic bone loss, vestibular fistula and pain on palpation. The patient reported history of having been pre-viously subjected to an urgent inter-vention in this tooth by other pro-fessional, as it presented acute pain characteristic of pulpitis.
Fig. 1-2: Initial clinical and radiographic appearance of teeth 36 Fig. 3: Obturation of root canals.
Irrigating the root canal
By Dr Vittorio Franco, UK and Italy
The patient reported on in this ar-ticle is a student in dentistry and his parents are both dentists. They referred their son to a good endo-dontist, 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
A Case Report
Fig. 1: Pre-operative radiograph. Fig. 2: Intraoperative radiograph of apical plug of tooth #21
Fig. 3: Post-operative radiographÿPage A3
with symptoms related to tooth #21. The tooth, opened in an emer-gency by the patient’s mother, was tender when prodded, with a mod-erate level of sensitivity on the re-spective 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
Dental Tribune Middle East & Africa Edition | 1/2018 ENDO TRIBUNE A3
Endodontics
MTA Repair HPBioceramic high-plasticity reparative cement • New formula: After hydration, it allows for easy manipulation and
insertion in the dental cavity• New radiopacifier Calcium Tungstate (CaWO4 ): Does not cause staining of the root or dental crown• Initial setting time of 15 minutes: Allows for completion of treatment in a single session• Low solubility: More prolonged action and quicker tissue recovery• Setting expansion: High marginal sealing capacity which prevents the migration of microorganisms and fluids into the root canal• Stimulation of regeneration: Excellent biological sealing of root perforation (channel and furcation) to induce formation of periradicular cement• Stimulation of pulp regeneration: Induces the formation of a dentin barrier when used on pulp exposures• Hydrophilic: Allows for use in humid conditions without change of its properties
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Dr Vittorio FrancoHe is an endodontist who runs an endo-dontic referral practice in London and in Rome. An active member of the European Society of Endodontology, Franco is also the President-elect of the Italian Society of Endodontics.
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
◊Page A2
exceed 25mm. My treatment plan was as follows: root ca-nal therapy with two apical plugs with a calcium silicate-based bio-active 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 tem-porary 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 irrigat-ing solution and not a shaping in-strument.
Root canals are usually shaped so that there will be enough space for proper irrigation and a proper shape for obturation. This usu-ally means giving these canals a tapered shape to ensure good con-trol when obturating. With open apices, a conical shape is not need-ed, 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 hy-pochlorite and EDDY, a sonic tip produced by VDW, for delivery of the cleaning solution and to pro-mote turbulence in the endodon-tic space and shear stress on the canal walls in order to remove the necrotic tissue faster and more ef-fectively. 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 hypochlo-rite, checked the working length with a paper point and then ob-turated the canal with a of 3mm in thickness plug of bioactive ce-ment. I then took a radiograph be-fore obturating the rest of the ca-nal with warm gutta-percha. I used a compomer as a temporary filling material.
The symptoms resolved, so I con-ducted 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 radio-graph showed healing).
Editorial note: The article was origi-nally published in International Mag-azine for Endodontics 4/2017.
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