“Faster, higher, stronger”—this motto certainly no longer applies only to the Olympic Games. How can certain tasks be performed even more precisely, even better, even more smoothly? Where can one save precious minutes? And which techniques and technologies can be of assistance here? What is in vogue in endodontics right now? What are the research and development teams in the dental industry working on? What is the role of new technologies in root canal therapy and its simplification, improve- ment and acceleration? These are the topics of this article.
Using the correct files: The advantages of electrical discharge machining technology
In some aspects, dentistry and Formula One are actually not that dissimilar: if you do not expect the root canal to make an abrupt turn during a treatment session, you can quickly end up in the crash barriers here too. Even a seemingly easy case can lead to complications— fractured instruments, edges and ledges in the root canal, tooth loss—which is precisely what one wishes to avoid, particularly in endodontics.
Files manufactured using electrical discharge machining (EDM) can prove helpful here. Manufactured using a special EDM process, the HyFlex EDM files (COLTENE) mainly differ from conventional files in that they are extremely flexible and exceptionally resistant to breakage. Like the proven HyFlex CM files, the HyFlex EDM system also features the controlled memory (CM) effect. For this reason, HyFlex nickel–titanium (NiTi) files can follow the anatomy of the root canal with great precision, thus reducing the risk of ledge formation, apex transportation or even perforation. Furthermore, the files can be prebent.
This is particularly advantageous in root canals with abrupt curvatures.
Owing to the special anatomy of the patient case presented next, flexible, pre-bendable and fracture-proof files together with the appropriate technique were very important. I therefore, decided to use the modular
HyFlex NiTi file system for preparation purposes.
The patient case: Vertucci Type V
When the 40-year-old male patient was referred to our practice in the spring of 2018 with persistent complaints regarding the mandibular left second premolar, he was already rather frustrated. He had previously undergone several endodontic treatments at another practice, unfortunately without success. He was suffering from an acute periapical abscess and was in severe pain.
This was due to a special dental anatomy that had not been identified. In the middle of the root, about 13–14mm from the cusps, the root canal splitted into two different canals (Vertucci Type V or deep split). This was easy to see on the initial panoramic radiograph (Fig. 1), which is why I decided to prepare the canals with HyFlex CM and HyFlex EDM files and under magnification (Figs. 2 & 3). This allowed me to follow the respective canal profiles and preserve the root canals as far as possible through optimal and centred preparation in each canal.
The treatment was performed in two appointments. The first appointment involved preparation, cleaning and interim medication with calcium hydroxide. After applying the dental dam to isolate the working field, the 25/.12 HyFlex EDM Orifice Opener and the 10/.05 HyFlex EDM Glidepath files were initially used to open the canal and create the glide path. The actual preparation was performed with 15/.04 and 20/.04 HyFlex CM files followed by the 25/~ HyFlex EDM OneFile (Fig. 4). During treatment, the canals were rinsed extensively with CanalPro sodium hypochlorite and EDTA and dried with the corresponding HyFlex paper points and the practical, flexible Surgitip endodontic aspirator tips (COLTENE) before application of the calcium hydroxide dressing (Fig. 5). Ultrasonic activation was also used to enhance the effect of the irrigation solutions.
Root canal obturation and final restoration with a fibre post were performed at the second appointment. The radiograph confirmed that I had been able to treat both root canals along the entire length of the tooth (approximately 23 mm) with minimal loss of tooth structure and in the most conservative manner possible (Fig. 6).
The follow-up appointments observed complete healing of the treated tooth (Fig. 7). Together with the patient, we decided that a crown was not necessary for the moment.
The easy-to-remember sequence can be recalled intuitively
Root canal therapy in a premolar may appear to be a fairly straightforward procedure at first glance, but as the present case illustrates, even a supposedly simple treatment can lead to complications and persistent pain without careful analysis of the tooth anatomy. Therefore, it is extremely important to pay the necessary attention to the specific canal profile from the beginning and to use appropriate instruments and techniques for further treatment. In cases of a deep split or other complex anatomies, particularly flexible and fracture-proof files should be used. In my experience, the files with CM effect from the modular HyFlex file system are very helpful.
The present patient case furthermore illustrates that treatment should never be rushed. This also contributes to the patient being given the necessary attention for successful dental treatment.
Next to choosing the correct files, employing the latest technology simplifies treatment immensely. For example, the CanalPro Jeni motor (COLTENE) can be used to automate preparation and at the same time even determine the working length. Similar to a navigation system, the motor reliably guides the user through the respective root canal anatomy, and a preprogrammed sequence of NiTi files can be easily selected via the touch screen. Newcomers in particular benefit from the intuitive operation and software-supported analysis of the canal profile by the fully automated endodontic motor.
With COLTENE’s new HyFlex EDM OGSF (Opener, Glider, Shaper, Finisher) sequence, which was first announced at this year’s International Dental Show in Cologne in Germany, endodontic procedures will become even easier. Owing to the defined, easy-to-remember sequence, learning to use these files is relatively quick, and being intuitive, the sequence is easily recalled and repeated.
New technologies in endodontics ensure that daily routines in the dental practice are continuously improved, individual work steps are accelerated and treatment is made more pleasant for everyone involved—the dentists, assistants and patients.
Dr Andreea Oana Cristescu Roşu, Romania