| case report
Practical tips for reliable endodontic treatment Dr Friederike Listander, Germany
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Fig. 1: Pre-op radiograph of tooth #27. Fig. 2: Measurement radiograph for working length control.
Introduction Orifice opener, glide path file, shaping file and finishing file—for classic endodontic treatment, a compact system of nickel–titanium (NiTi) files is often sufficient to achieve reproducible results in the preparation of the respective root canal anatomy. The following case report illustrates how the skilful use of a fixed sequence of prebent files enables even dental practices with only occasional endodontic cases to develop a treatment routine in which they can have a high level of confidence. In addition, in this article, practical tips for drying and obturating root canals are provided. The principle of maximum tooth preservation constitutes a key component of our practice philosophy. Owing to our broad range of services, we utilise state-of-the-art technology in the various indication areas in our daily routines to offer our patients the best possible treatment in each case. In endodontics, this means, among other things, automated preparation using a state-of-the-art motor as a navigation aid, as well as the use of an easy-to-remember NiTi file sequence. This structures workflows and ensures that the sequence of work steps becomes intuitive and quick to perform after a brief learning period. A standardised treatment protocol minimises potential sources of error on the one hand and facilitates an effective procedure on the other hand, as reflected in the following endodontic case.
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roots 1 2024
Case presentation: Irreversible pulpitis of tooth #27 In February 2024, a 46-year-old female patient presented to our practice with severe pain in her left upper jaw. After a positive vitality test and strong response to the percussion test, a diagnosis of irreversible pulpitis of tooth #27 was confirmed radiographically (Fig. 1). The patient agreed to a two-session root canal treatment, which was started at the first appointment. After surface anaesthesia and numbing of the affected tooth, a dental dam was placed, which is standardly done ahead of tooth preparation. Additional sealing of the dental dam with liquid dental dam effectively prevented irrigation solution from running into the patient’s throat. This was of particular advantage because treatment was made even more difficult by limited opening of the mouth. After creating the access cavity, the individual root canals were probed and expanded under the operating microscope using a diamond-coated ultrasonic tip. The respective working lengths were determined with the aid of an apex locator. A measurement radiograph was taken as a confirmation and showed that the lengths matched the electronic measurements (Fig. 2). The affected canals were first prepared manually using a hand file to the required size 20. This was followed by the electrochemical irrigation protocol using an ultrasonic tip (Fig. 3). The classic sequence of sodium hypochlorite,