Cases from Dr. Abd El-Rahman Ali Hamouda
By Dr. Abd El-Rahman Ali Hamouda Lecturer of Endodontics.PhD of Endodontics.BDS, MDS of Endodontics.Faculty Of Dentistry, Al-Azhar University.Cairo, Egypt
CASE HISTORY
-A 30-year-old female patient was referred to Dr. Abdelrahman Hamouda with the chief complaint of "dull throbbing pain that is usually worse when lying down. The tooth was tender to percussion."
- Clinical examination revealed an occlusal carious lesion in the upper right second molar tooth (tooth no. #27). Intraoral periapical radiography (IOPA) showed that the occlusal carious lesion approximated to the pulp.
Pulp sensibility tests were positive, indicating that the pulp was still vital.
Based on the clinical and radiographic findings, the diagnosis was irreversible pulpitis with symptomatic apical periodontitis. Orthograde endodontic treatment was planned as the appropriate treatment.
treatment process
Step 1: Removal of caries lesion
With the tooth anesthetized and a rubber dam applied, the treatment proceeded as follows:
- Using a dental operating microscope, the carious lesion was removed, and an access cavity was prepared. The access was refined using a diamond-coated ultrasonic tip until all canal orifices were located.
- During the refinement process, the dentin shelf between the palatal and mesiobuccal canals was removed in an attempt to search for an MB2 canal. However, no additional canal was found.
Step 2: Pre-endo build-up（build-up）
- Before proceeding with endodontic treatment, a pre-endodontic buildup is often performed. This step helps to strengthen the weakened tooth structure, which is particularly important for teeth that are structurally compromised. The pre-endodontic buildup provides a stable foundation for the subsequent endodontic treatment.
Step 3: Cleaning & Shaping
A. Scouting, Patency, and working length determination
After locating all the canal orifices, the negotiation of the root canals began using multiple manual K-files, starting with size #10. The patency of all the canals was checked using a manual Denco’s K-file #10.
The working length of the root canals was determined using an Electronic Apex Locator (EAL) and confirmed with an intraoral periapical radiograph (IOPA).
Following the determination of the working length, a micro-glide path was achieved using a manual K-file #15 for all the canals. Then, an NC SHAPER glide path file (Tip size of 0.16 and a taper of 2-4%) was used to create a reproducible macro-glide path for all the canals.
B. Shaping for Cleaning
- The canal shaping process started with NC SHAPER S2 (tip size 25, 4% taper) for the coronal pre-flaring of the canals. This was done by performing an outward brushing motion on the outer canal walls.
- Following the coronal pre-flaring, the NC SHAPER S1 (tip size 20, 4% taper) and NC SHAPER S2 (tip size 25, 4% taper) were used to shape the canals to the full working length.
- For the mesiobuccal (MB) and distobuccal (DB) canals, the shaping was completed using the NC SHAPER S2 (tip size 25, 4% taper).
- For the palatal canal, the shaping was finished using the NC SHAPER S3 (tip size 30, 4% taper).
C. Disinfection Protocol (Irrigation & Activation)
- During the canal shaping and maintaining apical patency, the root canals were irrigated with 5.25% sodium hypochlorite (NaOCl) solution.
- The final rinsing protocol involved the following sequence:
- 5.25% NaOCl.
- Saline.
- 17% EDTA.
- Saline.
- The irrigation solutions were activated using a sonic activation device, to enhance their cleaning and disinfection effectiveness.
D. Step 4: 3D Obturation & Coronal Restoration
Obturation was done using Hydraulic calcium silicate-based root canal sealers with the Warm Vertical Compaction technique (WVC), Followed by coronal restoration of tooth no.#27 using a layering technique of resin-bonded composite at the same visit.
