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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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Zumax Medical: From endodontics to general dentistry

Zumax Medical is headquartered in Suzhou in China. (All images: Zumax Medical)
Zumax Medical

Zumax Medical

Thu. 25. April 2024

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SUZHOU, China: Founded in 2005 and based in Suzhou, Zumax Medical is a manufacturer specialising in dental surgical magnification devices. The company offers a wide range of these devices to meet diverse clinical and academic research needs. Additionally, Zumax has developed dental surgical magnification products specifically designed for training purposes at educational institutions.

Zumax offers a range of specialised loupes tailored for dental professionals. The SLH binocular loupes provide a clear, crisp image through multi-coated, high-grade glass lenses. The TTL loupes feature a wide field of view and adjustable angles for reduced fatigue during extended use, enhancing depth of focus and stereoscopic vision. The DFK PRO loupes, designed for microsurgery, include a prism deflection design for precise adjustment, high resolution and custom-fit options for optimal comfort.

The company’s commitment to quality and advancement has positioned it as a world-class brand, contributing significantly to global oral medicine. “Since 2005, we have introduced several groundbreaking innovations in China’s oral healthcare field, including the first Chinese dental microscope, LED dental microscope and high-magnification dental microscope, the world’s first integrated 3D dental microscope and the unique Easy360 smartphone high-definition imaging system,” said Xiangdong Li, chairman of the board.

“Our aim is to make significant contributions to oral medicine in China and globally.”—Xiangdong Li, chairman of the board

Zumax primarily focuses on oral healthcare and generates 85% of its revenue from the dental industry. The company has a significant global presence, particularly in Europe, the Americas, Asia Pacific, Oceania and South Africa, and recently in the Gulf region and North Africa. Zumax’s products are widely used in prominent dental schools worldwide, solidifying its reputation as a symbol of Chinese excellence in dental equipment.

Zumax’s products also cover fields such as ophthalmology, otorhinolaryngology and head and neck surgery and are used in both community and general medical practice. Zumax has extensive experience in the industry and expertise in the research, development and manufacturing of medical optical devices.

New product development as a driving force

New product development is pivotal at Zumax, and Li highlighted its critical role in driving the company’s growth. Each year, Zumax dedicates around 20% or more of its sales revenue to research and development expenditure. Over the next three years, the company plans to introduce new oral microscopes, aiming to provide cost-effective solutions for the expansive private dental market while also preparing to launch advanced surgical microscopes for the high-end product segment.

Zumax is known for its original and innovative technological contributions, including the development of integrated microscopic 3D technology and a portable high-definition microscopic imaging system. The company maintains a focus on continuous product improvement, optimisation and innovation, striving to craft high-quality domestic products with meticulous attention to detail.

From left: Xiangdong Li, chairman of the board; Xing Wang, former president of the Chinese Stomatological Association, and Karl Wang, general manager at Zumax.

From left: Xiangdong Li, chairman of the board; Xing Wang, former president of the Chinese Stomatological Association, and Karl Wang, general manager at Zumax.

Quality inspection of the Zumax optical system.

Quality inspection of the Zumax optical system.

Zumax surgical microscope OMS3500.

Zumax surgical microscope OMS3500.

From endodontics to general practice

In the future, Zumax will focus on promoting oral microscopy technology, ensuring that dentists recognise its broad applicability beyond the treatment of caries and pulp disease. Oral microscopes are also invaluable in periodontics, implantology, restorative dentistry, orthodontics and preventive dentistry, among others. This broadens the scope of what can be seen and diagnosed, providing a common technological foundation for various dental specialties.

In addition, Zumax will gradually shift its market focus towards private dental practices, introducing a plan to enhance training goals and improve personalised service capabilities for private clinics. This initiative aims to ensure that users are proficient in microscopic techniques. Zumax intends to collaborate with training centres recognised by the Chinese Stomatological Association and engage in educational programmes with various dental societies. This strategy highlights Zumax’s broadening scope from endodontics to general dental practice.

“After more than a decade of continued effort, Zumax has risen to the ranks of world-class brands, becoming a prominent symbol of China in the global dental–medical equipment domain,” commented Li.

“Looking ahead, we will continue to persist in technology-driven innovation and focus on providing high-quality products and satisfactory services to our users. Our aim is to make significant contributions to oral medicine in China and globally,” he added.

More information about the company’s products can be found at www.zumaxmedical.com.

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