Successful single-visit molar endodontics
It was a great honor to be asked to do a live presentation at the Greater New York Dental Meeting. To perform molar endodontics, in a single visit, in front of 300 dentists was both exciting and challenging. Everything that I saw through my Zeiss surgical operating microscope (Zeiss) was being simultaneously broadcast on large screen monitors throughout the auditorium.
It takes great confidence in your instruments and in your techniques to be able to achieve a high level of treatment in this type of environment.
To secure the proper patient, I turned to the referral base of my private practice. A long standing colleague sent me a radiograph and a case history of a patient requiring root canal therapy for tooth # 19 (Figure 1). This was a tooth with an apparently complex root canal anatomy for which a pulpotomy had been done. After meeting with my patient, my assistant and I packed all of the instruments that we would need for the procedure. The two most important pieces of the armamentaria were LightSpeedLSX nickel titanium rotary files (Discus Dental, Culver City, Calif.) and the EndoVac irrigation system (Discus Dental, Culver City, Calif.).
On the day of the live presentation, after anesthetizing my patient, preparing proper access, and creating a glide path, I began instrumentation with LightSpeedLSX. LightSpeed files allow me to create root canal preparations that thoroughly clean the critical apical third without unnecessarily removing root structure coronally. The mesial canals were finished to a size #45 and the distal canal to a size #50. Those sizes might sound large, but because of LightSpeed’s unique, non-tapered design (Figure 2), I know the canals had been properly instrumented, and I had actually removed less overall dentin due to a more conservative coronal preparation.
With instrumentation complete, I began final irrigation with EndoVac. EndoVac irrigation is a ground-breaking, true apical negative-pressure irrigation system. Studies have shown that current irrigation techniques are effective at cleaning root canals coronally, but significantly less effective apically. EndoVac is the only system that can safely deliver full strength sodium hypochlorite to full working length, allowing hydrolysis of tissue and complete canal disinfection. Three unique components of the EndoVac system make this all possible (Figure 3). During irrigation, 17 percent EDTA is also used to remove the smear layer, creating clean canal walls, ready for obturation. After obturating using warm vertical compaction of gutta-percha, the case was complete (Figure 4).
The combination of the LightSpeed technique for apical enlargement facilitates effective irrigation with EndoVac. Safety and efficacy are the key elements of both of these products, and studies have shown that patients treated with LSX and EndoVac experience significantly less post-operative pain than those treaded with traditional methods. These safe, evidence-based technologies allow me to confidently treat both vital and non-vital cases in one visit. If you are presently performing one visit endodontics or would like to begin doing so, I strongly suggest considering both what is presented here and in the literature.
Learn more at IDS
Learn more about "Safe, Effective & Proven Endodontic Irrigation: The Final Frontier" at the IDS on Wednesday, March 24, at 11:30 am to noon. Discus Dental will offer a lecture with Dr. Garry Bey at the Speaker's Corner, which is free for IDS visitors to attend and can be found in Hall 3.1 at the bottom of the staircase that leads to hall 11. See you there!