


Case presentation: A 40-year old female was referred for upper second premolar (tooth 1.5) endodontic consultation. The patient was on sertraline. Pain on chewing initially started last week. There was no initiating factor. The referring dentist has prescribed antibiotics which reduced her symptoms. She was not a grinder and has never cracked a tooth. Original root canal treatment was performed 10 years ago. There was no swelling and the soft tissue was normal. Palpation and percussion were negative. Adjacent teeth responded to cold WNL. Bite test on 15 was positive. Mobility was WNL. Periodontal probing was B 425 & P 425. The radiograph showed a curved root, and an inadequate previous root canal treatment (Fig.2). The middle and apical part of the root canal system was seemed totally calcified on the radiograph (Fig.2). The diagnosis was previous root canal treatment and symptomatic apical periodontitis. Treatment plan was to perform re-treatment through the crown. The prognosis was good provided that the apical third of the canal(s) would be accessible for cleaning and disinfection.




The re-treatment was completed in one visit. A ledge was encountered where the previous gutta percha terminated; at the initiation of the curve (Fig.2). The ledge was bypassed (Fig.3). Laser assisted irrigation was used during the opening of the blocked segments of the canals and at the end to remove smear layer. Two canals were joining. The canals were obturated by warm vertical compaction of gutta percha and a resin sealer (Figs.4 &5). The final radiograph showed a hidden anatomy which I was not aware of (Fig.5)! Laser assisted irrigation allowed for a minimal root canal preparation (ProTaper Ultimate, 20/04, Dentsply Sirona). The patient returned to her dentist for restoration.
Conclusion:
Laser activated irrigation can help overcome the limitations of previous traditional irrigation systems and contribute to minimally invasive endodontics.
Reference:
- Modern endodontic surgery concepts and practice: a review. Syngcuk Kim , Samuel Kratchman. J Endod 2006 Jul;32(7):601-23.
- Effects of four Ni-Ti preparation techniques on root canal geometry assessed by micro computed tomography. Peters OA, Schönenberger K, Laib A. Int Endod J. 2001 Apr;34(3):221-30.
- Comparison of the EndoVac System to Needle Irrigation of Root canals. J Baumgartner JC, Nielsen B. J Endod. 2010 Mar; 36(3):509-11.
- Minimally Invasive Endodontics: Challenging Prevailing Paradigms. Gluskin, A.H., Peters C.I., Peters, O.A. British Dental Journal 2014;216:347-353
- SSP/SWEEPS Endodontics with the SkyPulse Er:YAG Dental Laser. Tomaz Ivanusic et al Journal of the Laser and Health Academy Vol. 2019, No.1: 1-10
We use laser assisted irrigation at our offices!
Disclaimer:
No financial gain for preparing this news letter was intended.