Case Presentation: Efficient Endodontic Therapy to Treat Irreversible Pulpitis

Published Date 12/12/2018
A 74-year-old woman presented as an emergency patient with a chief complaint of a “toothache on the upper right.” The patient had an uncomplicated medical history, and upon further questioning, it was determined that she had pain to temperature and chewing. Radiographs were obtained using a KaVo NOMAD handheld x-ray unit (KaVo Dental) and a SOPIX2 sensor (ACTEON). The radiographs were within normal limits and showed zirconia crowns on the maxillary first and second molars (Figure 1). Percussion testing exhibited a positive response on the maxillary second molar. The diagnosis was irreversible pulpitis.
Figure 1—Radiographs show zirconia crowns on the maxillary first and second molars.
Figure 2—Canals are instrumented using a Bien Air electric reduction handpiece.
Figure 3—Canal depths are determined with hand files and the Root ZX (Morita).
Initial Treatment
After discussion with the patient, it was determined that endodontic therapy would be the treatment of choice. The patient was anesthetized using The Wand (Milestone Scientific) and a rubber dam was placed. Access was gained with an electric handpiece (Bien-Air) at a speed of 100,000 rpm with a diamond bur, with magnification and illumination through EyeZoom loupes with XV1 frames (Orascoptic) at 4x and 5x magnification. The pulp chamber was accessed, and 3 canals were identified. A pulpotomy was performed.

UltraCal calcium hydroxide paste (Ultradent) was expressed into the canals. Cotton and Cavit temporary filling material (3M) were placed as the temporary restoration. The patient was dismissed with postoperative instructions and scheduled for the rest of her endodontic therapy.
Figure 4—Canals are instrumented with TF Adaptive Files (Kerr Endodontics) in the handpiece.
Figure 5—Canals are dried and obturated with Tubli-Seal and Gutta Percha (Kerr Endodontics).
Figure 6—Pulp chamber is cleaned of cement and debris, then etched with 35% phosphoric acid.
Continued Endodontic Therapy
The patient returned for further treatment a week later and stated that she was pain free. She was anesthetized, a rubber dam was placed, and the cotton and Cavit were removed.

The canals were instrumented using an electric reduction handpiece (Bien-Air) (Figure 2). Canal depths were determined with hand files and Root ZX (Morita) (Figure 3). The canals were then instrumented with TF Adaptive Files (Kerr Endodontics) in the Bien-Air handpiece (Figure 4). The canals were thoroughly instrumented and irrigated with NaOCl, EDTA, and finally, with 90% ethanol. The canals were dried and then obturated with Tubli-Seal and Gutta Percha (Kerr Endodontics) (Figure 5).
Figure 7—SonicFill (Kerr Restoratives) is used for the final restoration.
Figure 8—Restoration is cured using Demi Plus curing light (Kerr Restoratives).
Figure 9—Occlusion is adjusted and polished on the final restoration.
Creating the Final Restoration
The access hole needed to be repaired. The pulp chamber was cleaned of cement and debris, and the internal walls of access were etched with 35% phosphoric acid. OptiBond Universal (Kerr Restoratives) was applied to the access walls and pulpal floor (Figure 6). SonicFill (Kerr Restoratives) was used for the final restoration (Figure 7).

Prior to the restoration being cured, Ease-In- Shields were placed inside my EyeZoom lenses to protect my eyes from the Demi Plus curing light (Kerr Restoratives) (Figure 8). The occlusion was adjusted and polished, and the case was successfully completed (Figure 9). Postoperative instructions were given and the patient was dismissed.
TF Adaptive Files are designed with Adaptive Motion Technology, a patented algorithm that allows the files to self-adjust to intracanal torsional forces. The files leverage the proven Twisted File R-Phase technology, improving file durability and flexibility. Their intuitive, color-coded system is easy to learn and use.
The Demi Plus curing light has a lightweight, ergonomic design and a whisper-quiet fan. The cordless curing light’s exterior is made from Valox resin, a high-performance plastic that protects and extends the life of the unit. An Extended Turbo Light Guide enables better application with improved access for posterior procedures, while intensity from 1,100 W/cm2 to 1,330 W/cm2 delivers a 5-second cure for shades A3 or lighter.
Dr. Jablow is America’s Dental Technology Coach. He received his dental degree from Rutgers School of Dental Medicine in 1986 and practices in Woodbridge, NJ. He is a member of the Cellerant Best of Class selection committee, charged with the annual selection of industry awards, and is Chief Development Officer of Cellerant Consulting. Dr. Jablow has achieved Fellowships from the Academy of General Dentistry and the International Association of Dental-Facial Esthetics. He has been selected multiple times as one of Dentistry Today’s Top Lecturers. Dr. Jablow holds memberships in the American Dental Association and NJ Dental Association. He is a longtime member of his county’s Peer Review Committee. Dr. Jablow has written articles for many dental journals and has had his own column and video series.
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