Case Presentation: Efficient Endodontic Therapy to Treat Irreversible Pulpitis
Efficient Endodontic Therapy to Treat Irreversible Pulpitis
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).
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.
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.
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.
Tags: NOMAD Pro 2 in Black Model, OptiBond Universal, Cavit Original Temporary Filling Material, Root ZX Original, SOPIX2, UltraCal XS, XV1 Loupe + Light, The Wand All Injection System, Demi Plus, XRay Film Extraoral, Apex Locators & Obturation Systems, Cement temporary, Digital Sensors, Cement endodontic, Endodontics Miscellaneous, Ultradent Products, Inc., Loupes, LED, Injectable Anesthetics, Adhesives, KaVo Dental, Milestone Scientific Inc., Acteon, Kerr Dental, J. Morita Usa, Bulk fill, 3M, Endodontic Files, Reamers & Accessories, Orascoptic, EyeZoom (3x-5x) Loupe, TF Adaptive, SonicFill