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Special Issues
July/August 2018
Volume 39, Issue 3
Peer-Reviewed

Single-Visit Endodontic Procedure for a C-Shaped Molar

Steven L. Frost, DDS

A C-shaped molar root canal can cause even seasoned clinicians to question whether to perform treatment in a one- or two-visit procedure. Tortuous anatomy and unusual root complexities make it difficult to clear all the tissue from the root canal system. Clinicians often opt for sonic or ultrasonic irrigation and a two-visit procedure to assure a positive clinical outcome. In this case, GentleWave® Procedure Multisonic Ultracleaning® technology (Sonendo, sonendo.com) was used to treat irreversible pulpitis in a C-shaped lower second molar, which is often difficult to address. After administration of anesthesia, and with the use of a dental microscope (Leica M320, Leica Microsystems, leica-microsystems.com), conservative straight line access was achieved, and three canals were located, measured, and instrumented. The GentleWave Platform was then built onto the tooth, the Procedure Instrument attached to the GentleWave Console, and the GentleWave Technology finished the procedure. Eight minutes later, the platform was removed, the canals dried, and the canal system filled. Upon completion of the GentleWave Procedure and warm vertical obturation the results were astonishing as evidenced in the final radiograph.
 

Key Takeaways

Endodontic challenges such as a C-shaped molar root canal can be treated successfully in one visit with minimal instrumentation and the GentleWave Procedure.

Closed-loop Multisonic Ultra-cleaning technology reaches deep into lateral canals and microscopic tubules to remove tissue, debris, biofilm, and bacteria. It also helps preserve the integrity of the tooth by leaving dentin intact.

With advanced fluid management, the self-contained GentleWave System delivers the precise concentration of procedure fluids, resulting in the simultaneous ultracleaning of each canal from crown to apex.

About the Author

Steven L. Frost, DDS
Co-Founder, OnCall Dental
Urgent Care;
Private Practice
Mesa, Arizona

Fig 1. In the initial pre-procedure radiograph, the anatomical complexity within the root canal system of this C-shaped molar was not immediately apparent.

Figure 1

Fig 2. Conservative straight line access was accomplished with a carbide bur (Great White®, SS White, sswhitedental.com), and access was refined with a football diamond two striper. Note the pulp tissue in the orifices and isthmus. With an apex locator (Apex ID, Kerr, kerrdental.com), the canals were measured at 21.5 mm.

Figure 2

Fig 3. To conserve dentin, a 20.05 S2 ProTaper (Dentsply Sirona, dentsplysirona.com) was used to create a pathway for delivery of the optimized procedure fluids from the GentleWave System to the root canal system. Because the GentleWave Procedure effectively cleans and disinfects the root canal structure with minimal instrumentation, mechanical debridement was not used to remove the tissue. Here the base was built for the platform on which the instrument rests during the procedure.

Figure 3

Fig 4. A light-cure conforming resin material (SoundSeal™, Sonendo) along with a molar matrix were used to complete the GentleWave Platform build and ensure that a sealed environment was retained throughout the procedure.

Figure 4

Fig 5. The GentleWave Procedure was then performed. The mechanism of action begins in the GentleWave console where sodium hypochlorite (NaOCl), ethylenediaminetetraacetic acid (EDTA), and distilled water are degassed. These optimized procedure fluids flow through a Procedure Instrument, which rests on the SoundSeal platform, and into the root canal chamber. The procedure was completed in 8 minutes.

Figure 5

Fig 6. Tissue dissolution, cleaning, and disinfection were accomplished with the GentleWave System by introducing broad-spectrum acoustic technology and fluid dynamics into the root canal system.

Figure 6

Fig 7. Next, staged cone fit was carried out, as conservative straight line access with minimally invasive canal preparation makes it a challenge to place all gutta-percha (GP) cones at once.

Figure 7

Fig 8. To achieve warm vertical obturation, GP cones were placed in stages with sealer (ThermaSeal® Plus Ribbon Sealer, Dentsply Sirona) and downpacked with warm GP backfill (System B™ and Obtura™ backfill, Kerr). Note that the complex accessory anatomy is starting to be filled.

Figure 8

Fig 9. This image represents the final chamber fill. The true canal configuration was revealed in the C-shaped GP filling material.

Figure 9

Fig 10. Final radiograph. The pre-procedure radiograph (Fig 1) did not reveal the complexity of this C-shaped molar root canal. The GentleWave Procedure, however, was able to handle tissue dissolution and clean all lateral canals, fins, webbing, isthmus, deltas, anastomosis, and multiple portals of exit. The clinical result was outstanding for both the patient and clinician.

Figure 10

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