Case studies from Drs. Godfrey Cutts and James Prichard take a look at how ultrasonic technology is simplifying endodontics
Endodontics has experienced a number of technological advancements in recent years, which have seen it emerge as a far more predictable treatment modality. One particular technology that has enhanced endodontic treatment is ultrasonics. Dr. Sanjeev Bhanderi says: “Ultrasonics energy, when applied to fluid media, has been shown to create two physical phenomena: acoustic streaming (Ahmad, et al., 1987; Lumley, et al., 1991) and cavitation (Walmsley, 1987). It has seen a re-emergence in endodontics with specifically designed tips that can easily be implemented into dental practice as most general dentists already routinely use the ultrasonic devices in their surgeries for periodontal care.
“The ultimate aim of endodontics is, of course, to biologically restore the health of the supporting periodontal tissues that have been under a microbiological challenge from within the roots. This involves the judicious removal of microorganisms and infected material from the pulp space to reduce the bacterial load to a clinically insignificant level and then seal the anatomy from crown to apex. With a crown-down approach, ultrasonic energy can be utilized at each stage of preparation to progressively reach the hallowed working length.”
Versatility as standard
Satelec® Acteon produces a portfolio of endodontic ultrasonic tips for use in its P5 Newtron® ultrasonic unit to treat a variety of different endodontic cases. The P5 Newtron is indicated for scaling, removal of pulp stones, removal of secondary dentin, modifying access cavity, removing cements and temporary dressings, locating canals, cleaning canals, removal of fractured instruments, removal of posts, removal of screws and pins, retreatment, obturation, and apical micro-surgery; and it has restorative applications too.
Dr. Godfrey Cutts runs an endodontic referral practice in Nuneaton. He is passionate about further developing endodontic treatments to improve the outcome for patients.
He says: “The Satelec P5 Newtron is the most versatile instrument in the surgery. Whereas most products are single use, this is multi-functional. I have two P5 units in constant use and really feel that I couldn’t perform my endodontic treatments without them.” The Newtron technology used in Satelec piezoelectric generators ensures that the tips work efficiently and effectively to enable clinicians to work with superior precision and reliability.
Dr. Godfrey Cutts pioneered the use of Irrisafe™ irrigation tips in the United Kingdom.
The use of acoustic micro-streaming enhances the effect of irrigants in cleaning canals and the removal of smear layer.
The new irrigation inserts (Irrisafe):
- Are parallel and non-cutting
- Will not damage the dentinal structure
- Size 20-25 allows free oscillation in the canal
- Can be pre-bent for use in curved canals
- Can be introduced to within 1 mm of working length to produce active apical micro-streaming
- Are resistant to fracture, but if they do so, fracture coronally so the instrument can be retrieved with ease
Dr. Godfrey Cutts teaches an annual 2-day endodontic retreatment course in the UK with Dr. James Prichard.
They report that Satelec Acteon’s Endo Success™ Kit is an essential part of the course, without which they really couldn’t run it.
The following case studies illustrate the versatility of the P5 Newtron.
Case study by Dr. Godfrey Cutts
A 50-year-old male patient was referred by his general dental practitioner for retreatment to UL8, which had recently been treated and had remained symptomatic. Upon examination, there was a draining buccal fistula adjacent to the tooth. The periapical radiograph demonstrated apical periodontitis on all roots (Figure 1).
Local anesthetic was administered, the tooth isolated with rubber dam, and the coronal restoration removed, which revealed an extensive pulp stone that occupied the entire pulp chamber. Instruments from the Satelec Acteon Endo Success™ CAP range (Figure 2) were employed to fragment the pulp stone and locate the canal entrances, including MB2 (Figure 3).
The existing gutta percha was removed and all canals re-instrumented with Race files to ISO #35 .04 taper, irrigated with copious amounts of 3% sodium hypochlorite, passive ultrasonic irrigation (PUI) with Satelec Irrisafe™ (Figure 4) instruments, and a 1-minute soak with 17% EDTA prior to dressing with calcium hydroxide.
At the second visit, the fistula had healed, so the tooth was again isolated with a rubber dam, the temporary filling, and calcium hydroxide removed with further irrigation with 3% sodium hypochlorite and PUI with Irrisafe.
The canals were then obturated with Kerr Pulp Canal Sealer EWT and gutta-percha, thermal down pack with System B™ (Sybron-Endo) and MicroSeal backfill. The access cavity was restored with a bonded amalgam core, which demonstrates the extent of the pulp stone that was removed (Figure 5).
Case study by Dr. James Prichard
This case study demonstrates how ultrasonics were used to grouch out the access cavities and find additional canals. It also illustrates Biodentine® (Septodont) being tamped down using ultrasonics.
Figures 1, 2, and 3 show the use of the ETPR (Figure 1) to loosen a metal post and core from a lower incisor and a scaler placed into a coronal groove (Figure 2) to gently rotate while ultrasonics were applied to loosen the cement.
Figure 4 shows Irrisafe being used in the disto-buccal root of an upper molar to activate sodium hypochlorite to remove tissue from an internal resorption lesion. Figure 5 shows the view of the access cavity and the defect after use. Figure 6 shows placement of a Biodentine base in the same case (post-obturation) to seal the defect prior to the coronal restoration being placed.
Figure 7 shows three mesial canals in a lower molar having used the ET18BD to trough between the mesio-buccal and mesio-lingual canals. Sodium hypochlorite can just be seen in the distal canal. Figure 8 shows an access cavity in an upper second molar.
Ultrasonics are highly versatile tools that can be employed at all stages of endodontic therapy.