Retreatment of a large apical lesion instrumented with Excalibur® and obturated with NeoSealer Flo® from Zarc.
Doctor Noé Hernández portrays a 22 with Excalibur® files and fills it with NeoSealer Flo® cement from Zarc with a single cone technique.
Doctor Noé Hernández receives in his clinic a patient suffering from acute pain in the area of the second quadrant. After carrying out the pertinent diagnostic tests, it is observed that tooth 22 has been previously treated and now presents acute apical periodontitis that must be re-treated.
After unsealing, the tooth is shaped with Excalibur® and abundantly irrigated with ultrasonically activated sodium hypochlorite and then filled with the new ZARC NeoSealer Flo® cement using the single cone technique.
Diagnosis
A patient comes to Dr. Noé Hernández’s clinic with acute pain in the second quadrant area. Different tests are performed to establish an accurate diagnosis:
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- Previously treated tooth
- Positive percussion test
- Positive palpation test
- Physiological probing
The final diagnosis is acute apical periodontitis on tooth 22 in a previously treated tooth.
Diagnostic radiography.
Non-surgical retreatment.
When treating the cause of the apical lesion of a deficient endodontics, the first option is always re-endodontics or retreatment, since the success rate in these cases is very high. In a study conducted by De Chevigny et al. in 2008, established that when the previous obturation of the canals was not adequate, the success rate was very high (86%), compared to 50% in well-treated canals.
The endodontic sequence is performed as follows:
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- Unsealing of the coronal third using a a Gates Gliden #2 bur, whose tip is 70 gauge.
- Disobturation and shaping of the canal with the Zarc Excalibur® 35.05 reciprocating file until apical patency is obtained and measurement with the LEA.
- Apical sizing with Zarc Excalibur® 45.05.
Shaping with Zarc Excalibur® files
Irrigation must be profuse, as it is a previously treated tooth with an apical image. Therefore, sodium hypochlorite is used in three 30 second cycles of ultrasonic activation with Z-Activator®. Ultrasonically activated 17% EDTA is also used for 30 seconds.
Subsequently, a conometry x-ray is performed to check the apical fit and proceed to obturate.
Conometry X-ray.
Obturation with Zarc NeoSealer Flo® bioceramic.
For obturation, the new Zarc NeoSealer Flo® bioceramic cement is used with the single cone technique.
Obturation with NeoSealer Flo® cement from Zarc
The main advantage of these new cements lies in their ability to set even in humid conditions inside the canal, which is of great help in cases of retreatment and pulpal necrosis.
Finally, the definitive reconstruction of the case and the final postoperative X-ray are performed. The case will be reviewed in 6 months to see the evolution of the apical lesion.
Final postoperative radiograph.
Dr. Noé Hernández
Dr. Noé Hernández has a degree in Dentistry from the Alfonso X El Sabio University in Madrid. He completed his Master’s Degree in Advanced Endodontics and Dental Aesthetics at the European University of Madrid.
He has participated in several national congresses of the Spanish Association of Endodontics and in national and international congresses on Dentistry and Stomatology.
In 2019 he published the article “Importance of ferrule in the restoration of endodontically treated teeth: a review of the literature” in the journal “Endondocia” of AEDE.
Es miembro de la Asociación Española de Endodoncia (AEDE).
He is dedicated exclusively to the practice of endodontics and aesthetic restorative dentistry in Mallorca.
More information
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