Conservative opening in a 46 with pulp necrosis, instrumented with BlueShaper® and obturated using Z-Condensor®.
In this clinical case, Dr. Noé Hernández shows a conservative opening in a 46 tooth in which a large pulp necrosis can be seen. The pink alloy of the BlueShaper® system is the one chosen to start the treatment thanks to its extraordinary resistance to torsion. In addition, Dr. Hernandez uses Z-Condensor thermocompaction in the obturation.
Clinical case: Conservative opening to treat pulp necrosis with acute apical periodontitis.
Diagnosis
A patient was admitted to the clinic with acute pain in the fourth quadrant area.
Various tests were performed to establish a precise diagnosis.
- Negative vitality test.
- Positive percussion test.
- Physiological probing.
Final diagnosis: pulp necrosis with acute apical periodontitis.
Fig. 1 Pre-treatment photograph. Fig. 2 Diagnostic X-ray.
Treatment: Necropulpectomy.
As the cause of necrosis is a deep class V filling, a conservative opening is performed to preserve as much of the remaining dentine as possible, and 4 canals are located using a DG-16 probe.
The endodontic sequence is performed as follows:
- Pre-flaring of the coronal third (preflaring) using the Blueshaper® Z1 file at 500 rpm at 2/3 of the T.L. The Z1 file is chosen because it has been manufactured with pink alloy, which increases resistance to torsion, ideal in the initial phase of treatment, and offers greater resistance at the tip.
- Permeabilisation or Glide Path with #10 files.
- Instrumentation with the Zarc BlueShaper® file system using the basic sequence (Z1, Z2, Z3 and Z4).
Fig. 3 Instrumentation with the BlueShaper Z1 file.
As this is necrosis, irrigation must be profuse. Sodium hypochlorite is used in three 30-second cycles of ultrasonic activation with Z-Activator®. Ultrasonically activated EDTA 17% for 30 seconds is also used.
For obturation we use thermocompaction with Z-Condensor®. This condenser makes it possible to soften the gutta-percha and achieve the necessary fluidity so that it can adapt to all the sinuosities of the canal.
Fig. 4 Final X-ray after treatment.
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.
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