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Jon Cowie discusses a recently referred endodontic case. The key to predictable outcomes in endodontics is the efficient use of instrumentation. Whilst hand files remain an important part of root canal treatment, particularly in the creation of a glide path and manually locating the canals, the new generation of reciprocating file systems can make preparation of the root canal faster, safer and more predictable.
The following case clearly illustrates this point, especially when access is restricted in the posterior region of the mouth.
Case study
A lady in her mid-60s was referred to me for endodontic treatment of the LL7. She had a recently fitted porcelain bonded crown which had become symptomatic specifically to hot and cold. At her consultation we made a diagnosis of symptomatic irreversible pulpitis (fig 1) and she agreed to endodontic treatment which was completed in a single visit to retain the tooth. Whilst very keen to keep the tooth she was naturally slightly hesitant about her new crown so we opted to take a reasonably minimal approach to preserve as much of the tooth structure as possible.
The access cavity was prepared in a stepped-access fashion to minimise the impact of dentine removal underneath the crown and help to preserve the tooth structure, particularly in the pericervical area. Initial access was made with a 016 medium round bur and small tapered diamond bur to locate and partially de-roof the pulp chamber (fig 2).
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