Root Canal Renaissance, 2008

Strategic teeth should not be removed unnecessarily but preserved with endodontic treatment. Through informed consent, the client is given the option of extraction versus root canal therapy. 

     
Dental X-ray with the addition of digital processing allows endodontic diagnostics to be achieved quickly. 
 
Changes in the shape and continuity of the lamina dura and in the width and shape of the periodontal ligament structure are important evaluations when determining the need for endodontic intervention. Root resorption and periapical osteolysis are important findings in pre-treatment root canal X-ray diagnostics.
    
Worn teeth from attrition, cracked or fractured teeth, discolored teeth [i.e. irreversible pulpitis] and cavities or caries in the crown of the tooth are potential red-flags for endodontic or root canal treatment. 
 
All these conditions require oral X-ray diagnostics to confirm the need for root canal treatment.
    
Root canal treatment requires special education. Endodontic treatment can be lengthy and not without complications. 
 
Wide-canal endodontics and narrow-canal endodontics both can be quite challenging. Mastering endodontics requires laboratory instruction with a mentor who can provide algorithms of treatment for difficult cases.
 

New Technology

 

The SimpliFill obturation plug is in place and the twist away removable carrier has already been removed. (Photo courtesy of Dr. D.H. DeForge)

Recently, a new rotary instrument system has become available to the veterinary dentist:

 

LightspeedLSX  [www.Lightspeedendo.com] with specialized rotary files and obturation plugs to match the anatomy of the canine and feline dentition has revolutionized veterinary endodontics. 
 
Unlike tapered instruments, the Lightspeed with NiTi rotary instruments thoroughly cleans the apical one third of the root canal without unnecessarily removing root structure coronally or in the mid-third of the root, which can weaken the root.
     
Before initiating LightSpeed rotary instruments, the operator must establish canal length and establish canal patency. Once a dental X-ray determines and confirms this, the rotary instruments are slowly advanced apically. 
 
They are advanced to a resistance point and then stopped or paused. The canal is thoroughly irrigated and the rotary instruments are continued to working length. Serial oral radiology is important.
 
It is also important to instrument short of working length with the next larger instrument than the final apical size. This shapes and prepares the canal for the SimpliFill obturator. 
 
Mid-root instrumentation is then initiated, followed by recapitulation to the working length. Copious irrigation with NaOCL is recommended to remove dentinal mud and clear the dentinal tubules. The final irrigation is with 0.12 percent Chlorhexidine solution. 
 
The canal is rinsed with sterile saline for irrigation and dried. It is perfectly prepared for obturation at this point.

Easy to Use

The canal obturation is complete and the canal has been back filled with sealant and additional gutta percha cones. (Photo courtesy of Dr. D.H. DeForge)

The SimpliFill obturating system is very simple to use.
 
Endodontic sealer using a paper point coats the canal. A SimpliFill plug the same size as the final apical size LSX instrument is coated with endodontic sealant. The endodontic stop on the instrument is set to working length. The plug is placed to working length with a firm push. 
 
A radiograph (X-ray? So that is matches the references) is taken at this point. Once set to working length, rotate the handle four counter clockwise turns to release the apical plug. Next, a small amount of sealant is placed in the canal coronal to the SimpliFill plug with a paper point. 
 
Warm gutta percha can be used to back fill the canal or additional gutta percha cones can be used to back fill coated with sealant. Repeat until the canal is filled without voids. 
 
Always radiograph to confirm endodontic obturation completeness.
    
One important characteristic of the SimpliFill obturator delivery device is that it features a twist-away removable carrier. With counterclockwise turns, the carrier is separated, leaving the apical plug in the canal.
    
After clinical investigation at The Connecticut and New York Specialty Centers for Oral Care, the LightSpeed LSX Rotary Instrument System and the SimpliFill Carrier–Free Obturation system have been found to be completely effective in root canal treatment in companion animals. 
 
The system is simple and makes canal preparation easy with fewer instruments. This decreases anesthesia time, which is a major advantage, especially if root canal and crown preparation are linked in a compromised tooth. <HOME>

 

Glossary of Dental Terms:

 
Attrition Loss of tooth substance as a result of wear or malocclusion contact between the teeth; this can lead to pulp exposure and need for root canal therapy.
Lamina Dura The layer of compact boned forming the wall of an alveolus. The alveolar bone.
Irreversible Pulpitis An inflammation of the dental pulpal tissues that cannot be resolved leading to pulp necrosis and necessitating treatment with root canal therapy or apicoectomy.
Periapical Osteolysis A destruction of bone at the apex of the root in response to periapical extension of bacterial pulpal inflammation.
Periodontal Ligaments A network of connective tissue structures that attaches and supports the tooth in the alveolus; they cushion the tooth and bone from occlusal forces.

 

Dr. DeForge is an adjunct professor at Northwestern Connecticut College and Mercy College, where he teaches concepts in oral radiology. He has a telemedicine oral X-ray reading service for analog and digital X-rays, VetDent Oral Imaging Service.

Disclaimer: Dr. DeForge has no contractual relationship with Lightspeed LSX™/Simplifill Obturator Delivery Systems.

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