Complex Anatomy on #15

TRUShape Files Used in Case with Extreme Curvature

"I’ve found the files have better contact with canal walls, allowing for a better cleaning of irregular geometries and a better disruption of biofilms to reduce bacteria, all while removing less dentin than conventional ISO preparation.”

Antonio Berto, DDS, Specialist in Endodontics
Dallas, TX

Chief complaint: The patient presented with complaints of pain on biting in tooth #14 and extreme cold sensitivity in tooth #15.

Exam/diagnosis: Tooth #15 was hyper-responsive to cold with lingering pain upon removal of cold and responded within normal limits to percussion; #14 did not respond to a vitality test and was tender to percussion. Radiographically, a severe curve was noted in the MB root of #15. The periodontal ligament space and trabecular pattern were within normal limits.

Pulpal diagnosis: #14 Pulpal necrosis, #15 symptomatic irreversible pulpitis. Periapical diagnosis: #14 Normal, #15 Normal.

Treatment options: Root canal treatment, no treatment or extraction.

Treatment: 1×1.8 ml carpule (36 mg) 2% Lidocaine, 1:100.000 epinephrine (0.018 mg) was administered via buccal and palatal infiltration. After rubber dam placement, minimally invasive access was made. Four orifices were located: MB1, MB2, DB and P.

The exploration of all systems was completed with #10 and #15 Lexicon K-files and copious irrigation of 6.15% sodium hypochlorite. The glide path management was done in two steps. First, the working length was secured prior to the curvature. A smooth and reproducible path was created by removing the coronal and middle third resistance. This step allowed the most complex anatomy to be negotiated with less fatigue.

“Rather than trying to force hand files to reach the apex, we first focused on the coronal and middle third. This not only allowed our instruments to work with less fatigue in the apical third, but also improved the exchange of irrigants in that strategic area. This step was crucial to avoid iatrogenic mishaps,” Dr. Berto said.

After establishing the glide path in the coronal and middle third, working length was determined using a ProMark Apex Locator. Patency was confirmed in all canal systems with a #10 Lexicon K-file. The glide path was then refined to length in all B canals using PathFile rotary files #13, #16, and #19. The orifices were opened with the TRUShape Orifice Modifier, and subsequently all canals were instrumented with TRUShape 3D Conforming Files. The master apical size for the MB, MB2 and DB canals was #25, while the Palatal was #35. After shaping was completed, the EndoActivator was used to agitate the 6.15% NaOCl. After rinsing out the NaOCl with sterile water, the canals were irrigated with QMix 2in1 Irrigating Solution, which was also activated. All canals were then dried with paper points.

Obturation was completed using Warm Vertical Obturation with the Calamus Dual system. A lateral portal of exit was noted on the palatal canal on the post-op radiograph.

"When using TRUShape® 3D Conforming Files, clinicians will find the shape reflects the natural anatomy, with no apical transportation. I’ve found the files have better contact with canal walls, allowing for a better cleaning of irregular geometries and a better disruption of biofilms to reduce bacteria, all while removing less dentin than conventional ISO preparation.” 

Dr. Antonio Berto has lectured both nationally and internationally, published over ten articles in peer reviewed journals and has won numerous endodontic awards, the most recent being the 2012 Rodriguez Carvajal Award for the best clinical case published on the official journal of the Spanish Association of Endodontics. Recently, several of his cases have been published in renowned endodontic textbooks.

He is currently the director of the endodontic section at the Advanced Education in General Dentistry Program at Baylor College of Dentistry, where he teaches one day per week. The remainder of his time is devoted to his private practice, Highland Park Endodontics in Dallas, TX.

Dr. Berto serves as a Key Opinion Leader and Advocate for DENTSPLY Tulsa Dental Specialties. In addition, through his lectures and hands-on technique courses, he provides continuing education to many of the Dallas/Fort Worth general dentists. He has also served as president of prestigious associations and study clubs like the North Texas Hispanic Dental Association, DFW Metroplex Endo Society and Dallas CE Dental Study Club. And he is actively pursuing Diplomate status by the American Board of Endodontics.

Dr. Berto graduated with a dental degree (DDS) from the University of Madrid in 2005. He practiced general dentistry for one year and then completed his specialty training in endodontics at Baylor College of Dentistry in 2009, where he earned a specialty certificate in Endodontics.