December 21, 2014
Brian Royle, DDS, MS
Description of tooth: Maxillary second premolar #4. 52 year-old healthy female. Patient indicated a history of pain to hot/cold in the upper right quadrant. Clinically, there was an exaggerated and lingering response to thermal testing. Radiographically, the tooth exhibited a severe mid root curvature (Fig. 1). No periapical lesion was present, but the patient had recently noticed the tooth was "sore to chew on."
Diagnosis: Irreversible pulpitis with symptomatic apical periodontitis.
Technique: 68 mg of articaine 4% with 0.036 mg of epinephrine was administered via buccal and palatal infiltration. Rubber dam placement and access was created into the pulp chamber which revealed a single oval shaped orifice. Slow speed round burs were used to excavate caries while Lexicon Gates Glidden drills were conservatively used to expand the opening to the canal system.
The exploration of the canal system was completed with .06 – .10 Lexicon K-files in the presence of 6.15% sodium hypochlorite. Coronal enlargement of all canals was achieved by using ProTaper Universal SX rotary files. A working length was then established using a Root ZX II apex locator and a K-file. Because of the severe curve in the middle third of the root, a series of Vortex Blue rotary files with a .04 taper were used to clean and shape the canal system, beginning with size 15, followed by 20 and ultimately finishing with size 25. The Vortex Blue files were incredibly flexible (Fig. 2).
Obturation was completed by lightly coating the root canal walls with AH Plus sealer followed by placement of a size 20 GuttaCore cross-linked gutta-percha core obturator. A working radiograph was taken before removing the handle of the carrier to verify proper obturation length (Fig. 3).
The handle of the obturator was then gently rocked back and forth and a composite build up was performed for adequate coronal seal. Sponge and cavit were placed in the center of the buildup (Fig. 4) before referring the patient back to her General Practitioner.
“This case demonstrates some of the amazing handling characteristics that GuttaCore offers. Because of where the curve in this tooth (middle third) was located, in my opinion, it would have been nearly impossible to get a heated plugger anywhere near the apex of the tooth. Using a carrier-based system like GuttaCore allowed warm, flowable gutta-percha to creep around the curve and make it way all the way to the apex," Dr. Royle said. "I love this product and its ease of use!”
A 90-degree curve in a #4 pre-molar “demonstrates some of the amazing handling characteristics that GuttaCore offers," said Dr. Brian Royle. "It would have been nearly impossible to get a heated plugger anywhere near the apex of the tooth. Using a carrier-based system like GuttaCore allowed warm, flowable gutta-percha to creep around the curve and make it way all the way to the apex."
Dr. Brian Royle is a native of California. He was born in Fresno and graduated from Golden West High School in Visalia. Dr. Royle attended Cuesta College in San Luis Obispo for one year before graduating from the University of Utah with a B.S. in Business and from Westminster College with an M.B.A. Dr. Royle attended dental school at the University of Southern California where he earned his D.D.S. Upon completion of dental school he returned to Fresno to practice as a general dentist, performing all aspects of dentistry. A few years later Dr. Royle sold his dental practice and moved his family to Michigan, where he received his endodontic specialty training and M.S. at the University of Michigan. Dr. Royle is an Eagle Scout and loves the outdoors. He enjoys cars, golf, music, surfing, the beach, and, of course, spending time with his wife and 2 sons.