Obturation with Single Cone ProTaper Universal Gutta Percha and Glass Ionomer On Mesial Drift Second Molar

Advertisements:

 


Abstract:

Supporting the  overlying restoration with the least amount of shrinkage and good adaptation to dentin walls, It has also been used as a luting agent for post and core restoration and was found to coat and Protect the apical cone from micro leakage are the characters of Glass ionomer, so we decided to use it in this study.

This is a study case that we save a tooth with root canal treatment in difficulty condition and situation and also use a new method to seal a canal with single cone protaper universal gutta percha and glass-ionomer as sealer.

An 18 year old patient complained of severe pain on the tooth#37, Radiograph examination shows;Mesial inclination of  tooth#37 towards the crown of tooth #35 was noted and 3rd molar unerupted, treatment plan was root canal treatment and endodontic treatment after wards, in this case we used the pro taper technique and single cone gutta percha and glass ionomer as sealer for obturation. Final radiograph shows that every 4 canals are completely seal no void and the canals that properly shaped with protaper files are filled appropriately. Sealing the gutta percha with Glass-Ionomer Cement gave the clinician the confidence that the obturated canal is protected from possible microleakage coronal to apical.

Introduction:

Glass-ionomer are commonly used as a cavity liner, base or barrier with good advantages such as ability to adhere to the surfaces; it can effectively reinforce and support overlying restoration with the least amount of shrinkage and good adaptation to dentin walls, It has also been used as a luting agent for post and core restoration and was found to coat and Protect the apical cone from micro leakage. [2]

Because of this favorable property we used it as a sealer during the obturation of a malposition molar. Root canal treatment of drifted tooth is more difficult during the access preparation, shaping and obturation of the canal, for this purpose we adjust preparation to minimal reduction of tooth structures with the best straight line access, and use the Glass-ionomer type 1 as sealer during of obturation with single cone protaper gutta percha, to have an acceptable result.

Objective:

Brittleness of the root canal treated tooth due to lost of the tooth structures during the treatment procedure may cause micro fracture, is one the most concern after treatment and.

Micro fractures will cause post operative sensitivity and micro leakage. So for prevention of this phenomenon we suggested to do access preparation with minimal reduction of sound tooth structures with a good straight line access and also use of Glass- Ionomer as sealer in order to, use of tooth bonding materials to increase the thickness of tooth structures for prevention of micro fracture, provide complete seal of the canals for prevention of micro leakage, Glass-Ionmer is friendly with composite restoration material for final restoration, Anti bacterial properties[4], Fluoride can  be released out without affecting the physical properties of cement that is Anticariogenic properties of Glass-ionomer[3]; All these properties encourage us to use of Glass-ionomer instead of ZOE based sealer due to disadvantage of ZOE based sealer like, low Strength, high Solubility, unable to be used under composite restorations and indirect restorations cemented with resin or hybrid glass ionomer cements.

Case Presentation:

An 18 year old patient complained of severe pain on the tooth#37 specifically during mastication which usually intensifies at night for 2 months.

In clinical examination distal wall of the crown was completely lost due to caries and drifted mesially due to the absence of tooth #36 and radiograph shows, mesial inclination of  tooth#37 towards the crown of tooth #35 was noted and 3rd molar unerupted.

Clinical signs and symptoms after objective diagnostic testing indicated that the complained tooth was affect by symptomatic irreversible pulpitis, the drifting and tipping of the affected tooth mesially would present a certain degree of difficulty in cleaning and shaping.

Treatment Plan was, Root Canal Therapy on tooth #37 and Crown of tooth #37 will be restored with porcelain jacket crown then Orthodontically movement of the tooth to provide space for the eruption of 3rd molar. [1]

Methods and Materials:

For this study we choose lower second molar left side that was mesial drifted. Biomechanical Preparation Procedure included the; Crown build up for this purpose

All previous restoration, affected and unsupported tooth tissue were removed and Distal of the Crown was restored close to its original anatomy using dentin bonded composite resin.

Next step was, Access preparation; Entry to the pulp chamber was made with minimal removal of sound dentin walls and completes unroofing of the chamber then proceed to Scouting, for this step we used A drop of Glyde was placed on the chamber and 0.02 k-file #15 marked at trial working length checked the “glide path” of the canals and Removal of pulp tissue and Chamber was flushed with NaOCl. For Orifice shaping we did, Coronal 1/3 of the canal was enhanced using Sx ProTaper hand file, Shaping of the coronal 2/3 was initiated using S1 Protaper hand file, After shaping all canals at the coronal 2/3, patency check was done using 0.02 k-file #15 And a radiograph was exposed with #15 file in each canals.[5]

Now WL was established, then The Protaper files S1 S2 F1 F2 F3 that will shape the canal at WL were all marked with rubber stop, canals were shaped one at a time then Canals were flushed with NaOCl and a drop of Glyde for every change of file. MB canal was shaped with S1 to working length followed by S2, Apical diameter was verified with 0.02 k-file #20 and “tug back” was not felt, Shaping proceeded to ProTaper file F1 to working length and verified with 0.02 k-file #25, “Tug back” was felt and shaping for MB ended and The rest of the canals were shaped and cleaned using the same sequence of instrumentation, after finish of shaping we proceed to Obturation.[5]

A ProTaper universal gutta percha point of the same size as the last ProTaper file used was selected and disinfected then, the gutta percha points were fitted into the canal and radiographed, before cemntation, Canals were emptied, irrigated and dried as a final attempt to eliminate potential infective by products before sealing. Sealing done by Glass Ionomer Type 1, was mixed and delivered into the first root canal system to be sealed using lentulo filler and with an absorbent paper point, a thin layer of sealer was spread to the canal walls then, the ProTaper GG point was thinly coated with sealer and was seated into the canal up to the WL.

At last with a “red hot” delivery system, cut the excess GG 1 mm below the orifice.

Obturation of the remaining canals one after the other was proceeded, an intra orifice plugs using GI type II was used to seal the orifice or to flood a thin layer over the orifice to flatten the floor of the pulp chamber[6]. The rest of the chamber was sealed with dentin bonded composite resin the crown was ready for full crown coverage.

Result:

Final radiograph shows that every 4 canals are completely seal no void and the canals that properly shaped with protaper files are filled appropriately.

Conclusion:

The correct assessment of the degree of difficulty of pulp cavity, the right choice of shaping technique and systems, correct armamentarium and their proper application are the key factors in the success of endodontic treatment. In the case presented, correct access preparation that established a straight line access to the apical third provided an effective cleaning and shaping of the entire root canal system.

With the use of the ProTaper hand files, shaping was faster, infected dentin layer of the canal walls were effectively removed and the canal shape was more definite allowing easy introduction of sealer throughout the canal. With a definite shape, obturation with a Protaper universal gutta percha points was accomplished with ease and accuracy. Sealing the gutta percha with Glass-Ionomer Cement gave the clinician the confidence that the obturated canal is protected from possible microleakage coronal to apical.

ACKNOWLEDGEMENT

Thanks God at the first and I am heartily thankful to my supervisor,

Dr. Ma Liza Orense and Dr. Alden Aguilar and Centro Escolar University

Those encouragement, guidance and support from the initial to the final level enabled me to develop an understanding of the subject.

Lastly, I offer my regards and blessings to all of those who supported me in any respect during the completion of the project.

The author declares no potential conflicts with respect to the authorship and /or publication of this article.

Refrences:

  1. Theodore .M.Roberson. Art and science.  Fifth edition . Patient assessment ,examination and diagnosisand treatment planning.P407
  2. Carel ,L.Davidson and Ivar A.Mjor, Advances in Glass-ionomer cement. Characteristics of Glass-ionomer cement.p15
  3. Carel ,L.Davidson and Ivar A.Mjor, Advances in Glass-ionomer cement,chemical properties of Glass ionomer cement.p85
  4. Carel ,L.Davidson and Ivar A.Mjor, Advances in Glass-ionomer cement,Glass-ionomer Luting Cement.p149
  5. Stephen cohen,Richard  C.burns, eight edition.path way of the pulp. Cleaning and shaping of the root canal system.p231
  6. Stephen cohen,Richard  C.burns, eight edition.path way of the pulp. Armamentarium and  instrument.p161
  7. Stephen cohen,Richard  C.burns, eight edition.path way of the pulp.instrument , materials and devices.p560
  8. Stephen cohen,Richard  C.burns, eight edition.path way of the pulp. Armamentarium and  instrument.p161
  9. doiserbia.nb.rs/img/doi/0370-8179/2010/0370-81791012694V.pdf
  10. sciencedirect.com/science/article/pii/S0099239905607248
  11. thedigitaldentalarchive.com/content/medialibrary/files/protaper.pdf
  12. dentistrytoday.com/endodontics/1104

By Golmoradizadeh Ali

Email: ali2ph-at-yahoo.com


Advertisements: