The alternative use of ExtEndo in non surgical retreatment
23/01/2022
Fabio Gorni
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In retreatments the phase of the disassembling can be difficult and time consuming. When gutta percha is too soft, for example, removing it by means of ultrasonics devices or rotary systems becomes more difficult, that’s why I stopped using solvents many years ago. In general, my approach in non surgical retreatment is to try to remove the gutta-percha points in one piece or in any case without softening it .
ExtEndo, a new instrument by Deppeler designed by Style Italiano Endodontics, is very useful in case of long roots during the cone fit but it could also be used for other applications. This case shows how easy it is to empty the root canal system with ExtEndo, increasing the control during disassembling and saving time.
Fig. 1
Pre operative X-ray: the upper right central incisor has an endodontic lesion, while the upper left incisor has an incomplete treatment.
This article will focus on the upper right incisor.
Fig. 2
Screw disassembling using ultrasonic tips
Fig. 3
The tip works in counterclockwise direction around the post in order to remove it.
Fig. 4
This technique allows unscrewing the post with maximum preservation of the dental tissue.
Fig. 5
The post is finally removed
Fig. 6
Once removed the post, it is time to focus on removing the existing endodontic obturation.
Fig. 7
Thanks to its sharp tip and the grooves, ExtEndo penetrates inside the material and with a light lateral pressure it removes gutta-percha in different pieces
Fig. 8
The removal of the gutta percha with this technique is effective and quick
Fig. 9
The action is easy, moreover it takes few time and leaves the root canal clean, with no debris on the canal walls
Fig. 10
Deep cleaning with sodium hypochlorite
Fig. 11
A little piece of gutta-percha is beyond the apex
Fig. 12
All the material has been removed , the foramen is empty and we can proceed in the final step of the treatment
Fig. 13
Using PREXO , a new plugger by Styleitaliano Endodontics , we packed collagen foam in the foramen, creating extra apical barrier useful to obtain a stop for the MTA that will be used for the apical obturation.
Fig. 14
The MTA is positioned with a dedicated carrier and compacted with PREXO.
Fig. 15
The smooth ends of PREXO allow us to press MTA in the best way
Fig. 16
The apical obturation with MTA
Fig. 17
Post operative x-ray
Conclusions
Thanks to its length and sharpness, ExtEndo can be useful also in non surgical retreatments to remove gutta percha.
Bibliography
Virdee SS, Thomas MB. A practitioner's guide to gutta-percha removal during endodontic retreatment. Br Dent J. 2017 Feb 24;222(4):251-257. doi: 10.1038/sj.bdj.2017.166. PMID: 28232689.
Gordon MP. The removal of gutta-percha and root canal sealers from root canals. N Z Dent J. 2005 Jun;101(2):44-52. PMID: 16011309.
Agrawal P, Ramanna PK, Arora S, Sivarajan S, Jayan A, Sangeetha KM. Evaluation of Efficacy of Different Instrumentation for Removal of Gutta-percha and Sealers in Endodontic Retreatment: An In Vitro Study. J Contemp Dent Pract. 2019 Nov 1;20(11):1269-1273. PMID: 31892677.