Ultrasonic Irrigation

During endodontic treatment, our goal is to remove all pulpal tissue and micro-organisms, by-products from within the root canal system. We know that the root canal system is not only made up of the main canal, but may have isthmuses, fins, webs, anastomoses & other irregularities. These variations in the canal shape are impossible to cleanse mechanically. We must rely on our irrigant to reach the places that our files cannot reach. Opening the canals to a large enough size for the irrigant to reach the apex is an important step. I also like to use what I call "ultrasonic stirring". I use an ultrasonic instrument to "stir" or "vibrate" the irrigant as it sits in the canal. Below is a little video clip showing how I do this.

A recent randomized, single blind study published in the Journal of Endodontics supports this practice as a way achieve more effective canal sterilization. Carver, Nusstein, Reader & Beck showed that canals cleaned and irrigated normally, followed by a one minute ultrasonic irrigation with an ultrasonic needle in a MiniEndo unit resulted in statistically significant (p = .0006) reduction in CFU count and positive cultures (p = .0047). Logistic regression showed that ultrasonic irrigation was seven times more likely to yield a negative culture. Source: Carver, K., Nusstein, J., Reader, A., Beck, M. In Vivo Antibacterial Eficacy of Ultrasound after Hand and Rotary Instrumentation in Human Mandibular Molars. Journal of Endodontics 2007;33:9:1038-1043.

There are many ways to perform ultrasonic irrigation. I simply irrigate the canals normally using a disposable syringe and 5.25% NaOCl. Then I use a small stirring tip attached to my ultrasonic handpiece. I am certain there are other products on the market, but I like to use the instruments that I already have.

Holistic Dentistry

This patient was referred to my office today. He had not slept for 3 days. He was in terrible pain. This tooth had recently been prepped for a crown by his holistic dentist. Maybe the holistic dentist did not see the apical lesion before he started the crown, but the tooth became symptomatic. His holistic dentist had recommended extraction of #30.
He decided to get a second opinion.
The tooth was diagnosed with a necrotic pulp and symptomatic apical periodontitis. He elected to save his tooth with endodontic therapy.

With good follow up, we'll see that the apical lesion has healed, and he will be glad that he got a second opinion, and retained his natural tooth. I think that is pretty holistic!

Endodontic Healing

This is a typical case of endodontic healing. This tooth was diagnosed with a necrotic pulp & chronic apical periodontitis. The periodontal probings were normal. The apical lesion was very large and extended up the lateral side of the tooth. This could be described as a "J-shaped" lesion which is sometimes indicative of a vertical root fracture. Since the perio attachment is normal, this is diagnosed as purely an endodontic lesion.

Endodontic treatment complete.

At one year recall, the lesions is almost completely healed. The periodontal probings are normal and the patient is completely asymptomatic. Proper endodontic diagnosis & treatment not only saved this tooth, but saved this bridge as well.