Abstract Title

Case Report: Retreatment of a radix entomolaris with Thermafil carriers

Lead Author Affiliation

Department of Endodontics

Lead Author Status

Graduate Endodontics

Expected Graduation Date

2019

Presentation Category

Endo

Introduction/Context/Diagnosis

This is a clinical case demonstrating a endodontic retreatment of a radix entomolaris. Normally the permanent mandibular first molar has two roots, mesial and distal. But mandibular molars may have an additional root located either buccally (radix paramolaris) or lingually (radix entomolaris). Understanding of the presence of an additional root and its root canal anatomy is essential for successful treatment outcome. The aim of this presentation is to show a Retreatment of Thermafil carierrs on a radix entomolaris.

Thermafil gutta percha carriers were introduced to the dental community by Tulsa Dentsply in the 80’s.

And over the years the product has change somewhat, but the idea remains the same. Essentially the product consists of gutta percha that surrounds another type of material which serves as the “carrier” of the gutta percha. Originally the carrier was a very thin metal that resembles a handfile. The metal based carrier phased out fairly quickly and was replaced with the most common carrier system which is a plastic.

Retreatment of Thermafil carriers can be tough. Unlike retreatment of a canal of gutta percha with Thermafil carriers there is a second material that must be removed; metal or plastic. Removing these materials is not at all the same as a homogeneous canal full of just gutta percha. Gutta percha is soluble in a chloroform solvent where as the metal and plastic are not (or in the case of the plastic not nearly as soluble). Even without solvent gutta percha can still be penetrated with hand or rotary files because there is a reasonable softness to the material. The metal or plastic carriers are much more dense, thus penetrating the material is tough and/or impossible. It is not uncommon to have cases in which removal of these materials can tack on an hour or two more onto the retreatment process. But none-the-less these carriers must be removed in order to fully reshape, irrigate, and properly clean the canal system.

Braiding Technique for Retreatment of Thermafil: This technique uses the file design of an Hedstrom file to entwine the carrier and pull it out. The H-file is unique in that it has a positive rake angle. This rake angle of the file allows the file to engage the carrier with more friction and binding strength.

Methods/Treatment Plan

A case will be presented, that shows a Retreatment Case on a 27-year-old female patient. She was diagnosed with previously treated, chronic apical abscess of tooth #30. A pre-OP CBCT revealed a radix entomolaris. The Retreatment required the removal of Thermafil carriers.

Results/Outcome

The outcome was successful non-surgical endodontic retreatment and resolution of patient's discomfort. The patient was advised to receive a full coverage restoration.

Significance/Conclusions

The oral health care professionals should be aware of this variation in anatomy of permanent mandibular first molars. The initial diagnosis is of utmost importance, to facilitate the endodontic procedure and to avoid treatment failures. Proper interpretation of radiographs taken at different horizontal angulations and CBCT may help to identify number of roots and their morphology. Once diagnosed, the conventional triangular cavity should be modified to a trapezoidal form distolingually to locate the orifice of the additional root.

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Case Report: Retreatment of a radix entomolaris with Thermafil carriers

This is a clinical case demonstrating a endodontic retreatment of a radix entomolaris. Normally the permanent mandibular first molar has two roots, mesial and distal. But mandibular molars may have an additional root located either buccally (radix paramolaris) or lingually (radix entomolaris). Understanding of the presence of an additional root and its root canal anatomy is essential for successful treatment outcome. The aim of this presentation is to show a Retreatment of Thermafil carierrs on a radix entomolaris.

Thermafil gutta percha carriers were introduced to the dental community by Tulsa Dentsply in the 80’s.

And over the years the product has change somewhat, but the idea remains the same. Essentially the product consists of gutta percha that surrounds another type of material which serves as the “carrier” of the gutta percha. Originally the carrier was a very thin metal that resembles a handfile. The metal based carrier phased out fairly quickly and was replaced with the most common carrier system which is a plastic.

Retreatment of Thermafil carriers can be tough. Unlike retreatment of a canal of gutta percha with Thermafil carriers there is a second material that must be removed; metal or plastic. Removing these materials is not at all the same as a homogeneous canal full of just gutta percha. Gutta percha is soluble in a chloroform solvent where as the metal and plastic are not (or in the case of the plastic not nearly as soluble). Even without solvent gutta percha can still be penetrated with hand or rotary files because there is a reasonable softness to the material. The metal or plastic carriers are much more dense, thus penetrating the material is tough and/or impossible. It is not uncommon to have cases in which removal of these materials can tack on an hour or two more onto the retreatment process. But none-the-less these carriers must be removed in order to fully reshape, irrigate, and properly clean the canal system.

Braiding Technique for Retreatment of Thermafil: This technique uses the file design of an Hedstrom file to entwine the carrier and pull it out. The H-file is unique in that it has a positive rake angle. This rake angle of the file allows the file to engage the carrier with more friction and binding strength.