Endodontic case study: Hybrid technique on 90-degree curve

Sept. 16, 2013
Nathaniel Behrents, DDS, MS, goes through an endodontic case study involving a diagnosis of irreversible pulpitis with long roots and greater than 90-degree curvature. He takes the reader on a successful journey of instrumenting the canal, explaining in detail how he completes the task.

Clinician: Nathaniel Behrents, DDS, MS; Fayetteville, AR

Description of the tooth, its position, and its root morphology: No. 15. Buccal inclination with four canals and the apical third curved slightly over 90 degrees to distal.

Diagnosis: Irreversible pulpitis with long roots and greater than 90-degree curvature.

Technique: To navigate a long 90-degree curve, Dr. Behrents took a hybrid approach: ProTaper® Universal files, Lexicon® C-Files, PathFiles, and PROTAPER NEXT™ files.

Dr. Behrents used a ProTaper® Universal S1 shaping file to begin coronal shaping after achieving patency with a #10 Lexicon® C-File. He proceeded through the PathFile® sequence, using all three files to length, and followed with the ProTaper Universal S2 to two-thirds length.

Dr. Behrents then began the PROTAPER NEXT sequence using the X1 and X2 to length in the MB1 and DB canals, while maintaining patency with the #10 Lexicon C-File. Because the MB2 joined the MB1 at midroot, it was instrumented with the X1 only.

He instrumented the P canal using the PROTAPER NEXT X2, X3 and X4. The apical segment of the P canal was finished by hand using a 20/08 GT® hand file.

Nathaniel Behrents, DDS, MS, grew up in Germantown, Tenn. He attended the University of Colorado at Boulder and The University of Texas at Dallas where he received a Bachelor of Science in Biology. Dr. Behrents then returned home to Memphis to attend the University of Tennessee College of Dentistry. He graduated in 2009 earning the Dean's Award for Clinical Excellence and the American Association of Endodontists’ Student Excellence Award. He attended St. Louis University where he received his Certificate of Endodontics and Master’s of Science in Dental Research in June 2011. He is also actively pursuing Diplomate status by the American Board of Endodontics and is a member of the American Dental Association, American Association of Endodontists, American Academy of General Dentistry, the Academy of Osseointegration, Rogers Study Club, and the Academy of Interdisciplinary Dentofacial Therapy.ADDITIONAL ENDODONTIC CASE STUDIES ...Dr. Kinra's case gallery: Soft landingEndodontic case study: Healing of a large lesion in a lower molar after proper dental instrumentation and irrigation