Dentsply Sirona's complete Signature® Workflow for endodontic procedures

Contents:

• Step 1: Diagnosis
• Step 2: Planning and Communication
• Step 3: Treat
• Step 4: Monitoring and Support

Root canal treatment is often considered to be a painful and unpleasant procedure, but thanks to advancements in technology, it has become easier and more effective than ever before. Dentsply Sirona is a leading dental equipment and technology provider offering a complete workflow for endodontic treatments. Our best-quality products for endodontic treatment can be explored here.

The Dentsply Sirona Signature™ Workflow for endodontic procedures involves four main steps:

1. Diagnose: Evaluating the patient's condition, diagnosing the problem, and determining if an endodontic treatment is required. 
2. Plan and communicate Planning the steps and timeline of the treatment and communicating and explaining the treatment plan to the patient. 
3. Treat: Performing different steps of root canal treatment, including access, cleaning and shaping, obturation and restoration. 
4. Monitor and support: Checkups and preventive care to monitor the patient's oral health. 

Step 1: Diagnosis

To determine if your patient requires a root canal treatment or if the pulp can still be healed, you should look out for some specific symptoms like pain on chewing, sensitivity to temperature (hot and cold), an abscess, or a bad taste in the mouth. Before starting with root canal treatment, diagnosing the condition of the teeth is a crucial step.

Diagnosing your patient involves multiple steps, including a thorough clinical examination of the teeth and soft tissue, taking necessary radiographs and digital impressions, and certain diagnostic tests such as hot/cold tests.

The most important thing in the diagnostic phase is to gather all relevant information. Aside from patient history and symptom review, it is important to get the most accurate imagery as possible with limited-radiation technology. 

There are several options here, depending on the information you need and the patient’s comfort level.

A common tactic is to create intraoral periapical films using the Xios^® Intraoral sensor and holders. These intraoral sensors come in a variety of sizes for all patients, even paediatric patients. In addition, they deliver premium image quality with a high resolution. This minimises the need for re-taking radiographs, thus limiting radiation exposure to a level that is “as low as reasonably achievable” (the ALARA principle).

In patients with a gag reflex who cannot tolerate intraoral radiographs, Axeos and Orthophos S deliver extraoral bitewings. If needed, those devices also provide precise 3D images and a high definition mode for fine structures, helping you to identify problems that may not be visible with 2D imaging and allowing you to plan the root canal treatment with great accuracy and confidence.

Primescan^® is an advanced intraoral scanner that provides faster, easier, and more accurate scanning of teeth and associated soft tissues. It allows you to take digital impressions, collect patient data, and visualise the patient's mouth in great detail for accurate diagnosis.

Step 2: Planning and Communication

Following diagnosis, you need to plan both the access and the eventual restoration, and then communicate everything to the patient with a firm timeline. DS Core^® supports all treatment options available, whether there will be a direct restoration or you choose to do an eventual single-unit chairside crown restoration or a single-unit lab-manufactured crown.

Regardless of your software, you will need to:

• Identify all the root canals
• Calculate the working length and depth of the access cavity in 3D
• Plan the root canal treatment
• Plan for effective communication with the patient.

You can decide if you need straight-line access or can go with a minimally invasive technique. This decision will in turn have an impact on the type of restoration to pursue following the endodontic procedure. 

Step 3: Treat 

Once the plan is made and communicated to the patient, next comes the full treatment procedure. This stage involves access opening, cleaning and shaping of the canals, obturation, and restoration.

Access

A well-prepared access cavity is a key factor in the success of endodontic treatment. You may either prepare access for a straight-line or minimally invasive procedure. Dentsply Sirona offers eight rotary instruments to efficiently create an access opening to start with the root canal treatment procedure for necrotic pulp or vital pulp therapy. Explore details on Dentsply Sirona products for access opening here.

For treating pulp necrosis, shaping and cleaning are crucial to removing all the necrotic pulp tissue from the canal. The Dentsply Sirona Endo workflows are providing you that complete approach where all products seamlessly work together. Choose the one that fits best in your hands and cover a full range of anatomical situations. Pairing them with our new X-Smart^® Pro+*, you’ll be ensured of optimal settings, thus highly safe and efficient work. 

For an efficient cleaning, passive soaks are not enough. Activating irrigant solution produces a surface with more opened dentinal tubules, providing better obturation of lateral and accessory canals. The SmartLite Pro EndoActivator^® is an equipment solution designed for intracanal activation of irrigating fluids used for cleaning and disinfecting root canals**. Designed for multi-directional movement, the SmartLite Pro EndoActivator^® uses elliptical motion and increased energy for effective irrigant activation.

Direct or Indirect Restoration

Restoration is the last step in the endodontic workflow. You need to decide if the patient needs a direct restoration or a single-unit crown, either manufactured chairside or from the lab. A direct restoration may be simplest when the access for the endodontic procedure was minimal, but a larger access for the root canal might make an indirect restoration with a single-unit crown better for the patient. 

Direct Restoration

For direct restoration after a root canal treatment, you need to choose the right armamentarium to enhance the quality of the restoration.

A matrix system should be used to create tight, natural contacts without requiring excessive interproximal finishing of the completed restoration. The Palodent^® system comes with stackable rings to allow the restoration of multiple teeth at once, maximising efficiency. It also includes a WedgeGuard that lets you prepare teeth significantly faster without worrying about damaging the adjacent teeth and gingiva, which can cause problems with haem contamination. In addition, the guard can be detached after preparation, leaving the wedge in place, thus serving two functions. The matrix bands themselves have a pin-tweezer hole that allows easy placement and removal. They are also available in multiple sizes, including several bands that have a gingival apron for those tricky subgingival preparations.

After placement of the matrix, the composite restoration follows. The preparation is etched, rinsed, and air dried (but not desiccated). An adhesive is applied with a microbrush. Microbrushes can be bent at a 45 degree angle to increase access to difficult-to-reach areas of the preparation. In addition, the dentist can designate specific colours to certain tasks to minimise the risk of cross-contamination. The Prime&Bond active^® universal adhesive has a minimal film thickness, thus preventing the adhesive from pooling into the corners of the proximal box. These pools typically appear radiolucent on X-rays and thus may be mis-diagnosed as a void or recurrent caries, leading to unnecessary replacement. In addition, Prime&Bond elect^® uses dipentaerythritol penta acrylate monophosphate technology to chase away residual water, creating a strong bond with decreased postoperative sensitivity.

After the adhesive is air dried, it can be light cured. The SmartLite^® Pro light cure has a 10 mm active curing diameter with a homogeneous light output, which minimises the risk of uncured adhesive, especially in those hard-to-reach areas.

Not all restoration materials and products are created equal. Our goal is to empower you to provide the best possible care to your patients, which is why we've created our procedure solution for Class II Restorations.

Once you have done the restoration, you need an effective finishing and polishing system to increase the durability and longevity of the restoration and avoid any irregularities and scratches on the enamel. Flowable composite can be placed in the gingival portion of the proximal box. This layer is not cured before placement of a packable composite material. This so-called “snowplough technique” helps decrease voids in arguably the most important portion of the restoration, the gingival floor. A material such as SDR^® flow+ can be used to flow easily into every nook and cranny. In addition, its self-levelling properties allow for excellent marginal integrity without the need for agitation.  

Indirect Restoration

If the access required for the endodontic procedure is deemed too invasive, you might decide that an indirect restoration with single-unit crown is a better option for your patient.

Crown preparation begins with a intraoral impression for the fabrication of the provisional crown.

If the crown is made charside, the provisional step and impression are eliminated by using CEREC^®. However, some clinicians find that having a preliminary impression is supportive in the instance of case interruptions during preparation, ultimately affecting the treatment outcome. The decision to fabricate a lab-based unit over a chairside-based unit depends on

the individual office. Not every practitioner has access to in-office milling machines; it comes down to workflow desires, dependant on cost, patient experience, and the desire for technology-driven practice integrations. If the crown is instead manufactured by a lab, the first step would include using Primescan^® to get a digital impression. Once the scan is complete, the lab is ready to fabricate the provisional by using the pre-op provisional impression matrix and Integrity^® temporary crown and bridge material.

For more information about single-unit crown procedures and solutions, please see Dentsply Sirona’s Indirect Restoration Signature Workflow, particularly the the planning and treatment stages.

Conclusion

Dentsply Sirona provides a comprehensive workflow for endodontic procedures, from diagnosis to aftercare, for you and your patients. Our product range includes imaging and digital impression solutions, treatment planning and patient communication software, and products for accessing, cleaning, and restoring the root canal and the tooth. DS Core^® is also essential to the workflow, making data easily accessible, sharing data with the lab, cloud storage, and patient communication. With Dentsply Sirona, you can be confident that you have the tools you need to achieve the best results for your patients.

To learn more about Dentsply Sirona's products for endodontic and root canal procedures, please contact us.