ROEN0210

Again, a variety of instruments can be used for this purpose. The goal is to thoroughly debridetheapicalextentofcanalsystemand prepare the tooth for obturation. Irrigation was accomplished with NaOCl and aqueous EDTA. Irrigants were activated with sonic agitation and copious irrigant exchange was encouraged with small K-files used in an exploratory fashion. After drying, a non-setting calcium- hydroxide paste was delivered to length in the canal and a secure interim restoration wasplaced.Calciumhydroxideaidsintissue digestion, disinfection, and neutralisation of LPS. Other agents may also be used, both as irrigants or dressings, to help optimise microbial control. The patient returned in two weeks to complete treatment. Symptoms resolved within a day or two of the initial visit. Use ofaqueousEDTA,withsonicactivationand instrumentation, assisted removal of the dressing. The apical preparation was again verifiedpriortoobturation.Sincethetooth was prepared with LSX, a corresponding Simplifill (Discus Dental) gutta-percha obturator was used. This allows for excel- lentapicalcontrolandcompactionofgutta- percha. Following this, a backfill using a heated gutta-percha delivery injection device was performed. Composite resin was then used to complete access closure. Several lateral canals were noted after ob- turation,demonstratinghydraulicpressure and thorough obturation of the canal sys- tem (Fig. 2). _Predictable healing Thesecondcase(Figs.3&4)thatwaspre- viouslytreatedwithsimilarpresentationand preparation philosophy demonstrates that by adhering to biologically based treatment philosophiesthatflowfromathoroughdiag- nosis, our patients can expect predictable healinganddiseaseprevention._ AD Dr Kendel Garretson is a 1989 graduate of the Dental School at the University ofTexas Health Science Center at SanAntonio. Since 2004,he has limited his practice to endodontics and lectures on a regular basis to Advanced Education in General Dentistry residentsonavarietyofendodontictopics. HeisamemberoftheAmericanDental Association and an associate member of theAmericanAssociation of Endodontists. He maintains a private practice in San Antonio.Questions and comments are welcomed at onlyendo@gmail.com. _about the author roots Fig. 4