| case report
En route to the apex with the navigator Dr Thomas Rieger, Germany
Obstacles en route
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2 Fig. 1: Pre-op radiographic image of tooth #37. Fig. 2: Fully automated endodontic motor in the practice. (Image: © COLTENE)
Introduction Unfortunately, routine cases tend to be the exception in endodontic practice; creating the optimal root canal access cavity under tooth-coloured composite can sometimes prove quite tricky, even for experienced clinicians. In the following case, the author demonstrates how a digital endodontic assistance system noticeably facilitates navigation in obscure terrain. Long-distance travel without a navigation system is hardly conceivable for many motorists. So why should one voluntarily forego a fully automatic co-pilot when negotiating the curves in the root canal? In the following patient case, the author describes the decisions the intelligent co-driver can actively support and what congestion messages and other useful additional information can in principle be gained from such a system.
A 51-year-old male patient presented at our practice late this summer, having been referred to us by his dentist for further endodontic evaluation of pain in his left mandible. The most striking feature was pronounced periodontitis, which quickly became apparent during the initial examination. CBCT confirmed the suspected overall situation: severe periapical periodontitis was diagnosed in tooth #37, and there was no doubt that root canal therapy was indicated (Fig. 1). The patient was promptly informed about his poor periodontal status and agreed to endodontic therapy. It soon became evident that another factor would further complicate navigation through the root canal system: the mesial canal entrances contained tooth-coloured composite from a previous restoration. Identifying the transition from the pulp chamber to the root canal between dentine and the welladapted filling material would therefore prove to be rather difficult. The entire treatment was performed exclusively under the microscope and not only for preparing the access cavity. This at least allowed optimisation of the view of the work field. A second highly topical working aid supported us in the preparation of the mesial and distal root canals. The CanalPro Jeni endodontic motor was used for the first time in the case described (Fig. 2). The “enchanting Jeni” is a novel digital endodontic assistance system from international dental specialist COLTENE. Jeni derives its nickname from its inventor, Dr Eugenio Pedullà. The idea for quasiautonomous driving in the root canal came to the Italian endodontic expert during the preparation of an S-shaped root canal; a fully automatic endodontic motor that autonomously navigates its way through the root canal would make root canal therapy considerably safer and less prone to error, just like a navigation system in road traffic, especially in the often stressful daily routines of a dental practice.
Congestion reports and interval recommendations included In the same manner as a driving assistance system, Jeni navigates the user safely and quickly through the root canal. With its complex algorithms, the endodontic motor controls the variable file movements in millisecond cycles. Rotational movement, speed and torque are continuously adapted to the prevailing conditions in the root canal. Fig. 3: Sequence selection by touch screen.
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