Introduction
Root canal treatment for pulp necrosis combined with symptomatic apical periodontitis demands precision, efficiency, and reliable instrumentation to achieve optimal outcomes. This clinical case study highlights the successful management of a 69-year-old male patient with pulp necrosis and symptomatic apical periodontitis using the Rogin Elite INO Endo Motor and complementary Rogin instruments, emphasizing the system’s efficacy in preserving root canal morphology and ensuring accurate apical obturation.
Clinical Examination
A 69-year-old male patient presented to the clinic with complaints of discomfort in his maxillary right lateral incisor. Key clinical findings included:
– No spontaneous pain, but tenderness to percussion (a hallmark of symptomatic apical periodontitis).
– Absence of response to the electric pulp test, indicating loss of pulp vitality.
Diagnosis
Based on clinical examination and radiographic assessments, the patient was diagnosed with:
1. Pulp necrosis (confirmed by non-responsive electric pulp test).
2. Symptomatic apical periodontitis (evidenced by percussion tenderness).
Preoperative imaging further supported the diagnosis:
– A preoperative radiograph revealed deep cervical filling materials in close proximity to the pulp, a potential contributing factor to pulp necrosis.
– Preoperative Cone Beam Computed Tomography (CBCT) scans clearly identified an apical periodontal lesion associated with the maxillary right lateral incisor.
Treatment Procedure
The root canal treatment was performed using the Rogin Elite INO Endo Motor and Torna’s INO Shaper file system, following a systematic protocol:
Step 1: Access Cavity Preparation & Orifice Localization
– An access cavity was created from the appropriate facial/lingual surface to gain entry to the pulp chamber.
– The root canal orifice was localized, and its diameter was enlarged using the INO Shaper File Orifice Opener (Rogin ) to facilitate subsequent file insertion.
Step 2: Apical Localization & Working Length Determination
– Apical patency was established using an ISO 10 stainless steel hand file to ensure unobstructed access to the apical region.
– The working length of the root canal was measured and confirmed to be 23.5 mm.
Step 3: Root Canal Preparation with Rogin Elite INO Endo Motor
– Initial root canal preparation was conducted using INO Shaper Gold Files (Torna) driven by the Rogin Elite INO Endo Motor, leveraging the motor’s precise torque control for safe, efficient shaping.
– A glide path (a smooth, preliminary channel to the apex) was created using the Torna INO Shaper Gold File 15/.04 (Torna; size 15, taper 0.04) to reduce file binding and risk of instrument separation.
– Subsequent shaping was performed with a sequence of Torna INO Shaper Gold Files (Torna):
1. 20/.05 (size 20, taper 0.05)
2. 25/.04 (size 25, taper 0.04)
3. 25/.06 (size 25, taper 0.06)
– During preparation, the apical reverse function of the Rogin Elite INO Endo Motor was activated. This feature helps prevent over-instrumentation and ensures controlled apical shaping—critical for preserving root integrity.
Step 4: Irrigation & Interappointment Medication
– After each file exchange, the root canal was thoroughly irrigated with 2.5% sodium hypochlorite (NaClO) to remove debris, disinfect the canal, and dissolve necrotic tissue.
– Between appointments, the root canal was medicated with calcium hydroxide (Ca(OH)₂) to further eliminate residual bacteria and reduce inflammation.
Step 5: Final Apical Preparation & Obturation
– At the follow-up appointment, the patient reported no clinical symptoms (e.g., percussion tenderness, swelling).
– Final apical preparation was completed using an additional file, shaping the apical region to 35/.04 (size 35, taper 0.04) for optimal sealer and gutta-percha adaptation.
– The root canal was irrigated a final time with 2.5% NaClO, then obturated using gutta-percha and Bioactive Glass Sealer (Nishika, Japan) to create a hermetic seal and prevent reinfection.
Treatment Outcome
Short-Term Results
– Postoperative radiographs confirmed successful obturation (complete, uniform filling of the root canal) and preservation of the natural root canal morphology—no signs of over-filling, under-filling, or root perforation were observed.
6-Month Follow-Up
– Six months later, the patient returned for an unrelated issue (discomfort in the maxillary left lateral incisor). A CBCT scan was obtained, with a field of view (FOV) covering the previously treated maxillary right lateral incisor.
– CBCT images revealed that the root canal filling extended exactly to the apical foramen—a key indicator of successful obturation. This outcome directly validated the effectiveness of the Rogin Elite INO Endo Motor’s apical reverse function in achieving precise apical control.
Performance of Torna’s INO Shaper Files
– The INO Shaper File system (Torna) demonstrated exceptional performance, attributed to its unique cross-sectional design:
– Delivered higher cutting efficiency, reducing the time required for canal shaping.
– Ensured effective debris removal, minimizing the risk of postoperative inflammation.
– The file sequence (15/.04 → 20/.05 → 25/.04 → 25/.06) proved highly effective: after preparing with the 20/.05 file, the 25/.04 file advanced smoothly to the apex with minimal resistance—streamlining the preparation process.
Key Features of the Rogin Elite INO Endo Motor
The success of this case was significantly enhanced by the Rogin Elite INO Endo Motor’s advanced design, which addresses critical needs in endodontic practice:
1. Brushless Precision Motor & High-Precision Hall Sensor Control
Delivers consistent torque and speed, eliminating vibrations that can compromise canal shaping accuracy. The Hall sensor system ensures real-time feedback, preventing file overload and instrument breakage.
2. Extended Service Life
Boasts a service life 8–10 times longer than ordinary endo motors, reducing maintenance costs and downtime for dental practices.
3. 360° Rotation Capability
Adapts to diverse treatment positions and operator preferences, supporting comfortable, efficient access to all teeth.
4. Super-Mini Stainless Steel Integrated Contra-Angle
Reduces oral tissue irritation and enhances patient comfort—especially important for longer procedures like root canal treatment.
5. Enhanced Posterior Tooth Access
The compact contra-angle design enables easier reach to posterior teeth (e.g., molars), where limited space often complicates instrumentation.
Conclusion
This case study demonstrates that the combination of the Rogin Elite INO Endo Motor and Torna’s INO Shaper File system provides a reliable, efficient solution for treating pulp necrosis and symptomatic apical periodontitis. The motor’s precise control (including the apical reverse function) and the files’ cutting efficiency not only streamline treatment but also ensure superior clinical outcomes—evidenced by successful obturation, preserved root morphology, and symptom resolution at 6-month follow-up. For dental practitioners seeking to elevate endodontic care, this instrumentation system represents a valuable investment in precision and patient satisfaction.
