Presentation of the clinical case of deep distal caries with symptoms of acute pulpitis on tooth 46 in an 80-year-old patient:

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Clinical Case Steps

•Fig 1 & 2: After anesthesia, a pre-endodontic restoration was performed. The X-ray clearly shows the intrapulpal nature of the distal caries, with the distal pulp horn affected.

•Fig 3: Placement of the rubber dam and disinfection of the operative field using Betadine or a sodium hypochlorite-based solution.

•Fig 4 & 5: Installation of the Elements Connect motor and Kerr’s latest apex locator, Apex Connect, which connects via cable to the motor, allowing simultaneous localization—saving time and improving safety during canal shaping.

•Fig 6: Preparation of the endodontic access cavity, identification of canal entries, and catheterization using manual K-files (sizes 8 or 10) with sodium hypochlorite or EDTA-based gel.

•Fig 7: Marking and widening of canal entries using the Orifice Opener Traverse file. Result shown after canal entry opening.

•Fig 8: Canal shaping using Zenflex 20 file (taper 04) followed by Zenflex 25 file (taper 06) to working length. Motor settings: speed 500 rpm, torque 300.

•Fig 9: The combination of apex locator and motor allows precise work. The motor disengages at the desired working length—either at the radiographic apex or clinical apex (-0.5 mm).

•Fig 10: After canal shaping, gutta-percha cones are tried and adjusted. A clear and light “tug-back” resistance facilitates warm obturation, thanks to the matching apical taper between the files and non-standardized gutta-percha points.

•Fig 11: X-ray with cones in place for final working length verification.

•Fig 12: Canals are thoroughly rinsed with EDTA (Salvizol), followed by 4.8% sodium hypochlorite solution, and dried using sterile paper points.

•Fig 13: Tubli-Seal cement offers time and comfort advantages thanks to its mixing tip and fast setting.

•Fig 14: Warm vertical condensation allows reproducible and tight canal system obturation, with a downpack and backfill phase using Kerr’s Elements IC system.

•Fig 15: X-ray at the end of the downpack phase shows the mesiolingual canal joining the mesiobuccal canal.

•Fig 16: Backfill phase completed.

•Fig 17: Final radiograph.

•Fig 18: Final composite restoration.

Conclusion

Kerr Endodontics offers a complete range of instruments that enable efficient and reproducible results with chairside time savings. Zenflex files provide controlled tapering to minimize instrument binding during canal preparation. “A controlled shape memory (with a different alloy for each diameter) for perfect respect of canal trajectories.”

The opinions expressed in this article/clinical case are those of Dr. Nisky. As a medical device manufacturer, Kerr Dental does not provide medical advice. Practitioners must rely on their own professional judgment when treating their patients.