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Step 2 – Have the tools necessary decrease the forces applied to each file Cone beam CT images (Kodak) confirm
to make this success a reality used during instrumentation, minimizing pronounced curve in MB canals and S
In the treatment of curved canals, several chances for instrument failure. Hand files curvature in DB canal. Dental caries were
key products are instrumental in achieving should be used in a watch-winding, or removed, and aseptic treatment was
true success. These include small stainless preferably, the balanced force technique.12 maintained with a resin-modified glass
steel hand files, nickel-titanium hand Rotary instruments should never be forced ionomer cement (Fugi II, GC Corporation).
files, and rotary nickel-titanium files. First, apically to avoid unnecessary strains and Vital tissue in 5 (MB1/2/3, DB, and P)
the stainless steel hand files are used to possible failure/fracture of instruments.13 canals was confirmed upon pulp chamber
assist with creating a glide path. Passive Two types of failure occur with root access. Initial coronal debridement with
movement with a light touch is necessary canal instruments: torsional loading and a rotary Sx file (Dentsply Tulsa Dental
to debride pulpal tissues and negotiate cyclic fatigue. Torsional loading occurs if a Specialties) in conjunction with stainless
apical anatomy. However, larger stainless file binds within the canal and continues to steel hand files to remove pulpal tissues. A
steel instruments can alter the internal rotate to the point of separation (torsional glide path was created using a combination
structure of the canal (i.e., increased canal failure). Cyclic fatigue is the result of of stainless steel hand files and NiTi hand
transportation) when compared to nickel- continued forces being placed on an files (Flex Files, Dentsply Tulsa Dental
titanium instruments.9 Nickel-titanium hand instrument as it operates around curves. Specialties). After achieving repeatable
files can be used to increase the diameter This results in repeated strain on the file patency measurements with the Elements
of the glide path while maintaining the resulting in eventual work hardening and Apex Locator (Sybron Endo) and 15 NTK®,
canal anatomy. Nickel–titanium rotary fracture.14 In root canals with significant a 20/04 Typhoon (Clinician’s Choice)
files are flexible, but multiple curves or curves, cyclic fatigue is always a concern rotary file was introduced into each canal.
significant curves can still put incredible during treatment. The literature has Passive movement into each canal allowed
strain on these instruments. Recently, a demonstrated two key points. One, for appropriate cleaning and shaping of
new product, Typhoon Controlled Memory using CM files increases the resistance the canal system. If the file appeared to
(Clinician’s Choice), has been developed to fracture versus non-treated NiTi rotary stop moving apically while in the canal, the
that uses thermal treated NiTi alloy that files. Two, operating CM instruments in instrument was withdrawn, irrigation and
enhances the mechanical properties of the presence of fluid increased resistance recapitulation with a 15 NTK® hand file.
nickel-titanium.10 These files have been to fracture versus use in a dry environment In an apical enlargement approach, initial
shown to be more resistant to cyclic fatigue by over 200%.15 Clinicians should always instrumentation with a 20 and 25 NTK® was
than standard nickel-titanium files.11 These operate endodontic rotary instruments with used. Subsequent 25/04 through 35/04
three tools: small stainless steel hand files, canals flooded. This increases contact time instruments were used in all buccal canals
moderate-sized nickel-titanium hand files, between the internal root surface and the and a 45/04 for the palatal canal. After
and rotary Controlled Memory or CM files, disinfectant as well as decreases potential disinfection was completed, obturation
are essential for treating the moderately to for instrument separation. with master gutta-percha cones, Kerr EWT
severely curved canal systems predictably. Now that the steps to treat curved sealer (Sybron Endo) and Calamus® gutta
canal systems have been discussed, I percha (Dentsply Tulsa Dental Specialties)
Step 3 – Use the tools would like to present a few cases that was completed. The floor of the chamber
appropriately show the utilization of these steps and was sealed with a resin-modified glass
Each instrument has a specific function techniques. ionomer cement (Fugi IX, GC Corporation)
and should be used in the correct manner. and temporized with Cavit™ (3M).
Endodontic files are designed to create Case 1
additional space within the root canal to A 17-year-old male with non-contributory Case 2
decrease contact with subsequent files. medical history presented for evaluation A 39-year-old female with non-contributory
Endodontic files should have minimal of Quadrant 1. Vitality tests confirmed medical history presented for evaluation
contact along the root canal. Slow, a diagnosis of irreversible pulpitis with of Quadrant 4. Vitality tests confirmed
consistent enlargement of the canal can acute apical periodontitis for tooth 1.6. a diagnosis of necrotic pulp with
Figure 5: Postoperative radiograph with Figure 6: Postoperative radiograph Figure 7: Preoperative CBCT Figure 8: Preoperative CBCT image (coronal view
obturation complete with distal angulation image (radius of curvature on demonstrating three canals in mesial root)
M root)
Conclusion during local study club events. Follow the Acknowledgements: I would like to thank
Although manufacturers often tout a current literature on new products and Dr. Joe Petrino for his professional review
preassembled system for root canal resources. Our profession prides itself on and advice regarding this manuscript.
debridement, it is imperative for the an evidence-based approach to treat our
clinician to assess each tooth or canals on patients in the highest standards possible. This article was reprinted with permission
a case by case situation and realize which Apply these resources and focus on the from Oral Health.
instruments or techniques give the best end result. EP
chance of success. It is often far too easy
to adhere to the “cookie cutter” pamphlet
included in the packet of files rather than
take the time to strategize the correct References
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sequence to treat a tooth. Each tooth, and 1. Schilder H. Cleaning and shaping the root canal. Dent of cone beam computed tomography as a tool to explore
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furthermore each canal of a tooth, is unique
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straightforward. A standard cleaning and 3. American Association of Endodontists. AAE D, De Luca M, Testarelli L. Mechanical properties of
Endodontic Case Difficulty Assessment Form and nickel-titanium rotary instruments produced with a new
shaping protocol could be applied to Guidelines. http://www.aae.org/uploadedFiles/Dental_ manufacturing technique. Int Endod J. 2011;44(4):337-
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I would like to challenge each of you to applications of cone beam computed tomography in 14. Haïkel Y, Serfaty R, Bateman G, Senger B, Allemann
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7. American Association of Endodontists. Cone
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your craft. Utilize your local endodontic for_Excellence_Newsletter/ecfe%20summer%2011%20 2012;38(3):376-380.
FINAL.pdf. Accessed February 16, 2013.
specialist’s knowledge and discuss cases