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Newsletter 1a
 

Newsletter 1a

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Includes video of MB2 penetration

Includes video of MB2 penetration

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    Newsletter 1a Newsletter 1a Document Transcript

    • NEWSLETTERS SUMMER 2012 Dentsply Tulsa Dental Specialties Charline Morris Charline.Morris@dentsply.com 416.735.6777 WWW.TULSADENTALSPECIALTIES.COM I’d like to thank Dr. Ken Serota for his assistance in the preparation of our Summer Newsletters. His expertise and commitment to continuing dental education has been the hallmark of our collaborative efforts going back over nine years.....The material presented is an introduction to a series of courses being prepared for our fall evening study club sessions. Our objective is to ensure that you have continual access to information from both the print and digital worlds to provide you with the ability to deliver the highest calibre endodontic therapeutics possible. Synopsis of newsletters I. History of WaveOne™ Access - think 3D - axial, coronal, sagittal II. Glide Path - secret to NiTi safety ProUltra® Piezo Ultrasonic WaveOne™ system - ProMark™ Endodontic Motor Irrigation - Qmix® (antimicrobial) III. GuttaCore™ Cheers, Charline
    • DON’T LOOK BACKSummer 2012 Rehabilitate Replicate Reciprocate Evaluate Iterate, Innovate, Sophisticate Wave One: Changing the protocol The use of reciprocation for root canal preparation has is an iatrogenic issue that can be eliminated with been mainstreamed by several stainless steel (SS) file experience. In fact, the incidence of file breakage is as combinations. The concept originates from the 1985 low as 2.4% according to a recent study1. publication on the balanced force technique by James Roane. He suggested a clockwise, anti-clockwise, Crown down preparation, the use of a pecking motion or clockwise motion should be used to negotiate curved a brush-out motion has been suggested to reduce the canals with SS files. This process became motorized with incidence of file separation. Hybrid techniques combining the introduction of the M4 handpiece. A nickel titanium different brands of NiTi files were tried in the hope of (NiTi) file system was recently introduced using this reducing file fracture risk by potentiating the differences reciprocation preparation concept - WaveOne™ inherent in the design parameters. (Dentsply) files and the Dentsply ProMark® Endodontic Motor. Torsional failure occurs when the tip of the file is ‘locked’ or jammed in the root canal while the electric engine Does this represent a radical improvement in treatment running the handpiece continues to rotate the shank of outcomes compared to the over sixty some NiTi systems the file. This and the taper-lock phenomenon are the in the marketplace? Are there critical issues using NiTi primary causes of file separation. files with continuous rotation motion that necessitate this iteration? Torque control feed back along with altered instrument design, change in helical angle, radial land configuration, With the use of NiTi rotary files, it is simple and pitch length, and file taper have all been tried; however; convenient to create tapered smooth-walled funnel separation remains an issue. Now with the single file shaped root canals with minimal apical debris extrusion; technique using a reciprocation motion, it appears a new however, file separation remains a serious concern. This day has dawned. 2
    • Theoretically and clinically, clockwise and counter- (NiTi alloy) went to the stress-induced martensiticSUMMER 2012 clockwise movement will reduce the incidence of deformation which has a higher chance of fracture. torsional fracture. ProTaper F2 instruments used with By adjusting the engine to rotate the file in the reverse reciprocation were shown to demonstrate a prolonged direction (limited to 72 degrees), Yared was able to lifespan compared to their use with conventional prevent debris extrusion apically. rotation. The flute helix of the WaveOne file is designed to wind in This concept was first reported by Dr. Yared in 2008. He the reverse direction to conventional NiTi files. Thus used a ProTaper F2 file only with reciprocation to these files will cut dentin during counterclockwise complete the entire root canal preparation. Using the rotation not in the clockwise rotation. The use of a single Tecnika endodontic engine with a reciprocation motion NiTi instrument will invariably prove to be more cost- function, he was able to repeatedly produce ideal effective than the conventional multi-file NiTi rotary shapes without aberration or file separation. systems. The rationale for this approach lies in the stress release No initial hand filing is needed with this technique in the of the counterclockwise rotation. Reciprocation is an majority of cases. After measuring the working length oscillation or gyromatic motion. Files with continuous using #10 or #15 SS file, the WaveOne primary (size clockwise rotation incur torsional stress even in straight #25 tip with 08 taper) is introduced into the root canal root canals. While the engines for NiTi rotary files have a space without making another glide path because the special mode of auto reverse to prevent the over-load, inactive passive tip of the WaveOne primary will follow the main cause of fatigue fracture; however, it is not the path sculpted during the working length 100% successful. measurement. Modified convex triangular cross section at the tip end Convex triangular cross section at the coronal end By using the ProTaper F2 in the reciprocation mode (counterclockwise rotation after clockwise rotation), 1. Yared G. Canal preparation using only one Ni-Ti rotary instrument: preliminary observations. Int Endod J Yared showed a reduced wedging and screwing 2008;41:339-44. tendency. While reciprocating, the file cuts root dentin during the clockwise (144 degrees) rotation and the file is released with counterclockwise rotation before the file 3
    • Summer 2012 Access Uninterrupted flow by degree It is generally accepted that all maxillary first molars have a second canal in the MB root and in a small percentage of cases there may be three or more. In o almost 15% of the mesial roots of mandibular first molars, an “isthmus canal” can be detected. As the incidence in the maxillary molar is far more o o prevalent, let’s examine the means by which predictable instrumentation of the MB2 can be achieved.The MB2 is very curved at the coronal limit of the canal. The shelf of dentin that grows over and obscures the minute orifice o o has the effect of moving the canal entrance distal to the true path. When an exploratory file (.06/.08) is inserted, it immediately runs into a wall of dentin on the mesial aspect of the canal. The extremely narrow confines of these typically small canals will not allow the file to negotiate the typically abrupt curvature. Excessive vertical work merely crumples the file tip and risks ledging the orifice. In order to create access, the file tip was worked to the point where resistance is met, pulling the file to the mesial to remove the overhanging dentin. When the file first engages, only 2 or 3 flutes of the file may engage. As these few flutes are worked, movement of the MB2 orifice to the mesial becomes evident. Once the operator gains experience, this mesial shift is done with ultrasonic troughing tips to Axial slice of mandibular molar showing the middle mesial provide a more definitive mesial incline into or isthmus canal evident in almost 15% of cases. the canal. Ultrasonics can be augmented by micro- etching. The “satin finish” makes the orifice more visible with magnification and illumination. It should be noted that a thin film of water or alcohol enhances visibility at this point. When the initial access glide path is sufficient, the file begins to increase its penetration of the canal space. This will coincide with an increasingly vertical file orientation. A significant number of small files will be utilized for this procedure as they will tend to buckle. You want to avoid a lot of work with the file tip early on, following the balanced force watch-winding technique to prevent ledging within the canal. Slow and incremental removal of the cervical ledge obscuring the true path of the MB2 canal will enable accurate negotiation of the full canal length with time and patience. 4 to be cont’d