- 1.NEWSLETTERS SUMMER 2012Dentsply Tulsa Dental Specialties
Charline Morris [email protected]
416.735.6777WWW.TULSADENTALSPECIALTIES.COMId like to thank Dr. Ken
Serota for his assistance in the preparation of our Summer
Newsletters. Hisexpertise and commitment to continuing dental
education has been the hallmark of our collaborative effortsgoing
back over nine years.....The material presented is an introduction
to a series of courses beingprepared for our fall evening study
club sessions. Our objective is to ensure that you have continual
accessto information from both the print and digital worlds to
provide you with the ability to deliver the highestcalibre
endodontic therapeutics possible.Synopsis of newsletters I.History
of WaveOne Access - think 3D - axial, coronal, sagittalII.Glide
Path - secret to NiTi safetyProUltra Piezo Ultrasonic WaveOne
system - ProMark Endodontic Motor Irrigation - Qmix
(antimicrobial)III. GuttaCoreCheers,Charline
2. DONT LOOK BACKSummer 2012 Rehabilitate Replicate
ReciprocateEvaluateIterate, Innovate, SophisticateWave One:
Changing the protocolThe use of reciprocation for root canal
preparation has is an iatrogenic issue that can be eliminated
withbeen mainstreamed by several stainless steel (SS)
fileexperience. In fact, the incidence of file breakage is
ascombinations. The concept originates from the 1985low as 2.4%
according to a recent study1.publication on the balanced force
technique by JamesRoane. He suggested a clockwise,
anti-clockwise,Crown down preparation, the use of a pecking motion
orclockwise motion should be used to negotiate curved a brush-out
motion has been suggested to reduce thecanals with SS files. This
process became motorized withincidence of file separation. Hybrid
techniques combiningthe 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 differencesreciprocation
preparation concept - WaveOneinherent in the design
parameters.(Dentsply) files and the Dentsply ProMarkEndodontic
Motor. Torsional failure occurs when the tip of the file is
lockedor jammed in the root canal while the electric engineDoes
this represent a radical improvement in treatmentrunning the
handpiece continues to rotate the shank ofoutcomes compared to the
over sixty some NiTi systems the file. This and the taper-lock
phenomenon are thein the marketplace? Are there critical issues
using NiTiprimary causes of file separation.files with continuous
rotation motion that necessitate thisiteration?Torque control feed
back along with altered instrumentdesign, 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 fileshaped root
canals with minimal apical debris extrusion;technique using a
reciprocation motion, it appears a newhowever, file separation
remains a serious concern. Thisday has dawned.2 3. Theoretically
and clinically, clockwise and counter-(NiTi alloy) went to the
stress-induced martensiticSUMMER 2012clockwise 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 reversereciprocation
were shown to demonstrate a prolonged direction (limited to 72
degrees), Yared was able tolifespan compared to their use with
conventionalprevent debris extrusion apically.rotation.The flute
helix of the WaveOne file is designed to wind inThis concept was
first reported by Dr. Yared in 2008. Hethe reverse direction to
conventional NiTi files. Thusused a ProTaper F2 file only with
reciprocation tothese files will cut dentin during
counterclockwisecomplete the entire root canal preparation. Using
the rotation not in the clockwise rotation. The use of a
singleTecnika 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 rotaryshapes without aberration or file separation.
systems.The rationale for this approach lies in the stress
releaseNo initial hand filing is needed with this technique in
theof the counterclockwise rotation. Reciprocation is an majority
of cases. After measuring the working lengthoscillation or
gyromatic motion. Files with continuoususing #10 or #15 SS file,
the WaveOne primary (sizeclockwise rotation incur torsional stress
even in straight#25 tip with 08 taper) is introduced into the root
canalroot canals. While the engines for NiTi rotary files have a
space without making another glide path because thespecial mode of
auto reverse to prevent the over-load,inactive passive tip of the
WaveOne primary will followthe main cause of fatigue fracture;
however, it is notthe path sculpted during the working length100%
successful.measurement.Modified convex triangular cross section at
the tip endConvex triangular cross section at the coronal endBy
using the ProTaper F2 in the reciprocation mode(counterclockwise
rotation after clockwise rotation),1. Yared G. Canal preparation
using only one Ni-Tirotary instrument: preliminary observations.
Int Endod JYared showed a reduced wedging and screwing
2008;41:339-44.tendency. While reciprocating, the file cuts root
dentinduring the clockwise (144 degrees) rotation and the fileis
released with counterclockwise rotation before the file 3 4. Summer
2012AccessUninterrupted flow by degreeIt is generally accepted that
all maxillary first molarshave a second canal in the MB root and in
a smallpercentage of cases there may be three or more. In oalmost
15% of the mesial roots of mandibular firstmolars, an isthmus canal
can be detected.As the incidence in the maxillary molar is far more
ooprevalent, lets examine the means by which
predictableinstrumentation of the MB2 can be achieved.The MB2
isvery curved at the coronal limit of the canal. The shelf ofdentin
that grows over and obscures the minute orificeoohas the effect of
moving the canal entrance distal to thetrue path.When an
exploratory file (.06/.08) is inserted, itimmediately runs into a
wall of dentin on the mesialaspect of the canal. The extremely
narrow confines ofthese typically small canals will not allow the
file tonegotiate the typically abrupt curvature. Excessivevertical
work merely crumples the file tip and risksledging the orifice.In
order to create access, the file tip was worked to the point where
resistance is met, pulling the file to themesial to remove the
overhanging dentin. When the file first engages, only 2 or 3 flutes
of the file mayengage. As these few flutes are worked, movement of
the MB2 orifice to the mesial becomes evident. Oncethe operator
gains experience, this mesialshift is done with ultrasonic
troughing tips toAxial slice of mandibular molar showing the middle
mesial provide a more definitive mesial incline intoor isthmus
canal evident in almost 15% of cases.the canal.Ultrasonics can be
augmented by micro-etching. The satin finish makes the orificemore
visible with magnification andillumination. It should be noted that
a thin filmof water or alcohol enhances visibility at thispoint.
When the initial access glide path issufficient, the file begins to
increase itspenetration of the canal space. This willcoincide with
an increasingly vertical fileorientation. A significant number of
small fileswill be utilized for this procedure as they will tend to
buckle. You want to avoid a lot of work with the file tipearly on,
following the balanced force watch-winding technique to prevent
ledging within the canal. Slow andincremental removal of the
cervical ledge obscuring the true path of the MB2 canal will enable
accuratenegotiation of the full canal length with time and
patience.4 to be contd
