From the Docs

Articles and case studies from the users of EdgeEndo.

Separation Anxiety?

How To Minimize File Separation In Endodontic Therapy.

Dr. Short has published articles in several publications including Dentistry Today, UpScale Magazine, Rolling Out Magazine, and the Journal of Endodontics. The following article is republished with permission from Dr. Rico Short.

Well let’s talk about the elephant in the room.  All files can separate!  If you do enough root canal treatments it will happen to you as well…so relax.  Most of the research shows if the canal was cleaned decently and a working length was established, especially on a vital case, the success rate is still favorable if the separated file is at the apex.(1)  If the file is not at the apex, it should be able to be bypassed or removed.  If any file or other instrument separates inside the canal and can’t be removed, medical-legally, you must inform the patient that an instrument has separated inside the canal.  But you can insure them that the case still should be fine.  A 6 month to a 1 year follow up is generally recommended to make sure there are no issues.  This must be documented in their treatment notes and noted that you also informed the patient.

There are at least 50 various types of NiTi files on the market.  They are classified according to their design, metal properties, shaping characteristics, breakage potential, and clinical performance.  In addition, most rotary files are non-end cutting. Some files have radial lands for safety and some do not.  Radial lands tend to “slow” the efficiency of the file while keeping it centered for safety. (2)

“The 8 Golden Keys” To Minimize File Separation.

1) Assess Case Complexity

If a case has severe root curvatures or if you see a canal then it disappears in the middle or apical 1/3 then it will be a challenge.  There is probably a bifurcation.  Pick the best rotary file for the job after using handfiles to the working length.

2) Provide Adequate Access

Straight line access and coronal flaring is very important.  It take unnecessary stress off the file.  In addition, the “crown down” method is more efficient than the “step back” . In other words, the rotaries are used from larger to smaller sizes in the “crown down” method.  This allows for better irrigation and less binding of the files. (3)

3) Glide Path

Adequate glide path to the apex is critical before even picking up a nickel titanium rotary file.  Recommend a hand file at the apex to at least a size #15 prior to rotary use.

4) Light Pressure

Use light touch and torque control motor.  Various files cause for different speeds and torque settings.  Refer to the manufactures instructions.  The pressure I recommend is to hold the rotary hand piece like you would hold a very sharp #2 pencil trying not to break the lead tip while writing.

5) Don’t Start Then Stop

Sudden changes in the motion of the file while inside the canal can create unwanted forces on the file.  A smooth gentle motion should be used while inserting and withdrawing the file inside the canals.  I like to use the 5 second rule.  I work a canal with a NiTi file for five seconds or strokes then change to a different file.

6) Lubricate Well

The canals should be lubricated at all times while cleaning and shaping.  Recommend use of sodium hypochlorite in addition to RCPrep (Premier) or Gylde (Dentsply Tulsa).  These agents will create less friction on the files while cleaning and shaping the canals. (4)

7) Check Rotary Files

It is important to evaluate each rotary file before placing it into the canals.  Look for shiny spots or flattened areas.  If you see any of these replace immediately.  Thermal sterilization does not affect fatigue life of the files. (5)

8) Replace Rotary Files

Most manufactures recommend rotary files to be single use.  However, there are some cases in which the file may not contact any dentin or very little.  In these cases, it should be ok to re-use the file.  My golden rule regardless is “Three Strikes” and you are “Out”!

What is the perfect rotary file?

So you might ask, what is the perfect rotary file for every single case?  Well the answer is there is no perfect rotary file but there are some better than others.  Many lecturers and manufacturers are always trying to work on and sell the “one file that fits all”.  This is really an impossibility like.  Why?  It’s because ALL canals are different!  The file should not dictate the canal shape.  It’s the canal shape that should dictate the file type and the taper.

For instance, if you have a severely calcified canal, it does not make sense to pull out a .06 taper file.  This will remove unnecessary dentin which can weaken the root or create a vertical root fracture.  In addition, it can also cause a file separation especially if the root is curved.  If the canal is very calcified or have a severe curvature, an .04 taper should be used.

Choosing the Proper Rotary File

I’ve used many types of nickel-titanium rotary files in my over 17 years of practice.  Some were very good at the time and some were not.  However, now Edge Endo has developed some very unique files. One of my favorite files from Edge Endo is the Edge File X7 Universal .04 taper.

It’s strong, flexible, and economical.

These files can be pre-curved to get into difficult and limited access areas.  Once they are inside the canal, they follow the canal in a very smooth and silky way. They are also very durable due to their specialized heat treatment process of the nickel titanium.

In conclusion, root canal preparation with NiTi rotaries are very safe and effective.  However, you must choose the proper rotary file for the case.  It demands understanding the root canal anatomy and the usage principles of the select rotary system.  Not just every tooth, but every canal should be evaluation on its own merit regarding length, width, curvature, and apical diameter.  NiTi rotary usage also requires training and proper CE courses.  Following the guidelines above will help the clinician avoid “Separation Anxiety”  as related to endodontic therapy.

References

1) Spili P, Parashos P, Messer HH. The impact of instrument fracture on outcome of endodontic treatment. J Endod 2005; 31: 845−850.

2) Peters OA. Current challenges and concepts in the preparation of root canal systems A review. J Endod 2004; 30:559-97.

3) Leeb J. Canal orifice enlargement as related to biomechanical preparation. J Endod 1983;9: 463-70.

4) Bossler C, Peters OA et al. Impact of lubricant parameter on rotary instrument torque and force. J Endod 2007; 33:280-3.

5) Bergmans, Lars, et al. “Mechanical root canal preparation with NiTi rotary instruments: rationale, performance and safety.” Am J Dent 14.5 (2001): 324-33.

Join the mailing list for EdgeEndo and receive new product announcements, case studies, technique tips and more.

From the Docs

Articles and case studies from the users of EdgeEndo.

Dr. Figueroa Tames a Beast of a Case with EdgeFile®

“I haven’t received any endorsement…but this is the only file that could tackle that case.”The following case study was transcribed from a Skype interview and republished with permission from Dr. Yanina Figueroa. 

A Passion for Endodontics

When colleagues ask her why she decided on Endodontics as a specialty, she responds, “I love the challenge, every person and tooth is different.  There is never a dull moment just a dull bur!”

Dr. Yanina Figueroa’s sense of humor is as sharp as her skills. We understood that after only a few minutes of talking with her.

Growing up in Puerto Rico, she attended public high school, obtained a bachelor’s degree of science in Biology from the University of Puerto Rico-Mayagüez Campus in 2003, and received her D.M.D from the University Of Puerto Rico School Of Dental Medicine in 2007. During her post-graduate years she developed a passion for Endodontics while working as a general Dentist in private practice. Dr. Figueroa materialized her dreams by completing her training in Endodontics in 2013 from The University of Pennsylvania. There she was trained utilizing the newest technology and following the University of Pennsylvania Vision of Excellence in Endodontics.

We met her when we connected with her on our EdgeEndo® Facebook page. In her constant quest to find the newest and best instruments to tackle her challenging cases, Dr. Figueroa was one of the “early adopters” of the heat-treated EdgeFile®. She is such a fan that she and her “Beastly” case were featured in an EdgeEndo® advertising campaign.

Beastly Bifurcation

By Dr. Yanina Figueroa

I’m an endodontist from Atlanta, Georgia, and I did my specialty at the University of Pennsylvania, graduated 2013 and I wanted to share with you this case of a molar number 14 of a 33 year old patient with irreversible pulpitis and Symptomatic Apical Periodontitis. This case was diagnosed and accessed through the crown using diamond burrs. Then, irrigation with sodium hypochlorite.

“When you see a case like this, you’re wondering to yourself, what file am I going to use for this? How am I going to negotiate that canal without having file breakage?”

First, I tried to get patency of the canals, I did the patency of the distal mesiobuccal canal and distal canal using 10 files, and then worked my way up to a 15 file. I instrumented this case using an SX file to open the orifices, then used copious irrigation with sodium hypochlorite.

I started using the EdgeEndo files utilizing crown down technique, when you see these type of canals that are very curved, you want to flare up a little bit the upper portion of the canal, so your files can slide down easier and have less binding on the walls. I started doing the crown down from a 40 to a 25 and then went all the way to 40’s on the mesiobuccal, on the distal, and I did the palatal to a 45.

I went to a 40 on that root… any other file would have just broken and just could have been impossible to retrieve.

When I took the x-ray to see how the cones were fitting, I noticed that there was a canal missing, so I used the CBCT to find the MB2 canal. All this, of course, while I’m using my EdgeFiles, I used also lube, RC prep for the instrumentation, and I also used a lot of sodium hypochlorite to instrument. Before doing the cone fit, I do irrigation with ultrasonics using sodium hypochlorite , EDTA, and chlorhexidine. I did my cone fit with the Edge Gutta Percha and the AH Plus sealant.

When I took the x-ray to see how the cones were fitting, I noticed that there was a canal missing…

Now, I can tell you when I took the x-ray I saw that the MB2 was missing, so I took a CT scan and noticed the MB2 and noticed the weird unusual buccal inclination of the MB2 to the palate, and the MB  really pointing towards the buccal. It looked almost like a snake tongue. I was like, oh wow, this has been the thing that I was looking for. I found the MB2 on the second visit. I closed everything up before that with calcium hydroxide, then on the second visit I found MB2.

I proceeded to do the instrumentation up to a 35 on MB2 with the same sequence, using sodium hypochlorite, first of all going up to a number size 15 and doing crown down to a 35. After that, I irrigated everything with sodium hypochlorite, EDTA, chlorhexidine, and I dried everything up with sterile paper points, and took an x-ray with the cone fitting, with cones and age plus sealant.

“I haven’t received any endorsement…but this is the only file that could tackle that case.”

After verifying that the diagnostic intermediate x-ray looks fine, I closed everything up using vertical condensation, just leaving 4 millimeters of the apical portion of the cone, and then back filling with Edge Gutta Percha. After that, very important, I always put an orifice barrier. I use purple permaflow orifice barrier, then I put a cotton pellet and that was that.

“AAAAAAH the panacea…”

I was trained at U Penn and we believe in large apical sizes and I went to a 40 on that root… any other file would have just broken and just could have been impossible to retrieve. When I did this case I was like “AAAAAAH the panacea.”

The EdgeFiles have been the best files I have used so that is why I am so excited about them.

  Join the mailing list for EdgeEndo and receive new product announcements, case studies, technique tips and more.

From the Docs

Articles and case studies from the users of EdgeEndo.

Switched to Edge Endo! I’m a Believer! WaveOne® and Edge Comparison

The following article is republished with permission from Dr. John Ha. We have reformatted the images slightly for easy reading, and product trademarks have been added.

Introduction

I’m always trying to find ways to improve my technique and at the beginning of the year, I started to use the Wave One® (W1) files that made my endo much more efficient. It was a simple and the files cut great and fast. The taper was a little aggressive but the one file system has worked for me. Guttacore® (GC) has also been great.

My new associate gig does not use any rotary endo. Thus all materials that I use, I buy myself. Sucks but I can’t go back to hand filing (so 1980’s!!). You can imagine that the W1 and GC prices can add up on an associate’s pay.

I recently did a trial order with Edge to see what all the fuss was about. I’m glad I did. Below is just a quick comparison and a few cases that I’ve finished up using the Edge files and Edge-Core.

The W1 equivalent is the X1 file and that is what I ordered. I am using the Promark endo motor and Guttacore oven.

The W1 files actually have a plastic portion that expands upon autoclaving and prevents you from re-inserting it into your handpiece. The Edge file does not. Everyone has their own philosophies when it comes to re-using rotaries. For me, all files are used once then trashed.

Forgive the sensor change from the first two cases to the last two. The good sensor broke and the back up isn’t as great.

EdgeFile®

The file packaging. The files come in packs of three. They do not do assortment packs. You will have to purchase the various sizes you plan to use.The Edge files have a very interesting metallurgy and are dark in color unlike any file that I’ve used before (endosequence and W1).The Edge file can be bent with light pressure. But don’t mistake the flexibility with fragility. I used an Edge on an extracted premolar and did stupid movements and it didn’t break.The metallurgy allows for flexibility once bent. However, it is not like bending stainless steel handfiles. This feature is nice for getting into those hard to reach canal orifices. I would imagine it’d be good for ninja accesses.

WaveOne®

This is the W1 file. The nice thing about it is that the pre-measured increments can be seen pretty easily. The Edge files also have these measurements as well but is harder to see.As you can see, the W1 file has quite a bit of memory. They are very stiff compared to the Edge files.

Obturators

Red obturator is the Edge-Core and green is Guttacore. I haven’t noticed a difference except when it comes to clean up. The Edge-core is slightly more difficult to clean up but stating that is really nit-picking. Both work great.

One note: if you’re going to use the X1 edge files, order the X7 edgecore obturators. The X1 Obturators have a .08 taper to be used with the W1 files. They will not seat completely if you’re using the X1 edge files.

EdgeFile® Cases

Straight forward case. Single canal premolar. Really nice guy but couldn’t open wide for the life of him. Most of the appointment was filled with telling him to keep open since he couldn’t tolerate the bite block.No surprisesIrreversible pulpitis on 2 canal premolar. Nothing that was significant about this one either.Also no surprises with obturation.Really nice guy that was referred to me by a colleague of mine that doesn’t do RCT’s. 4 Canals found and shaped.Recurrent decay on the distal leading to irreversible pulpitis. Four canals found. MB2 was a bugger to find even though she was young.All four canals filled but DB was short. I had run out of my last obturator so I left it the way it was. I informed patient and told her that I buy all my own materials and that if it’s giving her any issues, I will re-do the root canal at no charge if gives her problems. She was very understanding about it. That was about 2 weeks ago and she’s been in a couple times since to get some fillings done. She hasn’t had any issues with chewing on it at all. Crown scheduled for the end of this month when she gets her bigger paycheck.I felt like the obturator may have bound to the pulp chamber wall while filling the ML, even though it went to length. So I kept the RD clamp on to take the final x-ray. Looks good to me!

Conclusion:

All in all there hasn’t been any loss in efficiency with the Edge files coming from the W1. However, it’s been a lot better on my wallet since I have to buy my own stuff. Check it out! Edge hasn’t disappointed me yet!