For printable PDF version click here: Cone-beam Computed Tomographic Analysis of Canal Transportation and Centering Ability of Single-file Systems
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Dr. Cliff Leffingwell
From the Docs
Articles and case studies from the users of EdgeEndo.
Dr. Leffingwell has been an EdgeEndo user for almost 4 years. He made the switch to Edge when he discovered the ability to effectively and safely navigate and shape root canal systems that previously used files could not accomplish. In this clinical case from Dr. Leffingwell, Edge files gave him the confidence to navigate the canal system after appropriate potency obtained with hand files (EdgeEndo K-file.)
Patient Background
Patient was a 46 year Caucasian female who presented with a chief complaint of a dull, lingering ache associated with tooth #31 (Mandibular Right Second Molar). The onset of discomfort began shortly after a carious exposure at a restorative appointment with her general dentist 2 days prior. The general dentist completed a “formocresol pulpotomy”.
After appropriate examnation, pulp testing, and radiographs, a pulpal and periapical diagnosis was provided of PREVIOUSLY INITIATED TREATMENT WITH SYMPTOMATIC APICAL PERIODONTITIS.
The patient was provided treatment options which included non-surgical endodontic therapy, removal of her tooth, or no treatment. After discussing the risk, benefits, and potential complications of each course of treatment, she elected non-surgical endodontic therapy. She would then follow up with her general dentist for a core build up and a full-cuspal coverage restoration. The patient’s medical history was reviewed and was unremarkable. She took no medications, and reported no know drug allergies. Appropriate written and verbal consent for treatment was obtained.
Procedure
Local Anesthesia was obtained with 68 mg Lidocaine with 0.034 mg epinephrine via a Right Inferior Alveolar Nerve Block and Right Buccal Infiltration. A rubber dam was placed in the appropriate fashion. Access was made and the previously placed temporary restorative material and cotton pellets were removed from the access. The access cavity was refined and 3 canals were located (Mesiobuccal, Mesiolingual, and Distal). Coronal flaring was completed in a step-wise fashion using EdgeTaper SX rotary file, followed by further flaring with Gates Glidden Drills #4, #2, and #3 sequentially. A #6 Edge K-File was used to determine and achieve canal patency in all 3 canals. Once this was established a #8, #10 and #15 Edge K-Files were used via a Kerr M-4 Handpiece to further establish canal patency. Edge Gel was used copiously along with irrigating with 6 % Sodium Hypochlorite in between file sizes. Upon drying of the canals, working length (WL) was determined with a Root Zx II. The Distal canal WL was measured at 21.00 mm. The Mesiolingual and Mesiobuccal canals were measured to be 23.00 mm. Rotary instrumentation with EdgeFile rotary files X-7 series were used in a crown down fashion. Again, Edge Gel and irrigation with 6% Sodium Hypochlorite was used in a copious manner throughout. A master apical file (MAF) size of #30 was created in the distal canal. A MAF of #25 was created in both mesial canals.
A final irrigation of the canal system was completed with 6 cc of 6% Sodium Hypochlorite. The canals were dried using paper points. They were then obturated with the appropriate sized .04 Taper Dia Dent Gutta Percha points coated with Edge Seal. Warm Vertical Compaction with a System-B was used. Back fill of the canal system was completed with the Obtura II. The pulp chamber was thoroughly cleaned, then conditioned. Dyract was placed over the canal orifices and a cotton pellet and Cavit were placed to temporarily restore the access cavity. The patient was subsequently referred back to her general dentist for permanent restorative care.
About the Doc
Dr. Leffingwell earned his Doctor of Dental Surgery (D.D.S.) with distinction from the University of Oklahoma College of Dentistry. He then entered the United States Navy as a dental officer. Dr. Leffingwell completed a General Practice Residency at Naval Hospital Camp Pendleton Marine Corps Base, California. Following his residency, he was assigned to Fleet Hospital/Naval Hospital in Jacksonville, Florida. After being honorably discharged from active duty, Dr. Leffingwell earned his specialty certificate in Endodontics from the University of Nebraska Medical Center College of Dentistry.
Lincoln Endodontics began in January 2006 when Dr. Leffingwell purchased the practice of Dr. Merlyn Vogt. Prior to practicing in Lincoln, Dr. Leffingwell practiced in Joplin, Missouri. He is an active member of numerous professional organizations including the American Association of Endodontists, American Dental Association, Nebraska Endodontic Association, Nebraska Dental Association, the Lincoln District Dental Association, and Delta Sigma Delta.
Dr. Leffingwell is married to Karla Dawn Maddux, formerly of Imperial, Nebraska. She is a Corporate Trainer and College Business Instructor. The Leffingwells are avid outdoorsmen. They also own King Twist Quarter Horses and raise, train, and show American Quarter Horses. They both compete in timed and cutting horse events.
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Dr. Jergensen
From the Docs
Articles and case studies from the users of EdgeEndo.
Can this tooth be saved?
This case study has been republished with permission from Dr. Justin Jergensen
Can this tooth be saved?
Root canals on second molars can be a tough job, but EdgeEndo flexible files seem to help in performing root canals in those hard to reach areas.
Truth, this patient has some bone loss. Her periodontium has been battered, but she has a healthy mouth now and wants to keep her teeth strong and fighting. The initial punch, a filling long ago placed near the pulp chamber finally wears its way in. Acute pulpitis of the irreversible kind, a real sucker.
Upper second molars are the hardest sites to perform a root canal. Yet, with the EdgeEndo files I can float like a butterfly and sting like a bee, opening up those canals even in the hard to reach molars. EdgeEndo files help me stick to a predictable protocol for any root canal from anterior to teeth touching the tonsils. After opening each canal, cleaning and shaping is worry free and predictable without getting strung up against the ropes.
The EdgeEndo is the uppercut knockout punch; the cost is right and the file finds it’s path right to the apex every time!
About the Doc
With his father as a dentist, Dr. Jergensen knew since he started college he would enjoy being a dentist. Dr. Justin Jergensen received his Bachelors degree from BYU in Zoology and did his dental school training at University CA San Francisco. After merging into his dad’s dental office he tried out EdgeEndo files and has used them for two years now, he was able to switch his father over to Edge too. He enjoys endodontics because he can save teeth from being extracted and relieving pain is rewarding to him. What makes Dr. Jergensen an EdgeEndo believer? “I love the way EdgeEndo makes their products affordable and their fields all the hard work for me without any breakage. I find the breakage very minimal and I love the flexibility of the files.”
EdgeEndo files make clean and shaping root canals so simple and effective. If you have not tried them, you are missing out.
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Use exactly like ProTaper® Gold.
Unmatched Strength,
Flexibility & Compatibility
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For GT® and GTX® Users
More Studies Keep Showing EdgeEndo Domination!
EdgeEndo® files continue to be recognized as superior files. Many manufacturers are focused on refining the performance of NiTi. In recent studies conducted by university students and presented at the AAE conference, EdgeFile® was shown to be significantly more resistant to cyclic fatigue. Cyclic fatigue of a NiTi file occurs when the metal blade is subjected to repeated cycles of tension and compression that lead to stress and hardening of the material. In this study the six rotary files were tested for cyclic fatigue in an artificial canal. The survival of the instruments were tested using Weibull reliability test.
Introduction
Cyclic fatigue occurs due to recurrent tension and compression inside the curved canals that leads to crack formation and propagation that progresses until failure. Many factors affect instrument cyclic fatigue including the type of wire that the instrument is made of, instrument design, instrumentation motion and surface integrity.
The efforts of manufacturers are consistently focused on refining the performance of instruments and increasing their resistance to fracture. Instrument modifications include surface electropolishing, changes in the file design and cross section and the use of reciprocating motions rather than continuous motions.
Recently, Thermal treatment optimizes the microstructure and maximizes the flexibility and resistance to cyclic fatigue of an instrument.
Today, instruments make of controlled memory wires have been introduced to the market and exhibit greater resistance to cyclic fatigue that regular NiTi alloys.
Aim
To compare the cyclic fatigue of six rotary instruments with different nickel-titanium (NiTi) wires.
Method
F2 ProTaper Universal® (PT) and ProTaper Gold® (PTG) (Dentsply, Tulsa Dental Specialties, Tulsa OK, USA), C2 EdgeFile® (EF) (EdgeEndo, Albuquerque NM, USA), R25 RECIPROC® (RC) (VDW, Munich, Germany), Primary WaveOne® (WO) (Dentsply, Taillefer, Ballaigues, Switzerland), and #25 OneShape® (OS) (Micro-Mega, Besancon Cedex, France) (n-15 instruments) were tested for cyclic fatigue in an artificial canal with a 6-mm radium and a 45 degree curvature. The artificial canal within a stainless steel block was milled by using laser with the aid of computer program which reproduced the instrument size and taper and preserved the instruments trajectory that was adapted to the parameters selected. Number of cycles to fatigue (NCF) was recorded; the lateral surface and fractured face of segments were examined using scanning electron microscopy (SEM) and the cross sectional area was measured. One-way ANOVAs and Games-Howell tests were utilized for data analysis.
Results
The EdgeFile had significantly greater resistance to cyclic fatigue, followed by the RC, WO, PTG, OS and PT (p<0.05). The WO and RC were significantly more resistant to cyclic fatigue than the PTG, OS, and PT.
No significant difference was found between the OS and the PTG (p<0.05), and the PT exhibited the lowest resistance to cyclic fatigue compared to the other systems (p<0.05).
Conclusion
The EdgeFile® was significantly more resistant to cyclic fatigue and was followed by the RECIPROC, WaveOne, ProTaper Gold, OneShape and ProTaper rotary files.
The improvements to rotary instruments were proven to increase their resistances to cyclic fatigue.
EdgeEndo® FireWire™ NiTi
EdgeEndo® proprietary heat treatment process called FireWire™ has created NiTi unmatched flexibility and resistance to cyclic fatigue. FireWire™ NiTi files provide cyclic fatigue resistance many times greater than other NiTi files. The increased flexibility of Heat treated NiTi allows files to better follow the canal, but EdgeEndo® FireWire™ NiTi does away with shape memory and “Bounce Back” and therefore gives incredible canal contouring capability. Dentin is preserved and canals in apical third are preserved.
*Based on Internal Testing. Click here for testing methodology.
NiTi is great but needs improvement.
Nickel-titanium [NiTi] rotary files have long been considered superior to stainless steel files for root canal procedures. The shape memory and flexibility of NiTi preserved dentin as well as enabled easier and better access. Since their introduction in 1991, the dental industry has continued innovation and improved the NiTi file with significant developments in metallurgy and design, which have improved shaping properties and flexibility. However, the most commonly used NiTi files still have room for improvement as they often fall short in key areas.
Where “classic” NiTi Fails.
1) Cyclic Fatigue & Separation
Cyclic fatigue of a NiTi file occurs when the metal blade is subjected to repeated cycles of tension and compression that lead to stress and hardening of the material. Eventually this leads to fracture of the metal. Cyclic fatigue is the most common cause of NiTi instrument separation and often one of the most difficult procedures to rectify. Judging when a NiTi file is poised to separate has proven to be very difficult.
2) Canal Transporting
NiTi files exhibit “shape memory” which can initially seem beneficial, as it files do not “wobble” when placed in hand piece. However, shape memory causes a NiTi file to “bounce back” in the tooth, putting pressure on the canal wall and can lead to transportation of the canal, and unnecessary removal of dentin.
Better with Heat Treatment… even better with FireWire NiTi
1. Incredible Flexibility & Resistance to Cyclic Fatigue
Several manufacturers have heat treated NiTi files which increase flexibility and resistance to cyclic fatigue. However, EdgeEndo® proprietary heat treatment process called FireWire™ has created NiTi unmatched flexibility and resistance to cyclic fatigue. FireWire™ NiTi files provide cyclic fatigue resistance many more times greater than other NiTi files. See Cyclic Fatigue Test results here.
Pre-bending the file is a great advantage when approaching a canal with severe curvature.
2. No “Bounce Back”
The increased flexibility of Heat treated NiTi allows files to better follow the canal, but EdgeEndo® FireWire™ NiTi does away with shape memory and “Bounce Back” and therefore gives incredible canal contouring capability. Dentin is preserved and canals in apical third are preserved.
Case by Dr. Yanina Figueroa.
EdgeEndo files with FireWire™ NiTi
EdgeEndo® offers a full line of FireWire™ NiTi Heat Treated Rotary Files. EdgeFile®, EdgeTaper Platinum™, EdgeSequel Sapphire™ and EdgeEvolve™, are each designed to be compatible with popular file systems with blade cross sections to cater to a doctor’s preference. All are treated with the FireWire™ process giving them incomparable ability to carefully follow the canal, preserving canal anatomy & dentin and allowing faster procedures making for increased productivity and ultimately happier patients.
FireWire™ NiTi Strength
CYCLIC FATIGUE TEST – AVERAGE TIME TO FAILURE IN SECONDS* EdgeEndo® FireWire Vortex Blue® Sybron K3XF® Sybon K-3® GT Series X® ProTaper® Sequence® *Based on Internal Testing. Click here for results
