Barry Musikant
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 HIS
PAPER’S TITLE might sound simple, but I hope it describes exactly what
follows.
We use PulpOut® round burs with a stop at 7
mm to create the initial access followed by non-end-cutting barrel diamonds
that extend the access laterally without deepening the preparation. This
procedure creates a chamber in which the depth is sufficient to allow entry
into the pulp chamber without allowing the instruments to perforate through
the floor of the tooth.
With this initial outline form, enough access now
exists to allow you to introduce a continuous stream of hot NaOCl into
the pulp chamber while your assistant suctions out the excess fluid. This
might sound like a routine that you always follow, but the difference is
the heated NaOCl. If the NaOCl solution is not hot, it loses a good
deal of its ability to dissolve pulp tissue. It is not until you
realize just how effective hot NaOCl is that you will take the extra steps
to make sure that you employ this form of irrigation. For the past
several days over at the EDS laboratory, we have been digesting the pulp
tissue from extracted teeth by placing hot NaOCl in the opened chambers.
The results are dramatic. All tissue remnants for at least a few
millimeters are dissolved away, leaving clefts of space clearly outlining
the location of canals, additional clefts and fins directing the dentist
to where further removal of dentin will be most productive. Using this
technique, particularly with magnification, preferably a microscope, the
dentist is far more likely to find auxiliary canals, and any missed tissue
remnants will often generate telltale bubbles.
I am quite impressed with the action of hot NaOCl
and would be remiss if I did not mention that the impetus to explore this
innovative avenue of endodontic simplification comes from Scott Perkins,
a most innovative dentist out of Houston who is quite active on Dentaltown
and has shown innumerable examples of hot NaOCl’s cleansing action. Suffice
it to say that the tissue-dissolving action of hot NaOCl will exceed any
you ever saw with room-temperature NaOCl and it will do it quickly.
Once the canals are defined and the access to the
canals refined, continuous hot NaOCl is an invaluable tool in dissolving
tissue the entire length of the canal. The most efficient method of continuous
delivery is still debatable, but one way is to warm 30-gauge needles filled
with NaOCl in a beaker of water that itself is being warmed close to, but
not to, boiling. After examining canals exposed only to hot NaOCl,
we found that many of them looked as if they had already been instrumented.
The resistance that reamers encountered in the treated canals was far less
than the resistance in canals not exposed to hot NaOCl.
As long as the 30-gauge needle used to deliver the NaOCl is used
in the pulp chamber, a stream of fluid is acceptable. Once the 30-gauge
tip starts entering the canals, however, the stream must be modified to
deliver only about 3 to 4 drops per second simply because a continuous
stream in a canal has too great a chance of going over the apex and causing
distress.
Try that hot NaOCl and be impressed and delighted.
Of course, the SafeSiders® work well with NaOCl
because the SafeSiders will now encounter even less resistance on their
way to the apex. Since these instruments were originally designed
to minimize the amount of engagement—and therefore resistance—that will
be encountered, the dissolution of tissue in the canals accentuates the
designed reduction in engagement with the walls of the canals.
Within the next four to five weeks, we will be introducing
a new tapered Peeso that has several advantages over a typical No. 2 Peeso.
The No. 2 Peeso is .90 mm at the most apical portion of its cutting length
and continues at that width for its entire 9 mm of cutting length.
The new tapered Peeso is .75 mm at the most apical portion of its cutting
length and increases over 9 mm of working length to a width of 1.02 mm.
The result is an instrument that finds the entrance to the glide path more
easily, negotiates to length which is ideally within 6 mm of the apex,
impacts less debris as it heads apically, straightens the coronal curve
more easily, and finally minimizes any chance of bottling. Of course,
the fact that no Peeso or Gates Glidden cuts at the tip makes these instruments
quite safe to use.
These innovations are all interactive and mutually
reinforcing. Better access allows better irrigation which leads to
enhanced instrumentation. We even reinforced the effects of an improved
Peeso by adding an optional SafeSider NiTi, the 25/06, which is a transition
instrument from the 30/04 to the 25/08. This transition step compensates
for those dentists who are a little shy with the Peeso which will now be
an easier step due to the introduction of the new tapered Peeso.
Without adequate use of the No. 2 Peeso, going to full length with the
25/08, the last instrument in the SafeSider sequence, was difficult at
times. Now, if resistance to apical length is encountered with this
instrument, the dentist can go to length with the 25/06 and follow that
with the 25/08, eliminating the strong resistance initially encountered
with the 25/08.
The total effect of these improvements makes endodontics
easier. That is not to say that it is easy. Tight curved canals will always
present a challenge, first possibly in finding them and then negotiating
them to the apex without distortion in the apical third of the root.
However, because all the SafeSiders can be used in a 30-degree reciprocating
handpiece, separated instruments are virtually eliminated because cyclic
fatigue and torsional stress are also eliminated and these are the two
main causes of separation whether the instrument is made of stainless steel
or NiTi.
I just came back from the Dentaltown meeting in
Las Vegas and I realized that what I am teaching the dentists who learn
the SafeSiders system with all the adjuncts that make endodontic life even
easier is a technique that allows dentists to increase their experience
and expertise while no longer going through the hazing process of broken
instruments that is so much a part of the learning curve of rotary NiTi.
At the end of the day, the dentists learn a system that continually expands
in usage as they become familiar with the system while rotary NiTi’s learning
curve is just the opposite where “learning” really means learning where
not to use them, territory that is continually expanding as a requirement
for minimal breakage.
As usual, we conduct a variety of learning classes—some
for a fee, others for free. I am still giving my free 2?3 hour one-on-one
workshops for anyone interested in becoming acquainted with this ever-improving
alternative technique as well as the adjuncts that make it even easier.
If you are interested, don’t be shy. Many dentists have said that
it has changed their professional lives dramatically for the better, and
I am delighted to teach as long as I can.
April-June 2006
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Try
hot NaOCl and be impressed and delighted.
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