Doug Kase
|
 hroughout
issues of Endo-Mail, we have discussed in great detail the Simplified Endodontic
Technique (S.E.T.). As we know, this system utilizes a combination
of instruments that includes both .02 stainless steel files, .04 files,
and files of greater taper which are both made of nickel titanium.
The other important instrument that is used at various times throughout
the Simplified Endodontic Techniques is the Peeso or Gates Glidden reamer.
It is used to widen the coronal one-third to one-half of the canal,
which greatly reduces the stress on the hand file or reamer being used
and on the operator using that file. Using this rotary instrument
in a canal should not induce fear or hesitation, for we have been taught
to use it proficiently for post preparation since we were dental students.
First Use of the Peeso Reamer
The number 2-Peeso reamer is used three times during the procedure.
It has always been used with a passive pressure in a wet environment allowing
the wieght of the hand piece to exert the force. Generally, this
rotary instrument is first used after the full length has been negotiated
to a number 20 file or reamer.
Why should we ask a thicker .02 tapered instrument or even worse,
a NiTi instrument that is easier to fracture to continue to enlarge the
full length of the canal? Once the Peeso has been used, the dentist
will find that instrumentation of the remaining one-half to two-thirds
of the canal will proceed with much less resistance.
It is important to remember when using these rotary instruments
in the canal that one must keep the internal and external anatomy of the
tooth in mind. We never want to widen a canal towards an external groove
or concavity such as the mesial concavity of maxillary bicuspids.
Check your radiographs for root and canal angulations and root diameters.
By using a passive pressure and staying in line with the canal you will
never create a ledge and never perforate.
Second Use of the Peeso Reamer
The second time we employ the use of the 2-Peeso reamer is after the
canal has been fully instrumented with the .02 series of files or reamers
which includes the back step to a number 45 instrument. The Peeso is placed
back into the coronal aspect and advanced under passive pressure perhaps
only 1/2 to 1 more millimeter. In some canals that possess a greater
curvature, you may be able to widen the coronal aspect a bit more which
actually reduces the curvature for future instrumentation.
Third Use of the Peeso Reamer
The third time the 2-Peeso is used is after instrumentation with the
.06 File of Greater taper. Again, you may only advance the Peeso
or widen the canal minimally, but after using the final Ni-Ti hand instrument,
the .08 GT., the perfect resistance form for the insertion of a medium
gutta percha point to measurement control has been created.
Using a rotary instrument such as a Peeso reamer to augment hand instrumentation
will lessen stress for both dentist and instrument and ultimately lead
to a final endodontic obturation that any dentist could point to with pride.
11/02/1999
|
|
