Doug Kase
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USE OF SafeSiders instruments in the EZ-Fill technique facilitates a standardization
of procedure that leads to a standard superior result. However, certain
clinical circumstances may require a slight deviation from the formula
that we have taught our loyal readers. As I’m sure you have all seen,
the technique over the years has evolved to a point where you can achieve
a superior result with minimal stress to the dentist, the dentist’s hand,
schedule, and instruments—and, of course, to the dentist’s patient.
There are, however, those annoying situations that arise in which, when
we try to follow the EZ-Fill technique map, we find that we are not getting
to the final destination as easily as we want to.
Certain anatomical situations may pop up, such as
severely curved canals, that really throw a monkey wrench into the machinery
of the finely tuned EZ-Fill assembly line. Sometimes inherently harder
dentin, calcifications within the canal, or both, compound an already difficult
situation. In such cases, working each instrument to the apex becomes
much more difficult, particularly as the instruments increase in diameter.
As a result, we must sometimes remind ourselves of our old philosophy that
it is OK to work a little slower and longer to ultimately finish a little
faster. The issue of not biting off more than you can chew applies
both to instrument design and to instrumentation technique. Now,
of course, the design aspect is a built-in “no brainer”! The SafeSiders
instruments are reamers by design and have a flattened surface to ultimately
engage less dentin when negotiating the canal walls. This unique
design thus facilitates reaching apical measurement more easily with each
increase in diameter of each instrument we use.
The issue of technique is an entirely different
story. The EZ-Fill “formula” in its present form utilizes a one millimeter
back step when progressing from a #35 instrument to a #40.
Sometimes, in curved or very tight canals, initially using an incremental
one millimeter back step from apical measurement helps us achieve our final
.08 tapered resistance form with less stress to instruments and dentist.
First take each of the number 6, 8, 10, and 15 instruments to the apex.
Then step back one millimeter with a #20 and then two millimeters with
a #25. At that point you can use your #2 Peeso reamer to widen and
straighten the coronal anatomy of the canal as needed. Return to
the apex with a #15 instrument and then try moving apically with the #20
and #25. If reaching the apex with the #25 is still difficult, then
step back in half-millimeter increments from measurement control with this
instrument and then a #30 and then try again. Once the #25 makes
it to measurement, follow the same procedure with the numbers 30, 35, and
40, making sure that you reintegrate the use of the #2 Peeso and #2 Gates
as described in the EZ-Fill technique to gain a little more coronal canal
straightening and depth. From this point, using the NiTi .04 and
.08 tapered instruments and moving them to the apex will be a simple process.
Remember to use the reamers with a light rather than heavy touch; the light
touch is very important. Don’t try to engage the dentin as if
the reamers were files.
Please keep an eye out for instrument fatigue and
remember to test-bend all NiTi instruments before use. Remember that
the final result will be the same (.08 taper and fitting a medium gutta-percha
point) even though we used a slightly modified formula to achieve our goal.
Case Report
THIS CASE is an interesting retreatment. The patient presented with
an old silver point RCT having both clinical symptoms and radiographic
evidence of breakdown at the apices (Figure 1).
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FIGURE 1: Showing evidence
of breakdown at the apices.
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He was placed on Clindamycin 150 mg three times a day for ten days to
reduce the mild symptoms, which began to abate within three days.
Retreatment was started on day four, and the crown was removed with out
any damage. In this situation, I felt that retreating with the crown
off would be easier because of the necessity of removing a post from the
palatal root and the silver points from the buccal canals. Was I
right! Under the crown was an amalgam core, which I removed with
a fine diamond around the remaining tooth structure. I then used
an ultrasonic scaler to selectively loosen any remaining amalgam from the
post head and silver wires in the pulp chamber. The patient indicated
that he had a problem on the contra lateral tooth with an undiscovered
fourth canal (MB2), and after the points and post were removed I did find
an MB2 canal that had not been treated. The case was instrumented
with SafeSiders and obturated using the EZ-Fill technique (Figures 2 and
3). The patient is doing well and is asymptomatic.
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FIGURES 2 and 3: After
instrumentation and obturation using the EZ-Fill technique.
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Summer 2004
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