Doug Kase
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THE LAST EPISODE of Tales From the Chamber, we discussed a few tips that
fell outside of the basic Safesiders® technique sequence to help the
practitioner reach the ultimate goal of easy, safe, and predictable endodontics.
So without further delay I will continue with a few more valuable tidbits
you may want to consider.
Let’s talk about irrigation. Using copious
amounts of irrigating solution during instrumentation is very important.
We use 5.25 percent sodium hypochlorite in combination with RC Prep for
lubrication and calcium chelation. As Dr. Musikant pointed out in
his last article, when the solution is warmed its effectiveness in dissolving
tissue is greatly increased. Thus while working you can keep your
irrigating syringe in a cup of hot water to keep it warmed. Remember
to deliver the solution in a slow and gentle fashion, to flood the canal,
and to be very careful not to jam and lock the 30 gauge tip apically so
that solution is not forced out the apex into the bone.
The next solution used in the canal with our last
two Safesiders NiTi instruments is 17 percent EDTA liquid. Using
the EDTA for two to three minutes removes the smear layer in the canal
and opens up the dentinal tubules. After the EDTA, washing the canals
with sterile saline or a new anesthetic carpule is a good idea because
the next and final solution we use, 2 percent chlorhexadine, can react
with the EDTA and form a sticky precipitate that can be a bit problematic
to remove. Let the chlorhexidine sit for two minutes for a final
sterilization of the canal. This sequence of solutions will help
to greatly reduce post-operative flare-ups when doing one-visit endodontics.
I usually use my orange #30/.04 Safesiders instrument in a reciprocating
handpiece to initially stir up the solution and then re-irrigate again.
Stirring and re-irrigation help to make sure that the solution is distributed
throughout the entire length of the canal. Before drying, make sure
that you re-check measurement control one last time before obturation.
Thus far I assume we all have done everything right.
We used all our instrumentation correctly and yet we try our master point
in our .08 tapered canal and it falls short of the apex. One cause is that
although the production of gutta percha is standardized to taper, it is
not to apical diameter. Some boxes of points may have a blunter tip
and thus be wider than the diameter of a # 35 reamer and not make it to
the apex. Save these for canals that were instrumented to a larger
size and try another box or manufacturer. Dr Deutsch’s article in
the last edition of Endo-Mail (which will be on the web July 1) will help
you make a choice. Also please remember that the longer the canal
the wider the coronal taper has to be to accommodate the .08 taper of the
gutta percha point. Thus a point that stops short of the apex may
only be a coronal bind and all that is needed is to use your #2 Peeso reamer
to increase the coronal flare. Remember we do this away from the
furcation as we have taught.
Once your master point fits correctly mix your EZ-Fill®
according to the manufacturer’s directions. If the cement mix feels
thick or starts to set slightly, it can be loosened by re-spatulating with
a warmed spatula. This will loosen the mix sufficiently to use.
Adding additional liquid will retard the set and reduce radio-opacity.
Do not use the EZ-Fill cement spiral around a severe
curve. Give this curved canal an extra dose of cement and use the
spiral in a pumping motion up to the curve to help move the cement apically.
With a complete flooding of the canal with cement, a good 10 mm coating
of cement on the apical end of the gutta percha point, and a minor pump
of the point on insertion, you will insure a good apical fill and seal.
Clean out the excess cement with a dry cotton pellet first and then use
an alcohol pellet.
I hope this second round of tips will help
my readers continue to practice easy, safe, and predictable endodontics.
If you have any questions or suggestions, please feel free to contact me
at the office any time.
July - August 2006
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I
hope this second round of tips will help my readers continue to practice
easy, safe, and predictable endodontics.
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