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Young Bui, D.D.S.
One-Visit Root-Canal Treatment
Young Bui

Young Bui

AS TECHNOLOGY in dentistry advances, we approach our treatment techniques in different manners.  We continue to strive for perfection while speeding up chair-time and reducing overhead costs.  This methodology applies to all specialties in dentistry including endodontics.  The fundamentals of endodontics remain the same.  The only difference is the process by which we attain our goals.  With the many different hand files and mechanical systems in the market today, we can reduce the number of visits for our patients and still maintain a high rate of success.  Root-canal treatment usually required more than one visit in the past because of the difficulty in cleaning and shaping curved and calcified canals and the low success rate of non-vital or necrotic cases. 
    Most root canal systems are straight and patent enough for a size 15 file to fit down to the apex with ease.  However, there are cases where the root is severely curved or dilacerated, and some canals are tight due to calcification.  To engage into such canals, we need a file that has great tensile strength to resist deformation, flexibility to negotiate the curves, and is thin enough to fit into such tight space.  Upon finding a tight canal, we automatically pull out the size 8 or 10 files either in Hedstrom, K-type, or reamers.  The problem with these files is that they have weak tensile strength.  They tend to bend or buckle at the tip when a little pressure is applied.  They do not have the strength to withstand the force exerted upon them as you try to push them down the tight canal.  I love to use Hedstrom files, but what I found to be a great file for a tight or partially calcified canal is the EZ-Fill® SafeSiderô size 10 file.  This file can negotiate a tight canal with ease and has the tensile strength to withstand deformation.  If you have not tried this type of file in a situation like this, I would recommend it highly.  I used to be a strong proponent of Hedstrom files until I tried out the SafeSider files. 
    The success or outcome of a root-canal treatment depends on the ability to remove all infected pulp tissues and then seal the canal completely with gutta-percha and sealers.  In order to have a tight, dense fill we must first clean and shape the canals to fit the gutta-percha point.  Most of the landmark studies use a .02 tapered file to clean and shape the canals.  With a .02 file, you are not able to clean out the infected wall of a necrotic canal successfully.  Studies show that the cleaning and shaping procedures do not remove all the bacteria from necrotic root canals.  Removing all the bacteria requires the use of Ca(OH)2 in the canal as an inter-visit medicament to aid in sterilizing the canal system; thus, the patient is required to make a second visit.
    However, there is another way.  By using the new nickel-titanium greater-tapered files of .06 to .08, you can remove more infected dentinal wall of the root canal system and create a nice tapered canal wall to fit the greater tapered gutta-percha cone.  Another instrument you can use is the #2 Peeso reamer.  It can reduce your cleaning and shaping time significantly.  Once you have cleaned and shaped the canal to a .06 or .08 tapered, use EDTA to remove the smeared layer against the wall.  Then irrigate the canal with full strength NaOCl and clean the wall with an ultrasonic tip.  The vibration will allow you to kill the bacteria embedded .5 mm into the dentinal tubules.  By shaping the wall to a .06 or .08 tapered and then using the ultrasonic tip, you eliminate bacteria that are embedded at least 1 mm into the dentinal wall.  This will ensure a clean canal and eliminate the use of Ca(OH)2 in between visits.  By the way, Ca(OH)2 does not kill enterococci such as E. feacalis.  Potassium-iodine can kill all bacteria in the canal in seconds.  That is one alternative irrigating solution you can use.  Just be careful not to get it on the patientís clothing.
September-October 2001
We can reduce the number of visits and still maintain a high rate of success.
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