Young Bui
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 HE
RUBBER DAM is one of the most important pieces of equipment in the endodontics
armamentarium. One should never perform root canal therapy without first
isolating the infected tooth with a rubber dam. The rubber dam protects
both you and the patient. Imagine the patient’s accidentally swallowing
a reamer. The resulting lawsuit is one that you do not want to endure.
The rubber dam provides unobstructed access to the tooth. It prevents saliva
contamination and sodium hypochlorite spillage.
Remember to place a rubber dam over the tooth when
you are placing in a post. Many dentists do not use a rubber dam in that
procedure; without a dam, the saliva can enter and contaminate the post
space. This contamination will result in failure of the root canal in the
future.
Once you have achieved proper isolation, the next
step is to create the access opening. The best bur to use for this is the
PulpOut bur by Essential Dental Systems. This bur allows you to create
an access opening in less then two minutes without the fear of perforating
the chamber floor. The first bur is a #4 round bur with a side of it cut
flat and a stopper 7 mm away from the tip. The flat side creates a sharper
cutting edge that goes through metal with ease. The stopper prevents you
from going down too deep; thus there is no danger of perforation. Once
you get into the chamber, use the barrel diamond with the non-cutting tip
to create the straight-line access. Having straight-line access allows
you to find the canals more easily because of better lighting in the chamber.
If the tooth has advanced caries, use a #8 slow-speed round bur and remove
the decay completely before you instrument the canal. Leaving decay along
the chamber wall will prevent proper lighting and make locating the canals
difficult. If a wall has been destroyed by caries, remove the decay and
restore the wall temporarily with Ketac Cement. You need to have the walls
intact to hold the sodium hypochlorite during instrumentation.
You can instrument the canals with any of several
techniques. The SafeSiders reamers have a flat side that creates a sharp
cutting edge. The flat side also makes these reamers more flexible and
less likely to bind. These qualities allow the reamers to engage tightly
curved canals better than any other reamers in the market. If you like
rotary because of the reduction in hand fatigue, then use the NSK oscillating
handpiece with the SafeSiders reamers. Remember to flood the chamber with
sodium hypochlorite during the instrumentation process. The sodium hypochlorite
will provide lubrication, prevent debris impaction, and disinfect the canal
walls all at the same time. Leave the solution in the canal long enough
to kill the bacteria embedded in the canal wall and to remove tissues in
the lateral canal. The most important part of the root canal process is
to remove all the tissues in the canal. Open the canal wide enough
to get adequate cleaning of the apical few millimeters. The number
one reason for root canal failure is not short or long fill but not adequately
removing all the tissues impacted down at the apex. You would be amazed
at how much debris is left at the apex of the root after a complete cleaning.
The SafeSiders 30/.04 NiTi file is a great instrument to remove impacted
tissues. Even if you do not use SafeSiders reamers to do your root
canal treatment, invest in the 30/.04 NiTi and try it out for tissue removal.
You will be surprised at what you see.
Once instrumentation is complete, dry the canals
completely with paper points. Use the bidirectional spiral to coat the
canal wall with EZ-Fill cement. The spiral will force the cement laterally
so that it will enter any lateral canal present. Use a single gutta-percha
cone to fill the canal. Use alcohol-soaked cotton pellets to remove excess
cement from the chamber. Figure 1 shows a premolar with a lateral defect
at the coronal third of the root sealed with EZ-Fill cement. Figure 2 shows
complete healing of the defect in a six-month recall.
Fall 2004
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FIGURE 1: A premolar with
a lateral defect at the coronal third of the root sealed with EZ-Fill cement.
FIGURE 2: Complete healing
of the defect in a six-month recall.
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