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Medical Forum / General / Dentistry / March 2004Motorized Endo
All hail to the group again. Yesterday (Friday) I had a cont-ed course in Endo with the local Guru. He is an avid Profile user and he recommends the safer GT's for the generalist while he uses the more aggressive ProTaper system. I had abandoned the Tulsa/Densply system in favor of the Brassler RaCe files (ahem...perhaps y'all can guess why...). I voiced my concerns to him at the break and when we came back, he gave us his 'no-stess' formula: Straight line access (no exceptions) and establish patency using K-files #8 and #10. Then, using a modern torque-sensing motor at 300 RPM, do a crown-down prep, using lubricant and sodium hypochlorite at least 2.5 and preferably 4 or 5 percent. The important point is: Instrument THREE (3) mandibular canals or SIX (6) maxillary canals, and then throw the file set away... Period, and no exceptions. Just wanted to share this last statement with you all, and again, I'm sure you will agree, it will avoid untoward events. Why three in the mandible and six in the maxilla? Because tooth mimics bone: the mandibular bone is harder, and therefore so are the teeth. I was well aware that one should not over-use Ni-Ti rotary files. Just what that means is now clearer (safer), at least in the opinion of one Endo Guru. Cheers SP  SignatureTo reply: take out the TRASH... > All hail to the group again. > Yesterday (Friday) I had a cont-ed course in Endo with the local Guru. [quoted text clipped - 16 lines] > mandible and six in the maxilla? Because tooth mimics bone: the > mandibular bone is harder, and therefore so are the teeth. That's a new one on me! Steve I was well > aware that one should not over-use Ni-Ti rotary files. Just what that > means is now clearer (safer), at least in the opinion of one Endo Guru. > Cheers > SP > > Instrument THREE (3) mandibular canals or SIX (6) maxillary canals, and > > then throw the file set away... Period, and no exceptions. [quoted text clipped - 7 lines] > > Steve Uh-Huh... and maybe you all can use Ni-Ti files for more canals than that and get away with it. All I know is that I've had separation problems with ProFile GT in the past, and so from my point of view, that's mighty good (safe) advice. Don't forget, the local Endo Guru does two things almost all day long: Retreatment / fishing expeditions, and apicos. If he came to that conclusion, it was b/cs of seeing so many disasters in small canals. In his own words, the greatest danger in using these techniques is the reticence of the practitioner to chuck files that cost 10$ each. This danger is all the more real in that one doesn't see the fatigue in Ni-Ti files as one does with steel files. That makes sense to me. ;-) Cheers SP SignatureTo reply: take out the TRASH... >> > Instrument THREE (3) mandibular canals or SIX (6) maxillary canals, and >> > then throw the file set away... Period, and no exceptions. [quoted text clipped - 21 lines] >Cheers >SP One thing that may be helpful, GT files 'click' in the canal before failure most times. If you hear the 'click of death' get that file out of the canal and throw it away immediately, if not sooner ! What is $10 compared to the cost of a separated instrument ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com I agree with George. Use the files once and throw them out. Raise your fees $40 to cover the expense if you must. Signature+=_-+=_-+=_-+=_-+=_-+=_-+=_-+=_- Stephen Mancuso, D.D.S. Troy, Michigan USA .dr.steve@man.cuso.d.d.s.com. ~~~~~~~~~~~~~~~~~~~ > > >> > Instrument THREE (3) mandibular canals or SIX (6) maxillary canals, and [quoted text clipped - 35 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com >I agree with George. Use the files once and throw them out. Raise your >fees $40 to cover the expense if you must. Supressed fee increases for ~a year while introducing rotary technic. Once the word got out that it was faster and predictable, There were *Zero* patients that objected to being in the chair for less time for for RCT. Only at that time was RCT fee increased to cover the additional overhead. I get many referrals from my patients to their friends due to excellent pain management, and speed of treatment. YMMV, but we can bring you *up to speed* on the latest technics. X-tip for the difficult to anesthetize cases, Septocaine/articane as routine anesthetic, Marcaine for long term relief of post-op discomfort. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > YMMV, but we can bring you *up to speed* on the latest technics. X-tip for > the difficult to anesthetize cases, Septocaine/articane as routine > anesthetic, Marcaine for long term relief of post-op discomfort. Use StabiDent for the difficult cases, and Articaine is my standard Anesthesia. Don't have too may problems w/ that. En Passant, what does the acronym 'YMMV' mean? Thanks SP SignatureTo reply: take out the TRASH... >> YMMV, but we can bring you *up to speed* on the latest technics. X-tip for >> the difficult to anesthetize cases, Septocaine/articane as routine [quoted text clipped - 5 lines] >Thanks >SP Your Mileage May Vary Moi Frier (sp?) -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Your Mileage May Vary > [quoted text clipped - 5 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com Bon... I think you want *Frere* As in Mon Frere (my brother) if not tell me what you wanted to say and I'll translate for you. Thanks SP SignatureTo reply: take out the TRASH... >> Your Mileage May Vary >> [quoted text clipped - 10 lines] >Thanks >SP My Friend -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > >> Your Mileage May Vary > >> [quoted text clipped - 18 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com Then it's *Mon Ami* Merci, Mes Amis, et Bonne Nuit! Thanks, my friends, and Good Nite! SP SignatureTo reply: take out the TRASH... > One thing that may be helpful, GT files 'click' in the canal before failure > most times. If you hear the 'click of death' get that file out of the canal [quoted text clipped - 5 lines] > > W_B This is also excellent advice and I HAVE heard that clicking at times. I'll make a point of turning off the Laser when I file, in order to hear things better. Thanks again SP SignatureTo reply: take out the TRASH... >>>Instrument THREE (3) mandibular canals or SIX (6) maxillary canals, and >>>then throw the file set away... Period, and no exceptions. [quoted text clipped - 21 lines] > Cheers > SP Oh, I agree with not using a NiTi rotary file on more than maybe 2-3 teeth, max.--maybe up to 6 canals. Yes, I've broken one. That was not from using on too many canals, but trying to overforce a GT in a canal--and this was with torque control! Steve >>>>Instrument THREE (3) mandibular canals or SIX (6) maxillary canals, and >>>>then throw the file set away... Period, and no exceptions. [quoted text clipped - 28 lines] > >Steve Even with self-reversing, once the metal is fatigued the chance of instrument separation is almost inevitable. The real 'trick' with rotary NiTi is to let the instrument do the 'work', never force or over- instrument. Stop, irrigate copiously, and recapitulate with the patency file. Re-irrigate then proceed. The NiTi files should not be introduced into the canal more than 1 or 2 times. Never reintroduce a NiTi file into the canal that is 'clogged' with dentinal mud. Clean the file before re-introduction only if necessary to enlarge the canal for the next in the series. I keep the patency file very close and use it often to dislodge the dentinal mud debris. Usually at least once between file size changes. With copious irrigation, note that by copious I mean frequent and without pressure, the dentinal debris will float to the top with 2.5% HClO-. Disturb the 'mud' with the patency file and then re-irrigate. Use the same size patency file throughout the case. Sometimes it is advantageous to use a final sized file to hand prepare the final apical size before obturation. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Stop, irrigate copiously, and recapitulate with the patency file. > Re-irrigate then proceed. > The NiTi files should not be introduced into the canal more than > 1 or 2 times. Never reintroduce a NiTi file into the canal that is > 'clogged' with dentinal mud. Clean the file before re-introduction > only if necessary to enlarge the canal for the next in the series. The only thing the Endo Guru would add would be to use an EDTA product to help float up the dentinal mud. He doesn't like RC Prep b/cs it has a waxy product in it that coats the canal. He, of course, uses ProLube. Thanks SP SignatureTo reply: take out the TRASH... >> Stop, irrigate copiously, and recapitulate with the patency file. >> Re-irrigate then proceed. [quoted text clipped - 8 lines] >Thanks >SP We have no use for EDTA for any case. If you get *any* EDTA (Pro-Lube, or any other product like RC-Prep) past the apex, it will continue to chelate for at least 24 hrs. this is quite painful for the patient and is unacceptable IMNSHO. NaClO- 2.5 - 5 % is quite sufficient as an endodontic lubricant, organic solvent, and flotation irrigant. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Oh, I agree with not using a NiTi rotary file on more than maybe 2-3 > teeth, max.--maybe up to 6 canals. Yes, I've broken one. That was not > from using on too many canals, but trying to overforce a GT in a > canal--and this was with torque control! > > Steve Hooo Boy.... I have the Aseptico ATR and still managed to break files. That was why I went to RaCe (Brassler). It was not the file system, it was the human system, I know that now. Cheers SP SignatureTo reply: take out the TRASH... >All hail to the group again. >Yesterday (Friday) I had a cont-ed course in Endo with the local Guru. [quoted text clipped - 20 lines] >Cheers >SP Rotary files should be considered single use. I use both Profile and ProTaper as well as the GT files. While it may seem expensive to use files only once, what is the cost of a separated instrument ? >Why three in the >mandible and six in the maxilla? Because tooth mimics bone: the >mandibular bone is harder, and therefore so are the teeth. Sorry but this makes absolutely no sense to me. Dentin is dentin and is uniform in all teeth in the same mouth IMO. NiTi files just don't hold an edge that long, three cases max for me. Any 'untwisting' of the flutes and into "circular file 13" they go. Straight line access is mandatory when using rotary. I open the canals sequentially with Gates-Glidden #'s 2 - 5 or 6 with the torque controlled motor set to the #1 setting (for all) to minimize separation. Then on to the crown down with the GT's. I obturate using GP and Grossman's Sealer. Not a fan of Thermafil, expensive and no faster for me. Often use 6, 8, and 10 K-files for patency. Usually use a 15 for length determination. Pratice on extracted teeth highly recommended for those who have limited rotary experience. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Rotary files should be considered single use. > I use both Profile and ProTaper as well as the GT files. > While it may seem expensive to use files only once, > what is the cost of a separated instrument ? Exactly.... > >Why three in the > >mandible and six in the maxilla? Because tooth mimics bone: the > >mandibular bone is harder, and therefore so are the teeth. > > Sorry but this makes absolutely no sense to me. > Dentin is dentin and is uniform in all teeth in the same mouth IMO. All I can say is that the guy is Shilder-trained (Boston U) and I don't see why he would make that statement if there was no scientific back-up. However, I'll ask him again about it the next time we talk, and post the response. In the meantime, I know that you, W_B, know some Endo Gurus. You may want to get a second opinion. Obviously, I can't prove a thing. It does make sense to me though that teeth could be adapted to their position in the mouth not only in form but aslo in strength. I appreciate the summary of your technique here. I've archived it. Thanks SP SignatureTo reply: take out the TRASH... |
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