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The standardized-taper root canal preparation--Part 3. GT file technique in large root canals with small apical diameters.

AIM: To describe the preparation of Large Root canals with small apical diameters by the GT file technique. SUMMARY: Large Root canals with small apical diameters can usually be prepared with one to three GT files; one to nine clinical steps, and one to five minutes of clinical time. Following proper access, pulp tissue should be removed, and lubricant applied to prevent pulp compaction and blockage. Initial crown-down enlargement is accomplished with up to three standard GT rotary files 0.10, 0.08 and 0.06 taper, running at 300 r.p.m., and with light touch. Care should be taken not to overload instruments, and they should be withdrawn, cleaned and inspected whenever they bind. Sometimes, the shaping objective is achieved with a single instrument; often waves of instrumentation are required before the shaping objective file cuts to length. Prior to cone-fit, the apical resistance form is confirmed with conventional files, employed as feeler gauges of the tapering form created at the canal terminus. Regardless of the shaping time, canals should be soaked with sodium hypochlorite solution for at least 30 min for effective cleaning. KEY LEARNING POINTS: Large Root canals with small apical diameters should be prepared to shaping objectives 0.08 or 0.10 taper. Compacted pulp tissue causes many canal blockages. It should be removed early, and canals should be well lubricated. Large Root canals with small apical diameters should be prepared in crown-down sequence, with recapitulation of steps until the shaping objective is achieved. Apical resistance form should always be confirmed before cone-fit. Canals should be exposed to sodium hypochlorite for at least 30 min for effective cleaning.

Dental Pulp Cavity↗

The standardized-taper root canal preparation--Part 4. GT file technique in large root canals with large apical diameters.

AIM: To describe the GT file shaping steps required to create apical resistance in the presence of a wide root apex. SUMMARY: Canals are occasionally encountered with apices wider than 0.25 mm. These can be some of the most difficult to manage with conventional instruments, and overfills are common. Shaping such canals with GT files requires a paradigm shift of thinking, extending tapered files through the apex to create linear resistance in the apical few mm of the canal. GT standard and accessory files allow canals with apices up to around 0.7 mm to be prepared for tapered gutta percha cone-fit. Apices larger than this should be considered too large for further shaping, and repaired with MTA before filling. KEY LEARNING POINTS: Tapered apical preparations offer optimal resistance form for obturation. Tapered apical preparations can be prepared in most roots with wide apices by extending GT files and GT accessory files to or through the apex. Apices wider than 0.7 mm should be repaired with MTA prior to filling.

Aluminum Compounds↗

A comparison in vitro of two ultrasonic root canal preparation techniques.

Two ultrasonic techniques were compared for their ability to clean and shape root canals in extracted human teeth. One technique was recommended by the manufacturer (Cavi-Endo, Dentsply), while the other was a modification by the authors of the stepdown technique. Mesiobuccal root canals of molars were instrumented using these techniques, after which a silicone impression material was injected into the prepared canals. The roots were then split longitudinally and one half was stained for debris scoring while the silicone impressions were assessed for shape. The results showed that the modified technique produced significantly cleaner canals than the recommended technique. The shaping ability of both techniques was difficult to evaluate because of the complex morphology of molar root canals. The final shape of the prepared canal depended more on the initial shape than on the instrumentation technique.

Dental Cavity Preparation↗

An in vitro method for comparing the effects of different root canal preparation techniques on the shape of curved root canals.

This study introduced an in vitro model which was designed to observe the effects of instrumentation on the shape of curved root canals. The model may be accurately rotated through 90 degrees allowing reproducible radiographs to be taken from two different angles. The root canals were filled with a radiopaque contrast medium before radiographs were taken. Two-dimensional evaluation of the shape of the root canals, before and after preparation was made on enlarged photographic prints obtained from the radiographs. A custom-made grid was used as a guide for measurement and accurate transfer from the pre- to postpreparation prints. Reproducibility of measurement was within 4 per cent. This method is feasible for quantitative comparison of the effect of instrumentation on the shape of root canals.

Dental Pulp Cavity↗

[Root canal preparation techniques using nickel-titanium rotary instruments].

INTRODUCTION: The main purpose of endodontic treatment is to clean the root canal system, eliminate the infected and toxic contents, and shape it in order to get a tridimensional obturation. The aim of this paper is to inform dental practitioners about crown-down technques for root canal preparation using nickel-titanium rotary instruments. ROOT CANAL PREPARATION: Today most endodontists believe that root canal preparation is more efficious, cleaning and shaping are better, if pre-enlargement of coronal two thirds is performed first, and shaping of the apical part later. Machine driven rotary instruments provide much quicker and better root canal preparation. CONCLUSION: Contemporary endodontic rotary files vary in regard to their taper, cutting blades, guiding tip and material they are made of. The usage of rotary nickel-titanium files adds a new quality to root canal preparation.

Dental Alloys↗

[SEM studies on root canal preparation using ultrasound].

The root canals of 35 extracted mandibular incisors were instrumented with the ultrasonic-system alone or in combination with hand instruments. Hand instrumentation was compared with ultrasonic instrumentation. Following instrumentation the teeth were prepared for SEM examination. It was concluded that hand instrumentation using reamers was superior to ultrasonic debridement. After initial preparation and finally shaping with hand instruments the ultrasonic device shows good efficiency in cleaning straight root canals.

Dental Pulp Cavity↗

[Root canal preparation using Excimer laser beams].

An in vitro investigation of root canal preparation on extracted human teeth by 308 nm Excimer Laser radiation was performed. It could be demonstrated that a secure and effective root canal preparation is possible by Excimer Laser radiation. SEM investigations on axially splitted roots showed root canal walls free of smear layer or any other soiling. The dentin-tubuli where open and free of clogging. There was no case of via falsa or overinstrumentation.

Evaluation Studies as Topic↗

The standardized-taper root canal preparation--part 5. GT file technique in small root canals.

AIM: To describe the shaping of Small Root canals with GT files. SUMMARY: Small Roots are lower incisors, two and three canal bicuspids, buccal roots of upper molars, and mesial roots of lower molars. The Shaping Objective instrument for such cases is usually a 0.08 or 0.06 taper GT file. After proper access, pulp tissue should be removed to prevent its compaction and canal blockage. Orifice shaping and smoothing is then achieved with a 35-0.12 accessory GT File, running at full slow-speed r.p.m. (5-20K).Crown-down preparation commences with the 0.10 GT file, followed by the 0.08 and 0.06 tapers as needed. Occasionally, a 20-0.04 Profile is required to reach length. Files are rotated at 300 r.p.m. with steady, light pressure, and withdrawn frequently for cleaning and inspection. Once one of these files has cut to length, the canal terminus is enlarged to Shaping Objective. If difficulty is encountered, be willing to accept a 0.06 instead of the original 0.08 taper Shaping Objective. If the terminal diameter is 0.2 mm you will have plenty of apical resistance form in a tortuous canal with the 0.06 taper preparation. It is definitely better to end up with a smaller shape than originally planned, than to experience the heartache of separation. KEY LEARNING POINTS: Small Root canals should be prepared to a Shaping Objective 0.08 or 0.06 taper. Pulp tissue should be removed before preparation to prevent compaction and blockage. Preparation follows in a crown-down sequence, and may occasionally require the use of small Profiles. Final apical shaping is easily achieved when root length is reached.

Bicuspid↗

An improved technique for the evaluation of root canal preparation.

A device and a method are described for the simultaneous in vitro evaluation of several important parameters of root canal preparation, including root canal cleanliness, straightening, changes in root canal diameter, working safety (loss of working length, apical blockage, instrument fracture, and apical perforation), measurement of apically extruded debris, working time, and practicability. Using a modification of the muffle system described by Bramante et al. (J. Endodon, 13:243-5, 1987), all of these parameters can be investigated simultaneously during preparation of two mesial root canals in extracted mandibular molars.

Evaluation Studies as Topic↗

Comparative study of six rotary nickel-titanium systems and hand instrumentation for root canal preparation.

AIM: To compare ex vivo various parameters of root canal preparation using a manual technique and six different rotary nickel-titanium (Ni-Ti) instruments (FlexMaster, System GT, HERO 642, K3, ProTaper, and RaCe). METHODOLOGY: A total of 147 extracted mandibular molars were divided into seven groups (n = 21) with equal mean mesio-buccal root canal curvatures (up to 70 degrees), and embedded in a muffle system. All root canals were prepared to size 30 using a crown-down preparation technique for the rotary nickel-titanium instruments and a standardized preparation (using reamers and Hedströem files) for the manual technique. Length modifications and straightening were determined by standardized radiography and a computer-aided difference measurement for every instrument system. Post-operative cross-sections were evaluated by light-microscopic investigation and photographic documentation. Procedural errors, working time and time for instrumentation were recorded. The data were analysed statistically using the Kruskal-Wallis test and the Mann-Whitney U-test. RESULTS: No significant differences were detected between the rotary Ni-Ti instruments for alteration of working length. All Ni-Ti systems maintained the original curvature well, with minor mean degrees of straightening ranging from 0.45 degrees (System GT) to 1.17 degrees (ProTaper). ProTaper had the lowest numbers of irregular post-operative root canal diameters; the results were comparable between the other systems. Instrument fractures occurred with ProTaper in three root canals, whilst preparation with System GT, HERO 642, K3 and the manual technique resulted in one fracture each. Ni-Ti instruments prepared canals more rapidly than the manual technique. The shortest time for instrumentation was achieved with System GT (11.7 s). CONCLUSIONS: Under the conditions of this ex vivo study all Ni-Ti systems maintained the canal curvature, were associated with few instrument fractures and were more rapid than a standardized manual technique. ProTaper instruments created more regular canal diameters.

Dental Alloys↗

Morphological study on the capability of Er:YAG laser irradiation for root canal preparation.

OBJECTIVE: The purpose of this study was to evaluate morphologically the capability of Er:YAG laser irradiation for root canal preparation in vitro. BACKGROUND DATA: There have been no reports on root canal preparation using Er:YAG laser irradiation. METHODS: Forty extracted human teeth were divided randomly into two groups of 20. Laser irradiation was performed using three different sizes of fiber tips at the two different parameters (G 1, 2 Hz and 136-184 mJ/pulse; G 2, 2 Hz and 170-230 mJ/pulse). After laser irradiation, the teeth were bisected longitudinally and observed by stereoscopy and field emission-scanning electron microscopy (FE-SEM). The time required for preparation in each group was recorded and the achievement degree of root canal preparation was scored according to our criteria. Statistical analysis of the times was performed using one-way analysis of variance (ANOVA). A value of p < 0.01 was considered significant. RESULTS: Root canals were prepared using laser irradiation at 50% of teeth in G 1 and 40% in G 2. Remnant pulp tissue after laser irradiation was observed at 30% of teeth in G 1, but not recognized in G 2. Irradiated areas were scale-like and clean, but rough and irregular by FE-SEM. The statistical analysis revealed that the time required for preparation at high energies was significantly shorter compared with that at low energies (p < 0.01). CONCLUSION: These results suggest that Er:YAG laser irradiation is capable of root canal preparation if appropriate parameters are selected.

Dental Pulp Cavity↗

[Root canal preparation with Canal-Finder system. Scanning electron microscopy and clinical studies].

Root canal preparation was performed with the new Canal-Finder-System in extracted teeth and in simulated root canals in resin blocks. The results of SEM- and stereomicroscopic investigation showed severe alterations of root canal morphology in the apical part of the canal in many cases. Excellently cleaned and shaped canal walls were found as well as parts, which were not instrumented at all or covered with smear layer and debris. The Canal-Finder-System was found to be a good and suitable device for the initial instrumentation of narrow and severely curved canals, but cannot replace hand instrumentation as the standard method of root canal preparation.

Dental Pulp Cavity↗

NSK reciprocating handpiece: in vitro comparative analysis of dentinal removal during root canal preparation by different operators.

The purpose of this study was to assess dentin removal during root canal preparation by different operators using a NSK reciprocating handpiece. Eighty-four human single-rooted mandibular premolars were hand instrumented using Triple-Flex stainless-steel files (Kerr) up to #30, weighed in analytical balance and randomly assigned to 4 groups (n=21). All specimens were mechanically prepared at the working length with #35 to #45 Triple-Flex files (Kerr) coupled to a NSK (TEP-E10R, Nakanishi Inc.) reciprocating handpiece powered by an electric motor (Endo Plus; VK Driller). Groups 1 to 4 were prepared by a professor of Endodontics, an endodontist, a third-year dental student and a general dentist, respectively. Teeth were reweighed after root canal preparation. The difference between weights was calculated and the means of dentin removal in each group were analyzed statistically by ANOVA and Tukey's test at 5 % significance level. The greatest amount of dentin removal was found in group 4, followed by groups 2, 3 and 1. Group 4 differed statistically from the other groups regarding dentin removal means [p<0.001 (group 1); p=0.005 (group 2); and p=0.001 (group 3)]. No statistically significant difference was found between groups 1 and 2 (p=0.608), 1 and 3 (p=0.914) and 2 and 3 (p=0.938). In conclusion, although the group prepared by a general dentist differed statistically from the other groups in terms of amount of dentin removal, this difference was clinically irrelevant. The NSK reciprocating handpiece powered by an electric engine was proved an effective auxiliary tool in root canal preparation, regardless of the operator's skills.

Analysis of Variance↗

Efficacy of root canal preparation by Er,Cr:YSGG laser irradiation with crown-down technique in vitro.

OBJECTIVE: The purpose of this study was to compare the efficacy of Er,Cr:YSGG laser in root canal preparation and its effectiveness in removing debris and smear layer with the efficacy of the conventional hand instrument, in vitro. BACKGROUND DATA: Recently, the use of the Er,Cr:YSGG laser device in root canal preparation has been excepted in the dental clinic. However, there have been no published reports on root canal preparation by using the Er,Cr:YSGG laser irradiation. MATERIALS AND METHODS: A total of 40 straight root canals were prepared by an Er,Cr:YSGG laser at a output power of 2 W, and 40 canals were shaped by using the K file under irrigation with NaOCl and H2O2 by using the crown-down technique (control). The achievement degree of root canal preparation and debris score was morphologically investigated. RESULTS: The results showed that great improvement in the cleanliness of the walls was found using the laser technique as compared with the control technique; a significant decrease in smear layer or debris was also recognized in laser-prepared canals (p < 0.01). But canal preparations with the laser device sometime result in ledge, zipped, perforation, or over-instrumentation. CONCLUSION: The results demonstrated that root canal preparations with the laser device were significantly worse than in the control group. Further development in laser device and technique are required to ensure its success in root canal preparation.

Anti-Infective Agents, Local↗