Please activate JavaScript!
Please install Adobe Flash Player, click here for download

Endo Tribune United Kingdom Edition

June 201414 United Kingdom EditionEndo Tribune T here are many rotary systems on the dental market at present. All of these systems are rela- tively similar, except for one. This system is called Twisted Files (TF) and it was introduced to the dental market in 2008. I am glad to have been among the first users of this system, which has changed the endodontic world. How does this system differ from other rotary systems? Firstly, by its unique ma- chining—a SybronEndo patent. The NiTi wire is brought into a special state (called R-Phase) that allows the twisting of the file. This makes TF distinct from all the oth- er systems, for which the shape of the file is machined by milling, a mechanical process. This unique procedure lends particular resist- ance to TF, as well as an extraor- dinary flexibility. Owing to this manufacturing technique, a TF untwists before breaking, warn- ing the dentist in this way. In addi- tion, being made by twisting and not by polishing/milling, all the micro-cracks are eliminated, re- sulting in a more resistant, more robust file. The manufacturing process is completed by applying an advanced surface conditioning treatment that makes the edges active (cutting). The tip of a TF is inactive, which allows it to follow the route of the canal easily and to minimise canal transportation. The working sequence with this system is ter- ribly easy and consequently work- ing time is reduced. The files may be recognised and differentiated by the help of the practical system of codifi- cation. There are two coloured rings: the lower one (closer to the active part) shows the apical di- ameter (ISO standard; for exam- ple: red = 25) and the upper one shows the taper size (Fig. 1). Two working lengths are available: 23 and 27mm. The clinical procedure In this part, I will describe the TF technique. Treatment with TF al- ways begins by creating a glide path in the canals with #6 to 20 K-files. After opening and access, treatment inside the canal begins. In the absence of adequate access into the canal, there is the risk of overworking the file and its sub- sequent fracture. By opening the canals with K-files, important in- formation about the anatomy of the root canal is obtained, such as the existence of curves and the di- ameter of the root canal. Generally,thefirstTFthatisin- troduced into the canal is TF 25.08 (the apical diameter is 25mm and it has a taper of 8 per cent), which in most cases will reach the work- ing length previously detected by means of an apex locator. The endodontic engine must be set at 500rpm and the torque at 2Ncm. Thefileisintroducedintothecanal in rotation and without pressure applied. It is sufficient to advance 2-4mm when introducing the file into the canal. If the file does not advance, then a file with asmaller taper (TF 25.06) must be used in- stead to achieve working length. During preparation, there must be sodium hypochlorite in the root canal at all times. The file is cleaned and examined to de- tect possible distortion before in- troduction to the canal and upon withdrawal. If the file exhibits some distortion, it must be re- placed (Fig. 2). If TF 25.08 reaches working length easily, then a file with a greater taper can be used (TF 25.10 or 25.12). After reaching the desired ta- per, the final apical diameter is prepared. There are many studies in the endodontic literature that have found that apical prepara- tion up to a #25 K-file is insuffi- cient. For this reason, after reach- ing the taper the TF 30.06 or 35.06 or both are used. If greater apical diameters are desired, TF 40.04 or 50.04 can be used. The greater the apical diameter is, the greater the quantities of irrigation that reach the apex will be and the cleaner the apex will be. It is generally known that apical preparation by means of rotary files with large diameters can create many prob- lems because of the stiffness of the rotary files, such as transpor- tation of the apex and changes to the root-canal anatomy. With TF, however, this does not occur, ow- ing to the unique machining pro- cess, which ensures that the files are flexible, even those with large apical diameters. Case 1 The patient came to our clinic with acute apical periodontitis around tooth 26. When examined clinically and radiographically, the tooth showed a large composite filling next to the distal pulp horn (Figs. 3 & 4). The periodontal ex- amination did not find any irregu- larities; however, the tooth was extremely painful in vitality tests. Initially, I intended to replace the Twisted Files changed the world of endodontics A case report by Dr Sorin Sirbu Fig. 1_TF 25.12 to 25.04 files. Fig. 2_The 25.12 file is beginning to untwist near the tip because of overworking. This file must be replaced immediately. Fig. 3_Clinical examination of tooth 26 revealed a composite filling. Fig. 4_The initial radiographic examination showed a massive composite filling. Fig. 5_After removing the composite filling, a secondary occlusal decay was observed. Fig. 6_The opening of the pulp chamber in tooth 26 and the identifica- tion of the canals. Fig. 7_The shaped canals ready for endo- dontic obturation using the warm vertical condensation technique. Fig. 8_The canals obturated by means of the warm vertical condensation technique. Fig. 9_The sealing of the root canals us- ing RxFlow composite. Fig. 10_The final composite restoration. Fig. 11_The final X-ray showing all four obturated canals.

Pages Overview