Endo Tribune United Kingdom Edition

Endo Tribune United Kingdom Edition | 6+7/201520 reduces shaping time by a further 19percentincanalswhencompared withWaveOne.26 Reciprocating movement WaveOneGOLDfilesaredesigned with a reverse cutting helix, engage and cut dentine in a 150-degree counter-clockwise (CCW) direction andthen,beforetheinstrumenthas a chance to taper lock, disengages 30 degrees in a clockwise (CW) di- rection. The net file movement is a cutting cycle of 120 degrees and therefore after three cycles the file will have made a reverse rotation of 360degrees(Fig.4). The X-Smart iQ (Fig. 5) launched inconjunctionwithWaveOneGOLD isanendodonticmotorandcordless 8:1 handpiece designed for reci- procation and continuous motion. The handpiece is Bluetooth con- trolled by a DENTSPLY Apple iOS iQ app downloaded on to an iPad mini2(Apple).Asacompletedigital solution, it is designed for all stages of the endodontic procedure, in- cluding patient management, file selection, torque control training and patient education. The X-Smart iQalsoofferselectronicapexlocator functionality. Currently available DENTSPLYreciprocatingfilemotors and their respective handpieces, the X-Smart Plus motor (Rest of the World) and ProMark and e3 Torque Control motors (North America), can be used without modification when using the complete range of WaveOneGOLDfiles.Allreciprocat- ingfilemotorsarepreprogrammed toproducethereversebidirectional movement,buttheCCW/CWangles, torqueandspeedsettingscannotbe altered.Thesemotorscan,ofcourse, be used for continuous rotation when the clinician is able to adjust thespeedandtorque,asdesired. Shapingtechnique(Fig.6) The WaveOne GOLD Primary (025.07) is always used first to ini- tiate the shaping procedure. It will create optimal shape in approxi- mately 80 per cent of canals as a truesingle-filetechniqueandisused in canals that have a confirmed, smooth and reproducible glide path. An expanded glide path is a perfectset-upforthesafeapicalpro- gressionofanymechanicallydriven endodonticfile.30 TheWaveOneGOLDSmall(020.07) file should be thought of as a bridge file, as the resulting shape is consid- ered too small to allow disinfection and filling of the root canal system. When the Primary file will not pas- sively advance through the glide path, which has been verified to length, the Small file is used to tran- sition and expand the shape. The Primaryfileisthenre-utilisedtoreach the full working length. Although a two-file sequence is the exception, this method must be considered a saferandmoreefficientoptioncom- paredwithmostothercommercially availablerotaryshapingtechniques. After the Primary file reaches length,theflutesareinspectedandif fullofdebriswouldindicateshaping isfinished.IfthePrimaryfileisloose at length with no dentinal debris on the apical flutes, shaping contin- ues with WaveOne GOLD Medium and/or WaveOne GOLD Large until the apical flutes are loaded. Apical gauging with ISO #25 or 35 hand files, respectively, will also confirm whether the apical foramen diame- ter is larger and that a Medium or Largefileisrequired. WaveOne GOLD files are used in a brushing action to reduce resistance and more effectively instrument canals that exhibit irregular cross- sections.Brushingeliminatescoronal interferences, creates lateral space, and promotes the inward advance- ment of the file. Further, a brushing action reduces the contact between the file and dentine, mitigates un- desirable taper lock, and allows the instrument to run more freely. In order to avoid transportation, never brushatlength.Thefilesareusedwith a gentle inward ‘stroking’ motion of short 2 to 3 mm amplitude, to pas- sivelyadvancethefilealongasmooth, reproducibleglidepath. Reduced shaping time with WaveOneGOLDmeansthereismore time available to focus on active irri- gationmethods.Inordertoenhance irrigationandimproveeffectiveness activation with sonic and ultrasonic irrigation is now well accepted.31 Dynamic irrigation in the apical one-third of highly curved canals has been shown to significantly improvedisinfection.32 The stages of the shaping proce- dure can be summarised as follows (Figs.7a–c): •Establish straight-line coronal and radicular access with emphasis on flaring,flatteningandfinishingthe internalaxialwalls.32 •In the presence of a viscous che- lator, use a #10 hand file to verify a glide path to length. In more re- strictive canals, use a #10 hand file in any region of the canal to create aglidepath. •Expand this glide path to at least 0.15 mm using either a manual or a dedicated mechanical file, such as the ProGlider or PathFile (DENTSPLY)(Fig.8). •Initiatetheshapingprocedurewith the Primary file in the presence of sodiumhypochlorite(Fig.9). •Use gentle inward pressure and let the Primary file passively progress through any region of the canal that has a confirmed glide path. Aftershaping2to3mmofanygiven canal,removeandcleanthePrimary file, irrigate, recapitulate with a #10handfileandre-irrigate. •Continue with the Primary file, in two to three passes, to pre-enlarge thecoronaltwo-thirdsofthecanal. •Inmorerestrictivecanals,usea#10 handfileinthepresenceofaviscous chelatorandnegotiatetothetermi- nusofthecanal.Gentlyworkthisfile untilitiscompletelylooseatlength. •Establish working length, confirm patencyandverifytheglidepath. •Expand this glide path to at least 0.15 mm using a manual or me- chanicalglidepathfile. •Carry the Primary file to the full working length (Fig. 10) in one or more passes. Upon reaching work- ing length, remove the file to avoid over-enlarging the apical foramen. Inspect the apical flutes; if they are loaded with dentinal debris, then theshapeisfinished(Fig.11).* •IfthePrimaryfiledoesnotprogress, usetheSmallfile(020.07yellow)in one or more passes to working lengthandthenusethePrimaryfile to working length to optimise the shape. •When the shape is confirmed, pro- ceedwith3-Ddisinfectionprotocols. Obturation solutions Obturation of the root canal sys- temisthefinalstepoftheendodon- tic procedure. The WaveOne GOLD system includes matching paper points, gutta-percha points and Thermafil obturators (Fig. 12). The new nanotechnology-engineered gutta-percha points with their ex- tended heat flow are ideal for all warm vertical compaction (WVC) techniques(Figs.13a–c,14a–c&15a–c). WaveOne GOLD shapes can also be effectively obturated with Gutta- Core (DENTSPLY), the cross-linked gutta-percha core obturator. Conclusion WaveOne GOLD is a safe, efficient and simple system for preparing canals.Sophisticatedmetallurgyand design result in improved flexibility and cyclic fatigue life with less bind- ing and torsional stress on the file during work. The fear of instrument breakage should be eliminated for many clinicians by using WaveOne GOLD. Root canal preparation with WaveOneGOLDisverycost-effective, since 80 per cent of cases can be completed with the single Primary instrument. Single use eliminates the need to spend valuable time and unnecessary expense in sterilising procedures, with further benefits in costsavings.Fasterpreparationtime allows the clinician to focus on the most important aspect of clinical endodontics, disinfection, thus ful- fillingthemechanicalandbiological objectivesofshapingcanals. WaveOne GOLD has set a new standard and shaping canals with confidence is now a clinical reality forall. *If the Primary file is loose at length with no dentinal debris on the apical flutes, continue shaping with the Medium or Largefile. Editorialnote:Theauthorhasacommer- cial interest in WaveOne and WaveOne GOLD file systems. A list of references is availablefromthepublisher. ENDO NEWS DrJulianWebber has been a prac- tising endodon- tics in London forover35years. He can be con- tacted at jw@ julianwebber.com. Figs. 13a–c & 14a–c: The series of pre- and post-op radiographs of tooth #26 demonstrates the ability of WaveOne GOLD to shape considerable curvatures in canals that are long, curved and narrow, following the apical anatomy. All canals were obturated with WVC.—Figs. 15a–c: The series of pre- and post-op radiographs of tooth #46 demonstrates the ability of WaveOne GOLD to shape considerable curvatures in canals that are long, curved and narrow, following the apical anatomy. All canals were obturated withWVC.(Images courtesy of Prof.Sergio Kuttler) 13a 13b 13c 14a 14b 14c 15a 15b 15c

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