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ePaper created 2016-09-05, 09:33:59 | version 1.38.0
canal shaping technique | 19 roots 3 2016 when a greater apical enlargement is needed due to larger original canal dimensions and/or enhanced fi- nal irrigation techniques. The sequences are also dif- ferent in their shaping concepts. Each file of the se- quence being used is taken to full working length in a ‘crown down’ manner so that the root canal wall is in- ternallysculptedincrementally,allowingdentindebris and tissue to be evacuated coronally rather than to be pushedapically.Thismayreducetheriskofcanalblock- age and the extrusion of debris into the apical tissues. TheSM1file(singlecolourbandgreen,04taper20tip size)isanexcellentflexibleGlidePathfilewhichmaybe used with either sequence to pre-enlarge the canal thereby decreasing instrument stress for the next largersizefileinsequence.Thisalsoallowsbettermain- tenanceoftheoriginalcanaltrajectory(Figs.2&5). The final apical enlargement with a size #35 file is not only meant to allow the use of the Endovac (EndoVac Kerr Endodontics, Orange, CA) irrigation technique, but to improve canal shaping by touch- ing more canal walls. Figure 6 clearly shows how improved and deeper the apical one-third shape is whena06taper35tipinstrumentfollowsa08taper 25tipinstrument.Thisiswhyinthemajorityofcases two instruments are much better than a single file technique, provided that the second instrument is a flexible one. The superior flexibility allowed by the use of TF technology permits TF Adaptive to follow these criteria, and safely enlarge canals with mini- mal risk of iatrogenic errors like tooth weakening and canal/apical transportation. The use of a more rigid alloy would have not made this possible, espe- cially in curved canals.”15 TF Adaptive technique TF Adaptive is an intuitive, color-coded system de- signed for efficiency and ease of use. The colour- coded system is based on a traffic light. The first in- strumentinsequenceisgreen.Thesecondinstrument in sequence is yellow and the third instrument in sequence, if required, is red. Green means go. Yellow means continue or stop. Red means stop (Fig. 2). Coronal access and glide path 1. Place rubber dam. 2. Obtain straight line coronal access with slightly diverging axial walls adhering to the concept of Minmimally Invasive Endodontics.37 3. Achieveapicalpatencyandestablishanapicalglide pathusing#8handfile,followthatwitha#10hand fileandcontinueatleastwitha#15handfile.Glide path may be facilitated with the M4 Safety Hand- piece (Kerr Endodontics, Orange, CA) (Fig. 7). The pulp chamber should be filled brimful with NaOCl (Sodium Hypochlorite). Canal size and file sequence determination (Figs. 5 & 8) Small Canals (SM) Usingtactilefeel,ifyoustruggletogeta#15K-File to working length (WL) then the canal size is deemed tobe‘small’.UsetheSmallPack(onecolourband)and itsinstrumentsequence.Thesmallsequencemayalso beusedinseverelycurvedcanalsaswellasrootsthat may be very thin and the risk of strip perforation is a possibility. Medium/Large Canals (ML) Usingtactilefeel,ifa#15K-Filefeelslooseatwork- ing length then the canal size is deemed to be ‘me- dium/large’. Use the Medium/Large Pack (two colour bands) and its instrument sequence. Establish working length Working length should be established with a reli- ableapexlocator.Aradiographmayhelptheclinician as well. TF Adaptive canal shaping technique 1. Use the ‘TF Adaptive’ setting on your Elements Motor. Figure #3 2. Ensure the pulp chamber is flooded with NaOCl or EDTAandmakesurethefileisrotatingasyouenter the canal. 3. Slowly advance the green (SM1 or ML1) with a sin- gle controlled motion until the file engages dentin then completely withdraw the file from the canal. Do not force apically. Do not peck. Fig.9: EndoVacApical Negative Pressure Irrigation System.The Master DeliveryTip (MDT) accommodates different sizes of syringes filled with irrigant,the macro cannula is attached to the autoclavable aluminum hand piece and the micro cannula is attached to an autoclavable aluminum finger piece.The macro cannula,the micro cannula and the MDT are connected via clear plastic tubing. The tubes are connected to the high volume suction of the dental chair via the Multi-PortAdaptor. Fig.9 32016