Endo Tribune Middle East & Africa No. 2, 2019
Minimally invasive root canal shaping – A new protocol / The influence of Glide Path preparation on the canal shaping times of WaveOne Gold in curved mandibular molar canals
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DTMEA_No.2. Vol.9_ET.indd
NL
Y
O
LS
NA
IO
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FE
O
PR
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AL
DE
www.dental-tribune.me
Published in Dubai
March-April 2019 | No. 2, Vol. 9
Minimally invasive root canal shaping –
A new protocol
By Dr Bogdan Moldoveanu, Romania
Minimally invasive—the most wellknown oxymoron in dentistry—is
probably nowadaysconsidered the
new standard of care in almost every
field of dental medicine, but more so
in endodontics. Despite improved
oral and dental health, the demand
for endodontic treatment and restorations remains high among individuals with relatively complete dentition and dental awareness.1 The need
for adequate endodontic treatment
is most likely one of the driving
forces behind all the improvements
that have reached practitioners in
recent years. The use of nickel-titanium (NiTi) rotary files in root canal
preparation is one of those improvements and has provided a reduction
in the frequency of procedural errors
and the time required for chemomechanical preparation in relation to
manual files.2
Shaping is considered a crucial phase
in root canal therapy because it not
only is aimed at removing remaining pulp tissue, microorganisms and
debris, but should also create the
preconditions for effective irrigation and obturation.1, 3, 4 These tasks
should be accomplished without
altering the diameter and position
of the apical foramen or excessively
Fig. 1
Fig. 2
weakening the root in any part. New
instruments have been introduced
every year, each claiming to be better than the previous one and having the ability to provide a better
outcome. Regardless of any commercial interests, with regard to root
canal shaping, from the aspect of the
success of endodontic treatment, it
is very important to maintain the
original form of the canal as far as
possible while the root canal is being
gradually enlarged from the apical to
the coronal region.3
The need for successful endodontics
has probably set the stage for a new
generation of rotary files, made with
heat-treated NiTi. The various thermomechanical procedures and the
improvement in composition of the
alloy that is used in manufacturing
NiTi files are aimed at improving the
flexibility of NiTi files.5–7 Improved
flexibility of NiTi files would minimise the intracanal irregularities,
such as canal transportation, and
would ensure an increase in the success of root canal therapy.
One of the most well-known instruments when it comes to heat-treated
rotary files are the HyFlex CM files
(COLTENE). The controlled memory
(CM) wire made with a thermally
treated NiTi alloy, owing to the
austenite/martensite transformation, has a stable martensitic microstructure at body temperature.8
Therefore, the structure of HyFlex
CM enables significant fatigue resistance, ease of bending and the ability
to return to its original shape when
heated above the transformation
temperature.9
Recently, COLTENE has introduced a
new type of file, the 20/05 EDM (the
preparation file), which comes as a
muchneeded addition to the already
existing EDM shaping system. Hy-
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Flex EDM instruments (COLTENE)
are manufactured using the technique of electrical discharge machining and are the first endodontic
files to be made with this method.10
Electrical discharge machining can
be used in manufacturing all types
of conductive materials (e.g. metals,
alloys, graphite and ceramics) of any
hardness at high precision levels.11
This manufacturing process uses
spark erosion to harden the surface
of the NiTi file, resulting in superior
fracture resistance and improved
ÿPage A2
[2] =>
DTMEA_No.2. Vol.9_ET.indd
A2
ENDO TRIBUNE
Dental Tribune Middle East & Africa Edition | 2/2019
◊Page A1
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
for severely curved root canal preparation.
The sequence proposed in the present article is easy to use, easy to
learn and highly versatile. One may
adapt it to different cases, be it a severely curved mesial root of a mandibular molar or a highly calcified
canal in a mandibular central incisor.
Following several easy steps, but respecting the order in which the files
must be used, success is just around
the corner.
Fig. 15
cutting efficiency. HyFlex EDM NiTi
files are manufactured using CM alloy technology just like the HyFlex
CM NiTi files. HyFlex EDM 25 has a
taper that changes throughout the
file shaft and a 0.25 mm apical diameter. Throughout the file shaft,
HyFlex EDM 25 has three different
cross sections: quadratic in the apical
third, trapezoidal in the middle third
and almost triangular in the coronal
third.12 The other HyFlex EDM files
(10/05 and 20/05) have a single taper
of 0.05 throughout the working part.
The purpose of this case report is
to present a new protocol that uses
only three files in order to reach an
optimum result, sacrificing a minimal amount of dental structure.
One of the most important things
that a clinician can focus on is being open-minded to question the
paradigms of our profession. In
time, some paradigms can become a
false “standard of care” to those who
blindly follow statements that are
not supported by valid information.
Adherence to some ideas promoted
in the virtual or actual professional
environment may ruin the balance
of accurate knowledge, leading both
clinicians and researchers to understand things solely from their
perspective, for it seems evident to
them that there is no other way to be.
This is what we have come to know
as the settlement of the paradigm.14
One of the most well-known paradigms in endodontics concerns the
Fig. 16
instrumentation of curved root canals, for which it is believed that the
use of a #25 file in the apical portion
fulfils all of the cleaning and shaping objectives of root canal therapy.
The idea behind this theory is mostly
centred around what can happen if
one over-instruments the root canal. Failures such as deviations, perforations and zipping may have a
higher rate of occurrence when one
enlarges the apical diameter beyond
a #25 file.15–17 However, when one is
treating a tooth exhibiting signs and
symptoms of periapical periodontitis, further enlargement by hand
files might be required, since it appears that the minimum instrumentation size needed for penetration
of irrigants to the apical third of the
root canal is a #30 file.18
Case report
The patient who is the focus of our
discussion came to our office reporting intense pain in response to hot
and cold stimuli in the left maxilla
(Fig. 1). He described the pain as being spontaneous at times and that in
order for it to subside administration
of anti-inflammatory medication
was required. Upon examination, an
accurate diagnosis was established
of symptomatic irreversible pulpitis
affecting tooth #27. The patient had
had the tooth prepared for a crown
sometime in the last 60 days (Fig. 2),
but unfortunately the treatment was
not completed for unknown reasons.
Caries seemed to be absent; therefore, a minimally invasive approach
was planned. Most likely, the pathology was caused by either trauma or
an iatrogenic event.
After isolation of the tooth (Fig. 3), an
access cavity was created using highspeed diamond burs and ultrasonic
tips (Figs. 4–8). Pre-flaring in the
coronal and middle thirds was done
with the HyFlex EDM 25 instrument
(at a torque of 4 Ncm and a speed of
500 rpm). It is a proven fact that preflaring allows an increase in the instrument size that binds in the root
canal, irrespective of the discrepancy
between the size of the file and anatomical diameter.19–21 Afterwards, canal scouting was performed using
an ISO size 10 stainless-steel K-file
up to working length. Upon establishing the working length, with the
help of an apex locator, the 10/05
EDM file (glide path file) was used
up to working length (at a torque of 3
Ncm and a speed of 300 rpm). Subsequently before finishing the preparation with the 25 EDM file, the 20/05
EDM (preparation file) was used to
full working length (at a torque of 3
Ncm and a speed of 400 rpm). At this
point, the working length was confirmed again with an ISO size 20 NiTi
K-file. Root canal shaping was completed with the 25 EDM file, which
was inserted to full working length
(at a torque of 3 Ncm and a speed of
400 rpm; Figs. 9–12).
This recommended shaping protocol also has the benefit of extruding
less debris outside the root canal,
thus improving the patient’s quality of life after the completion of the
therapy. Dentinal and pulp tissue
debris, microorganisms and irrigating solutions may extrude into periradicular tissue during the preparation of root canals,22 thus causing
complications such as postoperative
pain, inflammation/infection and
flare-up, and possibly delaying the
healing process.23
The instruments in such an order are
also very well suited for maintaining the anatomy of the root canals.
The HyFlex EDM 25 file determines
slightly less transportation at every
level and in most cases stays a little
more centred compared with other
instruments available.24
Using the HyFlex EDM instruments
as opposed to the HyFlex CM ones is
no random choice. HyFlex CM files
are manufactured via a grinding procedure. Grinding procedures during
the production of NiTi files cause the
formation of irregular areas, such as
pits, fissures and metal folds.25 Being
subjected to huge flexural and torsional forces, the instruments need
to be resistant and the surface of the
file must not change throughout
the therapy. According to a study by
Uslu et al., the surface of used HyFlex
EDM files was found to be statistically significantly rougher than that
of used HyFlex CM files.25 The surface
properties of HyFlex EDM files, when
compared with those of HyFlex CM
files, were better retained after use
After chemomechanical treatment,
the root canals were filled using a
single-cone filling technique (ROEKO
Guttapercha Points and ROEKO GuttaFlow bioseal, both COLTENE), and
the access cavity was sealed using
composite materials (Figs. 12–16).
Conclusion
Living in a world full of endodontic
opportunities, it is important that
the clinician use all the means available to provide the best quality of care
for patients. Hopefully by applying
this particular sequence in root canal
therapy, the clinician can achieve the
task more easily and in a much safer
manner.
Editorial note: A list of references is
available from the publisher.
This article was originally published
in roots – international magazine of
endodontics, Issue 3/2018.
Dr Bogdan Moldoveanu
He gained his DMD from the Iuliu
Hațieganu University of Medicine and
Pharmacy in Cluj-Napoca in Romania
and then a Master in Clinical and Surgical
Microendodontics from the University of
Turin. He is a visiting professor at the University of Turin and at the Iuliu Hațieganu
University. He practises in Cluj-Napoca,
focusing mainly on surgical and non-surgical micro-endodontics.
Dr Moldoveanu is the CEO of the educational platform Endodonție Cu Pasiune
[endodontics with passion] and an opinion leader for COLTENE. He is a certified
member of the Italian Academy of Endodontics and of the European Society of Endodontics, and an international specialist
member of the American Association
of Endodontists. He can be contacted at
bogdan@endodontiecluj.ro.
[3] =>
DTMEA_No.2. Vol.9_ET.indd
Dental Tribune Middle East & Africa Edition | 2/2019
A3
ENDO TRIBUNE
The influence of Glide Path preparation
on the canal shaping times of WaveOne®
Gold in curved mandibular molar canals
By Martin Vorster, Peet J. van der Vyver, Farzana Paleker
Introduction
The aim of this study was to compare the
glide path preparation times of stainless
steel hand files, PathFile® (Dentsply Sirona),
and the WaveOne® Gold Glider (Dentsply
Sirona). The preparation times for final root
canal shaping with the Primary WaveOne®
Gold instrument in extracted human molar teeth with and without prior glide path
preparation were also recorded and compared.
© Dentsply Sirona
Methods
Mesiobuccal canals of 60 extracted human mandibular molars (curvature angles
between 25° and 35° and radii <10 mm)
were selected and randomly divided into 4
groups with 15 canals each. Canals were negotiated to patency with a #8 K-file. Canal
preparations were performed by a single
operator using precurved #10-15-20 stainless steel manual K-files (the K-file group),
a #10 stainless steel manual K-file followed
by PathFile®s #1-3 (the PathFile® group), a
#10 stainless steel manual K-file followed
by WaveOne® Gold Glider (the WaveOne®
Gold Glider group), or no further glide path
preparation. Final canal preparation of all
60 canals was performed with the Primary
WaveOne® Gold instrument. Glide path and
final preparation times were recorded.
Results
Glide path enlargement was statistically
significantly fastest in the WaveOne® Gold
Glider group (19.7 ± 5.6 seconds) followed
by the PathFile® group (41.0 ± 6.8 seconds)
and then the K-file group (81.2 ± 26.3 seconds) using analysis of variance (ANOVA)
and Kruskal-Wallis tests (P < .0001). No statistically significant difference in the mean
final preparation times was found among
the WaveOne® Gold Glider (23.1 ± 6.0 seconds), PathFile® (24.4 ± 4.9 seconds), and Kfile groups (27.2 ± 9.5 seconds). All 3 groups
were statistically significantly faster than
the no glide path preparation group (35.4 ±
10.2 seconds) using ANOVA (P = .0004) and
Kruskal-Wallis tests (P = .0010).
Conclusions
Preparation time with the Primary WaveOne® Gold file was statistically significantly reduced when the file was used in
combination with any of the glide path
preparation techniques. The WaveOne®
Gold Glider performed statistically significantly faster in glide path preparation time
than the other glide path preparation techniques.
Editorial note:
This article was originally published in the
Journal of Endodontics, Vol 44, Issue 5, 2018
For more information about Dentsply Sirona Endodontics please contact your local representative
Dentsply Sirona
21st Floor, The Bay Gate Tower, Business Bay, Al
Sa’ada Street
Dubai, United Arab Emirates
Tel.: +971 (0)4 523 0600
Web: www.dentsplysirona.com/en
E-mail: MEA-Marketing@dentsplysirona.com
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[4] =>
DTMEA_No.2. Vol.9_ET.indd
Prof. Dr. Ivica Anic, PhD, DDS
Croatia
Dr. Francesca Ideo, DDS
Italy
Dr. Pierre Machtou, DDS, MS, PhD, FICD
ProTaper® designer
France
Dr. Clifford Ruddle, DDS, FACD, FICD
ProTaper® designer
USA
Dr. Hadi Alamri, BDS, MSC, F.R.C.D.(C)
Saudi Arabia
Dr. Alla Dobryshyna
Russia
Dr. Filippo Santarcangelo, DDS
Italy
Dr. Beth Damas, DDS, MS
USA
Dr. John West, DDS, MSD
ProTaper® designer
USA
Dr. Ivan Herrera, MS
Mexico
Dr. Eric Matlakala, BDS, Dip Odont.
South Africa
Dr. Vaibhav Garg, MDS
India
ProTaper®
Behind every case
is a story of passion
“For more than 20 years, ProTaper® instruments have been part
of my daily practice at university and in my private practice.
They have improved and accelerated my work and increased
the number of satisfied patients. For me, there is only ProTaper.®”
Prof. Dr. Ivica Anic, Croatia
Millions of ProTaper® files sold in 158 countries, used by thousands of clinicians,
taught in hundreds of universities worldwide. Proven innovation that’s still
shaping the future of endodontics.
Share your ProTaper® story with #ProTaperStories and visit dentsplysirona.com/endodontics
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[cover] => ![Endo Tribune Middle East & Africa No. 2, 2019]()
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[title] => Minimally invasive root canal shaping – A new protocol
[page] => 01
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[title] => The influence of Glide Path preparation on the canal shaping times of WaveOne Gold in curved mandibular molar canals
[page] => 03
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Table of contents
[toc_titles] => Minimally invasive root canal shaping – A new protocol
/ The influence of Glide Path preparation on the canal shaping times of WaveOne Gold in curved mandibular molar canals
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