Endo Tribune UK No. 1, 2015
Shaping canals with confidence: WaveOne GOLD single-file reciprocating system / Endo News / The One Shape Procedure Pack
Table of contents
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Untitled
ENDO TRIBUNE
The World’s Endodontic Newspaper · United Kingdom Edition
www.dental-tribune.co.uk
Published in London
Vol. 9, No. 6+7
WAVEONE GOLD
INTERVIEW
SINGLE-USE INSTRUMENTS
Dr Julian Webber explains why
shaping canals with confidence
is now a clinical reality for all.
Patric Charest about the EyeZoom
and the benefits it offers compared with conventional loupes.
The One Shape Procedure Pack
from Micro-Mega: A unique solution for root canal shaping.
” Page 17–20
” Page 21
” Page 22–23
Shaping canals with confidence:
WaveOne GOLD single-file reciprocating system
By Dr Julian Webber, UK
1a
1b
2
Fig. 1a: WaveOne GOLD file series, Small, Primary, Medium and Large.—Fig. 1b:
WaveOne GOLD files have variable and reducing tapers, producing a more conservatively shaped canal compared with their WaveOne predecessor.—Fig. 2: The
cross-section of WaveOne GOLD is a parallelogram with an 85-degree active cutting
edge with alternate one and two point contact.—Fig. 3a: WaveOne GOLD tip and
profile.—Fig. 3b: WaveOne GOLD ogival tip design.
The mechanical and biological objectives of shaping root canals were
beautifully described by Herbert
Schilder in 1974.1 As relevant today,
in the era of automated canal preparation techniques, as they were in the
days of hand preparation techniques,
these objectives provide the rationale
for the designs, tapers and tip sizes of
modern-day endodontic instruments.
Shaping the root canal facilitates
3-D irrigation and cleaning of the root
canal system of all pulp tissue, bacteria and their related by-products.2
Importantly, shaping the root canal
provides the resistance form and facilitates filling the root canal system.1,3
From hand to rotary
When manually shaping canals
with multiple sequences of stainless-steel files and Gates Glidden
Drills, root canal preparation tech-
4
niques, old and new, have many deficiencies and iatrogenic problems,
such as blocking, ledging, transportation and perforation, are common.4 The use of nickel-titanium
(NiTi) files in continuous rotation
driven by a dedicated endodontic
motor capable of speed and torque
control maintains the original
pathway of the canal while limiting
the amount of apically extruded
debris.5,6 However, while the advantages of continuously rotating NiTi
files are many, all commercially
available file systems are influenced
by cyclic fatigue and torque, especially in longer, narrower and more
curved canals.
Cyclic fatigue, caused by the
structural alteration and work hardening of the metal, is induced by repeated tensile–compressive stress,
especially when preparing canals
3b
3a
exhibiting curvature.7 Torsional
failure caused by using too much
apical force occurs more frequently
than flexural fatigue.8 Specifically,
taper lock results when an excessive length of a file’s active portion
binds in the canal during rotation.
Undesirable taper lock promotes
torsional failure and file breakage.
When the canal diameter is narrower than the diameter of the
rotating file, the latter has limited
ability to progress deeper into the
canal, binds and then potentially
unwinds and/or breaks.9
5
From rotary
to reciprocation
While the majority of commercially available NiTi systems are
mechanically driven in continuous
rotation, reciprocation—defined
as any repetitive up and down or
forward and reverse movement—
has been used to drive endodontic
instruments since 1958. Early attempts at reciprocation utilised
alternating, but equal, forward and
reverse angles of either 90 degrees
or, more recently, smaller angles of
30 degrees. As such none of these
instruments ever complete a full
rotation. Although these reciprocating systems offer an alternative to
manual preparation, multiple-file
sequences, apical transportation,
reduced cutting efficiency, inward
pressure and limited debris removal
remain issues.5,10 However, with a
novel reciprocating movement of
unequal bidirectional angles that
complete a full forward rotation of
360 degrees after four 90-degree
cutting cycles of reciprocation, just
6
Fig. 4: The WaveOne GOLD file engages 150 degrees CCW and 30 degrees CW, turning 360 degrees after three cycles of reciprocation.—Fig. 5: The new X-Smart iQ motor operated by the DENTSPLY iOS app downloaded
on to an iPad mini 2 is a full digital solution with a cordless Bluetooth 8:1 reducing handpiece.
[2] =>
Untitled
ENDO NEWS
18
Endo Tribune United Kingdom Edition | 6+7/2015
7b
7a
8
7c
10
9
11
Fig. 6: Summary of the WaveOne GOLD shaping technique: 80 per cent of cases start and finish with the Primary file. At completion of shaping, gauging with hand files or inspecting flutes for debris confirms whether
either the Medium or the Large file is needed.—Fig. 7a: WaveOne GOLD procedural flow chart where a #10 hand file is able to establish length: confirm patency and verify the glide path. ProGlider will expand any
confirmed, verified and reproducible glide path prior to the shaping procedure with the Primary file. (Rx: radiograph; AL: apex locator; IRI: irrigate, recapitulate and irrigate again).—Fig. 7b: WaveOne GOLD procedural
flow chart for more restrictive canals: use a #10 hand file in any region of the canal to create a glide path. ProGlider will expand any confirmed, verified and reproducible glide path.—Fig. 7c:WaveOne GOLD procedural
flow chart when the Primary file does not progress: use the Small file in one or more passes to working length and then use the Primary file to working length to optimise the shape.—Fig. 8: A ProGlider progressing
apically expands the glide path.—Fig. 9: WaveOne GOLD Primary progressing apically through the expanded glide path.—Fig. 10: WaveOne GOLD Primary at full working length.—Fig. 11: WaveOne GOLD Primary
loaded with debris, especially in the apical extent of the file, indicating that full shape has been achieved.
one single file can start and fully
complete the preparation of a canal
to a perfect shape.11 A single-file technique in conjunction with a novel
reciprocating movement has been
clearly shown to reduce both cyclic
fatigue and torsional failure, preventing broken instruments.12
In 2008, the concept of the
“single-file technique” was adopted
by DENTSPLY International as a
project in collaboration with eight
international clinicians to produce
a more optimal, dedicated, safe,
unique reciprocating single file
and to identify the most suitable
unequal bidirectional angles with
a motor system to generate this
movement. The outcome was the
launch of RECIPROC (VDW) in 2010
and WaveOne (DENTSPLY Maillefer)
in 2011. Both systems were marketed
as simple, efficient and predictable
automated methods to shape canals
and embraced by many general dental practitioners looking to move
into automated canal shaping after
years of unsuccessful attempts with
manual techniques and valued both
in terms of time and cost savings.
WaveOne and RECIPROC file systems (reciprocating files) demonstrate considerably improved mechanical properties, superior to rotary
files. While the cyclic fatigue properties of RECIPROC are superior to
WaveOne, the resistance to torsional
failure of WaveOne is superior to
RECIPROC.13,14 Overall, reciprocating
files are more resistant to fracture than
are continuously rotating files,15 extrude less debris than do conventional
multiple-file rotary systems16 and eliminate bacteria from root canal systems as efficiently as rotary systems.17
The shaping ability of reciprocating
files is as good as and in many cases
better than rotary files.18 Finally, it can
be clearly stated that reciprocating
files do not induce dentine cracks.19
WaveOne and RECIPROC were
designed as true single-use instru-
ments that cannot be sterilised and
re-used. The ISO colour-coded ABS
ring on the handle expands if sterilised and the file will not fit into its
handpiece. Single use is based on
sound scientific facts and common
sense, as elimination of repeated use
decreases the possibility of fracture
due to both fatigue and torsional
failure.20 The inability to consistently clean and sterilise used instruments eliminates any concerns
about cross-contamination,21 and
disposal after single-patient use
eliminates the cost of disinfecting,
cleaning and sterilising, reducing
costs overall.22 However, it should be
understood and fully appreciated
that a single reciprocating file performs the same task that would typically require three or more rotary
NiTi files to accomplish. Logic dictates that single use is by far the best
solution to reducing the incidence
of file breakage with all its ethical,
emotional and malpractice ramifications.
Advanced metallurgy
WaveOne GOLD instruments are
manufactured utilising a new
DENTSPLY proprietary thermal
process, producing a super-elastic
NiTi file. The gold process is a postmanufacturing procedure in which
the ground NiTi files are heattreated and slowly cooled. From
a technical perspective, the heat
treatment modifies the transformation temperatures (austenitic start
and austenitic finish), and this has a
positive effect on the instrument
properties.24,25 While this process
gives the file its distinctive gold
finish, more importantly, it considerably improves its strength and
flexibility far in excess of its predecessor. DENTSPLY internal testing
has shown the following: the cyclic
fatigue resistance of WaveOne
GOLD Primary is 50 per cent greater
than that of WaveOne Primary
(which itself was twice as great as
most standard rotary file systems),
and the flexibility of WaveOne
GOLD Primary is 80 per cent greater
than that of WaveOne Primary.26
Design features
There are four tip sizes in the
WaveOne GOLD single-file reciprocating system: Small (20.07, yellow),
Primary (25.07, red), Medium (35.06,
green) and Large (45.05, white)
(Fig. 1a), available in 21, 25 and 31 mm
lengths. The various tip sizes and
tapers afford the clinician the ability
to clinically prepare a wider range of
apical diameters and endodontic
anatomy commonly encountered
in daily practice.27 Canal preparations that have sufficiently tapered
resistance form are ideal for irrigant
exchange and removal of debris,28
New developments
With today’s increased focus on
minimally invasive endodontics,23 the
conclusions from the literature and
taking into account feedback from
clinicians using WaveOne since its introduction in 2011, four of the original
opinion leaders involved in the initial
development of the file, Drs Clifford
Ruddle (US), Sergio Kuttler (US),
Wilhelm Pertot (France) and Julian
Webber (UK), worked in collaboration
with the research and development
team at DENTSPLY in Ballaigues,
Switzerland, to further improve the
cutting efficiency and mechanical
properties of the file and give a new
level of confidence to the many clinicians still wary of automated techniques for shaping canals.
The result is the recent launch of
WaveOne GOLD, a new generation of
reciprocating files offering simplicity, safety and single use in shaping
canals.
12
Fig. 12: WaveOne GOLD obturating solutions with matching paper points, guttapercha points and Thermafil.
• Always initiate shaping procedures with WaveOne GOLD Primary.
• Irrigate abundantly and frequently with sodium hypochlorite after removing
any given WaveOne GOLD file from a canal.
• Remove the WaveOne GOLD file when it does not easily progress. Clean
and inspect the cutting flutes for wear and/or distortion and then irrigate,
recapitulate with a #10 hand file and re-irrigate.
• Owing to the unique WaveOne GOLD post-manufacturing process,
the files may appear to be slightly curved. This is not a defect and it is not
necessary to straighten the file before use. Place the tip of the file in the canal
entrance and start the motor. The file will follow the glide path conforming
to the natural curvature. The advantage is that a slightly curved file can be
more easily placed into canals of posterior teeth where access is restricted.
Table I: WaveOne GOLD tips.
thus promoting 3-D disinfection
and filling of the root canal system.
WaveOne GOLD has active cutting
lengths of 16 mm, shortened 11 mm
handles for improved posterior
access and the same expanding ISO
colour-coded ABS ring as WaveOne,
maintaining the philosophy of
single use. Variable and reducing tapers ensure a more conservatively
shaped canal with greater preservation of tooth structure at D16,
the coronal extent of the preparation (Fig. 1b). While the concepts of
“minimally invasive endodontics”
lack documented and meaningful
studies,29 any shaping objective that
removes less of the existing tooth
structure while optimising efficient
3-D irrigation and obturation is a
positive step in an effort to preserve
the integrity of the natural tooth.
The cross-section of WaveOne
GOLD is a parallelogram with two
85-degree cutting edges in contact
with the canal wall, alternating with
a patented DENTSPLY off-centred
cross-section where only one cutting edge is in contact with the canal
wall (Fig. 2). Decreasing the contact
area between the file and the canal
wall reduces binding (taper lock)
and, in conjunction with a constant
helical angle of 24 degrees along
the active length of the instrument,
ensures little or no screwing in. The
additional space around the instrument also ensures additional space
for improved debris removal. The
tip of WaveOne GOLD (Figs. 3a & b) is
ogival, roundly tapered and semiactive, modified to reduce the mass
of the centre of the tip and improve
its penetration into any secured
canal with a confirmed, smooth and
reproducible glide path.
Collectively, these design features
result in a reciprocating movement
that is very smooth, eliminating the
need to push on the file, and thereby
promoting safety and considerably
improving cutting efficiency. This
[3] =>
Untitled
1 Year Clinical Masters Program
TM
in Endodontics
12 days of intensive live training with the Masters in Rome (IT), Milan (IT), Athens (GR)
Participants will master techniques that are repeatable, predictable
and have the ability to create different but always excellent results.
Learn from the Masters of Endodontics:
Registration information:
12 days of live training with the Masters
in Rome (IT), Milan (IT), Athens (GR) + self study
Curriculum fee: €9,900
(Based on your schedule, you can register for this program one session at a time.)
Collaborate
on your cases
Sapienza University
of Rome
and access hours of
premium video training
and live webinars
you will receive
a certificate from the
Sapienza University
Tribune Group GmbH is the ADA CERP provider. ADA CERP is a service
of the American Dental Association to assist dental professionals in
identifying quality providers of continuing dental education. ADA CERP
does not approve or endorse individual courses or instructors, nor does it
imply acceptance of credit hours by boards of dentistry.
Details on www.TribuneCME.com
contact us at tel.: +49-341-484-74134
email: request@tribunecme.com
100 C.E.
CREDITS
Tribune Group GmbH i is designated as an Approved PACE Program Provider by the
Academy of General Dentistry. The formal continuing dental education programs of this
program provider are accepted by AGD for Fellowship, Mastership, and membership
maintenance credit. Approval does not imply acceptance by a state or provincial board of
dentistry or AGD endorsement.
[4] =>
Untitled
ENDO NEWS
20
13a
Endo Tribune United Kingdom Edition | 6+7/2015
13b
• Expand this glide path to at least
0.15 mm using a manual or mechanical glide path file.
• Carry the Primary file to the full
working length (Fig. 10) in one or
more passes. Upon reaching working length, remove the file to avoid
over-enlarging the apical foramen.
Inspect the apical flutes; if they are
loaded with dentinal debris, then
the shape is finished (Fig. 11).*
• If the Primary file does not progress,
use the Small file (020.07 yellow) in
one or more passes to working
length and then use the Primary file
to working length to optimise the
shape.
• When the shape is confirmed, proceed with 3-D disinfection protocols.
13c
Obturation solutions
14a
14b
14c
15a
15b
15c
Obturation of the root canal system is the final step of the endodontic 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 extended 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 GuttaCore (DENTSPLY), the cross-linked
gutta-percha core obturator.
Conclusion
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 with WVC. (Images courtesy of Prof. Sergio Kuttler)
reduces shaping time by a further
19 per cent in canals when compared
with WaveOne.26
Reciprocating
movement
WaveOne GOLD files are designed
with a reverse cutting helix, engage
and cut dentine in a 150-degree
counter-clockwise (CCW) direction
and then, before the instrument has
a chance to taper lock, disengages
30 degrees in a clockwise (CW) direction. 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
360 degrees (Fig. 4).
The X-Smart iQ (Fig. 5) launched
in conjunction with WaveOne GOLD
is an endodontic motor and cordless
8 : 1 handpiece designed for reciprocation and continuous motion.
The handpiece is Bluetooth controlled by a DENTSPLY Apple iOS
iQ app downloaded on to an iPad
mini 2 (Apple). As a complete digital
solution, it is designed for all stages
of the endodontic procedure, including patient management, file
selection, torque control training
and patient education. The X-Smart
iQ also offers electronic apex locator
functionality. Currently available
DENTSPLY reciprocating file motors
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
WaveOne GOLD files. All reciprocating file motors are preprogrammed
to produce the reverse bidirectional
movement, but the CCW/CW angles,
torque and speed settings cannot be
altered. These motors can, of course,
be used for continuous rotation
when the clinician is able to adjust
the speed and torque, as desired.
Shaping technique (Fig. 6)
The WaveOne GOLD Primary
(025.07) is always used first to initiate the shaping procedure. It will
create optimal shape in approximately 80 per cent of canals as a
true single-file technique and is used
in canals that have a confirmed,
smooth and reproducible glide
path. An expanded glide path is a
perfect set-up for the safe apical progression of any mechanically driven
endodontic file.30
The WaveOne GOLD Small (020.07)
file should be thought of as a bridge
file, as the resulting shape is considered too small to allow disinfection
and filling of the root canal system.
When the Primary file will not passively advance through the glide
path, which has been verified to
length, the Small file is used to transition and expand the shape. The
Primary file is then re-utilised to reach
the full working length. Although a
two-file sequence is the exception,
this method must be considered a
safer and more efficient option compared with most other commercially
available rotary shaping techniques.
After the Primary file reaches
length, the flutes are inspected and if
full of debris would indicate shaping
is finished. If the Primary file is loose
at length with no dentinal debris
on the apical flutes, shaping continues 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 diameter is larger and that a Medium or
Large file is required.
WaveOne GOLD files are used in a
brushing action to reduce resistance
and more effectively instrument
canals that exhibit irregular crosssections. Brushing eliminates coronal
interferences, creates lateral space,
and promotes the inward advancement of the file. Further, a brushing
action reduces the contact between
the file and dentine, mitigates undesirable taper lock, and allows the
instrument to run more freely. In
order to avoid transportation, never
brush at length. The files are used with
a gentle inward ‘stroking’ motion of
short 2 to 3 mm amplitude, to passively advance the file along a smooth,
reproducible glide path.
Reduced shaping time with
WaveOne GOLD means there is more
time available to focus on active irrigation methods. In order to enhance
irrigation and improve effectiveness
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
improve disinfection.32
The stages of the shaping procedure can be summarised as follows
(Figs. 7a–c):
• Establish straight-line coronal and
radicular access with emphasis on
flaring, flattening and finishing the
internal axial walls.32
• In the presence of a viscous chelator, use a #10 hand file to verify
a glide path to length. In more restrictive canals, use a #10 hand file
in any region of the canal to create
a glide path.
• 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).
• Initiate the shaping procedure with
the Primary file in the presence of
sodium hypochlorite (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.
After shaping 2 to 3 mm of any given
canal, remove and clean the Primary
file, irrigate, recapitulate with a
#10 hand file and re-irrigate.
• Continue with the Primary file, in
two to three passes, to pre-enlarge
the coronal two-thirds of the canal.
• In more restrictive canals, use a #10
hand file in the presence of a viscous
chelator and negotiate to the terminus of the canal. Gently work this file
until it is completely loose at length.
• Establish working length, confirm
patency and verify the glide path.
WaveOne GOLD is a safe, efficient
and simple system for preparing
canals. Sophisticated metallurgy and
design result in improved flexibility
and cyclic fatigue life with less binding 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
WaveOne GOLD is very cost-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
cost savings. Faster preparation time
allows the clinician to focus on the
most important aspect of clinical
endodontics, disinfection, thus fulfilling the mechanical and biological
objectives of shaping canals.
WaveOne GOLD has set a new
standard and shaping canals with
confidence is now a clinical reality
for all.
* If the Primary file is loose at length with
no dentinal debris on the apical flutes,
continue shaping with the Medium or
Large file.
Editorial note: The author has a commercial interest in WaveOne and WaveOne
GOLD file systems. A list of references is
available from the publisher.
Dr Julian Webber
has been a practising endodontics in London
for over 35 years.
He can be contacted at jw@
julianwebber.com.
[5] =>
Untitled
ENDO NEWS
21
Endo Tribune United Kingdom Edition | 6+7/2015
“Greater power in the
focus area”
An interview with Patric Charest, Orascoptic
Back in January, dental loupes manufacturer Orascoptic introduced its
adjustable magnification loupe
EyeZoom to dental professionals in
the UK. At the recent BDIA Dental
Showcase in Birmingham, Dental
Tribune had the opportunity to speak
with International Sales Manager
Patric Charest, USA, about the device
and the benefits it offers compared
with conventional loupes.
Dental Tribune: Mr Charest, EyeZoom
promises significant advantages
over conventional loupes. What features make it stand out from the
competition?
Patric Charest: With conventional loupes, the field of view is
usually very small. There are clinical procedures, however, for which
the operator would like to have
greater magnification without sacrificing on what he or she can see.
This system allows the operator to
do that. The EyeZoom is the only
loupe that has two prisms inside
and provides three to four times
the magnification while working.
Ergonomics plays a part, since
EyeZoom allows clinicians to see
better while being able to move
back and forth. Many clinicians
work from the 12 to 9 o’clock position and they typically move closer
when approaching the treatment
area. They need a loupe that allows
them to see the arch clearly and
maintain good posture while moving between positions.
The device has been on the market
for a couple of months. How has it
been received by the market here?
Like in the US, there are many
clinicians who like to work with
a wider field of view. It has been
well received and our customers
here are really enjoying it so far.
If the operator wants to increase
the power while performing endodontic treatment, he or she can
literally twist the loupe and the
field will not become narrower.
This is the only loupe in the world
that can do that. The operator gains
greater power in the focus area,
unlike with conventional loupes,
which have to be taken off during
the procedure.
In addition, most customers
like that it is lightweight and comfortable. The frame weighs only
96 grams and was designed in Italy.
It is perfectly balanced for a comfortable fit.
The price for conventional loupes
ranges between £1,600 and £3,000.
Where does the EyeZoom fall?
Normally, the dentist pays more
for a wider field of view from edge
to edge. The EyeZoom is located
at the higher end, but offers three
magnifications in one instead of
the dentist having to buy three
separate loupes. Many clinicians
find value in that.
As a company, we focus on high
quality and want our loupes to be
the best on the market. The quality
of the EyeZoom is really exquisite;
it has already received a number of
awards. It has been a really successful
product in both the US and the UK.
Thank you very much for the interview.
Patric Charest, Orascoptic
AD
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Untitled
TRENDS & APPLICATIONS
22
Endo Tribune United Kingdom Edition | 6+7/2015
The One Shape Procedure Pack
A unique solution for root canal shaping
Dr Tara Mc Mahon, Belgium
1
2
3
4
5
6
7
8
Fig. 1: One Shape Procedure Pack.—Fig. 2: Pre-op radiograph of tooth #17.—Fig. 3: Opening of the pulp chamber (P: palatal canal; DB: distobuccal canal; MB: mesiobuccal canal).—Fig. 4: Elimination of overhangs
with ENDOFLARE (P: palatal canal; DB: distobuccal canal; MB: mesiobuccal canal).—Fig. 5: After the passage of ENDOFLARE, access to the distobuccal canal is straightened (P: palatal canal; DB: distobuccal canal;
MB1: first mesiobuccal canal; MB1: second mesiobuccal canal).—Fig. 6: Exploration file, #10 MMC, in the distobuccal canal.—Fig. 7: One G.—Fig. 8: Radiograph of One G in the second mesiobuccal canal.
The objective of endodontic treatment is the elimination of pulp
debris or the bacterial biofilm and
its toxins from the root canal system in order to prevent or eliminate any periapical lesion.1 For this
purpose, root canal shaping is an
essential, necessary and complex
step. Essential because it allows
indispensable irrigation, necessary
to achieve 3-D obturation of the
endodontic root canal system2 and
complex because of the infinite
complexity of the root canal anatomy.3
Over the past several years, the
definition of an endodontically
successful root canal treatment
has changed considerably. In 1986,
success was based on the complete
disappearance of the periapical lesion.4 In 2004, the concept evolved
and the terms “recovered tooth”,
“tooth on the way to recovery”
and “diseased tooth”5 were used.
In 2011, the terminology of
“functional tooth” versus “nonfunctional tooth” was finally in-
troduced.6 Despite this, the concepts for root canal shaping established by Schilder in 1974 remain
unchanged,7 namely with respect
to the initial root canal anatomy
and position of the apical foramen, as well as conservation of
root canal patency and obtainment
of a sufficient taper to guarantee
the penetration of the irrigating
solutions to the apex.
Practitioners are familiar with
these concepts and try to implement them in the best possible
way. However, endodontic treatment remains an area that poses
great difficulties for dental surgeons, and time constraints can
often lead to inadequate treatments. Thus, general practitioners
desire a simple, efficient and rapid
solution that allows reproducible
treatments. The introduction of
rotary nickel-titanium (NiTi) instruments in endodontics in the
late 1980s has revolutionised the
discipline. The material’s extreme
elasticity imparts great flexibility
to instruments with greater diameters and tapers than those of
hand files. Stainless-steel hand
files are more rigid and can lead
to the creation of an apical ledge,
canal transportation, a crack in
the apical foramen or even instrument fracture.8, 9
Although NiTi instruments allow reliable and reproducible
results, they present a higher risk
of fracture than do stainless-steel
files, particularly those used in
continuous rotation, which is due
to cyclic fatigue or higher torsional stress. Instrument fractures
caused by cyclic fatigue occur
without prior deformation visible
to the naked eye. They are therefore impossible to foresee with
certainty.10
Too often does this elevated risk
of instrument fracture result in
general practitioners abandoning
endodontics altogether. However,
respecting several simple principles, such as using the speed
and torque recommended by the
instrument manufacturer, preenlarging the root canal, using
vertical up-and-down movements,
as well as cleaning and performing
visual control of the instrument
after each passage, makes the
practitioner’s work less stressful
and more relaxed.
The introduction of single-use
instruments not only eliminates
the risk of cross-contamination,
but also considerably reduces the
risk of instrument fracture due
to cyclic fatigue and simplifies
the operating procedure. MICROMEGA has designed the One Shape
Procedure Pack, which contains
an ENDOFLARE file, a #10 MMC
file, a One G file, a #15 MMC file and
a One Shape file (Fig. 1). It simplifies
the operating procedure, removes
the need for instrument maintenance and makes stock management easier. All of the necessary
instruments for the endodontic
treatment are single-use files supplied in sterile packaging.
9
10
11
12
13
14
15
16
Operating procedure
Each endodontic treatment requires a preoperative radiograph
taken with a radiograph film
holder (Fig. 2). Once a dental dam
has been placed and the access
cavity has been prepared, the
root canal entrances are localised
and the pulp chamber is irrigated with sodium hypochlorite
(Fig. 3).
The first step of the root canal
preparation is the enlargement
of the canal entrances. As the
first instrument in the One Shape
Procedure Pack, ENDOFLARE (with
a diameter of 0.25 and a 0.12 taper)
is used with up-and-down movements and pressure on the canal
walls in the first 3–4 mm of the
root canal to enlarge the canal
orifices. In this case, ENDOFLARE
eliminates the dentinal overhang at the entrance to the distal
root canal (Fig. 4) and lays open
the second mesiobuccal canal
(Fig. 5).
Fig. 9: Photograph of One G in the second mesiobuccal canal (P: palatal canal; DB: distobuccal canal; MB1: first mesiobuccal canal; MB1: second mesiobuccal canal).—Fig. 10: One Shape.—Fig. 11: Passage of
One Shape in the canal: two-thirds of the WL, 3 mm short of the WL, and WL.—Fig. 12: Radiograph of One Shape in the second mesiobuccal canal.—Fig. 13: Photograph of One Shape in the second mesiobuccal canal.—
Fig. 14: Radiograph with the master cone.—Fig. 15: Post-op radiograph.—Fig. 16: Post-op radiograph of tooth #17.
[7] =>
Untitled
TRENDS & APPLICATIONS
23
Endo Tribune United Kingdom Edition | 6+7/2015
17a
17b
torque of 2.5 Ncm. Root canal
shaping is performed in three
steps with progression of One
Shape to two-thirds of the WL,
3 mm short of the WL, and the
WL (Fig. 11). Between each passage,
the root canal is abundantly irrigated with sodium hypochlorite
and patency is checked with a #10
file. The instrument’s spires must
be systematically cleaned and
visually inspected.
17c
Figs. 17a–e: Pre-op photograph (a). Radiograph of One G in the second mesiobuccal
canal (b). Radiograph of One Shape in the
second mesiobuccal canal (c). Radiograph
with the master cone (d). Post-op radiograph (e).”
17d
The exploration file (#10 MMC)
serves to evaluate the root canal’s
complexity. It is introduced into
the root canal without axial constraints in the coronal zone, owing
to the previous action of ENDOFLARE. Any coronal interference
that might hinder the file’s passage must be eliminated to make
the treatment as safe as possible
(Fig. 6).
The second step of the root canal
preparation is the exploration of
the root canal and the creation
of a glide path. This step entails the
pre-enlargement of the root canal
and facilitates the passage of the
following rotary shaping instrument. Root canal exploration and
glide path development are performed with stainless-steel hand
files or rotary NiTi files.8 It has
been shown that the use of a
highly flexible instrument with an
asymmetrical cross-section reduces the risk of canal transportation.9 In addition, this kind of
cross-section combined with a
variable helical pitch diminishes
screwing effects.11
The second rotary instrument
in the One Shape Procedure Pack is
One G (Fig. 7). This NiTi instrument
with a diameter of 0.14 and a
Stress-free, relaxed working: Since
the instruments are single-use only,
the risk of instrument fracture due
to cyclic fatigue is considerably reduced and there is no risk of crosscontamination.
Short learning curve: All of the rotary
instruments are used in continuous
rotation.
Rapidity of the root canal preparation:
The gain in time during root canal
shaping allows for a more thorough
final irrigation.
Simplification of the operating procedure: A single instrument is used for
glide path creation, and one instrument for root canal shaping.
Gain in time for the dental assistant:
Simpler and quicker preparation of
the working materials, since no
cleaning and no sterilization of the
instruments are required after the
treatment. Thus, there is more time
to assist the practitioner during
treatment.
Optimised organisation in the dental
office: Stock management is easier
and less storage space is required.
better upward transport of the
debris and limit screwing effects.
Owing to its characteristics, One
Shape causes less extrusion of debris and irrigating solution in the
apical zone than other single-file
systems available on the market.14
17e
0.03 taper has an asymmetrical
cross-section. Its three cutting
edges are situated on three different radiuses to the root canal axis.
One G also has a variable helical
pitch and thus variable helical
angles. The narrower the angle,
the more active the rotating instrument, and the wider the angle,
the greater the efficiency of the
instrument’s traction.8 All of these
features provide One G with a high
flexibility and great efficiency.
Clinically, if the root canal is
patent, One G is taken to the working length (WL) previously determined with the #10 MMC file and
an apex locator. However, if the root
canal is not patent, One G penetrates
with vertical up-and-down movements on the canal axis down to the
length attained by the #10 MMC
file. This allows the elimination
of constraints in the cervical and
middle thirds of the root canal. The
#10 file is then pre-curved in order
to check the canal patency. The
WL is determined and transferred
to One G, which is then taken to
the WL at a speed of 250–400 rpm
and a maximum torque of 1.2 Ncm
(Figs. 8 & 9). After the creation of the
glide path with One G, the #15 MMC
file must penetrate down to the WL
without constraints. The root canal
is now ready for shaping.
capacity to negotiate curves.13 The
instrument’s tip is inactive and
allows for a smooth progression
in the root canal. The helical pitch
and angle are variable along the
instrument and thus guarantee
The instrument progresses with
an up-and-down movement of
low amplitude and without excessive pressure. One Shape is used in
continuous rotation with a speed
of 350–450 rpm and a maximum
Editorial note: A list of references is
available from the publisher.
Dr Tara Mc Mahon
is a working as
a dentist in an
endodontic practice in Brussels,
Belgium.
AD
PRINT
L
DIGITA N
TIO
EDUCA
EVENTS
The third rotary instrument
is One Shape (Fig. 10). This NiTi
instrument with a diameter of
0.25 and a 0.06 taper has a variable
cross-section. The apical 2 mm of
its active blade with a global length
of 16 mm has a triple-helix crosssection with three cutting edges
situated on three different radiuses to the canal axis. The following 7.5 mm constitutes a transitional zone that terminates in a
double-helix section of 6.5 mm in
the coronal part of the file.12
The cutting effect of the two cutting angles in the coronal zone is
more important and allows more
efficient elimination of the debris,
whereas the three cutting angles
in the apical zone provide the
instrument with a better centring
ability, a higher resistance totorsional constraints and a better
One Shape performs the root
canal preparation quicker than
other single-file system.15 This
gain in time must be used for the
indispensable final irrigation.
The DTI publishing group is composed of the world’s leading
dental trade publishers that reach more than 650,000 dentists
in more than 90 countries.
[8] =>
Untitled
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FACEBOOK
SWISS
PRECISION
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[cover] => ![Endo Tribune UK No. 1, 2015]()
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[title] => Shaping canals with confidence: WaveOne GOLD single-file reciprocating system
[page] => 01
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[title] => Endo News
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[title] => The One Shape Procedure Pack
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Table of contents
[toc_titles] => Shaping canals with confidence: WaveOne GOLD single-file reciprocating system
/ Endo News
/ The One Shape Procedure Pack
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