Referrers » Educational resources for dentists
FREQUENTLY ASKED QUESTIONS
Q: Do you use braiding technique for normal GP removal or just for carrier based GP?
A: The braiding technique can be used to remove large single GP cones and is helpful for removing carriers. So both!
Q: In the braiding technique, if the larger file is to the apex, what length would you go with the smaller file? Or do they both go to the apex?
A: The largest file goes to the apex and the second file goes as far as possible, if possible to the apex
Q. What is the risk of file separation with the braiding technique?
A: Separation is always a risk with any procedure involving files but it’s never happened to me using the braiding technique, use new files and you should be fine.
Q. What is the best type and size of file to use in braiding technique?
A: Use the largest file which will reach the apex and the second file should be as wide as possible to engage the obstruction, aim to get the second file at least halfway down the canal.
Q. Can debris block the canal? Can you elaborate on this?
A: The debris created during instrumentation can block the canal
Q. What can you do when there is excessive bleeding from the root canal? And, what is the cause of the excessive bleeding?
A: I assume this would be from an inflamed pulp rather than a perforation. If the pulp is so inflamed it keeps bleeding you can use adrenaline containing anaesthetic to stop the bleeding, or if you are confident you are at the correct working length and inside the canal just keep preparing the canal to remove the tissue.
Q: What technique do you use to remove a crown prior to root canal treatment?
A: There are a variety of ways to remove a crown- cutting the crown off is one way or using a crown remover, of which there are many. The WAM key is the one I have been using the longest and I find this extremely helpful for reusing the crown as a temporary crown between visits.
Q. If the root canal anatomy is shaped like a bottle, do you have any tips on delivering irrigants into the pulp chamber in sufficient quantities to fill it?
A: In these cases where the canal is narrow but the apex is wide (like a bottle), you need to adequately taper the preparation to deliver the irrigants and after cleaning and shaping MTA is usually the best material, to close the apex.
Q. Is the pulp chamber filled with sodium hypochlorite while you are using K-files to establish glide path?
A: Yes, the pulp chamber is filled with hypochlorite during establishment of the glide path
Q. When do you decide to stop the canal preparation? At which size and why?
A: The size of the preparation is determined by the existing anatomy and the pulp status. If the root is narrow then you cannot taper the prep much, but maybe if there is an inflamed pulp and no apical disease you do not need to prepare the canal much apically either, because the pulp apically is probably healthy. If you the apical 5mm of the file on the last pass are filled with debris, in my opinion the canal has been debrided.
Q. Which apex locator do you recommend?
A: There are many good apex locators. Propex pixi is a good one I have used. The Morita Root ZX is also a great tool.
Q. Is Morita Root ZX a good apex locator?
A: Yes this is a reliable apex locator, there are many good ones which I have used during my specialist training and at public hospitals I have worked in.
Q. Based on your experience, which do you believe is better and more reliable - radiographs or the apex locator?
A: When you get good at using an apex locator then the radiographs just back up your apex locator readings. In the right hands the apex locator is much more superior to visual inspection of radiographs. But remember if someone is to assess your treatment the radiographs will stand up against the notes, so having good radiographs is extremely important.
Q. What should be the RPM and torque settings be for WaveOne Gold?
A: Wave one gold is a reciprocating file and has a patented movement angle and rpm and torque settings. These can be found on the motor.
Q: Do you recommend pushing out the apex with a #10 K file?
A: As long as this is easily passed through the apex this technique is recommended. The idea is for the file to pass passively through the apex.
Q:Does pushing through the apex to get a glide path cause flare-ups?
A: If the passing of the file through the apex is passive then it should not cause a flare up.
Q. How safe is it to use rotary in open apex canals?
A: This is safe and often in wide canals we don’t need to use rotary files because the canal has a natural wide taper already.
Q: Which system has the best shaped tapers for open apex canals?
A: I assume you mean canals with immature apices. In these cases often we rely on activation of irrigants to clean the canal because the taper of the canal is wider than the rotary files
Q. When would you consider measuring working length?
A: Every case I take the working length as soon as the smallest k file looks like it is near the apex. So at the beginning of each case.
Q:How do you establish accurate working length for MB2 canal?
A: It is important to be able to negotiate the coronal curvature and then just take the 10 K file to length, use an apex locator and then I find ProGlider good to use if it is particularly curved.
Q. What would be the most likely cause if the matching GP doesn’t go to working length?
A: There are new cones that fit the preparations better.The other possibility is that you need to brush a little more to make space for the GP cone.
Q. Is the 3 files up from the one that binds necessary? If not, does that mean you can do vertical condensation without pushing through the apex?
A: 3 sizes up from the first file that binds was popular when we had narrow tapered preps due to hand filing, now that we have taper we just need to create an apical stop rather than some theoretical size.
Start-X 2 MB2 locating ultrasonic tip does not require water, what about the rest of the collection?
A: Start X2 doesn’t require water because you can’t see when water is being used. The power at which it is used should therefore used at low power in short bursts to locate the canal. The Start X4 tip for removing posts creates a lot of heat and is used at high power and therefore requires water.
Q:Are the Start X tips for use with EMS scalers?
A: Yes you can get them for EMS scalers
Q:Are ProGlider and ProTaper Next Files for single use only?
A: Yes, it is recommended that these files are for single use only.
Q:Do we need to use GuttaCore with ProTaper Next?
A: It is not essential to use GuttaCore with Protaper NEXT but it is a technique which can be used to quickly and adequately fill canals
Q. Based on your experience, what is your opinion on GuttaCore?
A: GuttaCore is a carrier based obturating system and is useful in narrow long roots with moderate curvature. If you are able to master the technique it is an quick and efficient way to fill canals
Q. Based on your experience, which would you recommend – WaveOne Gold or ProTaper Next?
A: ProTaper next is my go to system and most cases I treat with this system. If the case is more simple I use Wave One GOLD, because it significantly reduces preparation time for me.
Q:How do Hyflex files compared to ProTaper?
A: There are so many differences between these rotary files. Protaper NEXT files have shape memory and cut efficiently. I have not used Hyflex files. The best thing to do is to try the files and see which one you prefer. Your local rep should be able to provide you with a sample.
Q. What size K-file do you use to recapitulate in between the ProTaper Next file sequence?
A: Size 10 K is my recapitulating file
Q. Are #10 K-files too small/thin to show up on the radiograph?
A: The smallest file which is easy to see radiographically size 15 for this reason I find ProGlider helpful to quickly get to length after the size 10 K file, so then you can take a radiograph using a 15 K
Q. In the webinar, you mentioned for some cases you can use reciprocating files and, for others you will use ProTaper Next? Can you please elaborate on how you make that decision?
A: ProTaper next is my system I use most, but in simple untreated cases I use Wave One GOLD. I prefer to use Wave one gold when the curvature is not severe.
Q:Can you use reciprocating files without glide path creation?
A: This is not recommended because if you make an error then it can be catastrophic!
Q: When would you use ProTaper Next X4 and X5 files?
A: In wide canals, I almost never use these files as X3 has sufficient taper for a 30 gauge irrigation needle to reach the apex.
Q. When using the ProTaper Next X1 file, when you meet resistance is that when you start the brushing motion? And should you keep the motor running at all times?
A: Yes when you meet resistance you withdraw the file and keep it running and brush away from the furcation.
Q. What motion do you use for the micro-opener?
A: the same motion as a probe
Q:What kind of motion would you use with the C+ files? (e.g. watch-wind?)
A: a watch winding motion also called the balanced force technique.
Q:Do you prefer C pilot files or C+ files?
A: C+ files are good for starting preparation of calcified canals. C pilot files are for use after this.
Q:How far would you take the C+ files into canal?
A: Once the file has progressed 2-3mm I would try again to use K files
Q. Does it matter if the C+ files are fluted stainless steel or diamond coated?
A: C+ files are stainless steel and not diamond coated.
Q:Why do you need to brush the file towards the cusp?
A: This moves the prepared canal away from the furcation. We don’t want to strip the furcation when preparing the canal.
Q. Can you please describe exactly what brushing action is?
A: The brushing action used with Protaper next is a brush away from the curvature on the retrieval stroke, as opposed to a gliding action used with Proglider, to learn about this you really need to attend a hands on course.
Q:What is the best method of identifying calcified canals?
A: I prefer the use of slow speed round burs such as the LN bur.
Q:What were the names of the instruments used for locating calcified canals?
A: LN Bur and Micro Opener 10/06
Q. Is it mandatory to use ProGlider in the case of calcified canals?
A: It isn’t mandatory but it helps create a tapered glide path and eliminates the big jump in file size from 10 k to 15k (50% bigger)
Q:Do you obturate with Protaper Next? Are there matching GP points and what are your thoughts on them? Are traditional GPs just as good?
A: Yes you definitely need to obturate at some point! There are new variable tapered cones available that appear to be easier to use than the previous ones.
Q:For ProTaper Next obturation, do you recommend cold lateral condensation or are the custom GP points too close to fit to allow access?
A: Use whatever root filling technique that works for you, but if you can get experienced using warm vertical condensation with the custom GP cones it will save you time.
Q. With the brushing action of the ProTaper Next X1 and X2 files, can I still use a single cone obturation?
A: You can use a single cone obturation technique but I don’t use this technique
Q. What is your opinion on thermafil gutta percha??
A: I don’t routinely use carrier based obturation systems. If you like Thermafil you should try Gutta Core as it has a gutta percha carrier.
Q. Can you please elaborate on GP point removal?
A: There are so many ways to remove GP, you can use small sized 2 Gates Glidden drills and also there are retreatment files available D1-D3
Q:Is there any other material you use to seal canals after obturation besides Cavit?
A: I try and restore all the cases I treat and have been doing so for 4 years now. My favoured base over the GP is SDR (smart dentine replacement).
Q. Do you recommend using EDTA as the final irrigant prior to obturation?
A: I use EDTA as a rinse after my last file and then sodium hypochlorite after this.
Q. How long do you typically wait after root canal treatment obturation before crowning a tooth?
A. In theory if the treatment has been done to a high standard there is no need to delay it.
Q. What is your opinion on using VorteX Blue 15/04 file before ProTaper Next X1?
A: This is another option rather than ProGlider, but ProGlider will be able to fit in smaller glide paths as it has smaller taper at the tip.
Q. Does EDTA help decrease torsional stress?
A: No, if the tip binds in the canal edta will not prevent this. Creation of a glide path does reduce torsional force on the next file and this is why creation of a glide path is so important to what we do.
Q. What sort of water is used to irrigate?
A: I use sodium hypochlorite and EDTA as my stock irrigants
Q:Does "activation" of your irrigant affect the success rate of your chemomechanical prep?
A: This is a difficult thing to prove. We have a high success rate without activation of irrigants and so its difficult to show it makes a difference but, in theory it helps remove bacteria and circulate irrigants into lateral canals
Q. What are irrigation tips you use? Why are they useful?
A: I use 30 guage irrigation needles and also the TruNatomy plastic irrigation needle. I also use the EndoActivator and the Eddy they are useful for moving the irrigant solutions into lateral canals
Q:How are the overall success rates affected by extrusion of sealer apically?
A: Sealer extrusion per se is unlikely to reduce success but many sealers are cytotoxic and if they are extruded this can delay healing. It is thought that overpreparation often results in overfilling. These may go hand in hand and maybe the reduction in the ability to create a good apical seal is part of the reason for delayed healing with extruded treatments. In general, its better to aim to finish your root canal preparation 0.5mm-1.5mm short of the radiographic apex. This has been shown in many studies.
Q. How much sealer affects the success rate of root canal treatment?
A: There is no significant differences with regard to success of cases based on sealer.
Q. What sealer do you use?
A: I have used bioceramic AH+ sealers. My go to sealer is AH+ and I would consider bioceramic sealers only if there was a resorptive defect.
Q. Do you commonly use posts?
A:I commonly use fibre posts to restore teeth, either if the referrer has requested this or I feel it would benefit the clinical situation.
Q. Do posts increase retention of the core?
A: Yes this is their purpose
Q:Do you recommend the use of the EndoActivator?
A: EndoActivator is simple to use and useful as an agitator of irrigants. I also use the Eddy, which is higher in frequency.
Q:What magnification loupes do you recommend for new users?
A: If you want to use loupes just for endo then I would recommend at least 4X magnification.
Q:Is there any benefit to heating the NaOCl when using the bubble technique?
A: There is no advantage in heating hypochlorite when using the bubble technique, as the oxygen release is similar
Q. What is the “bubbling” phenomena in locating canals?
A: Sodium hypochlorite releases oxygen as it dissolves organic tissue and this creates bubbles. So it can be used to locate canals
Q. What is your opinion on using lentulo spirals?
A: I don’t routinely use lentulo spiral fillers, I prefer to inject calcium hydroxide using Navi tips or place it using EndoActivator
Q:For retreatment cases, or for cases where there has been a chronic infection, would that affect the size of the canal preparation and what size preparation would you go up to?
A: The width of the preparation depends on many things but if you can reach a size 30 then in theory a 30 gauge irrigation needle can easily reach 1mm short of the apex and fully irrigate the canal
Q. How do you bypass an iatrogenic ledge in the apical third?
A: There are many ways to do this and probably it would be difficult to describe this without being at a hands on course
Q. From your personal experience what can we use to assist in removing ledges or prevent forming them?
A: To prevent forming them create a glide path with hand files and use small rotary files like X1 and ProGlider. Ledging usually occurs as a result of incorrect angle of insertion and use of files which are wide and rigid. It is less of a problem for rotary instrumentation, due to the emphasis on gradual increase in preparation size and tactile sensitivity.
Q. For a case of chronic apical periodontitis - how many Ca(OH) dressings would you suggest? And when would you obturate?
A: I recommend dressing the canal long enough to resolve their symptoms or sinus tract and occasionally I do this over 3 visits. But if you can prepare the canals and then remove symptoms after 1 dressing then that is often enough.
Q. Can you please give some advice on treating older patients who have long standing chronic apical periodontitis?
A: Older patients often have calcified canals and in cases of long standing apical periodontitis I would recommend dressing the canals for many weeks and then making sure symptoms are gone before filling the canals.
Q:What was the most difficult case you have encountered? Any unusual and strange anatomy you had to deal with?
A: The Radix Paramolaris case which is a lower molar with 2 separate mesial roots was the rarest case I’ve treated. I have also treated dens invaginatus cases where the canals are in completely random formation. These are fun!
Q. Specific case enquiry: Very calcified canals were prepped to length with size 25 ProTaper Next file but the corresponding ProTaper Next GP master cone wasn't reaching length.
Would you recommend more brushing with size 25 ProTaper Next file, widening with a Size 25 hand file or using a smaller master GP cone?
A: Brushing with the X2 file or using one of the new variable tapered GP cones would overcome this.
Q. Specific case enquiry: I often find after dressing the canal with ca(OH)2, the file does not go to working length.
Why do you think that is happening and how do I handle the situation?
A: Calcium hydroxide can block the canals, you should use the X1 file to remove it, this will correct this problem
Q. Specific case enquiry: I find sometimes the canals are blocked in the apical third as soon as go with first file #8 or #10, even if there is no obvious bend or curve.
Why do you think this is happening and what should I do to negotiate these canals?
A: This is just narrowing of the canals and this is when your balanced force hand filing technique needs to be good to overcome this