Lurn Endodontics

"Simplicity is Ultimate Sophistication"

This tooth presented with symptoms of irreversible pulpitis w.r.t. 37

When approaching such curvatures, key points to be taken
into considerations are

1. Coronal Flare is must to access apical curve
2. In severely curved cases, AVOID WATCH WINDING motion
go only Up and Down
3. Precurve the file, get 10 C pilot super super smooth
4. Preparation can be kept at 4% 25/30 depending on resistance to K file.
5. Liq EDTA and Hypo alternatively with Saline as separating solution in between
6. Keep canals patent all the time by using 10 C file in between rotaries..

Happy Endo

To the dentist
By the dentist
For the Patient

Simplicity is ultimate sophistication

The removal of the root filling material is a key step in
root canal re-treatment. The majority of recent studies
have focused on the impact of newer rotary NiTi files,
or other innovative devices, designed to aid the
removal of gutta-percha, the most commonly encountered
root filling material. However, regardless of the
root filling material, the availability of newer devices
and rotary instruments does not necessarily signal the
end of established techniques or hand instruments.

Although one of the aims of re-treatment is to
completely remove the previously placed root filling
material, there is universal agreement that predictable
clearance of all of the material, including sealer, is
impossible.

Many Colleagues have asked as to what speed do you
use rotary file for retreatment ?

Answer : Minimum speed need to be range of 700-1000 RPM on you endomotor. I am NOT a big user of solvents (I personally use Liq EDTA more often than solvents) because High speed achieves 2 Objectives.
1. It Generates frictional heat which thermoplasticizes GP
2. Reduces the chances my hand applying pressure on rotary file in order to engage GP

One must remember, Previous dentist has already created some glide path till the GP is filled.

My sincere advice in retreatment would be to use rotaries at higher speed ( Till the length of GP filled) in order to remove GP effectively then u can shift to C pilot files for negotiation and scale down the speed for final apical shaping.

Simplicity is Ultimate sophistication

Classic Manual Dynamic Agitation Technique

- A well-matching GP master cone whose taper is slightly less than the taper of the canal is selected. A snug fit is sought after at the working length.

- Then 1 ml is trimmed at the tip of the cone in order to get tug-back 1 ml shorter than the canal terminus.

- After suction of the primary irrigant NaOCL,
the canal is filled with 1 ml of EDTA delivered with a 30 gauge NiTi needle (either Navy tip from Ultradent or Stropko NiTi Flexi-Tips from SybronEndo or CanalPro Flex-Tips from Coltene/ Whaledent).

- Manual agitation of the master cone is started with an up and down motion and a 2 mm amplitude at a frequency of 100 strokes during approximately 1 min After that, 1 ml of EDTA is delivered with the irrigating needle to flush out debris. EDTA is then suctioned to eliminate any residual chelating action.

- The canal is flushed with 1 ml of NaOCl, and the same protocol is repeated using 50 in and out strokes during 30 s. A final flush is performed with 3 ml of NaOCl.

This protocol has proven very effective in
removing the smear layer and producing very
cleaned canals in the apical area

Concern : The main concern during irrigant activation is the risk of apical extrusion. According to available data, all tested devices included MDA appear to extrude some irrigant except ANP
which is the safest (but ANP should be seen more as a delivery device rather than an activation system).

However, it is noteworthy to notice that in a
clinical situation, the resistance of the periapical tissues plays a role in limiting the occurrence of extrusion.

Irrigant extrusion can be prevented
with an accurate use of the MDA technique.

Central to successful endodontics is knowledge, respect, and appreciation for root canal anatomy and careful, thoughtful, meticulously performed cleaning and shaping procedures.

“C” configuration is known to present a complex canal anatomy; its irregular areas house soft-tissue remnants or infected debris that may escape thorough cleaning or filling procedures, thus requiring supplementary effort to accomplish
a successful root canal treatment.

This has provoked many modified techniques to manage such cases endodontically Challenges range from diagnosis to endodontic instrumentation, obturation,and post space preparation.

Such cases demand use of thermoplasticized gutta percha and use of " ZAP AND TAP " method to obturate such complex system.

Tale of 3 cases... One anterior, One Premolar and One molar all with Lesions of Endodontic Origin or called as PA lesion...

Key to successful endo for an individual practitioner is "Follow UP"

Top 5 tips to achieve PA healing in these type of cases.

1. Prefer to do TWO VISIT approach then single visit ( It may work ) but two visit is better

2. Minimum Apical prep of 30/06% or higher so that greater amount of bacteria and toxins removed from end of the canals.

3. AGITATE full CONC 5% Hypo and 17% Liq EDTA for atleast 2-3 min per canal. Irrigation device choice is yours.

4. Place interim calcium hydroxide for a week.

5. Use Warm vertical condensation to seal as much area
as possible and Coronal seal within a month of obturation.

excellent article for colleagues on "Tug back" for Gutta Percha.

False and True Tug-Back in Endodontic Obturation What is false tug-back? What is good tug-back during root canal obturation? Find out why this is so important to do in each and every case!