Shaping for Cleaning the Root Canals: A Clinical-Based Strategy

Description

This book provides clinicians with up-to-date, scientifically based guidance on the most important stages of endodontic treatment, i.e., cleaning and shaping of the root canal space, including mechanical preparation and chemical disinfection. Five internationally recognized experts present and discuss recent developments and new perspectives in the field. Important advances in root canal preparation and irrigation procedures are described with the aid of numerous high-quality illustrations. A key feature of the book is the detailed attention devoted to the latest research findings and to their impact on contemporary evidence-based clinical guidelines and modern clinical practice. On this basis, simple treatment protocols are proposed that take the anatomy of the root canals fully into account. In addition, emerging problems and trends are considered. The book will be an excellent resource for clinicians and advanced practitioners who are seeking to update their practice. Foreword Preface Contents Contributors 1: Classical Cleaning & Shaping: Historical Cornerstones 1.1 Historical Development of Shaping Concepts 1.2 Classical Cleaning & Shaping Concept by Schilder 1.3 From the 1980s to the 1990s 1.4 Overfast Mechanical Shaping: An Undeniable Current Reality 1.5 What Should Be the Main Target in Endodontics? Speed or Quality? References 2: Shaping for Cleaning: Reconsidering Root Canal Debridement 2.1 How Effectively Can We Debride? 2.1.1 The “Fake Iceberg Illusion” 2.1.2 Debridement Deficit 2.1.3 Unnecessary Root Dentin Removal 2.1.4 Accumulated Hard-Tissue Debris 2.2 The Overload on the Shoulders of Irrigation 2.3 The Shaping for Cleaning Concept 2.4 What to Do After Shaping? Maximizing the NaOCl Intracanal Time 2.4.1 NaOCl as a Non-agitated Intra-Visit Medication 2.4.2 Updated Syringe-Needle Irrigation: A Close-to-WL Approach 2.4.3 Handling the Vapor Lock Phenomenon 2.4.4 The Role of the Patency File 2.4.5 Negative Apical Pressure Irrigation 2.4.6 Is It Still Necessary to Agitate the NaOCl? 2.4.6.1 Sonic and Ultrasonic Irrigation 2.4.6.2 Manual Dynamic Activation (MDA) Technique 2.4.6.3 Continuous Instrumentation and Irrigation: The Self-Adjusting File (SAF) System 2.4.7 Chelating Agents: Washing out the Biofilm? 2.5 Shaping for Cleaning Irrigation: Clinical Guidelines References 3: The Glide Path Matter 3.1 Introduction 3.2 Definitions 3.2.1 Natural Path 3.2.2 Canal Scouting 3.2.3 Apical Patency 3.2.4 Glide Path 3.3 Micro Glide Path 3.3.1 Guidelines for Canal Scouting 3.3.2 Guidelines for Establishing the Apical Patency 3.3.3 Challenges in Scouting and Patency Procedures 3.3.3.1 Easily Negotiable Root Canals 3.3.3.2 Root Canals with Difficult Negotiation 3.3.3.3 Non-negotiable Apical Canal Anatomies 3.4 The Glide Path Per Se 3.4.1 Manual Glide Path Preparation 3.4.2 Glide Path Using Hand Files in Dedicated Oscillatory Pneumatic Contra-Angles 3.4.3 Rotary NiTi Glide Path Preparation 3.4.3.1 PathFile 3.4.3.2 ScoutRaCe 3.4.3.3 ProGlider 3.4.3.4 The Critical Role of Micro Glide Path for Rotary Pathfinder Instruments 3.4.4 Reciprocating NiTi Glide Path Preparation 3.4.4.1 WaveOne Gold Glider 3.4.4.2 R-Pilot 3.5 Concluding Remarks References 4: NiTi Rotary Systems: From Revolution to the “More of the Same” Phenomenon 4.1 Nickel-Titanium Alloy: History and Properties 4.2 NiTi Alloys and Specific Features 4.2.1 Austenitic NiTi Alloy 4.2.1.1 Conventional NiTi Alloy 4.2.1.2 Electropolishing Treatment 4.2.1.3 M-Wire 4.2.1.4 R-Phase 4.2.2 Martensitic NiTi Alloy 4.2.2.1 CM-Wire 4.2.2.2 Electrical Discharge Machining 4.2.2.3 Gold and Blue Wires 4.2.3 MaxWire 4.3 The Genealogical Tree of NiTi Systems 4.3.1 The Patriarchs (First Generation) 4.3.2 Improving Metallurgical Properties (Second Generation) 4.3.3 Heat Treatment Is the Pathway to Follow! (Third Generation) 4.3.4 No! Kinematic Is Better (Fourth Generation) 4.3.5 The Asymmetrical Proposition (Fifth Generation) 4.4 Clinical Recommendations for Safe Use 4.5 Rotary NiTi Systems: “The MORE of the SAME” Phenomenon References 5: Reciprocating Movement: Mastering the Mechanical Preparation 5.1 Reciprocating Steel Instruments: The First Beginning! 5.2 Asymmetric Angles: The Rebirth of Reciprocating Movement 5.2.1 The Story of Reciprocating Movement with NiTi Instruments 5.3 Reciprocating Systems 5.3.1 Reciproc M-Wire 5.3.1.1 Manufacturer Guidelines (Fig. 5.12) 5.3.2 Reciproc Blue 5.3.3 WaveOne Gold 5.3.3.1 Manufacturer Guidelines (Fig. 5.17) 5.3.4 Race Evo R-Motion 5.3.4.1 Manufacturer Guidelines (Fig. 5.19) 5.4 Reciprocating Motors 5.4.1 Dedicated Electronic Motors 5.4.2 Air-Driven Contra-Angle 5.5 The R25: A Multitasking Single-File Instrument 5.5.1 Is Reciproc a Single-Use Instrument? 5.5.2 Reciprocation and the Coronal Preflaring Procedure 5.5.3 Is Glide Path Mandatory for Canal Preparation with Reciprocating Movement? 5.5.4 Feedback of the R25 Instrument 5.6 Finally, Low Risk of Fracture! 5.7 Rational Approach for Reciprocating Preparation of Root Canals: A Clinical Perspective 5.7.1 Main Reasons for Using Reciprocating Instruments 5.7.2 A Simple and Easy to Learn Workflow 5.8 Concluding Remarks: Reasons Why Reciprocation Is Not “More of the Same” References 6: Scientific and Educational Aspects of Reciprocating Movement 6.1 Introduction 6.2 Scientific Aspects of Reciprocating Movement 6.2.1 Cyclic Fatigue Resistance 6.2.2 Torsional Resistance 6.2.3 Cutting Efficiency 6.2.4 Shaping Ability 6.2.5 Microcrack Formation 6.2.6 Preparation Time 6.2.7 Accumulated Hard Tissue Debris and Debris Extrusion 6.2.8 Disinfection Ability: Reduction of Bacterial Load and Toxins 6.2.9 Clinical Performance: Postoperative Pain 6.3 Educational Aspects of Reciprocating Movement References 7: Shaping for Cleaning in Retreatment Cases 7.1 Introduction 7.1.1 Predictability of the Initial Endodontic Treatment 7.1.2 Success and Clinical Practice 7.1.3 Purpose of Retreatment 7.1.4 The Filling Materials 7.2 When Is Retreatment Possible? 7.2.1 Access Preparation and Retreatment 7.2.2 The Critical Last Millimeters: Regaining the Apical Patency 7.2.3 Anatomical Diameter of the Apical Foramen: To Enlarge or Not to Enlarge? 7.3 Effects of Gutta-Percha Removal in the Canal Walls 7.3.1 Getting Rid of the Bulk-Filling Material: Solvent, Burs, and Files 7.3.2 Challenges: Oval Canals, Irregularities, and Isthmuses 7.4 Root Canal Reshaping 7.4.1 Vertical Extent of Instrumentation 7.4.2 Which Is the Best File for Retreatment? 7.4.3 Interappointment Medication: Actual Scientific Status 7.5 Suggested Clinical Protocol 7.5.1 Case Planning: Anatomical Knowledge with 3D Visualization of the Canals 7.5.2 Instruments and Materials 7.5.3 New Instruments and Approaches to Deal with the Remaining Gutta-Percha 7.5.4 Main Clinical Protocol 7.5.4.1 Removal of the Bulk Filling Material (Fig. 7.15) 7.5.4.2 Regain Apical Patency (Fig. 7.16a, b) 7.5.4.3 Reshaping the Canals at the Established Working Length (Fig. 7.16c) 7.6 Final Considerations 7.6.1 How to Determine the Outcome in Retreatment Cases 7.6.1.1 Healing: Grouped into Two Types 7.6.1.2 Disease 7.6.2 Selective Root Canal Retreatment References 8: Managing Canal Anatomies in the Context of Shaping for Cleaning Proposal 8.1 The Importance of Anatomical Knowledge of Root Canals in Clinical Practice 8.2 Applied Anatomy: What We Really Need to Know About Each Group of Teeth 8.2.1 Root Canal Complexities: Rule or Exception? 8.2.2 One Root Means a Single Canal? 8.2.3 Anterior Teeth: Are They the Easiest Teeth to Treat? 8.2.4 The Hidden Secrets of Premolars 8.2.5 The Complexities of Molar Teeth 8.2.6 The “Critical Apical Zone”: Is It Really Critical? 8.3 Anatomical Factors and Their Impact on the Prognosis of Root Canal Treatment 8.4 Anatomical Factors in Practice for Treating Complex Anatomies 8.4.1 Diagnostic Tools to Identify Anatomical Complexities: 2D × 3D 8.4.2 Planning a Case: Armamentarium for a 3D Approach 8.4.3 Access Preparation: To Open or Not to Open? 8.4.3.1 Minimally Invasive Endodontics: A Cost–Benefit Rationale 8.4.4 Cleaning and Shaping or Shaping for Cleaning? 8.4.5 3D or 4D Canal Filling? 8.5 Dealing with Complex Cases 8.5.1 Multiplanar Curvatures: What You See Is Not What You Get! 8.5.2 Overcoming Preparation of Multiple Canals in Narrow Roots 8.5.3 The Challenge of C-Shaped Canal Management 8.5.4 Taurodontism: Expanding the Pulp Chamber Size 8.5.5 Extra Roots in Maxillary and Mandibular Molars: The Radix 8.5.6 The Dens Invaginatus Dilemma: Conservative and/or Surgical Approach? 8.5.7 MB2 Again? Yes, But Let’s Also Talk About the MB3! 8.6 Concluding Remarks References