Endodontic Sequence

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Re: Endodontic Sequence

Postby BarryMusikant on Sun Mar 23, 2014 8:10 am

Bernard,

Since I last wrote to you I have been experimenting with the instruments that form the SafeSider kit. Here is a sequence that I have tried on multiple teeth that should be pretty much full proof.

After shaping to a 20 with the relieved reamers, take the 30/04 to within 3-4 mm working the walls with some vigor for no more than 5 secons. You will find this allows you to take the 30/02 stainless steel relieved reamer to the apex with little resistance. Please note that I am not using the tapered peeso at all. You now have a canal space that most likely can be routinely fitted with a fine medium point to the apex with nice tugback. The fine-medium I use comes from Dentsply Maillefer. If by some chance this doesn't go to the apex after making sure you have full patency to the apex, yuou can use a fine point from Denstply Maillefer which absolutely will go to the apex with tugback although you will probably have to cut it back at the tip a bit.

I know this works, having used in on many extracted teeth and am now teaching it to those who attend our workshops.

It will have the following advantages over Wave One.
1. virtually no breakage
2. the ability to use the instruments several times without replacement with significant savings.
3. minimizing the amount of tooth structure removed coronally and also mesio-distally
4. the ability to work the buccal and lingual extensions far better than the use of a crown down rotating NiTi system
5. eliminate the possibility of dentinal microcracks that are associated with rotating NiTi.

Please let me know how this goes. I cannot imagine it will not work and solve your problems.

Regards, Barry
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Re: Endodontic Sequence

Postby bfinch383 on Sun Mar 23, 2014 10:10 am

Hello Barry,

Thanks for the important information. One other thing. When I have the patient back for a post and core, I have a very difficult time removing the gp to create a post space. I use a #3 peezo. I attempted to create the post space per your instructions immediately after completion of the rct, but I usually end up removing the entire gp point.

Thanks,
Bernard
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Re: Endodontic Sequence

Postby BarryMusikant on Sun Mar 23, 2014 10:21 am

bfinch383 wrote:Hello Barry,

Thanks for the important information. One other thing. When I have the patient back for a post and core, I have a very difficult time removing the gp to create a post space. I use a #3 peezo. I attempted to create the post space per your instructions immediately after completion of the rct, but I usually end up removing the entire gp point.

Thanks,
Bernard


Bernard,

Before you use the No. 3 peeso which is the correct size, flatten the gutta percha in the canal just after you seared off the excess with a plugger. It is still somewhat thermoplastic and will conform to the canal walls where you just seared it off. Now take the No. 3 peeso and center it in the gutta percha. You don't want to get the non-cutting tip between the gutta percha and the canal wall. You want the non-cutting tip to be centered in what is most often the pink disk at the orifice. Now without using any more pressure than the weight of your hand on the peeso, press on the rheostat so the peeso is rotating about 1500-2000 rotations per minute. After about 3-4 seconds of such rotations the tip of the peeso should start sinking into the softening gutta percha from the top. As it sinks in about 3-4 mm the canal space is tapering down and you could not get the tip of the instrument between the canal wall and the gutta percha if you wanted to. At this point, you can simply peck away at the gutta percha to the depth you want without worrying about engaging length and pulling the entire point out.

Please let me know if this technique works for you. I do it routinely and haven't pulled out a freshly placed point in years. I say freshly placed because I make the post holes immediately after obturation when requested.

Regards, Barry
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Re: Endodontic Sequence

Postby scotty on Tue Apr 08, 2014 12:24 am

Barry
I am going to give the new improved shortened sequence a try.
1 Shape up to a size 20 going 0.5mm beyond the constriction.
2.Take the 30/04 to within 3-4mm of the apex, vigorously on the walls for no more than 5 seconds.
3 Take the 30/02 to the apex.
4 Fine medium point from Dentsply Mailler to apex with tugback or a fine point from the same company.
5 Vital teeth start with 17%EDTA and use NaOCl after most vital tissue removed, generally after the use of a 20 SafeSider
6 Non vital teeth activate the Chlorox, 17%EDTA and the CHX with the 30/04 at 3-4K/min.
7. Flood the canal with the EZ-Fill sealer using the bidirectional spiral 3-4mm form the apex, and then place a measured GP point?

Anything I've missed?

Thanks

Scotty.
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Re: Endodontic Sequence

Postby BarryMusikant on Tue Apr 08, 2014 6:40 am

scotty wrote:Barry
I am going to give the new improved shortened sequence a try.
1 Shape up to a size 20 going 0.5mm beyond the constriction.
2.Take the 30/04 to within 3-4mm of the apex, vigorously on the walls for no more than 5 seconds.
3 Take the 30/02 to the apex.
4 Fine medium point from Dentsply Mailler to apex with tugback or a fine point from the same company.
5 Vital teeth start with 17%EDTA and use NaOCl after most vital tissue removed, generally after the use of a 20 SafeSider
6 Non vital teeth activate the Chlorox, 17%EDTA and the CHX with the 30/04 at 3-4K/min.
7. Flood the canal with the EZ-Fill sealer using the bidirectional spiral 3-4mm form the apex, and then place a measured GP point?

Anything I've missed?

Thanks

Scotty.


Scotty,

Sounds right to me. The other thing I learned is that yes opening the canal to a 30/04 3-4 mm short of length followed by the 30/02 to length predictably allows the placement of the fine gutta percha point. If you then go back to the 30/04 and take that to or close to length you can then predictably fit a fine medium point. It is just another detail that I discovered as I play with these instruments with shortened sequences. I like the 30/04 usage because it sacrifices less tooth structure coronally and it is the preservation of dentin that is becoming an increasingly important goal.

Hope you are well as usual and always good to hear from you.

Warm regards, Barry
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Re: Endodontic Sequence

Postby scotty on Wed Apr 09, 2014 11:32 pm

Thanks Barry
We have printed that sequence up and will start to use it.
I will use my favorite sealer on all the reamers as I clean and shape the canals along with the irrigants you recommend. I will use the EZ fill sealer as the final fill with the GP.
At the Biomimetic meeting I went to last year, they were all about preserving tooth structure and not making these broad pathways to the apex to get "the look" that many like to see with endo.
This shortened sequence does preserve tooth structure.

Got back from Africa last week, where I was using Silver Nitrate to arrest decay and fluoride varnish to prevent decay. It was a very productive visit.

Best

Scotty.
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Re: Endodontic Sequence

Postby BarryMusikant on Thu Apr 10, 2014 7:01 am

scotty wrote:Thanks Barry
We have printed that sequence up and will start to use it.
I will use my favorite sealer on all the reamers as I clean and shape the canals along with the irrigants you recommend. I will use the EZ fill sealer as the final fill with the GP.
At the Biomimetic meeting I went to last year, they were all about preserving tooth structure and not making these broad pathways to the apex to get "the look" that many like to see with endo.
This shortened sequence does preserve tooth structure.

Got back from Africa last week, where I was using Silver Nitrate to arrest decay and fluoride varnish to prevent decay. It was a very productive visit.

Best

Scotty.


Scotty,

I like this capability for several reasons. It is compatible preserving more coronal dentin.It clearly displays the adaptability of a system to different conditions (tight narrow canals) and I'd be lying if I did not say it is a good answer to Wave One which is sacrificing more coronal tooth structure while under preparing apically. That and the fact that we can use the instruments multiple times makes it a good alternative to these recently introduced rotating NiTi systems that also require spending a lot on a new motor.

Silver nitrate still works. We're supposed to worry about the impact of this material on pulp vitality, but it is taking care of your primary concern. You are adventurous in a way that I will never be. Thank goodness for people like you who are willing and curious enough to want to help people all over the world. I am proud to call you a friend.

Warm regards, Barry
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Re: Endodontic Sequence

Postby DentLee on Fri Apr 11, 2014 9:56 am

So Barry, in this shortened sequence, you no longer recommend the use of the 25 .06 3-4mm short of the apex after the 20 .02 but instead want people to use the 30 .04?  Does it really make that much difference?  What made you decide to try using the 30 .04 instead of the 25 .06?
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Re: Endodontic Sequence

Postby BarryMusikant on Fri Apr 11, 2014 10:30 am

DentLee wrote:So Barry, in this shortened sequence, you no longer recommend the use of the 25 .06 3-4mm short of the apex after the 20 .02 but instead want people to use the 30 .04?  Does it really make that much difference?  What made you decide to try using the 30 .04 instead of the 25 .06?


Warner,

I have become increasingly aware of the need to preserve coronal dentin,something that is treated fairly cavalierly when using rotating NiTi. Pretty pictures but at the expense of coronal dentin in the mesio-distal plane and particularly on the furcal sides of roots. By using the 30/04 as opposed to the 25/06 I am further reducing the amount of coronal tooth structure removed. It may not be a big difference but it is headed in the right direction.

Regards, Barry
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Re: Endodontic Sequence

Postby stg1333 on Thu Aug 21, 2014 11:01 am

I have been practicing with the new shortened sequence.  One of the problems I have is that a Medium Fine Patterson gp point seems to frequently be 2-3 mm short . My question is do I perhaps need to work the 30/04 more aggressively or do I need to use another brand of gp point? It seems that the gp point is binding in the middle third but that is just my perception.  Also if we only open the apical 1/3 of the canal to a 30 file can we still get sufficient amounts of NaOCl to thoroughly clean the apical 1/3? I thought we needed to get to at least a #35 to do this?
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Re: Endodontic Sequence

Postby BarryMusikant on Thu Aug 21, 2014 2:43 pm

stg1333 wrote:I have been practicing with the new shortened sequence.  One of the problems I have is that a Medium Fine Patterson gp point seems to frequently be 2-3 mm short . My question is do I perhaps need to work the 30/04 more aggressively or do I need to use another brand of gp point? It seems that the gp point is binding in the middle third but that is just my perception.  Also if we only open the apical 1/3 of the canal to a 30 file can we still get sufficient amounts of NaOCl to thoroughly clean the apical 1/3? I thought we needed to get to at least a #35 to do this?


Scott,

If you take the 30/04 to within 3-4 mm of the apex and then take the 30/02 relieved stainless steel reamer to the apex, it is a fine point that fits that space not the fine medium which is slightly larger. Try a fine point and I think you will find that if the 30/04 went to the apex the fine point will also make it to the apex. I'm guessing that you are not using a medium fine, but a fine medium because the medium fine is actually thinner than the fine point.

Please let me know what you think of this observation.

Regards, BArry
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Re: Endodontic Sequence

Postby stg1333 on Thu Aug 21, 2014 4:02 pm

I just checked the box and once again you hit the nail on the head.  I've been using fine-medium points.  I have already ordered the medium-fine and look forward to getting better and more consistent results.  Thanks again for your help.

Scott Graham
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Re: Endodontic Sequence

Postby DentLee on Thu Aug 21, 2014 6:38 pm

No, don't order the medium-fine.  That is too thin.  You need the Fine points.
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Re: Endodontic Sequence

Postby BarryMusikant on Fri Aug 22, 2014 6:32 am

DentLee wrote:No, don't order the medium-fine.  That is too thin.  You need the Fine points.


Scott, Warner is correct. You need the fine points.

Regards, Barry
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Re: Endodontic Sequence

Postby chuchro on Tue Dec 16, 2014 4:09 pm

What ISO size / taper are Fine points?
What size were points that came in SafeSiders Intro box?

regards
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Re: Endodontic Sequence

Postby BarryMusikant on Wed Dec 17, 2014 10:06 am

chuchro wrote:What ISO size / taper are Fine points?
What size were points that came in SafeSiders Intro box?

regards


Przemyslaw,

Fine points are about an 03 taper. The one's in the SafeSider box are between an 05 and 06 taper. Obviously, we are shaping the canals less aggressively when creating a space for the fine points. More conservative shaping is in line with the latest research that is coming out regarding the deleterious effects of greater tapered rotary NiTi preparations. Greater tapers not only weaken the tooth excessively by removing too much dentin in the mesio-distal plane, but a number of studies correlate the production of dentinal defects with rotating NiTi aggravated further by employing greater tapered NiTi instruments. I rarely prepare a canal space beyond an 04 taper today although I do go out of my way to apply the instruments from the thinnest on to what are often the wider buccal and lingual extensions of many canals.

Regards, Barry
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Re: Endodontic Sequence

Postby drdoug2 on Sun Mar 15, 2015 4:04 pm

In new trimmed down sequence, why only scrub the walls with the 30/04 a maximum of five seconds?
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Re: Endodontic Sequence

Postby BarryMusikant on Sun Mar 15, 2015 5:26 pm

drdoug2 wrote:In new trimmed down sequence, why only scrub the walls with the 30/04 a maximum of five seconds?
Thanks


Doug,

The instruments are oscillating at 3000-4000 cycles per minute. That is a lot of action. I think 5 seconds is actually a lot of time. Yo do no harm by scrubbing longer, but I see no real benefit. In fairness, I suppose at times I also go for a bit longer than 5 seconds if I felt any type of resistance.

Regards, Barry
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