Endodontic advancements

March 21, 2012

I love endo! To some of you that may seem like a statement of lunacy, but I really do find it fascinating.

I love endo! To some of you that may seem like a statement of lunacy, but I really do find it fascinating.

If I was forced to specialize, I’d be an endodontist. It’s also a great service to offer our patients, and one thing I’ve learned over my career is patients don’t really want to be referred to another office. Also, routine endodontics really is easy, and in my opinion, should be done in your office.

Difficult cases that you don’t feel comfortable treating can be referred out, but the easy ones? You should be doing those yourself.

So in this issue, we’re going to take a look at a few products that can have a dramatic effect on your endo cases.

Twisted Files

SybronEndo has come up with a pretty amazing file, called the Twisted File, or TF for short. The concept is pretty interesting. Rather than machining the cutting flutes into the nickel titanium file, Sybron has developed a way to twist NiTi to create the flutes.

What does this mean to the clinician? Simply put, twisting the metal creates less metallic fatigue than machining it would. This means the files are more flexible as well as more resistant to fracture.

Any time you place a rotating piece of metal into a snug space with lots of surface area, you run the risk of fracture, but Twisted Files have proven themselves to me over the long haul. I probably shouldn’t write this, but I’ve never broken one!

Bonded Obturation

One of the best ideas to come along in endo is the idea of bonded obturation. As general dentists we deal with bonding on a regular basis, and we know its advantages. One of the major problems we have with endodontics is helping to ensure that a properly cleaned, shaped and filled canal remains free of bacteria that can leak into this well cleansed system. To that end, the idea of actually bonding our root canal filling material into the roots should make good sense to us.  

Well how about two different systems that allow you to bond the material in and retreat easily if need be? The first is RealSeal from SybronEndo. It features a synthetic material called Resilon that looks and acts like gutta-percha. It’s available in cones that are ISO sized in varying tip sizes and tapers.

You can instrument and shape the canal in any manner you choose and you can then fill the canal in any way you choose-only instead of gutta-percha, you use RealSeal and its self-etching resin sealer. This means whether you are using warm vertical, lateral condensation, single cone, or any other technique, RealSeal will work for you. The only thing you lose is the leakage associated with gutta-percha.

The other system is from Ultradent and features gutta-percha coated with a material that bonds. This system also employs a self-etching resin sealer, called EndoRez. Ultradent recommends using their instrumentation protocol “TiLOS,” but you also can prepare in your usual manner and simply fill with their obturation system if you’d prefer.

I haven’t used gutta-percha in a case in at least 5 years and have had amazing success with these two products.

Obturator Technology

If you are one of the doctors out there who prefer obturators over points, then you have a few new options to be aware of. The first is GuttaCore. It is an obturator developed by Tulsa Dental, but instead of a plastic or metal core that is covered by gutta- percha, GuttaCore uses a special type of gutta-percha as a rigid core that is covered by a different type of gutta-percha as the obturating material. The advantage of this system is its easy placement as well as easy removal. GuttaCore is currently available in tip sizes 20, 25 and 30.

The second obturator that could well change the way you practice is SybronEndo’s RealSeal 1. The obturator is designed to offer both an obturator delivered fill that also incorporates the bonded advantages of the RealSeal product discussed earlier in this article. The Resilon is actually injection molded around a plastic core for uniform thickness, and it also ensures the material will not get stripped off the carrier as it is placed. The carrier itself is made of a plastic that provides good support during placement, but can be softened and dissolved with the same solvent you would use to remove Resilon or gutta-percha. This means that despite the plastic core, it is 100% re-treatable.

Wrapping it up

So there it is, a few nuggets to make your life easier and to help you provide a better service for your patients. At the end of the day, it’s the patient who benefits…and that’s what makes exploring these new products and ideas worthwhile.

About the author

John Flucke, DDS, is Technology Editor for Dental Products Report and dentistry’s “Technology Evangelist.” He practices in Lee’s Summit, Mo., and has followed his passions for both dentistry and technology to become a respected speaker and clinical tester of the latest in dental technology, with a focus on things that provide better care and better experiences for patients. He blogs about technology and life at blog.denticle.com.