How to deliver simpler root canal therapy with Komet USA ’s F360™ file system [VIDEO]

April 12, 2014

Practicing general dentistry at a consistently high level of quality is perhaps the hardest “specialty” in our profession.

Practicing general dentistry at a consistently high level of quality is perhaps the hardest “specialty” in our profession.

Today, many general dentists who are able to successfully perform root canal procedures find it challenging to do so efficiently enough to justify the routine in their practices.

If the procedure could be streamlined without compromising the clinical result, many more endodontic procedures would be performed within general dental practices.

Rotary instrumentation of the root canal

In dental school, rotary instrumentation of the root canal was contraindicated because rotary instruments often ledged the canal system, created “false canals” due to a lack of flexibility and caused separation of instruments in the root canal.

With the ability to flex and follow complex canal systems, nickel-titanium (Ni-Ti) files revolutionized this process. They are easier to use and much more efficient than previous generations of hand instruments and, when properly paired with a handpiece that offers controlled rotation and torque and stops or reverses if the instrument binds in the root canal, they significantly simplify the cleaning and shaping of root canals.

The Komet F360™ endodontic file system aims to further streamline endodontic procedures by combining an easy working sequence with a technique suited to both specialists and general dentists.

Most root canals can be prepared with a simplified sequence requiring just two files. Highly flexible to minimize canal transportation, the .04- taper files feature a unique S-curve design and a thin instrument core to deliver outstanding cutting efficiency while respecting natural root-canal morphology.

Curved root canals can be easily negotiated without “ledging” or “zipping,” and the presterilized, single-use files significantly reduce or eliminate the risk of file separation due to instrument fatigue.

Used with a torque-limited motor (250-300 rpm), the files are ISO color coded to match all standard endodontic file systems. The files effectively debride the root canal space while maintaining a high degree of flexibility to negotiate the “elbows” of root-canal systems.

The following is a case report on root canal therapy using Komet USA’s new F360™ file system with NSK’s Endo Mate DT handpiece.

Case report: a mandibular central incisor

The patient presented previously with a fractured mandibular central-incisor porcelain restoration that had been repaired with a temporary composite restoration. A periapical radiograph showed the presence of a defined periapical radiolucency necessitating root canal therapy prior to remaking the ceramic restoration.

Note: With an efficient way to perform this service, it is now possible to complete the root canal therapy, place a fiber post, prepare the tooth and take a master impression for the replacement restoration-all in one visit.

This is a major time-saver for the patient and an efficient revenue producer for the practice.

Watch the technique slideshow now:

Read the detailed technique case on the next page ...

1 A lingual access cavity is made using a round diamond bur from the Komet Rotary Endo Solutions Kit. Note: The access cavity should provide a near straight-line access to the apex of the mandibular central incisor.

2 A rubber dam is placed, and cleaning and shaping of the root canal system begins.

3 A number 10 endo file is used to establish the working length of the root canal.

4 If a number 10 file cannot reach the apex or if additional flare to the canal is desired, the Komet Pathfinder instrument (PF03L25) is used to establish a mechanical glide path to the apex.

5 The root canal is irrigated with sodium hypochlorite or other appropriate antiseptic solution to remove any remaining infected canal debris.

6 The size 25 F360™ file is used with the NSK Endo Mate handpiece at 300 rpm in a slow, up-and-down motion; it is employed to the working length until the file is loose. Note: The double-S cross section of the file has very sharp cutting angles for efficiency and a large chip space for removal of infected canal debris during cleaning and shaping.

7 The root canal is copiously irrigated shows a periapical radiograph following completion of cleaning and shaping with the first F360™ file.

8 The size 35 file is used to the full working length of the root canal. Note: If the file binds prematurely, go back to the 25 and work it around the diameter of the canal to slightly enlarge it, enabling the 35 to extend to the working length. Once the size 35 instrument is non-binding in the root canal at the working length, the cleaning and shaping is complete.

9 The orifice opener (AK10L19) is used to further taper the coronal third of the root canal to facilitate obturation. Note: If needed, this instrument can also be used prior to the glide-path instrument to open a restricted canal orifice.

10 The obturation procedure is initiated with try-in of the 35 master gutta-percha cone. A radiograph is used to verify that the cone goes to the working length.

11 Root canal sealer is mixed, and the master gutta-percha cone is covered with sealer and then placed to the working length of the root canal. A size-25 finger spreader is pushed into the orifice next to the master cone as far apically as it will go, laterally condensing the gutta-percha in the root canal.

12 After the finger spreader is withdrawn, a size-25 accessory gutta-percha point is placed into the void left by the spreader. This procedure is repeated with more accessory points until the coronal third of the root canal is adequately obturated.

13 A plugging instrument is heated in a flame and used to remove the excess gutta-percha in the canal access cavity. With the root canal obturated, the next clinical step is to establish post room and place a prefabricated fiber post into the coronal two thirds of the root canal space. Note: Komet’s DentinPost® system is used for this case.

Composed primarily of special glass fibers to ensure high stability while offering exceptional esthetics and radiopacity, DentinPost® prefabricated, tapered-root posts are available in four different sizes with matching instrumentation.

For this case, a DentinPost size 050 is selected.

14 A Gates Glidden drill is measured 5 mm short of the radiographic apex of the root canal and used to remove the gutta-percha from that portion. The DentinPost® yellow preparation drill is measured, again 5 mm short of the working length of the root canal, to prepare the internal shape of the canal to accept the yellow fiber post.

15 Once the post room is achieved, the fiber post is cemented using Bisco’s Select Etch HV® etchant and Duo Link™ luting cement. Note: A bit of sealer has passed into the periapical area, indicative of a good periapical seal of the root canal apex.

16 After the post is trimmed and the crown preparation is refined, a master impression can be made, followed by a provisional crown.

 

Conclusion

In this case, a simple, effective way of performing root-canal therapy has been demonstrated using Komet USA’s new F360™ rotary file system.

This system can add a whole new dimension to the practice by enabling doctors to combine clinical procedures and shorten treatment time for the patient. In turn, practitioners who may or may not be experienced at performing root-canal therapy can now confidently incorporate endodontics into their routine.

Quite simply, the Komet F360™ file system is a “must have” in any general dental practice.