Root Canal – Instrumentation
Okay, so now we’re back to our video series on root canals and this section is going to be on instrumentation, so let’s just figure we’re working with this molar.
Okay, I’m always going to use. Oh, four taper! I have oh six taper in my inventory, but, to be quite honest, I’ve never had to use it.
I never come across that really flared out canal, yet I just always work with the oh four taper and that’s every time.
I start off with a number forty file. I vocative all the orifices and I’m now going to go through and instrument each orifice and then I move on to the next file. Your technique, I’m going to be using is the crown down technique, so I go with the number 40 file most the time.
I get down to probably about there that’s about as far down as I can get with a number 40 I’ve been able to get down inside the canal.
I’M definitely not all the way down to the apex, but at least gives me an opening gives me an idea of where I’m going to be after I’ve gotten that first one.
I’M then going to irrigate I’m going sodium hypochlorite with a safe sided needle, and I’ll go ahead and irrigate. Now I should say: whenever you’re going with one of those safe side of needles, you never want to clog or get the tip stuck inside.
Their impress you don’t want to have any that fluid shoot out there vape X, so I always make sure that that tip when I’m squirting it I can be moving it up and down inside the canal, just as a safety measure and also just to make sure We have a good flow of material of same hypochlorite in there to start cleansing out the canal. Okay, so then we’ll move on from 40 to number 35.
Now I don’t have a working length, yet I haven’t gone in with a number 10 file, or even a number 8 or 15 to try to determine where the apex is yet because the number 40 just never goes down to the apex.
Then move on to number 35 and perhaps number 35 gets down to about – maybe here yeah. This is just going off of feel since I haven’t measured.
Yet I don’t know exactly, but that’s about where the number 35 lines up, depending upon how tight those um files felt when I went in there usually at this point I will stop irrigate the area out, take a number 10 file, or maybe a number 15 put It on a PEC, slow, cater and then go down and determine where the apex is.
I should point out there’s a flaw here in my photo, my drawing member, I removed the top of the tooth, so that’s gone, so I can use my measurement at this location or this location when determining my overall length. Well, it’s nice about this.
Is I find that most of the time the lengths come back is your 18 to 21 millimeters and since the file system they’re using comes either twenty-one or twenty-four millimeters? It’s so much easier to work with the 21 million, because that extra three millimeters when you’re trying to get up and over and in that extra three millimeters, really makes a difference in ease of access.
So, you can remove the top again. It just makes for easier. Visual access, as well as physical access into the root canal system.
Okay. So at this point it’s been cleansed out not completely, of course, just enough to remove any major debris.
That’s in there and use an apex locator to determine where we are that’s a ninety percent of time.
I’M able to get a reading on it, and it does a very good job. As most you know, who’ve used apex, locators they’re just fantastic radiographic.
Determination of the apex has its limitations. If you may have a, you, may have a route that actually comes out and flares this way or flares. That way and you may see vertically that you may have achieved the right length.
But you don’t know if that that wrote on that radiograph, it’s curving towards you at all now curves are rarely going to be to the buckle or to the lingual like that, but it is a possibility that could happen. The electronic apex locator just seemed to be very accurate how they work.
So, that’s just a moment or imagine for a moment that I’m able to get this canal and, let’s just say it comes in at 19, millimeters and just for a moment.
Let’s just assume, there’s not a second, a mesial canal here, let’s just imagine, there’s just one just ease of drawing, but on this one I can’t really determine yet the apex locator isn’t coming up with the reading.
That’s no big deal. I’M going to move on from 35 to 30, I’m gonna keep instrumenting. If I know this one’s 19 I’m going to set the stopper on the rotary night type file go down to 19.
Another thing I found that when I make it flat like this most time, this canal and that now are going to have the same measurement or within a millimeter of each other.
So if I go down all the way to 19 on this one – and I go over here, and I’m down to about 18 to 18 and a half, then I may go back and measure again.
I like to just always go back and measure to make sure that we are at the apex if it still doesn’t seem like it’s going down all the way. That’S okay, move on to the next file at 25. It 25 goes all the way to length.
Then there is no point in continuing on with this canal. This one is now fully instrumented all the way and this one’s still being stubborn. I will continue on with 25 until it looks like it reaches about that 19 or whatever you know.
This measurement was it’s over here, it’s in the same ballpark, and then I’ll dial it in by using the apex locator to get down to the very tip. Now, if I run into a problem, I go 25 20 15, and it’s still not there.
Now it’s time to start using hand, files and that’s restart, doing the apex location and then enlargement technique, and so they only going to 10.
If the 10 doesn’t do it, then usually the 8 wills, and so the 8 will go down there, and we’ll just be very gently working that tip, and you can feel it when it gets down to that measurement.
It’s just say in this case: it was 19 here by getting down to 18, with my rotaries went out the hand files.
I finally get that last little millimeter with the lace to say that on number 8 or the number 10 – and I will gently work – that in a back-and-forth motion, take it out irrigate, go back in work. It a little bit more irrigate, go back and forth back and forth, and then I’ll advance up to the next file, maybe even the number 15 hand file.
Even though I have a 15 rotor I’ll, take a 15 hand file and work that apex and then by the time I do that by the time I go into using the rotary again, it will usually go all the way down to where it needs to be.
If not just keep working it by hand, but I’d say 90% of time. I don’t need to do that. It’s going to work out with the rotary night.
I files anyways, so I use the crown down technique.
Now I forget where I stopped. Let’s say this one went down to a 25 right here. Let’s say this apex came out at 25.
I don’t just stop there. I then March, I call March back up the sequence.
I will take a number 13. I find that even though the 30 on the first go down after the 25 went all the way I put the 30, the 30 will usually go down, and it will go to full-length will go to the full 19 millimeters I’ll then go to number 35 and That one may go all the way down again enlarging this canal at full working length and then let’s say going to the number 1440 doesn’t go down all the way it doesn’t go down to 19.
It may only go down to say 18. If that’s the case, then 35 would be the final canal or sorry the final instrument that went all the way down the canal, the full working length. So, I will use that as my gutta-percha try it.
So, let’s just say this one ended up at 35. There were 25 initially, but then we were able to enlarge it to a 30 to 35 and then the 40 didn’t go down all the way so 35 is going to be. Our is going to be our final cone on that one.
Let’s just say this one wound up at: I don’t know, let’s just say 30 at that point. What I’ll do is put the gutta-percha points in their take an x-ray.
I know we just talked about the limitations of radiographs, but it’s nice to have a confirmation just to make sure you’re not overly instrumented, or you’re not too long, and that you’re not too short either, and so we’ll take a confirmation film, with the cone of Each one of those sizes, one other thing,
I’d like to mention what we do in our office is when we go through and tooth, has multiple canals.
We have a recording sheet which will be available on our website, which canal it was and what the final length was and what the final instrument was and what we do is we fill out those different boxes, and I usually just have the assistant put around the Patient’S bib, because when it comes time to instrumenting these all the way through, I won’t have a visual reminder of what goes where, because, after you do several root canals in a day or just all the different patients.
You see you might get confused between the mesial-buccal and the mesial-lingual, and so you know if one went 19 millimeters alone was 18 and a half one finished out of 35.
Another finished at authority trying to keep that all straight I’d, rather not rely upon trying to remember that I’d rather have a written record of it, and I would just lay it right in a patient’s bib.
It’s real easy for me to look over for a second to see what it was, and then I can go into the right spot.
It’s just an extra safety measure and last thing I have one less thing I have to think about it’s like. I always tell my staff, the less.
I have to think the better off its going to be for everybody so download that form. I think it might help you in just making sure you keep everything straight when you’re actually doing multiple canals on tooth