This is Dr. Cliff Ruddle.
I would like to show you how to use the ProTaper Next instruments clinically.
As with any endodontic procedure, it all starts with an accurate diagnosis.
Diagnostics is comprised of gathering your clinical findings, performing the vital pulp
testing, and, of course, attaining one or more well-angulated films.
When we look at this specific radiograph, notice the orientation of the prosthesis to
the underlying roots.
Notice that the canals appear to be narrow, long, and quite curved.
Let's get started.
As we saw in the pre-operative film, we had a difficult prosthesis and so in this instance,
we elected to go ahead and remove the bridge.
I want to emphasize the importance of straight-line access to each orifice.
Certainly, the internal walls of any access cavity should be flared, flattened and finished.
It's important to use a 10 file to assure that there's sufficient working width to passively
accommodate the end of the ProTaper SX file.
SX is used to remove triangles of dentin, to relocate canals away from external root
concavities, and to pre-flare the orifice.
Here I'm placing a viscous chelator such as ProLube.
Let's talk just a little bit about glide path management.
It's really important to secure canals and have a smooth, reproducible glide path before
we ever entertain shaping canals with rotary files.
In this instance, if the canals are longer, more narrow, and curved or recurve, we might
have to drop to an 08 to reach length.
Once this instrument has achieved length, the canal's still pretty small in diameter.
So it's oftentimes wise to transition from the 08 to the 10 file.
And when the 10 file is loose and can easily travel over the apical one-third, it's time
to take a working-length film or use an electronic apex locator.
Once we've established working length, it's important to verify patency.
Patency means that the instrument is deliberately and intentionally inserted gently through
the foramen repeatedly until the instrument is loose.
Once the instrument is loose, we have working length and patency, now we need to verify
the glide path.
The glide path is verified when a 10 file can slip and slide easily and reproducibly
over the apical one-third of the canal.
Now, expand the glide path using a 15 hand file or a dedicated mechanical glide path
file.
Once we have a confirmed reproducible glide path, we can commence shaping using the ProTaper
Next X1 file.
Notice its unique asymmetrical rotary motion.
Notice that I'm brushing a little bit to make more contact between the instrument and the
dentinal walls.
Oftentimes when a file bogs down and doesn't want to travel apically, it's important to
recognize you produced a lot of mud.
So irrigate, recapitulate with a 10 file and then re-irrigate to liberate that debris.
In one or more passes, we can continue with the X1 file using this brushing motion.
To come back to brushing, brushing allows us to effectively work into the eccentricities
off the rounder parts of canals.
Brushing allows us to create lateral space which promotes the instrument's inward movement.
When we've achieved length, as usual, irrigate to kick out gross debris, then use the 10
file to break up residual debris and move it into solution, then re-irrigate to liberate
this debris.
We can now continue on using the ProTaper Next X2 file.
From the lateral view, you can really see I'm emphasizing brushing.
Brushing gives us more centered preparations, it maximizes remaining dentin on the furcation
side, and it ensures that we're making more contact than just using a pecking or pumping
motion.
Let's take a quick look at one of the unique design features of the ProTaper Next instruments.
Notice in this cross-section only two points are contacting dentin at one time.
Notice the available space for collecting and augering debris out of the canal.
The finishing criteria for ProTaper Next is determined after removing a ProTaper Next
file.
After removing the X2, gauge with the 25/.02 hand file.
If the 25/.02 is snug at length, you're done.
Alternatively, like in the distal canal, if the 25/.02 is loose at length, then we go
on to the X3 instrument.
And again, in one or more passes, using a brushing motion, we can allow this instrument
to progressively float towards length.
Again when length is achieved, we would irrigate, recapitulate, and re-irrigate and then gauge
with a 30/.02 hand file to assure we've met our preparation goals.
Well, it's important to recall that files shape canals, but irrigants clean root canal
systems, so in preparation for three-dimensional disinfection, we can use our favorite final
rinse solution in conjunction with the EndoActivator.
The EndoActivator serves to exchange solution into the un-instrumentable portions of the
root canal space.
Here I'm using a size verifier that must match the last ProTaper Next file that was carried
to length.
Mix the sealer of your choice, and insert it into the canals.
And now we can use a GuttaCore obturator and coming out of the oven there's sufficient
thermal plasticity with the material that allow it to easily slide to length.
Once this obturator has been carried to length, rock the handle gently back and forth to separate
the coronal aspect from the radicular part.
Flush out the tooth in preparation for provisionalization.
I hope you've enjoyed watching this endodontic procedure.
We've covered the steps that comprise start-to-finish endodontics, focusing on shaping canals.
To appreciate the post-operative result, let's review the pre-operative film.
Again, notice the bridge and the orientation of the underlying roots.
Appreciate the canals are long, narrow, and highly curved.
When we look at the post-op film, it reminds me of the old expression 'the thrill of the fill'.
Notice in this particular instance we've re-provisionalized the bridge, we have smooth-flowing shapes,
and we filled multiple lateral portals of exit.