So as the Vortex Blue™ technique is taught from the Directions for Use,
um, this is, they usually start, they, we like to discriminate between small and large canals.
On small canals we will start with a 30/.04. On a large canal we'll start with a 40/.04.
You always take the file to resistance or working length, whichever occurs first.
I can tell you in my practice, resistance occurs first on the
vast majority of the cases that I treat.
And basically what I try to do is put
light apical pressure on these files and
it's almost basically, almost just the
weight of the handpiece and contra-angle.
I do not push on these files. When we,
we all have a tendency, when we hit
resistance, to push the file and that's
when you get into trouble. That's exactly
the opposite of what you want to do.
If you feel resistance and if you feel that
the file is not progressing the half to
a millimeter at a time, remove the file,
clean the flutes and re-enter the canal
or go to a smaller instrument.
So if you enter resistant, go to the next smallest instrument.
We're always recapitulating
with a number ten or fifteen hand file
to maintain the glide path and to
obviously, to maintain apical patency.
With any rotary filing technique,
it’s always… starts with the, uh,
a well-machined, well-instrumented glide path.
And I like to always make sure that
that glide path starts, um, with a 15 or a 20,
and I prefer actually a 20 diameter.
So the glide path is always established with
hand files or other techniques before a
rotary file is introduced.
This video will show the flexibility of the Vortex Blue file
And for demonstration purposes,
we're doing this with our gloved hands
obviously clinically we would not do it
with a gloved hand but with a sterile
forceps. But you can see the reduced
shape memory. It does not come out of the
box straight, there's a little curvature
on it and as you place the curve some of
the curve remains.
We take advantage of this reduced shape
memory by actually being able to pre- curve,
pre-curve these instruments which
is amazing advantage for us in
maxillary and posterior, maxillary and
mandibular posterior molars.
Um, you can notice the blue color. This is fantastic
where you can see the debris as it
contrasts against the blue color of the
file. You don't normally see this in
other rotary files but this is fantastic.
If you see, this you need to remove this debris.
Take that sterile two-by-two with
alcohol or chlorhexidine.
Just a couple of slides we're showing
you here that accurately and graphically
display to you the flexibility of a
Vortex Blue files. The proper way to pre-curve any instrument,
whether it be Vortex Blue or a hand file, is with sterile
cotton forceps that you see in the upper
right-hand portion. You put a gentle
curve on the instrument that you see in
the bottom left and on the bottom right
again it's displayed again. These files
are extremely flexible. I think that's a
tremendous advantage for all of us to be
able to pre-curve these files. It shows
you the flexibility of the file and in
the constricted canal space how it can
adapt to the curvature, so again this is
one of the characteristics of this file
that really has attracted me to it and
and I apply it every day in my practice
on on every case that I treat.
Okay, so let's talk about the Vortex Blue
variable tip, variable taper sequence.
This is a very interesting and very
easy way to use these Vortex files.
Obviously, first of all, we're always
going to establish a glide path and I
like to do it to a size number 20. I like
to either use hand files or the new
path files to establish this
reproducible pathway between the orifice
and working length with size number 20.
Once I've done that, I will start with a
35/.06 Vortex Blue instrument to
resistance and I may make one, two,
sometimes three passes. Then a 30/.04 to resistance.
Then a 25/.06, and now I’m probably approaching working length.
In many of the cases that I treat,
I would say probably 75% of the time,
I’m at 25/.06, I’m at my working length at that file size.
Very calcified, constricted cases,
I may have to go to a 20/.04, a 25/.04,
or even a 20/.04 or 15/.04.
Okay, but this is basically the variable tip, variable taper sequence.
I’m varying the apical tip diameter and the taper
as I progress down the canal space.
Starting with a 35/.06, ending with a 25/.04.
So if I get a 25/.06 to the working
length, what I usually will do then, just
go back to reciprocate, and go back to
the 30/.04 instrument
Again, just for my own personal use, this for my own,
in my own eyes, I like to finish my cases
with an .04 taper at the apical one
third level. So again, if I stop at a 25/.06,
if that gets to working length, I will
then revert back to the 30/.04 and maybe
even the 35/.04.
Okay, on distal, on single distal roots of lower first molars
palatal roots, a lot of the time I'll
be able to get to 35/.06 to working length,
and if that's the case then I'll
sequentially file up with a 40/.04,
a 45/.04, or 50/.04 to the proper apical
dimension I want to establish.
If I feel that 35/.06 is that dimension, I'll stop.
So again, with this variable tip, variable
taper sequence, one of the advantages is
is again I'm using less number of
instruments, less number of files, which
is what we all would like to see.
And we'll go through the variable tip,
variable taper sequence starting with a 35/.06.
We're going to resistance - very
light apical pressure. One thing about
videos is sometimes it will
give you the wrong impression, that we're
putting pressure on the handpiece just
from the aspect of videotaping through
the microscope, but actually this is a
very light touch; so it's a very light
touch. Again, just the weight of the
contra-angle and the handpiece. Here I am at
the 25/.06 to working length.
Um, now i'm going to pre-curve the Vortex Blue file.
You can see the pre-curve for easier
access. Just another demonstration. The
file is not rotating yet. Now I start it.
Okay and now this is the 25/.04 in the
mesial buccal.
I may have to sometimes go
back and forth between the 25/.06 and
the 25/.04, make a second pass in order to
achieve my working length, 'kay. Cases I get,
extremely challenging, very difficult.
The ones that most general dentists don't
want to, don't want to deal with and
this is what I, this is what I have to do.
I have to be patient, once I reach the
25/.04 taper, I now progress up to the
30/.04, 'kay, so now the mesial buccal
canals instrumented to length with a
30/.04 Vortex Blue instrument. You can see
I make a couple passes to that working
length. So once again, be patient with the
files. Do not put a lot of pressure on it.
A very, very slight apical pressure,
recapitulate between the file system,
between the variable tips and the
variable tapers, and I think this will
really give you a successful instrument
result if you follow the principles of
the instrumentation. Take your time.
Take your time. Don't be in a hurry. Do not use
excessive force. Make sure the flutes of
the files are cleaned once they are
removed from the canal space. Do not
instrument the canal space if the flutes
are built up with debris.