#30 with Four Canals
“Only the 0.13 and the 0.16 PathFiles were used to obtain the proper glide path for the ProTaper Gold files…”
Larry Farsakian, DDS
Highland Park, IL
Chief complaint: The patient presented with complaints of sensitivity to cold and chewing following placement of a new composite restoration two months prior.
Exam: Tooth #30 exhibited an increased response from percussion, biting and cold. The tissue was healthy and stable without pocketing. Radiographically, the tooth exhibited some sclerosis within the pulp chamber.
Diagnosis: Subacute pulpitis with subacute apical periodontitis.
Treatment recommendation: Root canal therapy on tooth #30.
Treatment: Anesthetic was administered: 1.8 cc 2% Lidocaine with 1:100,00 epinephrine for inferior alveolar nerve block and 1.0 cc 4% articaine with 1:100,000 epinephrine for buccal infiltration. A rubber dam was then applied to isolate the tooth. Occlusal access was made. Once the chamber was entered, a Pulp Shaper Bur was used to obtain proper visualization and straight line access to all canals.
Glyde File Prep was placed in the chamber and all canals were scouted with #8 and #10 Lexicon K-Files. An apex locator was utilized to obtain proper working lengths. Working lengths were 23 mm for the MB and ML canals and 22 mm for the DB and DL canals.
Once working length was obtained, a size 0.13 PathFile rotary file was taken to each apex followed by a size 0.16 PathFile. When using the PathFiles, a combination of Glyde file prep and sodium hypochlorite (8.25%) was used to clean the canal space.
“PathFiles were used initially because the canals were narrow and tight when the #10 Lexicon K-File was scouting the canal. In this particular sequence, only the 0.13 PathFile and the 0.16 PathFiles were used to obtain the proper glide path for the ProTaper Gold files. Given that the tip of the ProTaper Gold S1 is a size 0.18, the third PathFile (tip size 0.19) was not necessary to accomplish the sequential preparation of the apical canal,” Farsakian said.
After establishing a glide path, ProTaper Gold rotary files were used to obtain proper canal shape in all canals in the following sequence with the use of sodium hypochlorite (8.25%):
ProTaper Gold S1 was taken to the apex and used in a brushing motion.
ProTaper Gold S2 was taken to the apex and used in a brushing motion.
ProTaper Gold F1 was taken to the apex and removed.
ProTaper Gold F2 was taken to the apex and removed.
ProTaper Gold F3 was taken to the apex of the distal canals only.
After shaping was completed, EDTA (17%) was placed in each canal and agitated for 30 seconds with an EndoActivator. Sodium hypochlorite (8.25%) was then placed in each canal and was also agitated for 30 seconds with the EndoActivator.
“Use of the EndoActivator creates a type of cavitation and acoustic streaming, which promotes the deep cleaning and disinfection of canals, lateral canals, fins, webs, and anastomoses. Activation of each of the irrigation solutions for 30 seconds improves debridement and disrupts the smear layer and biofilm aiding in their removal,” he said.
Following agitation, it was then allowed to sit in each canal for approximately 10 minutes. The canals were then dried and irrigated with saline. As a final rinse, QMix 2in1 irrigating solution was placed into each canal and agitated for 30 seconds with the EndoActivator. The canals were then dried again.
Prior to obturation, the canals were gauged with the proper GuttaCore size verifiers. A passive fit was verified by rotating the size verifier within the canal 180 degrees.
MB: F2 (25/.08v) @ 22.5 mm
ML: F2 (25/.08v) @ 22.5 mm
DB: F3 (30/.09v) @ 21.5 mm
DL: F3 (30/.09v) @21.5mm
To prepare for obturation, Thermaseal Plus sealer was placed into each canal. The canals were then filled with GuttaCore obturators: size 25 for the MB and ML canals and size 30 for the DB and DL canals. The GuttaCore handles were removed with a spoon excavator at the level of the orifice. The chamber was then refined and excess gutta-percha was removed with the Pulp Shaper Bur. Finally, the chamber was cleaned with chloroform, a cotton pellet was placed and the access was sealed with a temporary filling material.
“Only the 0.13 PathFile and the 0.16 PathFiles were used to obtain the proper glide path for the ProTaper Gold files. Given that the tip of the ProTaper Gold S1 is a size 0.18, the third PathFile (tip size 0.19) was not necessary to accomplish the sequential preparation of the apical canal.”
Dr. Larry Farsakian received his undergraduate degree from California State University, Fresno in 1978 and his dental degree from Loyola University School of Dentistry in Chicago in 1984. He was a dental resident in the General Practice Highland Park Residency Program at Loyola University’s Foster McGaw Hospital from 1984-85. He practiced general dentistry in his hometown of Visalia, California, from 1985-88.
He received a Certificate in Endodontics in 1990 from Loyola University School of Dentistry in Chicago. He served as a part-time clinical instructor at Loyola University from 1988-93. He has been practicing as an Endodontist since 1990 and presently is in private practice in Highland Park, Illinois.
He has been lecturing on endodontics and rotary instrumentation for DENTSPLY Tulsa Dental Specialties since 1999. He also has presented lectures at the Chicago Midwinter Dental Meeting and for local study groups and dental societies.