For root canal treatment to successfully and predictably treat apical periodontitis, an accurate diagnosis is needed, and each stage of treatment must be completed to a high standard. As such, it’s important that clinicians think carefully about the equipment, techniques, and instruments they choose to use throughout the process, and the ways in which they may impact treatment.
Technological developments to support predictability
Reproducibility is key in every aspect of dentistry, including endodontics. Each stage of diagnosis, treatment, and review will be more successful if it is predictable and accurate. As such, clinicians should consider the ways in which new technology could assist in producing more accurate diagnostic results, and more predictable treatment processes.
CBCT scans, for example, are a fantastic way for clinicians to produce more accurate diagnostic images. The 3D visualisation capabilities of CBCT imaging are superior when compared to traditional radiographs. They provide detailed 3D images and enable reorientation for improved accuracy. Digital-guided endodontic therapy is another exciting advancement. Static-guided endodontics (SGE) involves creating a detailed template, whereas dynamic-guided endodontics (DGE) uses a tracking system. CBCT scans are taken and used to create a 3D printed guide for SGE, and a real-time navigation system is used to devise a drilling path in DGE. Research suggests that digital guided therapy is an effective treatment method, including in challenging cases, demonstrating precision and time saving benefits, in addition to being a minimally invasive solution.
Benefits of a glide path
In order to maintain control of the root canal during treatment, there are a number of factors that must be considered during and prior to the procedure. This should include a comprehensive assessment of the tooth – establishing the number of canals, in addition to their location, length, curvatures, the presence of any calcifications, anomalous anatomy, and any potential difficulties with access. During treatment, excellent illumination and magnification should be achieved, as well as adequate and well-planned access, and good irrigation and preparation techniques.
The creation of a glide path is also considered essential for a successful root canal treatment. As NiTi files are flexible, they are sometimes unable to negotiate the initial opening of the root canal adequately. As such, coronal enlargement of the canal should first be performed. Once the root canal has been opened, a glide path should be created, allowing the rotary files to pass through the canal, reducing torsional stress and the risk of fracture or file separation. The glide path can be narrow, but should be a tunnel from the orifice of the canal to the radiographic terminus, allowing the following files to follow the path uninterrupted, for a simpler preparation. By effectively refining the anatomy of the root canal in this way, the subsequent files can advance safely. Additionally, the creation of a glide path increases the life span of instruments and reduces the risk of errors in the rest of the procedure, as the clinicians have a more detailed guide of the root canal.
Choice of equipment
Predictability is essential when providing endodontic treatment. The diagnostic and treatment planning stages should contribute heavily, ensuring the clinician has all the information they need to provide accurate treatment. Equally, the equipment and techniques chosen should help to ensure reliability during treatment.
Clinicians should, therefore, carefully consider the file types they use for their treatments. File separation and fracture are real concerns, which can have huge effects on the treatment outcome and impact the patient’s experience of treatment. As such, choosing reliable files that have high cutting performance and offer fracture resistance and flexibility for safer treatment enables clinicians to offer the best possible treatment outcomes.
The HyFlex EDM OGSF file sequence includes a new Orifice Opener and Glidepath file for opening the glide path, as well as a Shaping file for shaping the root canal over the full length and a Finisher file. The file sizes and tapers are optimised to provide a smooth feeling when changing from one file to another – for better control during treatment. The sequence of files is also pre-programmed in the new CanalPro X-Move and the top-of-the-range CanalPro Jeni endomotor, further enhancing predictability. CanalPro Jeni is able to control the variable file movements, producing a response in milliseconds, adapting to the root canal anatomy in real-time, for a safe option.
In order to provide your patients with the high-quality, reliable endodontic treatment they need, ensure you’re using the techniques, instruments, and equipment which enable predictable workflows. By doing so, root canal treatments will go smoothly, with improved accuracy, and patients will be able to enjoy the results of a successful outcome. In particular, ensure you’re using high-quality endodontic files in an appropriate sequence which facilitates safe and effective root canal preparation.