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ProTaper Gold - Shaping the Future of Endodontics | Dentsply Sirona — Transcript

by Dentsply Sirona USA · 5,532 words · 849 segments · language en · Watch on YouTube

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0:02welcome to another one of my just in
0:04time indid donic educational episodes hi
0:08I'm Cliff rutle and I'm really happy to
0:10be with you today thank you for joining
0:12me so we can learn more about indid
0:14donics together my assignment today is
0:16to talk about Canal preparation
0:19specifically I'm going to focus on glide
0:21path management and shaping canals
0:24well-shaped canals promote
0:25three-dimensional cleaning and filling
0:27root canal systems speaking of Glide
0:30path management and shaping canals let's
0:33radiographically evaluate this maxillary
0:35second by cuspid for idic treatment from
0:38a restorative standpoint note the
0:40recurrent Decay and that the clinical
0:43Crown has been extensively
0:46prepared idic note the pulp chamber has
0:49receded below the crest of bone and that
0:52the root is dilacerated in its apical
0:551/3 experienced clinicians appreciate
0:57that canals are virtually always more
0:59curved than the roots that hold them I
1:02have found that inid performance
1:05improves dramatically when we use the
1:07strategy start with the end in
1:09mind this means try to visualize the
1:12post- treatment result on the
1:13pre-treatment
1:14film if we're going to carry out with
1:17this concept then we need a treatment
1:19plan a mechanical strategy and we should
1:23be utilizing the best and most proven
1:26instruments available in the marketplace
1:28today I know that might be subjective
1:31but let me just say this I have
1:33practiced for 40 years I have taught for
1:3637 years and I come before thousands and
1:38thousands of dentists like you on an
1:41annual basis I can tell you that what
1:43we'll talk about today will make a major
1:45difference in your clinical practice
1:48although I've described Canal
1:49preparation many times in many different
1:52ways over many many years based on the
1:55level of inic development in any given
1:57era today I will describe what I've
1:59believe to be the best and most proven
2:02way to repair canals using continuous
2:05rotation let's get started today's
2:08episode on Canal preparation will be
2:10conducted on this maxillary animated
2:13Muller the reason we're going to use an
2:15animated Muller is so we can be very
2:17clear and Visually see a lot of the work
2:19that's done inside the canal regarding
2:22Dental debris mud how the shaping
2:25progresses right on down to the final
2:28preparation when you look at the
2:29maxillary molar tooth it's nice to
2:31recall that it's the most frequently
2:34researched tooth in the mouth it's the
2:35largest tooth by volume but sadly or
2:39regrettably it's probably the most
2:40misunderstood tooth in the mouth and
2:42it's led to a lot of misunderstandings
2:43during indic
2:45treatment probably it's related to the
2:47anatomy of this tooth today's assignment
2:49is going to focus on the distal Buckle
2:52notice the distal Buckle root is
2:55deceptively simple if you look at the
2:57root itself but if you begin to Zone in
3:00on the system that moves down through
3:02that route you can see there's multipler
3:04curvature and the canal makes an Abrupt
3:07recurvature towards the distal and the
3:10portal of exit is actually on the distal
3:12aspect of the distal Buckle
3:14route of course when you look down on
3:17this tooth you're starting to be able to
3:20see where you're going to cut your
3:21outline pattern because access is
3:24everything and good IND theonics in fact
3:27the access pattern should include the
3:30orices the size of the AIS cavity isn't
3:33a school of thought it's not a personal
3:36philosophy the size of the axis cavity
3:38is dictated by the orices on the popo
3:41floor the walls then should diverge from
3:45the popo floor out to the accusal table
3:48it's important to finish the accesses
3:50and a good indicator for finished
3:52accesses is the axial walls are flared
3:55flattened and
3:57finished well now that you're into the
3:59two safe ly we're now to our assignment
4:01of canal preparation and of course it
4:03all starts with glide path management
4:06there's a lot of misunderstandings
4:08internationally what Glide path
4:10management really means what really is a
4:12Glide path so my multimedia team had a
4:15little fun and we took some examples
4:17outside of the world of dentistry and
4:20specifically outside of the world of
4:22indid donics to show you examples in
4:24everyday life of a Glide path here we
4:28go
4:30oh you might want to fasten your
4:37[Applause]
4:41seat there's a lot of
4:43Curves there are some Rec curvatures
4:47there's abrupt turns and all of this
4:50whether you're talking about roller
4:53coaster a lug flying down an ice track
4:57sliding towards the finish line or or
4:59whether you're on a water slide and
5:01you're following that track down to the
5:03pool below what all these examples have
5:06in common is there is a smooth
5:10reproducible Glide path to the Terminus
5:13now that you know what a Glide path is
5:15and a fun way that's something that can
5:18be considered when you look at these
5:20post- treatment films it's easy to look
5:22at these films and be somewhat excited
5:26and enthusiastic about root canal system
5:28Anatomy but what all these cases have in
5:31common is they were all accessed every
5:34one of the canals was negotiated a Glide
5:37path was confirmed and that Glide path
5:40then could be shaped and we all know
5:42that shaping facilitates cleaning and
5:44shaping facilitates filling root canal
5:47systems so the instruments traditionally
5:49used for Glide path management have been
5:51the iso 10 and 15 hand file notice these
5:54are fix tapered files and they're
5:56stainless
5:57steel always appre appreciate that the
6:0015 file is 50% bigger at its working tip
6:03than the 10 file so when you throw in
6:07that they stainless steel and fix
6:09tapered with a big percentage change
6:11between files the 15 files led to a lot
6:14of problems iatrogenically
6:16internationally blocks Ledges
6:19transportations and regrettable outcomes
6:22so many times around the world there's
6:25been emphasis on how can we improve
6:27light path management and perhaps
6:29consider eliminating the 15
6:31file Den by TSA Dental Specialties and
6:34den byly myair their solution to the
6:36problem was prider proglider is a
6:39revolutionary new instrument it's made
6:41of nickel titanium not stainless steel
6:44and more importantly it has MRE
6:47technology which reduces the potential
6:49for cyclic fatigue by
6:52400% if you look at the file carefully
6:54you'll notice it's not fixed tapered
6:56there's Progressive tapers and there are
6:58over eight changing tapers along the
7:01active portion of the
7:03file the file would spin then at 300
7:05RPMs and a torque could be anywhere from
7:08400 to 520 G CM based on the motor you
7:13have well now that we know a little bit
7:15about the file back to our 10 and our 15
7:18file you can begin to see the geometries
7:22the cross-sectional geometries of these
7:24various instruments every 4 mm up the
7:27active portion it's kind of fun to
7:30compare the pr glider with the white 15
7:34hand file notice that the pr glider is
7:37virtually the same in the front end but
7:40notice how different the cross-sectional
7:43geometries get as we move to d8 D12 and
7:46D16 what I'm saying is one PR glider can
7:50make a significantly bigger pathway than
7:53a single 15
7:55file so the new proposal for Cliff rutle
7:58and what I'm teaching is Glide path
8:00management just got a lot better because
8:03we can use the 10 file to catheterize
8:06and secure the canal then we can expand
8:09that slide path with one single
8:11proglider
8:13file so back to our distal Buckle route
8:17we've talked a little bit about what the
8:18Glide path is and what the tools are the
8:21next thing to talk about is do we take
8:23the files to length immediately or would
8:26it be wise to work perhaps 2/3 of the
8:29Canal get pre- enlargement done so we
8:32have improved access to the Canal's apal
8:361/3 in general in shorter canals wider
8:41canals and straighter canals we have
8:44permission to take our Smalls size hand
8:46file to length immediately but often
8:49times in longer more narrow and more
8:52curved canals it's wise to not try to
8:55negotiate the full length of the canal
8:57at one time
9:00you can see that many colleagues do in
9:02fact use a viscous key later like Glide
9:05prol luu or RC prep they tediously work
9:09the 10 file often times it won't go so
9:12they'll drop to an eight and
9:14triumphantly they'll even go to the 06
9:16to get the length and they feel quite
9:17good about this many times when we do
9:20this we need to appreciate a lot of
9:22things are happening Beyond you were
9:24able to negotiate the canal notice the
9:27rate of taper of the file is more or
9:29less the rate to taper the canal there's
9:31virtually no irrigant in this system
9:34further the file is going to generate
9:36debris and that debris frequently gets
9:38pushed into the lateral
9:40Anatomy finally these canals are being
9:44instrumented by stainless steel files
9:46and we have to wonder can we really
9:48precurve a file and pass it through a
9:51canal where there's Canyons of
9:52restrictive Denton so I think if you
9:55look at these two images side by side
9:57you can see the Breakthrough the
10:00Breakthrough which I described and
10:02started teaching more or less in the
10:04late '70s was to pre- enlarge a canal
10:07pre- enlarging a canal is similar to a
10:09restorative dentist reducing the
10:11occlusion reducing the tooth Buckle the
10:13lingual and placing the margins on a
10:16clinical Crown last notice with pre-
10:18enlargement the file is free in its
10:21upper 2/3 and when you feel handle
10:23pressure it's relating to the file
10:24engaging Denton towards his terminal
10:28extent
10:29there are many advantages to pre-
10:31enlargement and I've written extensively
10:32about this and you're welcome to go to
10:35my website or this textbook to learn
10:36more about it if we pre- enlarge a canal
10:39we have a lot more apical one-third
10:41control with our hand
10:43files the Iran in a pre- enlarged Canal
10:46is there in sufficient volume that it
10:49can penetrate circulate and begin clean
10:51into the uninstrumented portions of the
10:53root canal space clearly plenty of
10:56research has shown that a pre- enlarged
10:58canal decreases post-operative pain
11:00because there's less likelihood of
11:02pushing debris inadvertently
11:04periapically finally when we have a
11:06pre-large canal its APO 1/3 can usually
11:09accept a larger instrument this improves
11:12radiographic control this also enhances
11:15the accuracy and reliability of all Apex
11:18locators so what is the secret to pre-
11:21enlargement in a sequential Glide path
11:24we fill the chamber with a viscous key
11:26later there are three advantages of
11:28viscous key later
11:29a viscus keator gives us a superior
11:32lubricant it emulsifies tissue by
11:35preventing the reher of collagenous
11:38vital tissue and finally the debris
11:40that's being generated is more
11:41effectively held in
11:43suspension so viscus keyers are examples
11:46would be prolube Glide or RC prep
11:50anytime rutles going into any part of a
11:52canal where I've never been before I
11:55need forgiveness and I need the viscous
11:57key later the 10 file now can be used to
12:00explore and discover and to negotiate a
12:04portion of the canal even in longer
12:06narrower and more curv canals we can
12:08usually carry a 10 file about 2/3 of the
12:11overall expected working length of that
12:14Canal once we have the 10 file up about
12:172third of the way let's move the file in
12:20and out in little short amplitude
12:22Strokes to verify that we have a Glide
12:24path in preparation for mechanical Canal
12:27preparation
12:30any part of the canal that is secured
12:32and I repeat any part of the canal that
12:34is deemed secure clinically can be
12:37shaped shaping is always done in a bath
12:39of full strength sodium
12:41hypochloride one single shaping files
12:44will shortly see can pre- enlarge remove
12:47coronal interferences remove triangles
12:50of Denton and expand the shape almost
12:52optimally in the upper 2/3 with the
12:55upper 2/3 optimally shaped we're free to
12:58go back to our viscous key later because
13:00again we're going to place a file into
13:02that part of the canal we've never been
13:04before so the viscous key later will
13:06give us lubrication
13:08emulsification and it'll keep the debris
13:11in suspension it is at this time when
13:14your rubber stop reaches your selected
13:16reference point you can be thinking
13:18about working length either using
13:21conventional films digital radiography
13:23or Apex
13:24locators certainly when we have a known
13:27working length we want to firm patency
13:29remember the canal was patent before
13:31rutle went into it and then of course if
13:33we're going to use mechanical
13:35instruments which is the whole concept
13:37here in modern indic we need to have a
13:39sliding path that can accept the 10 file
13:42in a smooth and reproducible way once we
13:45have a smooth reproducible Glide path to
13:48the Terminus we can shape a little
13:50region of 345 mm and blend the Deep
13:53shape up into the body of the previously
13:56prepared Canal we'll talk in a little
13:58bit bit about apical diameter and the
14:01apical taper I'll only say this at this
14:04point protaper is perhaps one of the
14:07only files in the world in full rotation
14:10that gives you the Seven 8 and 9% deep
14:13shapes that allow irrigant to actually
14:16circulate into the uninstrumented
14:17portions of the root canal
14:21space well we're in the tooth you know
14:25what a Glide path is we've talked about
14:26the armamentarium and we've even talked
14:28about the sequential Glide path we can
14:31dispense your favorite viscous key lator
14:34I use
14:35prolube and go ahead and fill the pulp
14:37chamber up virtually
14:39full now you can use a tin file and a
14:43precurved tin file can be inserted and
14:45it will carry viscous key layer by
14:47surface tension on The Cutting
14:50flutes the instrument is introduced into
14:54the canal and in this case the entry
14:56angle into the pulp chamber is quite
14:58abrupt
14:59so a little gentle back and forth
15:01reciprocation on the handle will pull
15:03the file down into the canal when we
15:05reciprocate the handle it feeds the file
15:08progressively deeper into the canal when
15:10the handle is snug pull each feeded in
15:13pole is a cutting cycle and after every
15:16few cutting Cycles move the instrument
15:20up and down vertically in little short 1
15:22mm amplitude
15:25Strokes what this serves to do is carry
15:28more viscous key later into the
15:30canal further it keeps debris more
15:33effectively in
15:34suspension and each little back and
15:37forth stroke serves to refine smooth and
15:40expand the Glide path continue
15:42reciprocating the handle that'll gently
15:45draw the file progressively deeper into
15:47the canal and what I want to really
15:50point out is we really don't want to
15:52over manipulate the handle just little
15:55gentle back and forth motions when the
15:58handle is snug pole and that's another
16:00cutting
16:02cycle when you're about 2/3 the way up
16:04the route what we can notice is that we
16:07could go to an 08 we could go to an ' 06
16:10but that's not the objective in a
16:12sequential Glide path
16:15strategy now move the file in little
16:17short amplitude strokes and begin to
16:20check to see if you in fact have a
16:23smooth reproducible Glide path in this
16:25region of the canal if you can confirm
16:29that the canal is deemed secured and
16:31this is an opening for rotary
16:34instrumentation irrigate with sodium
16:37hypochloride remove all your viscous key
16:39later never spin a file at 300 RPMs in a
16:43canal loaded with viscous key later the
16:45pr glider is allowed to float follow and
16:49run into the canal literally two 3 4
16:53seconds you will reach the level where
16:54the tin file was and you've expanded the
16:57shape considerably at this moment of
17:00treatment notice however there's still
17:03an awkward triangle of Denton notice the
17:06canal is still badly underprepared but
17:09we have a Glide path that's what we're
17:11talking about having a slide path to
17:14accommodate passively and safely
17:16mechanical shaping files now that we
17:19have got a Glide path let's digress for
17:22a moment and talk about the files that
17:25we'll use for shaping this
17:27canal
17:29I'm going to show you the protaper
17:31system protaper came to Market in 2001
17:34and at this moment it is the most
17:36utilized system in the world so this is
17:39what rle is using because it has the
17:41most success of any file ever
17:44made there are three shaping files and
17:47you can see that there are three
17:48finishing files and appreciate that
17:50there's actually an F4 and an F5 but
17:53we're showing you today what is
17:54typically generally most
17:57utilized notice specifically the last
18:00line variable
18:02tapers this is the first system in the
18:05world to introduce Progressive tapers
18:07over the active portion of a single file
18:10protaper runs at 300 RPMs in 520 G cimet
18:14I want to point this out because there's
18:17a lot of disagreement on this but if you
18:20look at the peer review journals there
18:22are plenty of scientific articles that
18:24show that progressively tapered files
18:27should be run at high torque it is
18:30dangerous to change the torque from one
18:33protaper instrument to the next in fact
18:35if you want to increase your breakage
18:37change your torque so maximum torque for
18:40all protaper files ensures maximum
18:44safety let's look at the Shapers the
18:47Shapers have a convex triangular
18:49cross-section and there's three of them
18:51but notice one is quite short the file
18:54on the left shaper X is only 19 mm long
18:57and it's the the industry leader for
19:00pre- enlarging canals it can't possibly
19:03reach the apal Fran of most canals so
19:06that's why we have two other Shapers
19:09that are used to reach length and that's
19:11the purple and the
19:14white let's look at SX to appreciate a
19:18little bit
19:19more shaper X or the auxiliary file is
19:2319 mm in its overall length if you
19:27divide the file into thirds you will
19:29notice that the middle 1/3 of the file
19:32is actually the part of the file that's
19:34designed to cut the apal 13 of this
19:37instrument is not designed to engage and
19:40do heavy work simply it is the steering
19:44wheel on the nickel titanium file that
19:47guides the instrument through curvatures
19:50so we don't want to cut in the apal 1/3
19:52we want to look at our file clinically
19:55as we use it to make sure debris is
19:57piling up in the middle 1/3 and we
19:59rarely go more than about 2/3 down any
20:03given
20:05Canal for tus Le for you oldtime Gates
20:08gliden lovers we have four ggs a gg1
20:12two3 4 at d67 8 9 and you can read those
20:16cross-sectional geometries so we have a
20:19way to rapidly pre- enlarge canals using
20:22shaper
20:24X well let's quickly look at the
20:27finishers
20:29the finishers there's five instruments
20:31total but three that are most frequently
20:33used and again as you would imagine the
20:36color identification on the band yellow
20:38red and blue corresponds to a tip of 20
20:4125 and 30 the tapers are 7 8 and 9%
20:46respectively But please understand the
20:49tapers of 7 8 and 9% are limited to the
20:53apical 1/3 of the file and behind this
20:56fix taper we have progressively
20:59decreasing percentage tapers over the
21:01rest of the active
21:04portion I want to come back to this one
21:07more time to make a sledgehammer
21:10point the first system in the world to
21:12do this and virtually the only system
21:14today that still does this is protaper
21:18notice the Shapers by Design work in the
21:21body of the canal the Shapers have
21:24progressively increasing percentage
21:27tapers whereas on the Right image the
21:29finishers have decreasing percentage
21:32tapers over their back end this is
21:35another explanation why you need high
21:37torque the Shapers are working away from
21:39their delicate tips they're working
21:41towards their stronger bigger and more
21:43efficient blades on the other hand the
21:46finishers at 7 8 and 9% tapers you need
21:50a big torque to turn that
21:51cross-sectional Mass so you can carve
21:53out the shape in the apal
21:551/3 now for the point if you want to
21:59increase the Terminus of the canal if
22:01you want to expand your deep shape this
22:04is the only file system in the world
22:06that will allow you to alter your deep
22:08shape and not continue to needlessly
22:12prepare the coronal 2third of the
22:15canal well I'm pretty proud of this me
22:18and my development team we started
22:20working on protaper universal back in
22:231995 the file was launched in 2001 so
22:26more than 12 years ago we were aware we
22:29were acutely aware of the concept of
22:32minimally invasive inod
22:34donics for years this has been the only
22:37file that really respects minimally
22:39invasive IND theonics and if you really
22:40want to see the take-home message if you
22:43look at any
22:45258 progressively tapered File versus
22:48any 258 fix tapered file please bring
22:52your attention to the cross-sectional
22:54comparisons along the active portion but
22:57if you look at 77 versus 89 that's
23:00massive that's right in the middle of
23:01the file 93 to
23:04121 I don't know but this is when we
23:06start to over prepare roots coronally
23:08and we worry about strip perfs compare
23:11105 to
23:13153 you can begin to see that protaper
23:16with its Progressive tapers brings
23:18something to the party called minimally
23:21invasive IND theonics
23:22well protaper just got a lot better in
23:272014
23:29Metallurgy kicked in and through Heating
23:31and Cooling Cycles Engineers could find
23:34the optimal phase transition between
23:37Marite and austinite and what this means
23:40is we have gotten an instrument now that
23:43is unbelievably flexible and the greater
23:47resistance to cyc fatigue is over two
23:50times the existing protaper regular
23:53night Tha version flexibility is what
23:56allows instruments to feel feed through
23:58the Glide path flexibility is what's
24:01necessary to do multipler curvature and
24:04of course when instruments are spinning
24:06around curves we definitely want to
24:09improve the resistance to cyclic fatigue
24:12protaper gold does precisely
24:15this so back to the tooth that we've
24:18been working on where we had the Glide
24:20path with a chamber full of sodium
24:22hypochloride let's go in with SX the
24:25take-home message is shape X is a big
24:29brush I want you to plant that
24:31instrument on the outer wall away from
24:33fkal danger and brush out on the
24:36outstroke and in one or two passes you
24:39can pre- enlarge virtually any Canal
24:41this is done very very quickly it's done
24:44safely because we had a Glide path well
24:47after you take out an instrument that
24:49has 19% taper and has four Gates gliden
24:54equivalents at d67 8 9 you can imagine
24:57there's signic ific debris inside the
24:59pulp chamber and the canal itself so go
25:02ahead and irrigate after every rotary
25:04file in fact indid donic religion is
25:08after you remove any given rotary file
25:11always
25:12irrigate recapitulate with a tin file
25:15and re argate the tin file breaks up
25:18debris and moves it into suspension so
25:21it can more effectively
25:23be liberated from the canal
25:26space learn learn to do that to keep
25:28your lateral Anatomy open during the
25:31shaping
25:32exercise well we've never been in the
25:34APO third and with an upper 2/3
25:37optimally prepared let's aspirate out
25:39the sodium hypochloride and let's return
25:42by topping off the pulp chamber with a
25:44viscous key
25:47later remember the viscous key later
25:50will be picked up on the file flutes and
25:52drag down into the critical Zone
25:54reciprocate the handle in very short and
25:57angles back and forth that draws the
25:59file in when you see the rubber stop
26:02about one or two stops off your
26:04reference point no more
26:07reciprocation simply slide I want you to
26:10be thinking it's baseball and slide in
26:15to
26:16length by sliding a precurve file to
26:19length we have less likelihood of
26:21ripping and tearing the framan shielder
26:24called this Transportation or iatri
26:27rically relocating the framan on the
26:30external root surface this would be a
26:32perfect time to get a working length
26:34film or use your Apex locator remember a
26:37pre- enlarged Canal often times can
26:39accept a 15 file for working
26:43length well with a known working length
26:46let's confirm patency the canal was
26:48patent before you started so let's
26:50confirm it's still patent patency
26:53doesn't mean Slide the instrument to and
26:56minutely through the framan a couple
26:58times patency means sliding the file
27:01through the framin repeatedly and
27:03deliberately until the file is loose now
27:06let's check the Glide path to verify the
27:08Glide path pull the file progressively
27:10out of the canal in ever increasing
27:13amplitudes and if the instrument can
27:15slip and slide and slide and glide over
27:18the apal 1/3 not only do you have a
27:20Glide path you own the Glide path and in
27:24this instance the Glide path can be
27:26expanded with ProGlide
27:28we'll want to irrigate kick out the
27:30viscous key layer top off with sodium
27:32hypochloride and let PR glider run let
27:35it advance and progress towards length
27:37if it bogs down a little bit lift the
27:39file up this will allow the debris to
27:42augur back up the blades of the
27:43instrument freeze up the file so it can
27:45engage cut and move towards length so in
27:48one or more passes you can generally
27:49carry your PR glider to the full working
27:53length at this point we have a smooth
27:57and reproducible Glide path that is
27:59ready for mechanical shaping procedures
28:02this probably is the best Glide path we
28:05could ever cut on planet Earth because
28:08not only is it smooth and reproducible
28:11but it's considerably bigger than a 15
28:14file or any other company's
28:17multifile dedicated Glide path sequence
28:24files look at this Anatomy isn't this
28:27fun well let's get back to our shaping
28:29files and obviously the first one in the
28:31series is the purple
28:34stripe shaper one has never been to
28:36length shaper one is used like a brush I
28:39can't overemphasize brushing I say
28:42brushing around the world and you all
28:44nod your heads and say yes yes but
28:46brushing is deliberate it's intentional
28:49and it's purposeful and it's done on the
28:52outer wall on the out stroke brushing
28:54makes lateral space and allows the
28:57bigger Eiffel Towers on S2 to reach
29:00length the shaper one and the shaper 2
29:03now have projected and carried a shaping
29:05wave ever deeper into the curvature
29:09we're now ready to talk about finishing
29:11the APLE
29:131/3 that brings us to the regressively
29:17tapered finishing
29:19files again in a fresh bath of reagent
29:23preferably 6% sodium hypochlorite the
29:26finished is allowed to run towards
29:28length notice the finishing file is not
29:31continuing to cut Denton in the body
29:34because of gowi Technology perfectly
29:37snakes around that apical curvature and
29:39arrives at length notice the shape is
29:42now expanded and is beautifully blending
29:45in to the body of the
29:48preparation astute clinicians learn to
29:50look at these instruments when they pull
29:52them out of the canal learn to look to
29:54see where the debris is on the flutes of
29:57the instrument when the apical flutes of
30:00Any Given finishing file are completely
30:02loaded the shape is done when the F1
30:06came out there was only some spotty
30:09Dental mud noted on the flutes so this
30:11would encourage the clinician to go a
30:13size bigger that would be the red
30:17258 appreciate the 2508 is just an 8%
30:21taper in its apal 3 mm dead soft metal
30:26rapidly negotiates the curve in a very
30:29safe way and now you have a blended
30:32shape from the framing to the orifice
30:35again look at that apal part of that
30:37instrument appreciate if it's totally
30:40loaded if the blades are loaded the
30:42shape is
30:44done well-shaped canals can be
30:47three-dimensionally cleaned and root
30:49canal systems that are clean can be
30:51filled in all their
30:54dimensions a well-shaped canal is easy
30:57to fit a cone
30:59into a medium non-standardized gutaper
31:02Master cone will easily slide to
31:05length you could also use a size
31:08verifier if you were using a gutor
31:10alteration method either a vertical
31:13condensation method or a gut core
31:15alteration method is the method of
31:18choice if we want to fill root canal
31:26systems it's interesting to rotate the
31:28shape around and see it in a way and
31:31animation that we never get to
31:33appreciate
31:34clinically I know that some of you have
31:36cbct and you can get more of a
31:38three-dimensional appreciation but I've
31:41learned so much over the years from
31:43working with my multimedia team to see
31:45how these shapes really look on real
31:47teeth with real root canal systems with
31:50real
31:50instruments the evidence is beginning to
31:53show up and what I'm happy to report is
31:56protaper gold has been on the market for
31:58just 3 months and already we're
32:00collecting cases from a wide array of
32:03doctors from around the
32:05world Michael nimit is a personal friend
32:07of mine but if we look at the meal
32:09systems notice that dog leg on the MB
32:12that's very very impressive and then
32:16there's two systems in the distal route
32:17and you can see very deep those systems
32:20actually
32:21divide and have two portals of exit it's
32:25important to have the right technology
32:26when we're treating difficult root canal
32:29system
32:30Anatomy I was really pleased when I
32:33received this radiographic image from my
32:35friend Scott Doyle I've known Scott for
32:38many years he's an IND theonest he used
32:39to be in the Air Force and he taught Air
32:41Force residents well when you look at
32:44this image his enthusiasm was he used
32:47protaper gold notice how difficult the
32:50anatomy is in the mesial system and
32:54please especially note the last two
32:56minutes mm is an Abrupt 90° curvature
32:59distally the distal system is a
33:02beautiful example of the importance of
33:04shaping when we shape canals well we can
33:08have a sufficient reservoir of arrogant
33:10that upon activation can be moved into
33:12the uninstrumented portions of the root
33:14canal space Scott was able to move his
33:17irrigant and clean out Anatomy that was
33:20actually uninstrumented because it's off
33:22of a deep division within the distal
33:25rout and of course we can look at Tom
33:28mcclammy and IND theonis from Scottsdale
33:30Tom has been a dear friend for years
33:33he's now opening up a brand new teaching
33:35Center and I'm sure many of you will
33:36benefit in the years ahead from being
33:38educated from Tom but look at again at
33:41what protaper gold can do in tough
33:46Anatomy well most of you have heard of
33:48John West a co-inventor along with
33:51Pierre msh 2 in the protaper world but
33:55his son was able to use Raper gold on
33:57this maxillary first Moler what's was
34:00impressive in this case beyond the
34:02curvature begin to think and appreciate
34:04the diameter of an F2 about 6 mm back
34:07from its Terminus that would be a fairly
34:10significant cross-section and that
34:12crosssection can spin at 300 RPMs and
34:15still prepare the shape and not separate
34:17through cyclic fatigue protaper gold has
34:20definitely set a new standard for
34:22shaping
34:23canals protaper Universal has been the
34:26number one selling file for many many
34:28years it's the most used system by IND
34:31theonest it's taught in over 950 dental
34:35schools to undergraduate students you
34:37can begin to see how this Legacy has
34:40moved over the last decade protaper gold
34:43as you know then got Advanced Metallurgy
34:45this greatly improved flexibility
34:47because in our larger previous version
34:50of finishers they were getting a little
34:52bit stiff in the F2 and F3 sizes so now
34:56we can snake f2s and f3s where we used
34:59to snake S1 and S2 to reach
35:03length Tulsa Dental certainly has
35:06developed a wonderful technique card
35:08that my multimedia team helped them with
35:11and I think if you look at the upper
35:12right area you can see that one side of
35:14the card perfectly explains Glide path
35:17management as we explained in this
35:20episode if you flip the card over
35:23there's a emphasis now on shaping canals
35:27with rotary files and you can see the
35:29sequence just as we've described today
35:31in the time allotted and of course
35:34there's articles and support material
35:36here's a couple articles that you can
35:38read you can go to my website they're
35:40downloadable PDF files for free and
35:43they'll go into it in more detail than
35:45certainly a webinar can
35:48do much of the world of indid donics has
35:50changed in recent years ironically much
35:53has stayed the same but this much is
35:55true there is an ongoing Relentless
35:57parade of new files that come to market
35:59for shaping canals the vast majority of
36:02these file systems simply instrument
36:05canals but and this is most important
36:08the canals prepared are neither shaped
36:10nor cleaned many of the remaining file
36:13systems simply copy and low price the
36:17most popular utilized systems
36:20internationally however very few systems
36:23bring R&D follow strict protocol for
36:28validation and then bring genuine
36:30Innovation protaper gold does exactly
36:33this protaper gold provides unsurpassed
36:36clinical safety efficiency with an
36:38economy of instruments at an affordable
36:40price I trust this just in time episode
36:43has arrived just in time before your
36:46next endodontic
36:52patient

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