Outside the Box Thinking Needed for Endodontic Patients
SAN ANTONIO ? It is generally accepted that there are 3 keys to endodontic success - debridement, sterilization, and obturation ? but even after a thorough cleaning, and a reasonably well-filled area, clinicians still manage to have occasional failures. Unfortunately, this is often a consequence of the anatomy of the root canal system, according to a speaker here at the 'Updates in Contemporary Dentistry' meeting.
Ron Kaminer, DDS, told the audience of about 200 attendees that even when clinicians perform all the key steps thoroughly, there are still going to be misses. ?You think you?ve created a nice taper in the canal, from the opening to the apex, which is free of debris, but you can still have failures in the mesial and secondary canals,? Dr. Kaminer said. ?What I have found is that going back in there to find it will often lead to success.? The way to go back in, Dr. Kaminer said, starts with irrigation and better instrumentation.
Different Shapes, Sizes
Dr. Kaminer noted that with the exception of most maxillary incisors, most teeth have canals with elliptical or cross sections, which often appear in different shapes, ?yet, we?re using the same shape instruments, over and over again.? He noted that Medidenta has a sonic handpiece that produces sonic energy, which assists in debriding the upper third of the root canal system. He noted specifically that the Revo line, with its 3 rotary files, addresses the many different types of elliptical spaces. He cited data from Peters et al, in the Journal of Endodontics (2001, 27:1), which demonstrated that 35% to 50% of the root canal system remains untouched when clincians only use rotary files.
Another important component of endodontics is proper anesthesia, Dr. Kaminer noted. He specifically discussed articaine, which he notes has been his anesthetic of choice for many years. He noted that Pierrel Research?s Orabloc (articaine hydrochloride 4% with epinephrine 1:100,000 and articaine hydrochloride 4% with epinephrine 1:200,000) offers the same rapid onset of action that dentists expect from existing articaine: anesthesia within 1 to 9 minutes, with complete anesthesia lasting about 1 hour for infiltrations and up to 2 hours for an inferior dental block. Additionally, the aseptic manufacturing process provides increased shelf life for Orabloc?up to 24 months at 25°C (77°F), compared to 18 months shelf life for terminally sterilized articaine. He said these features are important components of anesthesia for the endodontic process, and can facilitate success. Dr. Kaminer encouraged the clinicians in attendance to think ?outside the box,? when it comes to treating patients with endodontic issues.