![]() For instance, for a tooth that is 20 mm, one should use a 21-mm file, not a 25-mm file (Figures 12 and 13). Furthermore, one should not use a file that is unnecessarily long. It is recommended that NiTi files with very short shafts be used in cases with limited openings. NiTi files with a shaft that is a few millimeters shorter than conventional-length shafts can make the difference between one being able to perform the endodontic procedure or not. Short NiTi Files With Short Shafts When patients cannot open their mouths very much, every millimeter saved for operating space counts. View of endo access facilitated with a small mirror as the file is held at 90°. A pre-curved stainless steel hand file.įigure 9. A NiTi file held by a handpiece at 90° (red lines).įigure 8. A stainless steel hand file held at 90° (red lines) to the fingers.įigure 7. Obturation was facilitated with a small hand mirror and a small carrier-based obturator (GuttaCore ).įigure 6. Visibility inside an endo access was made possible with enhanced magnification (EXTARO 300 ).įigure 5. Figure 11 demonstrates how a pre-curved NiTi file can access a posterior tooth more easily.įigure 4. Examples of such files include EndoSequence Reciprocating (ESR) Files (Brasseler USA) and WaveOne Gold (Dentsply Sirona Endodontics). Hence, the same way that it was recommended to pre-curve stainless steel hand files to more easily gain access into tight spaces, it is strongly recommended that mechanized NiTi files with controlled memory be used. These are files that could be curved, and instead of bouncing back to their original straight position, these files remain curved. Mechanized NiTi Files With Controlled Memory NiTi mechanized files with controlled memory have been available for several years. With no fingers in the way, the EndoHandle also improves operator visibility into the endodontic access. The EndoHandle (Venta Endo) provides an easier grip of a file that can also be pre-curved or bent to facilitate access (Figure 10). A curved file is shorter from file handle to file tip, and a curve also makes it easier to “wrap” over mesial marginal ridges as one attempts to enter the endodontic access.Īnother option is to use a pen-like handle for a standard hand file. Pre-curved Hand Files Gaining access with stainless steel hand files into tight spaces is easier if you curve the hand file than if you attempt to use a straight file (Figures 8 and 9). Imagine how difficult, or even impossible, it would be to use a straight-nosed handpiece with your endodontic file that is exactly the problem when a hand file is held improperly. This should be considered in just the same way as any endodontic handpiece that holds a NiTi motorized file at 90° to the shaft of the handpiece (Figures 6 and 7). Instead, one should hold the hand file at approximately 90° to the direction of his or her fingers. Doing so makes it almost impossible to gain access when the opposing arch is in the way and there is a limited mouth opening. Many clinicians hold hand files with the file directed somewhat along the axis of their fingers (index and thumb). Hold Hand Files at 90° Proper handling of a stainless steel hand file is one of the most important tips for facilitating access. Access for visibility into a small space was facilitated with a small/size 3 hand mirror. ![]() ![]() Note size 3 and 5 (left) mirrors alongside a quarter coin.įigure 3. A pediatric patient with small mouth openings.įigure 2. In Figures 2 to 5, you can see how a smaller size 3 (Integra Miltex Instruments, USA) mirror can be more easily positioned to allow visualization vs an unnecessary and larger size 5 mirror.įigure 1. ![]() As such, a size 3 mirror would be small enough to gain access into small mouths and sites with limited openings while being large enough to see everything needed for carrying out root canal treatment. This could be an issue in patients with limited openings and when a handpiece or fingers holding files take up space over the tooth. In turn, the use of a hand mirror is required however, many clinicians tend to use a standard size 5 mirror, which is quite large and unnecessary. And, once the tooth is endodontically accessed, it is imperative that the clinician be able to directly visualize the pulp floor and locate the canals. For nearly all teeth, direct vision will not suffice, as the opposing arch obstructs one’s view. For instance, one cannot do proper and efficient root canal treatments without the ability to see the occlusal surface of the tooth during access preparation or inside the endodontic access. Small Hand Mirror Visibility in endodontics is essential. Various endodontic instruments that are currently available and recommended for use in patients who have limited mouth openings will also be discussed (Figure 1). This article will discuss various clinical tips and tricks that will help clinicians in the above scenarios. ![]()
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