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Products   Updated April '07

Clean and Shape
Cleaning and shaping technology has come far from the initial push pull filing methods performed with carbon steel and then stainless steel instruments. The use of highly flexible Ni-Ti alloys in rotary motion now create the desired continuously tapered cone shape that can be easily filled with vertical compaction of warm gutta percha. Here are some of the tools I have found useful in this part of endodontic treatment.


Ultracaine Forte - Articaine 4 % - 1/100,000 epi

Articaine 4 % HCl 1/100,000 epi. has proven to be an excellent anesthetic for use in endodontic treatment. Hoechst first introduced this product in Canada in the early 1990s under the name Ultracaine and Ultracaine DS Forte. They went as far as to design the carpules with a proprietary plunger grip that forced users to purchase special syringes because the standard harpoon type mechanism will not work. Since then Septodont has introduced its own version of Articaine with standard carpule plunger design. They claim the formulation is identical. In any case, Articaine has replaced all anesthesia in my office with the exception of surgical procedures that require 1/50,000 epi. for better hemostasis . It is currently being sold by Hansamed Ltd. 1 800 363 2876
 
 

Electronic Apex Locators

Updated Oct. 06
The NeoSono units are no longer being made. I would currently recommended the Root ZX or Elements units.

Update April 07  I just purchased a used NeoSono ( Satelec newer version) on E bay for around $250 US. It works perfectly. Interestingly enough, I bumped into Dr. Farber ( of Cherry Hill NJ and originator of  Amadent) at the AAE meeting. He has been lured out of retirement and is now selling a competitor's brand of Israeli made EAL that is about 1/10th the size of these units and claims to be much better. He said this Israeli technology is now standard for these smaller, solid state units.

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The Electronic Apex Locator (EAL) is an essential tool for determining the position of the apical foramen. Early resistance based units have been replaced by multisampling impedance based technology. Although manufacturers say they work in all fluids, these units work most accurately in a relatively dry canal. (See Getting the Most Out of Your Apex Locator for tips)

I have used 3 generations of NeoSonos and I have found them to be reliable and accurate when used with the correct technique. The Amadent company was purchased by Satelec. They are part of the Acteon Group . Click the link if you want to find out more about their latest version known as the NeoSono Co-Pilot. .Other units such as the Morita Root ZX , Kerr/Sybron Elements Unit and Bingo are also popular but I prefer the NeoSono because of its loud distinct audio tones.

Do not be misled by the graphic representations on some machines. They are not accurate. The most important information should be relayed to you in such a way that you do not have to actually look directly at the machine.

   
NaOCl solution heating

Heating of NaOCl solutions has some proponents. Research has shown that elevating the temperature causes an increase in the tissue solvent action of the NaOCl. Too high a temperature can cause breakdown of the solution. Other clinicians have stated that body temperature is already sufficiently above ambient room temperature to effect this change. They also state that the volume of solution used is so small that this increase in temperature is not significant when it comes out of a 3-cc syringe. Nevertheless, a very inexpensive method of accomplishing this is through the use of the standard coffee warmer. I used to use a Salton coffee warmer that may be purchased from your local hardware store for only a few dollars. NaOCl is placed in a glass jar and left on the heating element portion. The solution remains warm but not hot. It has a switch that may be turned off when not in use. Again, a cheap efficient aid to treatment. Link is Salton.

Another method of heating NaOCL in the canal is by using your Touch and Heat or System B tip. The tip is placed in the prepared canal and then the instrument is activated.

Update April 07

Most recently my standard Clorox (5.25 %NaOCl) solutions have been replaced with Vista Dental's Chor-XTRA.   See Vista Dental's Chor-XTRA for more info.

   
   

NaOCl solution heating - Endo Irrigator II - Vista Dental

Recently, I installed this irrigating device in one of my operatories. It is produced by Vista Dental ( www.vistal-dental.com) . The Endo Irrigator II has 3 reservoirs for irrigating solutions. I use NaOCl 5.25 % , EDTA 17% and alcohol95%. The gun on the right has four buttons. Three activate the solutions and one is for suction. The gun on the right is a Stropko irrigator and is an option. The device has a built in heater that also heats the lines so the irrigating solutions come out warm. There are two settings that allow for "push-intermittent" and "push-on, push-off" dispensing of the solutions. I originally was using the 30 gauge Ni-Ti Stropko tips with this machine but I found that this small gauge made using the suction feature difficult to use because the Ni-Ti tips were constantly clogging. I have moved to a dedicated 27 gauge stainless steel tip that works better for this. These are also sold by Vista Dental.

The only drawback with this unit is the slight awkwardness when using the irrigating gun. Unlike a small monoject type syringe used with the 30 gauge Ni-Ti Stropko tips because they can be passed form my assistant to me and and are easily maneuverable. The gun can sometimes be difficult to place in certain posterior teeth but this merely requires rebending the irrigating syringe tip to the proper angle. However its is harder to use than a standard syringe when using a gentle "in-out" motion that allows you to get right into the canal without risking getting irrigants out of the apex. The rate of flow can be regulated by adjusting the pressure to the unit. It also requires a dedicated high volume suction line and will NOT work without suction. This is a fail-safe feature. It is a very nice unit although reliability issues have plagued production. My first unit had to be returned because one of the reservoir unit connections was leaking. Overall, it is an excellent way to deliver multiple solutions with heat.

Update April 07

Both irrigation units were subsequently returned to Vista Dental for full credit. I had been having reliability and leakage problems since the original units were installed. Several loaner units were shuffled back and forth to my office due to problems with leakage of units and unit malfunctions. At the AAE meeting, I stopped by the Vista Booth and was told that Vista engineers had redesigned the units for better reliability. An attached ultrasonic handpiece accessory was also now available for an extra $400. The units were now approximately $2000 each. They may be more reliable but I am not considering repurchase at this point.

   
   
S Files by JS dental





These stainless steel ground S files are extremely sharp. Originally produced in Scandinavia, I believe they now have a US production facility. Until recently they were sold in Canada as the "Torendo" brand. They are no longer available as that brand and must be purchased directly from JS Dental as the "S-File."

They resemble a Hedstrom file and have similar cutting characteristics in that they cut best on the withdrawal stroke. However, unlike Hedstrom files, they have a high level of flexibility while retaining resistance to breakage. I have found this file to be the optimal file for cutting in the apical section of the canal and for canal exploration. They are also available in a Ni-Ti version that I do not use. Good product at a good price.
   
   

Irrigation syringes

I originally used these Monoject Endo Syringes by removing their blunted tips and bending them to a 45 degree angle. I have since discarded the tips in favor of the Stropko Ni-Ti Irrigation Needles listed below.

Update April '07
I am still using the syringes for irrigation but now with Ultradent's NaviTips .

   

Stropko Ni-Ti Irrigation Needles

One of the best products I have acquired recently are the Stropko Ni-Ti irrigation tips , available from Vista Dental. They are available in short (17 mm) and (25 mm) long sizes and can be sterilized and reused. I believe the needle size is 27 gauge, side vented . The best thing about them is their amazing flexibility and their resistance to clogging. Anyone who has does endodontics with "preloaded" NaOCL or EDTA syringes knows that the standard Monoject Stainless steel needles can clog. ( Especially if you modify them to resemble these syringes - bent at 45 degrees and cut tip) These are a huge time saver and can get very far down the canal safely. Get them, they are worth it.


Update April '07

Although I originally liked the Stropko NiTi tips, I found that they frequently clogged when the syringes were preloaded ( due to crystallization of irrigants in the lumen) and were too expensive for single use. i have since switched to Ultradent's NaviTips, which are far less expensive and while they can also clog, they are far more economical for single use.

   
   

Rotary Ni-Ti Engine- Aseptico DTC


You can read all about my migration to Ni-Ti Rotary endodontics here. This engine/handpiece combination has been flawless. Tulsa Dental sells these with an introductory package that may be of interest to those of you who do not yet have experience with Ni-Ti Rotary. ( I don't use Tulsa's obturation system.) I use the DTC with the Tulsa GT ProFile series. The torque control feature is beneficial for those who are new to Ni-Ti Rotary and want to be extra sure of limiting file breakage. Expensive, but worth it.

Update April 07
Normal handpiece repairs have been handled well by Tulsa. rare problems occurred with files stuck in the contra-angle and with rubber fatigue at the point where the cord enters the handpiece. Both problems fixed quickly and loaners were sent to prevent down time.
Excellent service.

 
 

ProTaper Files by Tulsa Dental


Illustration Courtesy Dr. Ken Serota


I have been frequently asked which rotary Ni-Ti system I use. Originally I was using the GT Profile by Tulsa but I have moved to the ProTaper System. For further detailed discussion of the system see the March 2003 Endofax Files.
 
 
EDTA Based Lubricants

There are many preparations based on the use EDTA as a calcium chelating agent. EDTA based preparations such as RC Prep and File Eze are helpful when instruments such as an #06 or #08 file have reached Working Length (WL) but do not move easily. These substances are also useful in reducing file breakage when Ni-Ti rotary files are used during cleaning and shaping procedures. They should NOT be used to unblock canals or attempt to bypass ledges or obstructions. Softening of the dentin by use of this preparation, combined with aggressive use of a file tip (like a size #15) is a guaranteed way of causing a perforation. I combine them with copious Sodium Hypochlorite irrigation. Click on Ultradent for more info. Ultradent has a wonderful range of endo products that are also listed by index on that page.

Other manufacturers make similar products such as Premier's, RC-Prep and Tulsa's ProLube and Kerr's Smear Clear. I also use 500 ml bottles of 17% liquid EDTA that can be made up at a fraction of the cost of these preparations.

Tulsa Dental will soon be announcing the release of MTAD, which is a new product that combines an irrigant with a detergent/surfactant and antibiotic.


Vista Dental's Chlor-XTRA


Vista Dental's Chlor-XTRA is a sodium Hypochlorite solution that has been enhanced with powerful Wetting Agent and proprietary Surface Modifiers. Alkylating agents have also been added to increase the electrical capacity of the solution.
•2.5 times more wettable than standard Sodium Hypochlorite
• Significantly more digestive than standard 6% NaOCl
• Significantly more stable and does not decompose as fast as normal NaOCl because normal NaOCl stays on the surface of the protein molecule and rapidly converts to HCl; Chlor-XTRA™ penetrates and does not convert to HCl


Update April 07

Chlor-EXTRA has become the main irrigating solution that I now use. This 6% per cent solution has proprietary surfactants in it and I have seen an improvement in the digesting qualities of this improved tissue solvent. It has become my main irrigating solution. However, it CANNOT be heated as it rapidly forms a dark precipitate. One drawback - this stuff is EXPENSIVE!! @ $57.50 US for a 16 oz. bottle !!

 

 

 


Ultradent NaviTips

Update April '07
NaviTips are irrigating tips available in 29 and 30 gauges and lengths of 17, 21, 25 and 27 mms. They have become the standard irrigating tip in my office.  See NaviTips   at Ultradent's website for further info.

 


 


Munce Discovery Burs

Update April '07


One of the BEST new products on the market i
s the new Munce Discovery burs. These are similar to a Mueller bur but are longer ( 21 mm!) and RIGID. The extended shaft allows you much better visibility in the deeper parts of the access. This is possible because handpiece is now far away from the access opening, allowing for better light and no blocking of the access with the handpiece head.

Although many clinicians have recommended Ultrasonics for this kind of work, ultrasonic tips are notoriously expensive. For optimal life, ultrasonic tips also should be used with water, which kind of defeats the purpose of using them for greater visibility. Another problem is setting the power levels. You want cutting but you never are sure whether the tip is being worked too hard and may break.  Any one who has spent time removing a broken diamond coated or titanium U/S tip from deep in a canal can appreciate this sentiment!

Munce burs seem to be a LOT more efficient in cutting than ultrasonics. I also find visibility in canals is easier than U/S tips because U/S seem to generate a lot of "powder" when used dry. This can obscure canal openings ( like MB2) which seem to be easier to see with the Munce burs.  Highly recommended and definite candidate for "Best Product" of 2007.  Check CJM Engineering for further info. Also check the Endo File Cabinet and check under Munce Products for details.  Congratulations to John Munce for a great idea!