Root canal treatments and retreatments are meticulous, intricate procedures that not only require skillful, nimble hands, but also strong, sterile instruments. Professionals who do not dedicate time and effort to ensure proper technique will experience fracture and separation regularly, oftentimes without prior warning.
But even the most diligent and accurate endodontists experience fractures. After all, most files endure fractures as part of the machining process to begin with.
While avoiding file fracture and separation during all canal treatments isn’t yet possible, there are a few best practices endodontists can implement to decrease the likelihood of instrument fracture. Here, we discuss three:
- Ensure there is straight line access to the canal. Before placing files into the canal, all impediments and obstructions must be removed. When you place your first file into the canal, it should literally stick straight up in the mouth.
- Create a glide path. Creating a glide path will serve as a map from the canal orifice to the canal terminus, which rotary shaping files can then follow. (Glide paths are often created with size 10, 15, and 20 stainless steel hand files.) Creating a .02 tapered glide path is imperative for the safe use of larger tapered rotary instruments. Even with magnification, you cannot see down inside the canal; using these tools gives you a sense of what is in the root canal system.
- Choose the right file size. The file sizes you select will set the tone for your canal treatments and retreatments. The fit and tightness of the hand files in the canal will dictate which system you should use.
- For small canals, a .04 tapered #25 file is recommended
- For medium canals, a .06 tapered #25 file is recommended
- For large canals, a .08 tapered file with a #25 tip is recommended
Check back next time for additional best practices you can use to decrease the likelihood of file fracture and separation.