Always do transportation when working with curved roots :(

[AnneSoul]

How can I avoid transportations with curved canals?
The school teaches us to work with hand files not rotary, although I always precurve the files, when I reach size 30 or 25 the files go out straight from the canals and when I reach cone fit stage I find out I made transportation
Any advices please?

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[frozenicecreamDMD]

so you do endo with only hand files? handfiles isnt flexible enough to negotiate curve root as far as i know. you can possibly hand file to like size 15 max or 20 for some. then you have to switch to rotary. some canal is so curve you have to get the proglider (waveone gold system) to negotiate.

 

[Molar Whisperer]

Using only hand files is not optimal. The school that teaches you only hand files are taught by hungry endodontists not wanting general dentists to do any rcts. My school taught us ridiculous ways that even the same instructors don't follow (I read their chart notes). According to a peer-review studies, the cross sections of canals instrumented with only hand instruments are in various oval shapes instead of circular. One can never obturate oval canals completely with GP (maybe carrier based). Also you leave behind micro anatomies like fins and webbings. The key to minimize transportation and iatrogenic events is to obtain as straight line access (glide path) as possible. If the root apices are curving distally, try to open the access more mesially to offset the curve as much as possible. Also, I like crown-down to allow room for the instrument to follow the curvature without stressing the canal and the instruments. Modern rotaries have treated metals that adapt to curves more efficiently.

 

[oralcare123]

You need to bend you handfiles to adapt to the shape of the curvature

 

[schmoob]

Are you using too much RC prep and NaOCl? You may be softening the dentin too much before you establish a glide path to WL.

 

[Molar Whisperer]

Are you using too much RC prep and NaOCl? You may be softening the dentin too much before you establish a glide path to WL.

Not sure if I'm "softening the dentin too much." After I access the pulp (molar), I lightly irrigate with full strength NaOCl to initiate debridement process and use large (#45) or Medium (#35) Wave One as an orifice shaper to open all the canals applying light passive pressure. I use about a pea size amt of RC prep for the whole molar procedure to avoid waste (RC prep is expensive) and mess. After opening the canals, I smooth the orifices with Brasseler Endo Z pulp shaping bur and irrig. I obtain WLs with #10 or 15 hand file in straight line glide path (not tipped) using passive pressure. If the hand file is still tipped upon insertion, open up the access to straighten it. One can pre-bend the tip of #10 and #15 since many canal termini are at an angle. For me, I like crown down (#45, 35, 25) depending on how large and patent the canal is to WL. For example, #30 has MB, ML, DB, DL canals located under magnification. I predetermined that I will use #45 as the final size for DB & DL and #35 for the MB & ML canals. I use #45 as my first orifice shaper and try to obtain WL using only passive pressure. If I can't achieve WL, I use #45 and #35 and Endo Z to smooth the orifice the last time and try again. If I still can't get WL, then #45, 35, 25, and repeat until WL is achieved. I always irrigate to maintain patency (avoid dentinal debris obstruction). Once WL is achieved, all the crown down work opened the glide path and I just finish with the desired instr sizes. That is how I can do a routine molar in 35 to 45 minutes. Wave One is reciprocating and really accommodating if you use passive pressure.

What can get many into trouble is the lack of access/glide path and using too much instr pressure. A good molar access will allow your DA to place paper points on every canal even MB2s. A good glide path will allow instr to WL with minimal stress. One should never apply pressure that will break a pencil lead.

 

[AnneSoul]

Thank you all so much
I am about to start RCT for a lower molar next week and because I am somehow traumatized from endo work so I am little bit nervous.Hope everything will go smooth ,please pray for me.