US20170143450A1 - Endodontic instruments and root canal treatment methods - Google Patents
Endodontic instruments and root canal treatment methods Download PDFInfo
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- US20170143450A1 US20170143450A1 US14/946,716 US201514946716A US2017143450A1 US 20170143450 A1 US20170143450 A1 US 20170143450A1 US 201514946716 A US201514946716 A US 201514946716A US 2017143450 A1 US2017143450 A1 US 2017143450A1
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- A61C5/023—
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
- A61C5/00—Filling or capping teeth
- A61C5/40—Implements for surgical treatment of the roots or nerves of the teeth; Nerve needles; Methods or instruments for medication of the roots
- A61C5/42—Files for root canals; Handgrips or guiding means therefor
Definitions
- the present invention relates to instruments for endodontic use, and more particularly to apparatuses and associated methods for performing root canal treatment.
- the apical foramen is the opening at the apex of the root of the tooth, through which the nerve and blood vessels that supply the dental pulp pass.
- the dental pulp resides in the root canal and is comprised of living circulatory, connective, and nerve tissues.
- the endodontic clinician shapes the root canal prior to inserting a filler material in place of the original dental pulp.
- spiral instruments i.e., electrically operated
- spiral instruments have a generally triangular, square, or rectangular cross section, and comprise edges (or corners) that attack the dental wall and strike the dentine wall at an acute angle. Consequently, these conventional files have a tendency to wear out prematurely and to break.
- these conventional files may bind when resisted by obstacles and eventually break inside the root canal, as they do not have a sufficient thickness to resist torsion fatigue induced thereon.
- such files do not generally perform a complete rubbing of the dental wall in order to achieve a hermetic obturation of the root canal, thus yielding to a risk of infection.
- Root canal filling instruments Although cylindro conical instruments have been used by dentists only in root canal filing material (spreaders) with a smooth surface, they have not been used to probe, shape, debride, catheterize, penetrate or bypass obstacles in root canal treatments. Reference is made to Carrotte, P., “Endodontics: Part 5 Basic instruments and materials for root canal treatment,” British Dental Journal 197, 455-464 (2004), Published online: 23 Oct. 2004, at http://www.nature.com/bdj/journal/v197/n8/full/4811738a.html Root canal filling instruments.
- the instruments generally may not be totally suitable for use under elevated torque or high speed, due to the high fracture risk.
- the spiral instruments generally exert force on the dental wall and are therefore subjected to a reactive force. In fact, rubbing the dental wall does not facilitate penetration in the desired direction of the dental apex.
- the present invention satisfies this need, and presents several preferred designs for endodontic instruments and associated methods of use for performing root canal treatment. These instruments penetrate or bypass most, if not all blockages in the root canal, while achieving optimal root canal treatment with optimal root canal shape, in order to maximize irrigation and hermetic obturation of the root canal.
- the teeth and grooves of the endodontic instruments of the present invention may become worn with use, they will not easily break because they do not attack the radical dentine at weak pointed angles.
- the use of sandblasting to form the endodontic instrument helps to avoid corrosion of instrument resulting from stocking, storage, or usage.
- the instruments are very flexible so that they may follow difficult curved root canals without damaging the apex, making a false canal, or causing a shear in the coronal part and the apex of the root canal.
- each instrument of the present invention comprises a handle that secures an elongated tapered shank.
- the shanks of the instruments include cylindro-conical files having a circular cross section, which penetrate the root canals using most, if not the entirety of their peripheral surfaces, thus providing a better ability to resist torsion fatigue, to preserve the initial circular dental canal anatomy, and to attain a hermetical obturation of the root canals.
- the shanks can assume a variety of designs based on a combination of characteristics, including but not limited to: a roughed surface, a cutting surface, a smooth area, a conical cutting tip, a non-cutting tip, a beveled tip, and a non-beveled tip.
- the endodontic instruments may generally be categorized, as follows:
- the instruments in the 1 st Class of the 1 st Category can be either hand operated or electrically rotating. Each of these instruments includes a lateral surface that contains a number of superficial horizontally, vertically, or transversally striated grooves that define slightly cutting edges, and that are either separated by smooth areas or sandblasted areas.
- the instruments in this class include a generally circular cross-section, and a conical tip that may be cutting or non-cutting, beveled or non-beveled.
- These instruments include hand operated files for root canal treatment that are preferably made from stainless steel (with nos. ranging from 10 to 25) or NiTi (with nos. ranging from 20 to 25) and electrically rotating NiTi files (with nos. ranging from 10-to 25), all with a taper of approximately 0, 1, 2, 3, or 4% and a length ranging from approximately 12 mm-32 mm.
- the instruments in the 2 nd Class of the 1 st Category are hand operated instruments having a series of horizontally, vertically, or transversally striated deep grooves with cutting edges, that are separated by restricted smooth or sandblasted areas or even instruments that are completely sandblasted.
- the instruments in this class include a generally circular cross section, and a conical tip that may be cutting or non-cutting.
- the shanks of these instruments range from No. 6 to 20.
- the shanks may be made from stainless steel, and range from No. 6 to 20.
- the shanks may alternatively be made from NiTi, and range from No. 20 to 40.
- the shafts of all these instruments have a taper of approximately 0%, 1%, 2%, and 4%, and a length that ranges from approximately 12 mm to 32 mm.
- the instruments of the 2 nd Category preferably include electrically operated rotating NiTi instruments, each having a tapered shank with a series of transversal, deep, striated grooves with cutting edges.
- the instruments include a series of horizontally or vertically striated, deep grooves with cutting edges, that are separated by either smooth or roughened (i.e., sandblasted) restricted areas.
- These instruments include electrically rotating files for root canal treatment with nos. 10 to 20, and having an approximate 2% taper and a length ranging from approximately 21 mm to 32 mm.
- the instruments of the 3 rd Category preferably include electrically operated rotating instruments, each having a shank with a generally circular cross section and a conical cutting or non-cutting tip, with a series of saw teeth that are separated by restricted smooth areas.
- the shank can include horizontally, vertically, or transversally striated grooves.
- These instruments include electrically rotating files for root canal treatment with nos. ranging from 20 to 40, and having an approximate 4% to 10% taper and a length ranging from approximately 21 mm to 32 mm.
- the endodontic procedure being administered determines the selection of the category, the instruments within each category, and the sequential use of the selected instruments.
- FIG. 1 comprises FIGS. 1A and 1B , and represents two schematic illustrations of an exemplary hand operated (or electrically rotating) instrument having a long, tapered shank which includes superficial horizontally striated grooves with slightly cutting edges that are separated by smooth areas ( FIG. 1A ), and which includes deep horizontally striated grooves with cutting edges that are separated by restricted smooth areas ( FIG. 1B ), according to preferred embodiments of the present invention;
- FIG. 2 comprises FIGS. 2A and 2B , and represents two schematic illustrations of an exemplary hand operated (or electrically rotating) instrument having a long, tapered shank which includes superficial vertically striated grooves with slightly cutting edges that are separated by smooth areas ( FIG. 2A ), and which includes deep vertically striated grooves with cutting edges that are separated by restricted smooth areas ( FIG. 2B ), according to preferred embodiments of the present invention;
- FIG. 3 comprises FIGS. 3A and 3B , and represents two schematic illustrations of an exemplary hand operated (or electrically rotating) instrument having a long, tapered shank which includes continuous, superficial transversally striated grooves with slightly cutting edges that are separated by smooth areas ( FIG. 3A ), and which includes deep transversally striated grooves with cutting edges that are separated by restricted smooth areas ( FIG. 3B ), according to preferred embodiments of the present invention;
- FIG. 4 is a schematic illustration of an exemplary hand operated (or electrically rotating) instrument having a long, tapered shank with a beveled tip, and discontinuous, superficial transversally striated grooves with slightly cutting edges, separated by smooth areas, according to a preferred embodiment of the present invention
- FIG. 5 is a schematic illustration of an exemplary hand operated (or electrically rotating) instrument having a long, tapered shank with superficial transversally striated grooves with slightly cutting edges, separated by roughened areas (such as by sandblasting), according to a preferred embodiment of the present invention
- FIG. 6 is a schematic illustration of an exemplary hand operated instrument having a long, tapered shank with deep transversally striated grooves with cutting edges, separated by restricted smooth areas, according to a preferred embodiment of the present invention
- FIG. 7 is a schematic illustration of an exemplary electrically rotating instrument having a long, tapered shank with deep transversally striated grooves with cutting edges, separated by restricted smooth areas, according to a preferred embodiment of the present invention
- FIG. 8 is a schematic illustration of an exemplary electrically rotating (or hand operated) instrument having a long, tapered shank with a series of saw teeth separated by restricted smooth areas, according to a preferred embodiment of the present invention
- FIG. 9 comprises FIGS. 9A and 9B , and represents two schematic illustrations of an exemplary hand operated ( FIG. 9B ) and electrically rotating ( FIG. 9A ) spiral instrument with an upper cylindro-conical part having a conical tip, wherein the cylindro-conically shaped area is roughened, for example, by transversally grooved striations with cutting edges separated by restricted smooth or sandblasted areas, according to preferred embodiments of the present invention;
- FIG. 10 comprises FIGS. 10A and 10B , and represents two schematic illustrations of an exemplary hand operated ( FIG. 10B ) and electrically rotating ( FIG. 10A ) instrument having a conical tip and a long, generally tapered shank that defines a series of cylindro-conically shaped areas (or sections) separated by spirally shaped sections, wherein the cylindro-conically shaped areas (or sections) are roughened by, for example, transversally grooved striations with cutting edges separated by restricted smooth areas, according to preferred embodiments of the present invention;
- FIG. 11 comprises FIGS. 11A and 11B , and represents two schematic illustrations of an exemplary hand operated ( FIG. 11B ) and electrically rotating instrument ( FIG. 11A ) having a long, generally tapered shank that defines a series of spirally shaped sections separated by cylindro-conically shaped areas (or sections) that are roughened by, for example, transversally grooved striations with cutting edges separated by restricted smooth areas, according to preferred embodiments of the present invention;
- FIG. 12 comprises FIGS. 12A and 12B , and represents two schematic illustrations of an exemplary hand operated ( FIG. 12B ) and electrically rotating ( FIG. 12A ) instrument having a conical tip and a long, generally tapered sand blasted shank that defines a series of cylindro-conically shaped areas (or sections) separated by spirally shaped sections, wherein the cylindro-conically shaped areas (or sections) are roughened by, for example, transversally grooved striations with cutting edges separated by restricted sand blasted areas, according to preferred embodiments of the present invention;
- FIG. 13 comprises FIGS. 13A, 13B, 13C, and 13D , and illustrates a cross-sectional view of an exemplary tooth, with the cross-hatching removed for clarity of illustration, showing the sequential steps of progressively treating a root canal without a resistive path, obstruction, or blockage, using the instrument and process of the present invention
- FIG. 14 comprises FIGS. 14A, 14B, 14C, 14D, 14E, and 14F , and illustrates a cross-sectional view of an exemplary tooth, with the cross-hatching removed for clarity of illustration, showing the sequential steps of progressively treating a root canal that is blocked by a fragment of a broken instrument, such as a file, by bypassing the lodged fragment using the instrument and process of the present invention;
- FIG. 15 comprises FIGS. 15A, 15B, and 15C and illustrates a cross-sectional view of an exemplary tooth, with the cross-hatching removed for clarity of illustration, showing the sequential steps of progressively treating a root canal that is blocked by hypercalcification, by piercing the hypercalcification using the instrument and process of the present invention;
- FIG. 16 comprises FIGS. 16A, 16B, and 16C and illustrates a cross-sectional view of an exemplary tooth, with the cross-hatching removed for clarity of illustration, showing the sequential steps of progressively treating a root canal that is partially blocked by a shoulder, by bypassing the shoulder using the instrument and process of the present invention;
- FIG. 17 comprises FIGS. 17A, 17B, and 17C and illustrates a cross-sectional view of an exemplary tooth, with the cross-hatching removed for clarity of illustration, showing the sequential steps of progressively treating a root canal that is blocked by a residual resistant paste, by piercing and removing the resistant paste using the instrument and process of the present invention;
- FIG. 18 is a flow chart that illustrates the endodontic treatment process that does not exhibit signs of a resistive path, obstruction, or blockage, by selectively using the instruments of FIGS. 1B, 2B, 3B, and 6 through 8 according to the present invention
- FIGS. 19A and 19B represent a flow chart that illustrates the endodontic treatment method of bypassing root obstructions resulting from fractured instruments, by selectively using the instruments of FIGS. 1A, 1B, 2A, 2B, 3A, 3B , and 4 through 8 according to the present invention;
- FIGS. 20A and 20B represent a flow chart that illustrates the endodontic treatment method of penetrating root obstructions resulting from hypercalcification, by selectively using the instruments of FIGS. 1A, 1B, 2A, 2B, 3A, 3B, and 5 through 8 according to the present invention;
- FIGS. 21A and 21B represent a flow chart that illustrates the endodontic treatment method of bypassing root obstructions resulting from a shoulder obstruction, by selectively using the instruments of FIGS. 1A, 1B, 2A, 2B, 3A, 3B , and 5 through 8 according to the present invention;
- FIGS. 22A and 22B represent a flow chart that illustrates the endodontic treatment method of penetrating root obstructions resulting from a previous root canal treatment, by selectively using the instruments of FIGS. 1A, 1B, 2A, 2B, 3A, 3B, and 4 through 8 according to the present invention.
- FIGS. 23A, 23B, 23C, 24A, 24B, 24C, 25A, 25B, 25C, 25D, 26A, 26B, 27A, 27B, 27C, 28A, 28B, 28C, 28D, 29A, 29B , 29 C, 30 A, 30 B, 31 A, 31 B, 32 A, 32 B, 32 C, 33 A, 33 B, 33 C, 33 D, 34 , 35 , 36 A, 36 B, 36 C, 37 A, 37 B, 38 A, and 38 B are X-ray views that illustrate various cases treated by the instruments and methods of the present invention.
- the instruments of the present invention can be used for probing, enlarging, penetrating, and bypassing difficult root canals obstructions, they may be hand operated or electrically operated, they may have a continued or a discontinued rotation, and they may have reciprocal rotation, a clockwise rotation, or an anti-clockwise rotation.
- each of these instruments comprises a handle that secures an elongated tapered shank.
- the cross section of the shank is generally circular, so as to eliminate sharp edges (or corners) that might otherwise attack the dental wall and strike the dentine wall at an acute angle, thus ultimately extending the life of the instrument.
- the shank can assume a variety of designs, based on a combination of characteristics, including but not limited to: a roughed surface, a cutting surface, a smooth area, a conical cutting tip, a non-cutting tip, a beveled tip, and a non-beveled tip.
- the endodontic instruments may be categorized as follows:
- This category comprises two classes of instruments:
- This class includes hand operated and electrically rotating instruments having a number of superficial horizontally, vertically, or transversally striated grooves (also referred to as “shallow grooves”) that define slightly cutting edges, and that are either separated by smooth areas or sandblasted areas or even instruments that are completely sandblasted.
- shallow grooves denotes a general depth that ranges between approximately 0.06 mm and 0.4 mm.
- the instruments in this class include a generally circular cross-section, and a conical tip that may be cutting or non-cutting, beveled or non-beveled.
- the shanks of the hand operated instruments may be made from stainless steel, and range from No. 10 to 25.
- the shafts of the electrically rotating NiTi instruments preferably range from No. 10 to 25.
- the shafts of all these instruments have a taper ranging from approximately 0% to 4%, and a length that ranges from approximately 12 mm to 32 mm. ( FIGS. 1-5 ).
- the more preferred embodiments of the instruments in this class that provide optimal results are the hand operated instruments Nos. 10, 15, and 20, with a shank taper with an approximate 2% taper, and that are made from stainless steel.
- Other preferred embodiments include the hand operated instruments No. 20 with an approximate 4% shank taper that is made from NiTi.
- Additional preferred embodiments include the electrically rotating instruments that are made from NiTi, Nos. 10, 15, and 20, with a shank taper of approximately 2%, and Nos. 20 and 25 with a shank taper of approximately 4%.
- Sandblasted instruments with superficial grooves with slightly cutting edges have provided good penetration results, namely in engraving a cutting adjacent to the fractured instrument without encroaching with the coils of the fractured instrument, and in removing the dentine of the root canal.
- Optimal penetration results have been obtained with instruments that are sandblasted with aluminum oxide.
- This class includes hand operated instruments having a series of horizontally, vertically, or transversally striated deep grooves with cutting edges, that are separated by restricted smooth or sandblasted areas or even instruments that are completely sandblasted.
- the term “deep” denotes a general depth that ranges between approximately between 0.12 mm and 0.8 mm.
- the instruments in this class include a generally circular cross section, and a conical tip that may be cutting or non-cutting.
- the shanks of these instruments range from No. 6 to 20.
- the shanks may be made from stainless steel, and range from No. 6 to 20.
- the shanks may alternatively be made from NiTi, and range from No. 20 to 40.
- the shafts of all these instruments have a taper of approximately 0%, 1%, 2%, and 4%, and a length that ranges from approximately 12 mm to 32 mm ( FIG. 6 ).
- the preferred embodiments of the instruments in this class that provide optimal results are those made of stainless steel with Nos. 10, 15, and 20, with an approximate 2% taper.
- These preferred embodiments include instruments that are made from NiTi, No. 20, with an approximate 4% shank taper.
- FIG. 1A is a schematic illustration of an exemplary hand operated instrument (or file) 100 for use as a first category, first class instrument, according to a preferred embodiment of the present invention.
- the instrument 100 generally includes an elongated, tapered shank 105 with superficial horizontally striated grooves 110 with slightly cutting edges that are separated by smooth areas 111 .
- the grooves 110 form horizontal linear striations that are approximately 1 mm wide. It should be understood that the grooves 110 might assume other different patterns.
- the width of each smooth area 111 varies between approximately 2 mm and 3 mm.
- the instrument 100 further includes a tip 120 and a handle 125 .
- the tip 120 may be cutting or non-cutting, beveled or non beveled, depending on the desired application.
- the handle 125 secures one end of the shank 105 , and enables an endodontist to safely and ergonomically hold the instrument 100 while performing the treatment. It should be understood that the instrument 100 may alternatively be electrically rotating, in which case, the handle 125 is replaced with an appropriate handle or interface that connects the shank 105 to an external rotary source (not shown), as is known or available in the field.
- the shank 105 can be made of any suitable material, including but not limited to stainless steel or NiTi (Nickel Titanium).
- the shank 105 may have a constant or variable taper along its axial length, ranging from approximately 0% to 4%, a length ranging from approximately 12 mm to 32 mm, and a width ranging from approximately No. 10 to 25.
- FIG. 1B illustrates another instrument 150 for use as a first category, second class instrument according to a preferred embodiment of the present invention.
- the instrument 150 may also be used as a second or third category instrument, as explained herein.
- the instrument 150 is generally similar in design and construction to the instrument 100 of FIG. 1A , and comprises an elongated, tapered shank 155 with deep horizontally striated grooves 160 with cutting edges that are separated by restricted smooth areas 161 .
- the grooves 160 form horizontal linear striations that are approximately 2 to 3 mm wide. It should be understood that the grooves 160 might assume other patterns.
- the width of each smooth area 161 is approximately 1 mm.
- the instrument 150 further includes a cutting or non-cutting tip 120 and a handle 125 , whose design and function are explained earlier in connection with the instrument 100 .
- FIG. 2 respectively illustrates two exemplary hand operated instruments 200 ( FIG. 2A ) and 250 ( FIG. 2B ) that are generally similar in design and construction to the instruments 100 , 150 (respectively) of FIG. 1 . It should be understood that these instruments 200 , 250 can be modified, as explained herein, for use as electrically rotating instruments.
- the instrument 200 can be used as a first category, first class instrument. It includes an elongated, tapered shank 205 with superficial vertically striated grooves 210 with slightly cutting edges that are separated by smooth areas 211 , according to a preferred embodiment of the present invention.
- the grooves 210 form vertical linear striations that are approximately 1 mm in width.
- the smooth areas 211 separate the grooves 210 at a distance of approximately 2 to 3 mm.
- the instrument 200 further includes a cutting or non-cutting tip 220 and a handle 125 , which are respectively similar to the tip 120 and handle 125 of the instrument 100 of FIG. 1A .
- the instrument 250 of FIG. 2B can be used as a first category, second class instrument, according to a preferred embodiment of the present invention. It may also be used as a second or third category instrument, as explained herein.
- the instrument 250 includes an elongated, tapered shank 255 having deep vertically striated grooves 260 with cutting edges that are separated by restricted smooth areas 261 .
- the grooves 260 form vertical linear striations that are approximately 2 to 3 mm in width.
- the smooth areas 261 separate the grooves 260 at a distance of approximately 1 mm.
- the instrument 250 further includes a cutting or non-cutting tip 220 and a handle 125 , which are respectively similar to the tip 120 and handle 125 of the instrument 150 of FIG. 1B .
- FIG. 3 respectively illustrates two exemplary hand operated instruments 300 ( FIG. 3A ) and 350 ( FIG. 3B ) that are generally, respectively similar in design and construction to the instruments 100 , 150 of FIG. 1 and 200, 250 of FIG. 2 . It should be understood that these instruments 300 , 350 can be modified, as explained herein, for use as electrically rotating instruments.
- the instrument 300 can be used as a first category, first class instrument. It includes an elongated, tapered shank 305 with superficial transversally striated grooves 310 with slightly cutting edges that are separated by smooth areas 311 , according to a preferred embodiment of the present invention.
- the grooves 310 form transversally linear striations that are approximately 1 mm in width.
- the smooth areas 311 separate the grooves 310 at a distance of approximately 2 mm to 3 mm.
- the instrument 300 further includes a cutting or non-cutting tip 320 and a handle 125 , which are respectively similar to the tip 120 and handle 125 of the instrument 100 of FIG. 1A .
- the instrument 350 of FIG. 3B can also be used as a first category, second class hand operated instrument, according to a preferred embodiment of the present invention. It may also be used as a second or third category instrument, as explained herein.
- the instrument 350 includes an elongated, tapered shank 355 with deep transversally striated grooves 360 with cutting edges that are separated by restricted smooth areas 361 .
- the grooves 360 form transversally linear striations that are approximately 2 to 3 mm in width.
- the smooth areas 361 separate the grooves 360 at a distance of approximately 1 mm.
- the instrument 350 further includes a cutting or non-cutting tip 320 and a handle 125 , which are respectively similar to the tip 120 and handle 125 of the instrument 150 of FIG. 1B .
- FIG. 4 illustrates an exemplary hand operated instrument 400 that is generally similar in design and construction to the instrument 300 of FIG. 3A . It should be understood that the instrument 400 can be modified, as explained herein, for use as an electrically rotating instrument.
- the instrument 400 can be used as a first category, first class instrument. It includes an elongated, tapered shank 405 with superficial transversally striated grooves 410 with slightly cutting edges that are separated by smooth areas 411 , according to a preferred embodiment of the present invention.
- the grooves 410 form short, transversally linear striations that are approximately 1 mm in width.
- the distance between two consecutive grooves 410 may be adjusted so that it can be either fixed or variable, along the axial length of the shank 405 .
- the separation of the grooves 410 (which constitutes the width of the smooth areas 411 ) can vary between approximately 2 mm and 3 mm.
- the instrument 400 further includes a pointed, beveled cutting tip 420 and a handle 125 .
- FIG. 5 illustrates an exemplary hand operated instrument 500 that is generally similar in design and construction to the instrument 300 of FIG. 3A . It should be understood that the instrument 500 can be modified, as explained herein, for use as an electrically rotating instrument.
- the instrument 500 can be used as a first category, first class instrument. It includes an elongated, tapered shank 505 with superficial transversally striated grooves 510 with slightly cutting edges that are separated by roughened areas 511 , according to a preferred embodiment of the present invention. In one exemplary embodiment, the grooves 510 form short, transversally linear striations.
- the roughened areas 511 are formed by sandblasting.
- the instrument 500 further includes a cutting or non-cutting tip 520 and a handle 125 .
- FIG. 6 illustrates an exemplary hand operated instrument 600 that is generally similar in design and construction to the instrument 350 of FIG. 3B . It should be understood that the instrument 600 can be modified, as explained herein, for use as an electrically rotating instrument.
- the instrument 600 can be used as a first category, second class instrument. It includes an elongated, tapered shank 605 with deep transversally striated grooves 610 with cutting edges that are separated by restricted smooth areas 611 , according to a preferred embodiment of the present invention.
- the grooves 610 form short, transversally linear striations that are approximately 2 to 3 mm in width.
- the separation distance between the grooves 610 may be adjusted so that it can be either fixed or variable, along the axial length of the shank 605 .
- the separation of the grooves 610 (which constitutes the width of the smooth areas 611 ) is 1 mm.
- the instrument 600 further includes a pointed, cutting or non-cutting tip 620 and a handle 125 .
- this category comprises electrically operated rotating instruments (e.g., 700 ) that are preferably (but not exclusively) made for example of NiTi, from No. 10 to 20, with a shank 705 having a taper of approximately 2%.
- the illustrated instrument 700 is shown to include a series of transversal, deep, striated grooves 710 with cutting edges, it should be understood that other embodiments can alternatively include a series of horizontally or vertically striated, deep grooves with cutting edges, that are separated by either smooth or roughened (i.e., sandblasted) restricted areas 711 , or even instruments that are completely sandblasted.
- the shank 705 of the instrument 700 has a generally circular cross-section, and a conical cutting or non-cutting tip 720 , with a length ranging from approximately 21 to 32 mm.
- the circular cross section and conical tip 720 of the shank 705 helps create a space around the segment(s) of the fractured instruments that are lodged within the root canal, thus enabling the instruments of the 1 st category, 1 st class, to bypass the lodged fractured segment(s).
- a handle 725 secures the shank 705 to an external motorized source (not shown).
- this category comprises electrically operated rotating instruments (e.g., 800 ) made of NiTi from No. 20 to 40, with a shank 805 having a generally circular cross section.
- electrically operated rotating instruments e.g., 800
- the illustrated instrument 800 is shown to include a conical cutting or non-cutting tip 820 , with a series of saw teeth 810 that are separated by restricted smooth areas 811 , it should be understood that other embodiments can further include horizontally, vertically, or transversally striated grooves.
- the saw teeth configuration expels the dental debris from the root canal and lessens the rubbing force of the instrument on the walls of the root canal, especially when using files from Nos. 20 to 40, thus avoiding root canal cracks.
- the taper of the shank 805 ranges from approximately 4% to 10%, and has a length of approximately 21 mm to 32 mm.
- FIGS. 9A, 9B illustrate an electrically operated instrument 900 and a manually operated instrument 950 that is generally similar in design and function to the electrically operated instrument 900 , and therefore only one instrument will be described in detail.
- the electrically operated instrument 900 generally includes an elongated, tapered shank 905 that defines an upper cylindro-conical section 910 and a spirally (or helically) shaped lower section 915 .
- the cylindro-conical section 910 includes at its upper end, a tip 920 that may be cutting or non-cutting, depending on the desired application. While in this particular illustration the cylindro-conical section 910 is illustrated as being a roughened surface, it should be understood that the cylindro-conical section 910 could include striated grooves with cutting edges separated by smooth or sandblasted areas.
- the length of the shank 905 preferably ranges between approximately 12 mm and 32 mm, and its width preferably varies from No. 10 to 40.
- the taper of the instrument preferably ranges from approximately 2% to 10%. In a preferred embodiment, the entire shank 905 of the instrument 900 is sandblasted.
- Section 910 is intended to penetrate root canal blockages while section 915 serves to debride and to shape the opened path.
- the instrument 900 further includes a handle 925 that secures one end of the shank 905 , and that enables an endodontist to connect the instrument 900 to an external rotary source (not shown) as is known or available in the field.
- the instrument 950 further includes a manual handle 955 that secures one end of the shank 905 , and that enables an endodontist to safely and ergonomically hold the instrument 950 while manually performing the treatment.
- FIGS. 10A, 10B illustrate an electrically operated instrument 1000 , and a manually operated instrument 1050 that is generally similar in design and function to the electrically operated instrument 1000 , and therefore only one instrument will be described in detail.
- the electrically operated instrument 1000 generally includes an elongated, tapered shank 1005 that defines a plurality of roughened cylindro-conical sections 1010 , 1011 , 1012 , that are separated by a plurality of spirally (or helically) shaped sections 1015 , 1016 .
- the cylindro-conical section 1010 of the instrument 1000 comprise striated grooves with cutting edges separated by smooth or sandblasted areas and further includes at its forwardmost end, a tip 1020 that may be cutting or non-cutting, depending on the desired application.
- the length of the shank 1005 ranges from approximately 12 mm to 32 mm, and its width preferably varies from No. 10 to 40.
- the taper of the instrument preferably ranges from approximately 2% to 10%. In a preferred embodiment, the whole instrument will be sandblasted.
- Section 1010 is intended to penetrate root canal blockages while section 1015 serves to debride and to shape the opened path.
- the instruments illustrated in FIG. 10 provide better penetration results than the instruments in FIG. 9 . They are preferred in case of hard hypercalcifications and resistant paste.
- FIGS. 11A, 11B respectively illustrate an electrically operated instrument 1100 , and a manually operated instrument 1150 that is generally similar in design and function to the electrically operated instrument 1100 , and therefore only one instrument will be described in detail.
- the electrically operated instrument 1100 generally includes an elongated, tapered shank 1105 that defines a plurality of roughened cylindro-conical sections 1110 , 1111 , which are separated by a plurality of spirally (or helically) shaped sections 1115 , 1116 , 1117 .
- the spiral section 1115 of the instrument 1100 further includes at its forwardmost end, a tip 1120 that may be cutting or non-cutting, depending on the desired application.
- the length of the shank 1105 ranges from approximately 12 mm to 32 mm, and its width preferably varies from No. 10 to 40.
- the taper of the instrument preferably ranges from approximately 2% to 10%.
- the cylindro-conical sections 1110 , 1111 may be striated with groves with cutting edges separated by smooth or sandblasted areas. In a preferred embodiment, the whole instrument will be sandblasted.
- FIGS. 12A, 12B illustrate yet other alternative embodiments of an electrically operated instrument 1200 and a manually operated instrument 1250 , that are respectively, generally similar in design and function to the instruments 1000 , 1050 of FIGS. 10A, 10B .
- the electrically operated instrument 1200 generally includes an elongated, tapered shank 1205 that defines a plurality of roughened cylindro-conical sections 1210 , 1211 , 1212 , that are separated by a plurality of spirally (or helically) shaped sections 1215 , 1216 .
- the cylindro-conical section 1210 of the instrument 1200 further includes at its forwardmost end, a tip 1220 that may be cutting or non-cutting, depending on the desired application.
- the length of the shank 1205 ranges from approximately 12 mm to 32 mm, and its width preferably varies from No. 10 to 40.
- the taper of the instrument preferably ranges from approximately 2% to 10%.
- the cylindro-conical sections 1210 , 1211 , 1212 may be striated with groves with cutting edges separated by smooth or sandblasted areas while the spiral sections may be similarly sandblasted.
- the new root canal treatment method generally aims to bypass root obstructions resulting from fractured instruments and to penetrate hypercalcification, to bypass dental shoulders, to penetrate resistant paste, curved root canals and other obstructions resulting from a previous root treatment. More specifically, the following exemplary treatment methods will now be described in more detail:
- I Metal of treating a root canal that does not exhibit signs of a resistive path, obstruction, or blockage.
- II Metal-to-emetic bypassing root obstructions resulting from fractured instruments.
- III Metal-to-emetic bypassing root obstructions resulting from hypercalcification.
- IV Metal-to-emetic bypassing root obstructions resulting from curved root canals.
- V Metal-to-emetic bypassing root obstructions resulting from a shoulder.
- VI Metalhod of penetrating root obstructions resulting from a previous root canal treatment.
- the endodontist starts at step 1810 of FIG. 18 , to enlarge the root canal 1312 by selectively and sequentially using the instruments (denoted with numeral reference 1320 ) of the 1 st category, 2 nd class (e.g., FIGS. 1B, 2B, 3B and 6 ), starting for example with a manual instrument No. 8 having an approximate 2% taper, in increasing order to No. 15 with an approximate 2% taper (1 st category, 2 nd class), exerting a manual force with a clockwise 90-degree rotation along the arrow F, in order to reach the apex 1333 of the root canal 1312 .
- the instruments denoted with numeral reference 1320
- the 1 st category, 2 nd class e.g., FIGS. 1B, 2B, 3B and 6
- a manual instrument No. 8 having an approximate 2% taper, in increasing order to No. 15 with an approximate 2% taper (1 st category, 2 nd class)
- the endodontist further enlarges the root canal 1312 using for example, an electrically rotating instrument (denoted with numeral reference 1330 ) selected from the 2 nd category (e.g., FIG. 7 ), starting with No. 10 having an approximate 2% taper, in an increasing order to No. 20, along the arrow F in order to reach the apex of the root canal 1333 .
- an electrically rotating instrument denoted with numeral reference 1330
- the 2 nd category e.g., FIG. 7
- the endodontist further enlarges the root canal 1412 using for example, an electrically rotating instrument (denoted with numeral reference 1430 ) selected from the 2 nd category (e.g., FIG. 7 ), starting with No. 10 having an approximate 2% taper, in an increasing order to No. 20, in order to reach the fractured instrument in the root canal 1412 .
- an electrically rotating instrument denoted with numeral reference 1430
- the 2 nd category e.g., FIG. 7
- the endodontist continues to enlarge the root canal 1412 using for example, an electrically rotating instrument (denoted with numeral reference 1430 ) selected from the 3 rd category (e.g., FIG. 8 ), starting with an instrument from No. 20 to No. 25 with an approximate 4% taper to No. 25 with an approximate 6% taper whenever possible.
- an instrument with No. 20 having an approximate 4% taper can be used to reach the fractured instrument in the root canal 1412 .
- the endodontist then enlarges the cutting 1444 into an initial path using a manual instrument (also denoted by the numeral reference 1440 ) selected for example from the 1 st category, 1 st class, and preferably made of NiTi, No. 20 with an approximate 4% taper and a non-cutting tip (e.g. 1633 B), exerting a manual force with a clockwise 90 degrees rotation along the arrow F, in order to preserve the initial path 1444 .
- a manual instrument also denoted by the numeral reference 1440
- a manual instrument selected for example from the 1 st category, 1 st class, and preferably made of NiTi, No. 20 with an approximate 4% taper and a non-cutting tip (e.g. 1633 B)
- the endodontist continues to enlarge the new path 1445 using a manual instrument (still denoted by 1450 ) selected for example from the 1 st category, 1 st class, and preferably made of NiTi, No. 20, having an approximate 4% taper with a cutting tip (e.g., 1633 A), followed by No. 20 having an approximate 4% taper with a non-cutting tip (e.g., 1633 B), in order to preserve the new path 1445 .
- a manual instrument still denoted by 1450
- a manual instrument selected for example from the 1 st category, 1 st class, and preferably made of NiTi, No. 20, having an approximate 4% taper with a cutting tip (e.g., 1633 A), followed by No. 20 having an approximate 4% taper with a non-cutting tip (e.g., 1633 B), in order to preserve the new path 1445 .
- the endodontist may use a manual instrument 1440 ( FIG. 14C ) selected for example from the 1 st category, 1 st class, and preferably made of stainless steel, No. 20, having an approximate 2% taper with a cutting tip (e.g., 1633 A), followed by No. 20 having an approximate 2% taper with a non-cutting tip (e.g., 1633 B).
- a manual instrument 1440 FIG. 14C
- the 1 st category, 1 st class and preferably made of stainless steel, No. 20, having an approximate 2% taper with a cutting tip (e.g., 1633 A), followed by No. 20 having an approximate 2% taper with a non-cutting tip (e.g., 1633 B).
- the endodontist may use a manual instrument 1450 ( FIG. 14D ) selected for example from the 1 st category, 1 st class, and preferably made of stainless steel, No. 15, having an approximate 2% taper with a cutting tip (e.g., 1633 A) in order to create a new cutting.
- a manual instrument selected for example from the 1 st category, 1 st class, and preferably made of stainless steel, No. 15, having an approximately 2% taper with a non-cutting tip (e.g., 1633 B), in order to preserve the newly opened path 1445 .
- the endodontist uses a smaller instrument preferably made of stainless steel, in the same sequence as described above, until the apex 1466 of the root canal 1412 is reached (step 1980 ), as follows:
- the path 1445 is enlarged manually, at step 1970 , using sequentially hand operated stainless steel instruments with cutting and non-cutting tips from No. 8 or 10 until No. 20 of approximately 2% taper (1 st category 1 st class).
- the introduction of the instrument with a cutting tip is followed by the use of the same instrument with a non-cutting tip.
- the endodontist starts at step 1980 with electrically operated instruments of the 1 st category, 1 st class, which are preferably made of NiTi, and having a non-cutting tip (e.g., 1633 B), in an increasing order starting by using instrument no. 10 with approximately 2% taper until reaching No. 20 of approximately 2% taper.
- 1 st class which are preferably made of NiTi, and having a non-cutting tip (e.g., 1633 B)
- the endodontist continues with electrically operated instruments of the 2 nd category, which are preferably made of NiTi, and having a non-cutting tip (e.g., 1633 B), in an increasing order instruments from No. 20 to No. 25 having approximately 2% taper.
- electrically operated instruments of the 2 nd category which are preferably made of NiTi, and having a non-cutting tip (e.g., 1633 B), in an increasing order instruments from No. 20 to No. 25 having approximately 2% taper.
- step 1990 upon completion of step 1980 as described earlier, the endodontist clears the widened root canal 1445 of any debris, as is known in the field, in preparation for the final obturation step.
- the endodontist obturates the root canal 1445 with the appropriate filling material 1446 , as is known in the field. It should be noted that the obturation may be performed with or without removing the fragment 1410 of the fractured instrument.
- the present invention teaches that it is possible to directly reach the apex 1466 , at step 1999 , by using electrically operated instruments with non-cutting tips, made of NiTi, after step 1970 , in an increasing order from No. 10 with an approximate 2% taper (selected from the 1 st category, 1 st class) to No. 20 with an approximate 4% taper (selected from the 1 st category, 1 st class), followed by the sequential use of instruments selected from the 2 nd and 3 rd categories, as deemed appropriate by the endodontist.
- the present invention teaches that in less difficult cases, it is possible from step 1950 to directly reach the apex 1466 , step 1999 , by using electrically operated instruments with non-cutting tips, made of NiTi, starting by enlarging the initial path 1444 with No. 20 having an approximate 4% taper (1 st category, 1 st class); then using in an increasing order NiTi instruments with non-cutting tip from No. 10 with an approximate 2% taper (selected from the 1 st category, 1 st class) to No. 20 with an approximate 4% taper (selected from the 1 st category, 1 st class), followed sequentially by instruments selected from the 2 nd and 3 rd categories, as deemed appropriate by the endodontist.
- root canal is irrigated with sodium hypochloride and EDTA (Ethylenediaminetetraacetic acid) at each relevant step of process 1900 .
- EDTA Ethylenediaminetetraacetic acid
- FIGS. 23A, 23B, 23C, 24A, 24B, 24C, 25A, 25B, 25C, 25D, 26A, 26B, 27A, 27B, 27C, 28A, 28B, 28C, 28D, 29A, 29B , 29 C, 30 A, 30 B, 31 A, 31 B, 32 A, 32 B, 32 C, 33 A, 33 B, 33 C, 33 D, 34 , 35 , 36 A, 36 B, 36 C, 37 A, 37 B, 38 A, and 38 B provide supporting illustrations of this novel process 1900 :
- FIG. 23A shows a broken file in tooth no. 26 blocking the totality of the root canal.
- FIG. 23B shows the bypassing of the broken file and reaching the apex with the new instrument according to the present invention.
- FIG. 23C shows the fully hermetic obturation of the treated root canal.
- FIG. 24A shows a broken file in tooth no. 46 blocking the totality of the root canal.
- FIG. 24B shows the bypassing of the broken file and the piercing of the hypercalcification and reaching the apex with the new instrument according to the present invention.
- FIG. 24C shows the fully hermetic obturation of the treated root canal.
- FIG. 25A shows a hypercalcification, a shoulder, and a broken file in the mesial canals of tooth no. 36.
- FIG. 25B shows the broken file.
- FIG. 25C shows the bypassing of the broken file, the penetration of the shoulder and the piercing of the hypercalcification in the 2 nd mesial canal and reaching the apex with the new instrument, according to the present invention.
- FIG. 25D shows the fully hermetic obturation of the treated root canal.
- FIG. 26A shows two fractured files in the mesio vestibular canal in tooth no. 46, blocking the totality of the root canal.
- FIG. 26B shows the bypassing of the two broken files and reaching the apex with the new instrument according to the present invention.
- FIG. 27A shows three broken files in tooth no. 35 blocking the totality of the root canal.
- FIG. 27B shows the bypassing of the three broken files and reaching the apex with the new instrument according to the present invention.
- FIG. 27C shows the fully hermetic obturation of the root canal.
- FIG. 28A shows a broken file in tooth no. 47 blocking the totality of the root canal due to hypercalcification.
- FIG. 28B shows a cutting made with the new instrument according to the invention, and a second broken file.
- FIG. 28C shows the bypassing of the two broken files and the piercing of the hypercalcification and reaching the apex with the new instrument according to the present invention.
- FIG. 28D shows the fully hermetic obturation of the treated root canal.
- a conventional file was used to enlarge the cutting and to bypass the broken file.
- the conventional file was broken, as expected, while the new instrument according to the invention has successfully bypassed the two broken files, pierced the hypercalcification, and reached the apex, without making a false canal ( FIG. 28C ).
- FIG. 29A shows two superposed broken files in tooth no. 26 blocking the third apical of the root canal.
- FIG. 29B shows the bypassing of the broken files and reaching the apex with the new instrument according to the present invention.
- FIG. 29C shows the fully hermetic obturation of the treated root canal.
- FIG. 30A shows a broken file in tooth no. 37 blocking the third apical of the root canal.
- FIG. 30B shows the bypassing of the broken file and reaching the apex with the new instrument according to the present invention.
- FIG. 31A shows a false canal and two broken files in tooth no. 36 blocking the apex of the root canal.
- FIG. 31B shows the avoidance of the false canal and the bypassing of the broken file and reaching the apex with the new instrument according to the present invention.
- FIG. 32A shows a broken file in the third apical of the mesial canal tooth no. 46 blocking the apex.
- FIG. 32B shows the bypassing of the broken file and reaching the apex with the new instrument according to the present invention.
- FIG. 32C shows the fully hermetic obturation of the treated root canal.
- FIG. 15 it comprises FIGS. 15A, 15B, and 15C and illustrates an exemplary tooth 1500 having a root canal 1512 that is blocked or obstructed by hypercalcification 1510 .
- the treatment method 2000 is performed according to the following steps:
- the endodontist enlarges, at step 2010 of FIG. 20A , the root canal 1512 of the tooth 1500 by starting with a manual instrument selected from the 1 st category, 2 nd class, No. 8, with an approximate 2% taper, in an increasing order to an instrument selected from the 1 st category, 2 nd class, No. 15, with an approximate 2% taper, exerting a manual force with a clockwise 90-degree rotation along the arrow F, until the tip 1525 of the instrument 1520 reaches the hypercalcification 1510 .
- the endodontist then further enlarges, at step 2020 , the root canal 1512 using electrically rotating instruments 1520 selected from the 2 nd category, starting with No. 10 with an approximate 2% taper, in an increasing order to No. 20 with an approximate 2% taper, until reaching the hypercalcification.
- the endodontist continues to enlarge the root canal 1512 using electrically rotating new instruments that are selected from the 3 rd category, using files from No. 20 to No. 25 with an approximate 4% taper, to No. 25 with an approximate 6% taper whenever possible. Preferred results were obtained with a No. 20 instrument with an approximate 4% taper, until reaching the hypercalcification 1510 .
- the endodontist then starts piercing the hypercalcification 1510 at step 2030 , to form an initial path 1555 therewithin, using manual NiTi instruments 1530 selected from the 1 st category, 1 st class, No. 20 with an approximate 4% taper, and a cutting tip 1525 .
- the endodontist exerts a manual force with a clockwise 90-degree rotation.
- the endodontist then withdraws the instrument 1530 by exerting an anti-clockwise rotation of the same angle.
- the relatively large cross-sectional surface of the cutting tip 1525 avoids opening a false canal when exerting a relatively high manual force.
- the endodontist continues at step 2040 by enlarging the initial path 1555 , using a manual NiTi instrument that is selected from the 1 st category, 1 st class, No. 20 having an approximate 4% taper with a non-cutting tip (e.g., 1633 B), in order to preserve the opened initial path 1555 .
- a manual NiTi instrument that is selected from the 1 st category, 1 st class, No. 20 having an approximate 4% taper with a non-cutting tip (e.g., 1633 B), in order to preserve the opened initial path 1555 .
- step 2050 in order to enlarge the initial path 1555 and to pierce the remainder of the hypercalcification, by using a manual stainless steel instrument selected from the 1 st category, 1 st class, No. 20, with an approximate 2% taper and a cutting tip 1525 . It is recommended to continue to manually enlarge the initial path 1555 using a manual stainless steel instrument selected from the 1 st category, 1 st class, No. 20 with an approximate 2% taper and a non-cutting tip (e.g., 1633 B).
- a manual stainless steel instrument selected from the 1 st category, 1 st class, No. 20 with an approximate 2% taper and a non-cutting tip (e.g., 1633 B).
- the endodontist further enlarges the initial path 1555 by first using a manual NiTi instrument selected from the 1 st category, 1 st class, No. 20, with an approximate 4% taper and a cutting tip 1555 , and then using a manual NiTi instrument also selected from the 1 st category, 1 st class, No. 20, with an approximate 4% taper and a non-cutting tip (e.g., 1633 B), so as to preserve the initial path 1555 .
- a manual NiTi instrument selected from the 1 st category, 1 st class, No. 20, with an approximate 4% taper and a non-cutting tip (e.g., 1633 B)
- manual stainless steel instrument 1540 selected from the 1 st category, 1 st class, No. 20, with an approximate 2% taper and a cutting tip 1525 is used whenever feasible. Otherwise, the endodontist uses a manual stainless steel instrument 1540 selected from the 1 st category, 1 st class, No. 15, with an approximate 2% taper and a cutting tip 1525 , in order to pierce a new path that is adjacent to the initial path 1555 . This step is followed by the use of a manual stainless steel instrument 1540 selected from the 1 st category, 1 st class, No.
- the endodontist uses smaller stainless steel instruments in the same sequence until reaching the apex 1566 of the root canal 1512 ( FIG. 15C ).
- the initial path 1555 is gradually enlarged manually using sequentially hand operated stainless steel instruments with cutting and non-cutting tips from No. 8 or 10 until No. 20 of approximately 2% taper (1 st category 1 st class).
- the introduction of the instrument with a cutting tip is followed by the use of the same instrument with a non-cutting tip.
- a NiTi instrument also selected from the 1 st category, 1 st class, No. 20 with an approximate 4% taper and a cutting tip 1525 followed by the same instrument with a non-cutting tip (e.g., 1633 B), may be introduced.
- the endodontist uses, at step 2070 , electrically operated NiTi instruments 1540 selected from the 1 st category, 1 st class, and instruments of the 2 nd category, with a non-cutting tip (e.g., 1633 B), followed by the use of instruments 1540 of the 3 rd category, with a non-cutting tip.
- the endodontist sequentially uses in increasing order the instruments 1540 starting with instruments selected from the 1 st category, 1 st class, No. 10 to No. 20 with an approximate 2% taper, and then, instruments from No. 20 to No. 25 of approximately 2% taper of the 2 nd category and finally instrument No. 20 or 25 with an approximate 4% taper of the 3 rd category at the apex 1566 .
- step 2080 upon completion of step 2070 as described earlier, the endodontist clears the widened root canal of any debris, as is known in the field, in preparation for the final obturation step.
- the endodontist obturates the root canal with the appropriate filling material 1446 , as is known in the field.
- the apex 1566 it is possible to directly reach the apex 1566 , after step 2060 , by using electrically operated NiTi instruments selected from the 1 st category, 1 st class with a non-cutting tip (e.g., 1633 B), in increasing order from No. 10 with an approximate 2% taper to No. 20 with an approximate 4% taper, followed by instruments of the 2 nd and 3 rd categories.
- electrically operated NiTi instruments selected from the 1 st category, 1 st class with a non-cutting tip e.g., 1633 B
- the endodontist may be able to directly reach the apex 1566 , after step 2040 , by using electrically operated NiTi instruments selected from the 1 st category, 1 st class with a non-cutting tip (e.g., 1633 B), starting by enlarging the piercing with a No. 20 instrument having an approximate 4% taper.
- the process is resumed by using, in increasing order, instruments selected from the 1 st category, 1 st class, from No. 10 with an approximate 2% taper, to No. 20 with an approximate 4% taper of the 1 st category, 1 st class with a non-cutting tip, followed by non-cutting tip instruments of the 2 nd and 3 rd categories, as deemed appropriate by the endodontist.
- root canal is irrigated with sodium hypochloride and EDTA (Ethylenediaminetetraacetic acid) at each relevant step of process 2000 .
- EDTA Ethylenediaminetetraacetic acid
- FIGS. 33 through 36 provide supporting illustrations of this novel process 2000 :
- FIG. 24A shows a broken file in tooth no. 46 blocking the totality of the root canal.
- FIG. 24B shows the bypassing of the broken file and the piercing of the hypercalcification and reaching the apex with the new instrument according to the present invention.
- FIG. 24C shows the fully hermetic obturation of the treated root canal.
- FIG. 33A shows an incomplete root treatment of tooth no. 35 due to hypercalcification blocking the third apical of the root canal.
- FIGS. 33B, 33C , and 33 D show the piercing of the old resistant paste and progressively piercing the hypercalcification with the new instrument reaching the apex, according to the present invention.
- FIG. 34 shows a fully hermetic obturation of tooth no. 46 after piercing a hypercalcification and passing through an accentuated curved line.
- FIG. 35 shows a fully hermetic obturation of tooth no. 47 after piercing a hypercalcification and passing through an accentuated curved line.
- the instruments of the present invention may be used to penetrate root obstructions resulting from curved root canals.
- the instruments of the 2 nd category may be used followed by the instruments of the 3 rd category, until the apex of the root canal is reached, with at least an instrument No. 20 having an approximate 4% taper.
- instruments selected from the 1 st category, 2 nd class are used, starting in increasing order from No. 8 to No. 15, with an approximate 2% taper followed by the instruments of the 2 nd and 3 rd categories.
- FIGS. 34, 35 provide supporting illustrations of this novel process:
- FIG. 34 shows a fully hermetic obturation of tooth no. 46 after piercing a hypercalcification and passing through an accentuated curved line.
- FIG. 35 shows a fully hermetic obturation of tooth no. 47 after piercing a hypercalcification and passing through an accentuated curved line.
- FIG. 16 it comprises FIGS. 16A, 16B, and 16C and illustrates an exemplary tooth 1600 having a root canal 1612 that is obstructed by a shoulder 1610 .
- the treatment method 2100 is performed according to the following steps:
- the endodontist enlarges at step 2110 of FIG. 21A , the root canal 1612 of the tooth 1600 by using a manual instrument selected from the 1 st category, 2 nd class, No. 8 with an approximate 2% taper, in increasing order to No. 15 with an approximate 2% taper, in order to reach the shoulder 1610 .
- FIG. 16A shows an enlarged view of a cutting tip 1633 A
- FIG. 16C shows an enlarged view of a non-cutting tip 1633 B.
- the endodontist then, at step 2120 , further enlarges the root canal 1612 using electrically rotating instruments selected from the 2 nd category, starting with files No. 10 and an approximate 2% taper, in an increasing order to No. 20 with an approximate 2% taper, up to the shoulder 1610 .
- the endodontist continues to enlarge the root canal 1612 at step 2120 , using electrically rotating instruments selected from the 3 rd category, starting with files No. 20 to 25 with an approximate 4% taper, and continuing with files No. 25 with an approximate 6% taper, whenever possible, until the shoulder 1610 is reached. Preferred results were obtained with a No. 20 instrument with an approximate 4% taper.
- the endodontist continues at step 2130 by creating a path 1655 through the shoulder 1610 using manual NiTi instruments 1620 selected from the 1 st category, 1 st class, No. 20 with an approximate 4% taper and a cutting tip 1633 , by exerting a manual force in a push and pull motion along the arrow F. Thereafter, the instrument 1620 is withdrawn.
- the relatively large cross sectional surface of the cutting tip 1633 A avoids opening a false canal when exerting a relatively high manual force.
- the endodontist enlarges the path 1655 using a manual NiTi instrument selected from the 1 st category, 1 st class, No. 20 having an approximate 4% taper and a non-cutting tip 1633 B in order to preserve the opened path 1655 .
- the endodontist uses a manual stainless steel instrument selected from the 1 st category, 1 st class, No. 20 having an approximate 2% taper with a cutting tip to penetrate the shoulder 1610 in a push and pull motion. Thereafter, it is recommended to manually enlarge the newly opened path 1655 using a manual stainless steel instrument selected from the 1 st category, 1 st class, No. 20 having an approximate 2% taper with a non-cutting tip 1633 B.
- the endodontist continues to enlarge the path 1655 using a manual NiTi instrument selected from the 1 st category, 1 st class, No. 20 having an approximate 4% taper and a cutting tip 1633 .
- a manual NiTi instrument selected from the 1 st category, 1 st class, No. 20 and an approximate 4% taper with a non-cutting tip 1633 B, may be used in order to preserve the newly opened path 1655 .
- the endodontist uses a manual stainless steel instrument 1620 selected from the 1 st category, 1 st class, No. 15 having an approximate 2% taper and a cutting tip 1633 , in order to penetrate the shoulder 1610 .
- This step is followed by the use of a manual stainless steel instrument 1620 selected from the 1 st category, 1 st class, No. 15 having an approximate 2% taper with a non-cutting tip 1633 B, in order to preserve the newly opened path 1655 .
- the endodontist may use smaller stainless steel instruments 1620 in the same sequence until reaching the apex 1650 .
- the endodontist further enlarges the opened path 1655 manually until the introduction of stainless steel instruments selected from the 1 st category, 1 st class, No. 20 with an approximate 2% taper (alternatively NiTi instrument No. 20 with an approximate 4% taper) having a cutting tip 1633 A and then a non-cutting tip 1633 B, is made possible.
- the endodontist uses, at step 2150 , electrically operated NiTi instruments 1630 selected from the 1 st category, 1 st class, 2 nd category, with a non-cutting tip 1633 B, followed by the use of a non-cutting tip instrument 1630 of the 3 rd category.
- the endodontist sequentially uses, in increasing order, the instruments 1630 starting with instruments selected from the 1 st category, 1 st class, No. 10 to No. 20 with an approximate 2% taper, and then instruments from No. 20 to No. 25 of the 2 nd category and finally instrument No. 20 or 25 with an approximate 4% taper of the 3 rd category at the apex 1650 .
- step 2160 upon completion of step 2140 as described earlier, the endodontist clears the widened root canal of any debris, as is known in the field, in preparation for the final obturation step.
- the endodontist obturates the root canal with the appropriate filling material 1446 , as is known in the field.
- the apex 1650 it is possible to directly reach the apex 1650 , following step 2140 , by using electrically operated instruments selected from the 1 st category, 1 st class, provided with non-cutting tips, in an increasing order from files No. 10 with an approximate 2% taper to files No. 20 with an approximate 4% taper, followed by instruments of the 2 nd and 3 rd categories as deemed appropriate by the endodontist.
- a manual NiTi instrument No. 20 (1 st category, 1 st class) having an approximate 4% taper and a non-cutting tip (e.g., 1633 B) the endodontist may be able to directly reach the apex 1650 by using electrically operated non-cutting tip NiTi instruments, starting by enlarging the path 1655 with a file No. 20 having an approximate 4% taper (1 st category, 1 st class) then using in increasing order, non-cutting tip instruments selected from the 1 st category, 1 st class, from No. 10 to No. 20 having an approximate 2% taper and then No.
- root canal is irrigated with sodium hypochloride and EDTA (Ethylenediaminetetraacetic acid) at each relevant step of process 2100 .
- EDTA Ethylenediaminetetraacetic acid
- FIGS. 25 and 37 provide supporting illustrations of this novel process 2100 :
- FIG. 25A shows a hypercalcification, a shoulder, and a broken file in the mesial canals of tooth no. 36.
- FIG. 25B shows the broken file.
- FIG. 25C shows the bypassing of the broken file, the penetration of the shoulder and the piercing of the hypercalcification in the 2 nd mesial canal and reaching the apex with the new instrument, according to the present invention.
- FIG. 25D shows the fully hermetic obturation of the treated root canal.
- FIG. 37A shows a blockage in the mesial canal of tooth no. 16 due to a shoulder.
- FIG. 37B shows the elimination of the shoulder with the new instrument reaching the apex, according to the present invention.
- FIG. 17 it comprises FIGS. 17A and 17B and illustrates an exemplary tooth 1700 having a root canal 1712 that is blocked or obstructed by, for example a residual, hardened paste 1710 from a previous root canal treatment.
- the treatment method 2200 is performed according to the following steps:
- the endodontist opens the root canal 1712 at step 2210 of FIG. 22A using instruments 1720 selected from the 1 st category, 2 nd class, starting with file No. 10 with an approximate taper 2%, in order to create an initial path 1733 in the existing residual paste 1710 , using an instrument 1725 with a cutting tip, to a depth of approximately 2 mm to 3 mm, using an appropriate softening agent.
- the endodontist enlarges the opened initial path 1733 with instruments 1720 selected from the 2 nd and 3 rd categories.
- the endodontist pierces again the residual paste 1710 , through the initial path 1733 , using an instrument 1720 selected from the 1 st category, 2 nd class, file No. 15, to an additional depth of approximately 2 mm-3 mm.
- the endodontist enlarges the width of the initial path 1733 using instruments 1720 selected from the 2 nd and 3 rd categories.
- the endodontist pierces again the widened initial path 1733 using an instrument 1730 selected from the 1 st category, 2 nd class, file No. 15, with a possible recourse to file No. 10 of the 1 st category, 2 nd class, until the apex 1750 is reached.
- the endodontist enlarges the opened path 1755 with instruments selected from the 2 nd and 3 rd categories in preparation for the obturation step.
- process 2200 will be used depending on the nature of the encountered obstruction, i.e. fractured instrument, hypercalcification, curved root canal or shoulder.
- the obstruction within the root canal includes a resistant, residual paste 1710
- the process 2000 described earlier in connection with FIG. 20 relating to the piercing of the hypercalcification can be used, in the same sequence from step 2030 through step 2070 .
- step 2270 upon completion of step 2260 as described earlier, the endodontist clears the widened root canal of any debris, as is known in the field, in preparation for the final obturation step.
- the endodontist obturates the root canal with the appropriate filling material 1446 , as is known in the field.
- root canal is irrigated with sodium hypochloride and EDTA (Ethylenediaminetetraacetic acid) at each relevant step of process 1900 .
- EDTA Ethylenediaminetetraacetic acid
- FIGS. 27, 33, 37, 38 provide supporting illustrations of this novel process 2200 :
- FIG. 27A shows three broken files with resistant paste in tooth no. 35 blocking the totality of the root canal.
- FIG. 27B shows the bypassing of the three broken files and the piercing of the resistant paste with the new instrument reaching the apex, according to the present invention.
- FIG. 27C shows the fully hermetic obturation of the root canal.
- FIG. 33A shows an incomplete root treatment of tooth no. 35 due to hypercalcification blocking the third apical of the root canal.
- FIGS. 33B, 33C , and 33 D show the piercing of the old resistant paste and progressively piercing the hypercalcification with the new instrument reaching the apex, according to the present invention.
- FIG. 37A shows a blockage in the mesial canal of tooth no. 16 due to a shoulder and a resistant paste.
- FIG. 37B shows the elimination of the shoulder and the piercing of the resistant paste with the new instrument reaching the apex, according to the present invention.
- FIG. 38A shows a false canal and a resistant paste in tooth no. 37.
- FIG. 38B shows the avoidance of the false canal and the piercing of the resistant paste with the new instrument reaching the apex, according to the present invention.
Abstract
Instruments and associated methods for performing endodontic treatment and that demand less time and fatigue onto the dentists and patients, while presenting the following accomplishments: debride the root canals in three dimensions and performing the optimal treatment; shape the root canals to facilitate the irrigation; these instruments are resistant to breakage and pressure while operating at high speed and torque; the instruments are capable of bypassing most obstacles, broken files, hypercalcification, curved roots canals, shoulders, and residual resistant pastes; and they present an alternative to arduous and expensive surgeries like endodontic or implant surgeries. As a result, they prevent fractures and procedural errors in making false canals or perforations of the root canals.
Description
- The present invention relates to instruments for endodontic use, and more particularly to apparatuses and associated methods for performing root canal treatment.
- In endodontics it is necessary to thoroughly debride a root canal (or pulp chamber) of a tooth, in order to reduce the chances of bacterial growth in the root canal, and to improve the healing potential of the remaining healthy tissue. As used herein, debridement includes for example, the removal of dead, damaged, or infected tissue of the dental pulp, as well as hypercalcification, residual resistant paste, various constrictions, broken instruments, and fragments or foreign material lodged in the root canal.
- This debridement would ideally terminate at the apical foramen. The apical foramen is the opening at the apex of the root of the tooth, through which the nerve and blood vessels that supply the dental pulp pass. The dental pulp resides in the root canal and is comprised of living circulatory, connective, and nerve tissues.
- As part of the endodontic therapy, and following the debridement of the root canal, the endodontic clinician shapes the root canal prior to inserting a filler material in place of the original dental pulp.
- To this end, hand (i.e., manual) files and rotary files (i.e., electrically operated) commonly called spiral instruments are used for the treatment of root canals. Typically, these spiral instruments have a generally triangular, square, or rectangular cross section, and comprise edges (or corners) that attack the dental wall and strike the dentine wall at an acute angle. Consequently, these conventional files have a tendency to wear out prematurely and to break.
- In addition, these conventional files may bind when resisted by obstacles and eventually break inside the root canal, as they do not have a sufficient thickness to resist torsion fatigue induced thereon. Moreover, such files do not generally perform a complete rubbing of the dental wall in order to achieve a hermetic obturation of the root canal, thus yielding to a risk of infection.
- In addition, the tip of these spiral instruments is usually a non-cutting tip based on the assumption that a cutting tip will facilitate the formation of false canals.
- Conventionally, withdrawing segments of fractured instruments that cause root obstructions, was done by means of ultrasonic files. An exemplary technique requires the use of conventional manual files from No. 8 to 15 having a taper of 2%, in order to open a cutting around the lodged segment of the fractured instrument. However, this withdrawal technique involves the risk of introducing additional breakage of the newly used instrument, as well as opening false canals. As a result, this conventional technique has not generally yielded optimal results.
- Furthermore, in order to overcome obstructions resulting from hypercalcification, certain conventional treatment methods propose the enlargement of the root canal using files from No. 8 to 15 having a 2% taper, or C+ files followed by the use of rotary files (electrically operated) from No. 10 to 25 with a 2%, 4%, or 6% taper. However, this method also does not provide optimal results and introduces the risk of breakage of the newly used file, as well as opening false canals.
- The weakness of the conventional endodontic files in fracture or in procedural errors, is due to their cyclic fatigue and torsional stress, and the difficulties of removing the broken files, as explained in the following publications:
- Bahcall J K, et al., “The causes, prevention, and clinical management of broken endodontic rotary files,” Dent Today. 2005 November; 24(11):74, 76, 78-80; quiz 80, Department of Surgical Sciences, Marquette University School of Dentistry, USA, the abstract of which is available online at http://www.ncbi.nlm.nih.gov/pubmed/16358801.
- Peters O. A., “Rotary Instrumentation: An endodontic perspective,” American Association of Endodontists, Winter 2008, which is available online at https://www.aae.org/uploadedfiles/publications_and_research/endodontics_colleagues_for_excellence_newsletter/winter08ecfe.pdf. This publication makes it clear that not all root canals lend themselves to rotary preparation, due to varying degrees of the clinicians' skills and case complexity, and to the fact that rotary files may fracture rather unexpectedly or create procedural errors.
- The following references clarify that the fracture of an endodontic file may cause the endodontic treatment to have a lower success rate, and that fragments of files may be removed using a retrieval system; however, this procedure can be technically demanding, and several fragments may be left in-situ:
- Metzger, Z. et al., “The Self-Adjusting File (SAF). Part 1: Respecting the Root Canal Anatomy—A New Concept of Endodontic Files and Its Implementation,” Journal of Endodontics 36 (4): 679-90 (2010).
- De-Deus, G. et al., “The Self-Adjusting File Optimizes Debridement Quality in Oval-shaped Root Canals,” Journal of Endodontics 37 (5): 701-5 (2011).
- Siqueira Jr., J. F., et al. “Ability of Chemomechanical Preparation with Either Rotary Instruments or Self-Adjusting File to Disinfect Oval-shaped Root Canals,” Journal of Endodontics 36 (11): 1860-5 (2010).
- Although cylindro conical instruments have been used by dentists only in root canal filing material (spreaders) with a smooth surface, they have not been used to probe, shape, debride, catheterize, penetrate or bypass obstacles in root canal treatments. Reference is made to Carrotte, P., “Endodontics: Part 5 Basic instruments and materials for root canal treatment,” British Dental Journal 197, 455-464 (2004), Published online: 23 Oct. 2004, at http://www.nature.com/bdj/journal/v197/n8/full/4811738a.html Root canal filling instruments.
- In addition to the risks involved with the use of conventional treatment methods, there is a potential for damaging the apex or causing a shear in the coronal part or in the apical part of the root canal.
- Yet another disadvantage of the conventional treatment methods is that the instruments generally cannot penetrate difficult hypercalcifications, blockages, and narrow canals, nor can they probe the ledges or pierce the most resistant residual paste in the root canal.
- In addition, they cannot bypass lodged segments of fractured instruments in the root canals, nor can they remove dental plugs. Moreover, they cannot penetrate blockages resulting from root canal treatment, nor can they penetrate the obliterated coronary infundibula due to the high fracture risk.
- Still another disadvantage of the conventional treatment methods is that the instruments generally may not be totally suitable for use under elevated torque or high speed, due to the high fracture risk. In addition, the spiral instruments generally exert force on the dental wall and are therefore subjected to a reactive force. In fact, rubbing the dental wall does not facilitate penetration in the desired direction of the dental apex.
- Wherefore, there still remains an unsatisfied need for new endodontic instruments and associated methods of use for performing better root canal treatment. These instruments should penetrate or bypass most, if not all blockages in the root canals, while achieving optimal root canal treatment with optimal root canal shape, in order to maximize irrigation and hermetic obturation of the root canals.
- The present invention satisfies this need, and presents several preferred designs for endodontic instruments and associated methods of use for performing root canal treatment. These instruments penetrate or bypass most, if not all blockages in the root canal, while achieving optimal root canal treatment with optimal root canal shape, in order to maximize irrigation and hermetic obturation of the root canal.
- In addition, the treatment of a root canal with the instruments and methods of the present invention, while avoiding damage to either the root canal or the apex, is ensured a very high rate of success.
- Although the teeth and grooves of the endodontic instruments of the present invention may become worn with use, they will not easily break because they do not attack the radical dentine at weak pointed angles. In addition, the use of sandblasting to form the endodontic instrument helps to avoid corrosion of instrument resulting from stocking, storage, or usage.
- The various instruments of the invention surpass the conventional stainless steel hand files and the NiTi rotary instruments, and present numerous advantages among which are the following:
- The instruments are very flexible so that they may follow difficult curved root canals without damaging the apex, making a false canal, or causing a shear in the coronal part and the apex of the root canal.
- They penetrate the difficult hypercalcifications, obstructions and narrow canals.
- They probe the ledges of the root canal.
- They pierce residual, resistant pastes.
- They bypass fractured files, lentulos, posts, and fractured silver cones.
- They do not create false canals, shears and dental plugs.
- They allow the removal of pre-existing dental plugs.
- They penetrate blockages caused by an inadequate use of other instruments.
- They penetrate the obliterated coronary infundibula with low risk of fracture or of damaging the apex.
- Furthermore, these instruments successfully perform and facilitate the complete endodontic procedure:
- They penetrate root canals that other endodontic instruments fail to penetrate.
- They resist increased torque and high speeds (ranging from approximately 1.5 N to 5 N and from approximately 300-600 rpm) due to their high resistance.
- Their success in treating and retreating root canals helps to avoid expensive and painful endodontic surgeries and eventually implants in case of failure of endodontic treatments.
- To this end, each instrument of the present invention comprises a handle that secures an elongated tapered shank. The shanks of the instruments include cylindro-conical files having a circular cross section, which penetrate the root canals using most, if not the entirety of their peripheral surfaces, thus providing a better ability to resist torsion fatigue, to preserve the initial circular dental canal anatomy, and to attain a hermetical obturation of the root canals. The shanks can assume a variety of designs based on a combination of characteristics, including but not limited to: a roughed surface, a cutting surface, a smooth area, a conical cutting tip, a non-cutting tip, a beveled tip, and a non-beveled tip.
- Based upon the various designs of their shanks, the endodontic instruments may generally be categorized, as follows:
-
- 1st Category: Instruments for catheterization and for passing through root obstacles.
- 2nd Category: Instruments for fine and curved roots.
- 3rd Category: Instruments that may be used for enlarging and shaping root canals.
- The instruments in the 1st Class of the 1st Category can be either hand operated or electrically rotating. Each of these instruments includes a lateral surface that contains a number of superficial horizontally, vertically, or transversally striated grooves that define slightly cutting edges, and that are either separated by smooth areas or sandblasted areas. The instruments in this class include a generally circular cross-section, and a conical tip that may be cutting or non-cutting, beveled or non-beveled. These instruments include hand operated files for root canal treatment that are preferably made from stainless steel (with nos. ranging from 10 to 25) or NiTi (with nos. ranging from 20 to 25) and electrically rotating NiTi files (with nos. ranging from 10-to 25), all with a taper of approximately 0, 1, 2, 3, or 4% and a length ranging from approximately 12 mm-32 mm.
- The instruments in the 2nd Class of the 1st Category are hand operated instruments having a series of horizontally, vertically, or transversally striated deep grooves with cutting edges, that are separated by restricted smooth or sandblasted areas or even instruments that are completely sandblasted. The instruments in this class include a generally circular cross section, and a conical tip that may be cutting or non-cutting. The shanks of these instruments range from No. 6 to 20. The shanks may be made from stainless steel, and range from No. 6 to 20. The shanks may alternatively be made from NiTi, and range from No. 20 to 40. The shafts of all these instruments have a taper of approximately 0%, 1%, 2%, and 4%, and a length that ranges from approximately 12 mm to 32 mm.
- The instruments of the 2nd Category preferably include electrically operated rotating NiTi instruments, each having a tapered shank with a series of transversal, deep, striated grooves with cutting edges. In other embodiments can alternatively, the instruments include a series of horizontally or vertically striated, deep grooves with cutting edges, that are separated by either smooth or roughened (i.e., sandblasted) restricted areas. These instruments include electrically rotating files for root canal treatment with nos. 10 to 20, and having an approximate 2% taper and a length ranging from approximately 21 mm to 32 mm.
- The instruments of the 3rd Category preferably include electrically operated rotating instruments, each having a shank with a generally circular cross section and a conical cutting or non-cutting tip, with a series of saw teeth that are separated by restricted smooth areas. In other embodiments, the shank can include horizontally, vertically, or transversally striated grooves. These instruments include electrically rotating files for root canal treatment with nos. ranging from 20 to 40, and having an approximate 4% to 10% taper and a length ranging from approximately 21 mm to 32 mm.
- The endodontic procedure being administered determines the selection of the category, the instruments within each category, and the sequential use of the selected instruments.
- The various features of the present invention and the manner of attaining them will be described in greater detail with reference to the following description, claims, and drawings, wherein reference numerals are reused, where appropriate, to indicate a correspondence between the referenced items, and wherein:
-
FIG. 1 comprisesFIGS. 1A and 1B , and represents two schematic illustrations of an exemplary hand operated (or electrically rotating) instrument having a long, tapered shank which includes superficial horizontally striated grooves with slightly cutting edges that are separated by smooth areas (FIG. 1A ), and which includes deep horizontally striated grooves with cutting edges that are separated by restricted smooth areas (FIG. 1B ), according to preferred embodiments of the present invention; -
FIG. 2 comprisesFIGS. 2A and 2B , and represents two schematic illustrations of an exemplary hand operated (or electrically rotating) instrument having a long, tapered shank which includes superficial vertically striated grooves with slightly cutting edges that are separated by smooth areas (FIG. 2A ), and which includes deep vertically striated grooves with cutting edges that are separated by restricted smooth areas (FIG. 2B ), according to preferred embodiments of the present invention; -
FIG. 3 comprisesFIGS. 3A and 3B , and represents two schematic illustrations of an exemplary hand operated (or electrically rotating) instrument having a long, tapered shank which includes continuous, superficial transversally striated grooves with slightly cutting edges that are separated by smooth areas (FIG. 3A ), and which includes deep transversally striated grooves with cutting edges that are separated by restricted smooth areas (FIG. 3B ), according to preferred embodiments of the present invention; -
FIG. 4 is a schematic illustration of an exemplary hand operated (or electrically rotating) instrument having a long, tapered shank with a beveled tip, and discontinuous, superficial transversally striated grooves with slightly cutting edges, separated by smooth areas, according to a preferred embodiment of the present invention; -
FIG. 5 is a schematic illustration of an exemplary hand operated (or electrically rotating) instrument having a long, tapered shank with superficial transversally striated grooves with slightly cutting edges, separated by roughened areas (such as by sandblasting), according to a preferred embodiment of the present invention; -
FIG. 6 is a schematic illustration of an exemplary hand operated instrument having a long, tapered shank with deep transversally striated grooves with cutting edges, separated by restricted smooth areas, according to a preferred embodiment of the present invention; -
FIG. 7 is a schematic illustration of an exemplary electrically rotating instrument having a long, tapered shank with deep transversally striated grooves with cutting edges, separated by restricted smooth areas, according to a preferred embodiment of the present invention; -
FIG. 8 is a schematic illustration of an exemplary electrically rotating (or hand operated) instrument having a long, tapered shank with a series of saw teeth separated by restricted smooth areas, according to a preferred embodiment of the present invention; -
FIG. 9 comprisesFIGS. 9A and 9B , and represents two schematic illustrations of an exemplary hand operated (FIG. 9B ) and electrically rotating (FIG. 9A ) spiral instrument with an upper cylindro-conical part having a conical tip, wherein the cylindro-conically shaped area is roughened, for example, by transversally grooved striations with cutting edges separated by restricted smooth or sandblasted areas, according to preferred embodiments of the present invention; -
FIG. 10 comprisesFIGS. 10A and 10B , and represents two schematic illustrations of an exemplary hand operated (FIG. 10B ) and electrically rotating (FIG. 10A ) instrument having a conical tip and a long, generally tapered shank that defines a series of cylindro-conically shaped areas (or sections) separated by spirally shaped sections, wherein the cylindro-conically shaped areas (or sections) are roughened by, for example, transversally grooved striations with cutting edges separated by restricted smooth areas, according to preferred embodiments of the present invention; -
FIG. 11 comprisesFIGS. 11A and 11B , and represents two schematic illustrations of an exemplary hand operated (FIG. 11B ) and electrically rotating instrument (FIG. 11A ) having a long, generally tapered shank that defines a series of spirally shaped sections separated by cylindro-conically shaped areas (or sections) that are roughened by, for example, transversally grooved striations with cutting edges separated by restricted smooth areas, according to preferred embodiments of the present invention; -
FIG. 12 comprisesFIGS. 12A and 12B , and represents two schematic illustrations of an exemplary hand operated (FIG. 12B ) and electrically rotating (FIG. 12A ) instrument having a conical tip and a long, generally tapered sand blasted shank that defines a series of cylindro-conically shaped areas (or sections) separated by spirally shaped sections, wherein the cylindro-conically shaped areas (or sections) are roughened by, for example, transversally grooved striations with cutting edges separated by restricted sand blasted areas, according to preferred embodiments of the present invention; -
FIG. 13 comprisesFIGS. 13A, 13B, 13C, and 13D , and illustrates a cross-sectional view of an exemplary tooth, with the cross-hatching removed for clarity of illustration, showing the sequential steps of progressively treating a root canal without a resistive path, obstruction, or blockage, using the instrument and process of the present invention; -
FIG. 14 comprisesFIGS. 14A, 14B, 14C, 14D, 14E, and 14F , and illustrates a cross-sectional view of an exemplary tooth, with the cross-hatching removed for clarity of illustration, showing the sequential steps of progressively treating a root canal that is blocked by a fragment of a broken instrument, such as a file, by bypassing the lodged fragment using the instrument and process of the present invention; -
FIG. 15 comprisesFIGS. 15A, 15B, and 15C and illustrates a cross-sectional view of an exemplary tooth, with the cross-hatching removed for clarity of illustration, showing the sequential steps of progressively treating a root canal that is blocked by hypercalcification, by piercing the hypercalcification using the instrument and process of the present invention; -
FIG. 16 comprisesFIGS. 16A, 16B, and 16C and illustrates a cross-sectional view of an exemplary tooth, with the cross-hatching removed for clarity of illustration, showing the sequential steps of progressively treating a root canal that is partially blocked by a shoulder, by bypassing the shoulder using the instrument and process of the present invention; -
FIG. 17 comprisesFIGS. 17A, 17B, and 17C and illustrates a cross-sectional view of an exemplary tooth, with the cross-hatching removed for clarity of illustration, showing the sequential steps of progressively treating a root canal that is blocked by a residual resistant paste, by piercing and removing the resistant paste using the instrument and process of the present invention; -
FIG. 18 is a flow chart that illustrates the endodontic treatment process that does not exhibit signs of a resistive path, obstruction, or blockage, by selectively using the instruments ofFIGS. 1B, 2B, 3B, and 6 through 8 according to the present invention; -
FIGS. 19A and 19B represent a flow chart that illustrates the endodontic treatment method of bypassing root obstructions resulting from fractured instruments, by selectively using the instruments ofFIGS. 1A, 1B, 2A, 2B, 3A, 3B , and 4 through 8 according to the present invention; -
FIGS. 20A and 20B represent a flow chart that illustrates the endodontic treatment method of penetrating root obstructions resulting from hypercalcification, by selectively using the instruments ofFIGS. 1A, 1B, 2A, 2B, 3A, 3B, and 5 through 8 according to the present invention; -
FIGS. 21A and 21B represent a flow chart that illustrates the endodontic treatment method of bypassing root obstructions resulting from a shoulder obstruction, by selectively using the instruments ofFIGS. 1A, 1B, 2A, 2B, 3A, 3B , and 5 through 8 according to the present invention; -
FIGS. 22A and 22B represent a flow chart that illustrates the endodontic treatment method of penetrating root obstructions resulting from a previous root canal treatment, by selectively using the instruments ofFIGS. 1A, 1B, 2A, 2B, 3A, 3B, and 4 through 8 according to the present invention; and -
FIGS. 23A, 23B, 23C, 24A, 24B, 24C, 25A, 25B, 25C, 25D, 26A, 26B, 27A, 27B, 27C, 28A, 28B, 28C, 28D, 29A, 29B , 29C, 30A, 30B, 31A, 31B, 32A, 32B, 32C, 33A, 33B, 33C, 33D, 34, 35, 36A, 36B, 36C, 37A, 37B, 38A, and 38B are X-ray views that illustrate various cases treated by the instruments and methods of the present invention. - It should be understood that the sizes of the different components in the figures might not be in exact proportion, and are shown for visual clarity and for the purpose of explanation.
- The instruments of the present invention can be used for probing, enlarging, penetrating, and bypassing difficult root canals obstructions, they may be hand operated or electrically operated, they may have a continued or a discontinued rotation, and they may have reciprocal rotation, a clockwise rotation, or an anti-clockwise rotation.
- As it will be explained later in more specific details, each of these instruments comprises a handle that secures an elongated tapered shank. The cross section of the shank is generally circular, so as to eliminate sharp edges (or corners) that might otherwise attack the dental wall and strike the dentine wall at an acute angle, thus ultimately extending the life of the instrument.
- The shank can assume a variety of designs, based on a combination of characteristics, including but not limited to: a roughed surface, a cutting surface, a smooth area, a conical cutting tip, a non-cutting tip, a beveled tip, and a non-beveled tip.
- Based upon the various designs of their shanks, the endodontic instruments may be categorized as follows:
-
- 1st Category: Instruments for catheterization and for passing through root obstacles.
- 2nd Category: Instruments for fine and curved roots.
- 3rd Category: Instruments that may be used for enlarging and shaping root canals.
- Each of these categories will now be described in more detail.
- 1st Category: Instruments for Catheterization and for Passing Through Root Obstacles, Shoulders, Resistant Paste, and Hypercalcifications
- This category comprises two classes of instruments:
- First (1st) Class: Instruments for Passing Through Root Obstacles, Shoulders, Resistant Paste, and Hypercalcifications
- This class includes hand operated and electrically rotating instruments having a number of superficial horizontally, vertically, or transversally striated grooves (also referred to as “shallow grooves”) that define slightly cutting edges, and that are either separated by smooth areas or sandblasted areas or even instruments that are completely sandblasted. As used herein, the term “shallow” denotes a general depth that ranges between approximately 0.06 mm and 0.4 mm. The instruments in this class include a generally circular cross-section, and a conical tip that may be cutting or non-cutting, beveled or non-beveled.
- The shanks of the hand operated instruments may be made from stainless steel, and range from No. 10 to 25. The shanks of the hand operated instruments that are made from NiTi, preferably range from No. 20 to 25. The shafts of the electrically rotating NiTi instruments preferably range from No. 10 to 25. The shafts of all these instruments have a taper ranging from approximately 0% to 4%, and a length that ranges from approximately 12 mm to 32 mm. (
FIGS. 1-5 ). - The more preferred embodiments of the instruments in this class that provide optimal results are the hand operated instruments Nos. 10, 15, and 20, with a shank taper with an approximate 2% taper, and that are made from stainless steel. Other preferred embodiments include the hand operated instruments No. 20 with an approximate 4% shank taper that is made from NiTi. Additional preferred embodiments include the electrically rotating instruments that are made from NiTi, Nos. 10, 15, and 20, with a shank taper of approximately 2%, and Nos. 20 and 25 with a shank taper of approximately 4%.
- Sandblasted instruments with superficial grooves with slightly cutting edges, have provided good penetration results, namely in engraving a cutting adjacent to the fractured instrument without encroaching with the coils of the fractured instrument, and in removing the dentine of the root canal. Optimal penetration results have been obtained with instruments that are sandblasted with aluminum oxide.
- Second (2nd) Class: Instruments for Catheterization
- This class includes hand operated instruments having a series of horizontally, vertically, or transversally striated deep grooves with cutting edges, that are separated by restricted smooth or sandblasted areas or even instruments that are completely sandblasted. As used herein, the term “deep” denotes a general depth that ranges between approximately between 0.12 mm and 0.8 mm. The instruments in this class include a generally circular cross section, and a conical tip that may be cutting or non-cutting.
- The shanks of these instruments range from No. 6 to 20. The shanks may be made from stainless steel, and range from No. 6 to 20. The shanks may alternatively be made from NiTi, and range from No. 20 to 40. The shafts of all these instruments have a taper of approximately 0%, 1%, 2%, and 4%, and a length that ranges from approximately 12 mm to 32 mm (
FIG. 6 ). The preferred embodiments of the instruments in this class that provide optimal results are those made of stainless steel with Nos. 10, 15, and 20, with an approximate 2% taper. These preferred embodiments include instruments that are made from NiTi, No. 20, with an approximate 4% shank taper. - The instruments of this 1st category will now be described with reference to
FIGS. 1 through 6 .FIG. 1A is a schematic illustration of an exemplary hand operated instrument (or file) 100 for use as a first category, first class instrument, according to a preferred embodiment of the present invention. Theinstrument 100 generally includes an elongated,tapered shank 105 with superficial horizontallystriated grooves 110 with slightly cutting edges that are separated bysmooth areas 111. - In one exemplary embodiment, the
grooves 110 form horizontal linear striations that are approximately 1 mm wide. It should be understood that thegrooves 110 might assume other different patterns. The width of eachsmooth area 111 varies between approximately 2 mm and 3 mm. - The
instrument 100 further includes atip 120 and ahandle 125. Thetip 120 may be cutting or non-cutting, beveled or non beveled, depending on the desired application. Thehandle 125 secures one end of theshank 105, and enables an endodontist to safely and ergonomically hold theinstrument 100 while performing the treatment. It should be understood that theinstrument 100 may alternatively be electrically rotating, in which case, thehandle 125 is replaced with an appropriate handle or interface that connects theshank 105 to an external rotary source (not shown), as is known or available in the field. - The
shank 105 can be made of any suitable material, including but not limited to stainless steel or NiTi (Nickel Titanium). Theshank 105 may have a constant or variable taper along its axial length, ranging from approximately 0% to 4%, a length ranging from approximately 12 mm to 32 mm, and a width ranging from approximately No. 10 to 25. -
FIG. 1B illustrates anotherinstrument 150 for use as a first category, second class instrument according to a preferred embodiment of the present invention. Theinstrument 150 may also be used as a second or third category instrument, as explained herein. - The
instrument 150 is generally similar in design and construction to theinstrument 100 ofFIG. 1A , and comprises an elongated,tapered shank 155 with deep horizontallystriated grooves 160 with cutting edges that are separated by restrictedsmooth areas 161. In one exemplary embodiment, thegrooves 160 form horizontal linear striations that are approximately 2 to 3 mm wide. It should be understood that thegrooves 160 might assume other patterns. The width of eachsmooth area 161 is approximately 1 mm. - The
instrument 150 further includes a cutting ornon-cutting tip 120 and ahandle 125, whose design and function are explained earlier in connection with theinstrument 100. - It should be understood that these
instruments -
FIG. 2 respectively illustrates two exemplary hand operated instruments 200 (FIG. 2A ) and 250 (FIG. 2B ) that are generally similar in design and construction to theinstruments 100, 150 (respectively) ofFIG. 1 . It should be understood that theseinstruments - The
instrument 200 can be used as a first category, first class instrument. It includes an elongated,tapered shank 205 with superficial verticallystriated grooves 210 with slightly cutting edges that are separated bysmooth areas 211, according to a preferred embodiment of the present invention. In one exemplary embodiment, thegrooves 210 form vertical linear striations that are approximately 1 mm in width. Thesmooth areas 211 separate thegrooves 210 at a distance of approximately 2 to 3 mm. - The
instrument 200 further includes a cutting ornon-cutting tip 220 and ahandle 125, which are respectively similar to thetip 120 and handle 125 of theinstrument 100 ofFIG. 1A . - The
instrument 250 ofFIG. 2B can be used as a first category, second class instrument, according to a preferred embodiment of the present invention. It may also be used as a second or third category instrument, as explained herein. Theinstrument 250 includes an elongated,tapered shank 255 having deep verticallystriated grooves 260 with cutting edges that are separated by restrictedsmooth areas 261. In one exemplary embodiment, thegrooves 260 form vertical linear striations that are approximately 2 to 3 mm in width. Thesmooth areas 261 separate thegrooves 260 at a distance of approximately 1 mm. - The
instrument 250 further includes a cutting ornon-cutting tip 220 and ahandle 125, which are respectively similar to thetip 120 and handle 125 of theinstrument 150 ofFIG. 1B . -
FIG. 3 respectively illustrates two exemplary hand operated instruments 300 (FIG. 3A ) and 350 (FIG. 3B ) that are generally, respectively similar in design and construction to theinstruments FIG. 1 and 200, 250 ofFIG. 2 . It should be understood that theseinstruments - The
instrument 300 can be used as a first category, first class instrument. It includes an elongated,tapered shank 305 with superficial transversallystriated grooves 310 with slightly cutting edges that are separated bysmooth areas 311, according to a preferred embodiment of the present invention. In one exemplary embodiment, thegrooves 310 form transversally linear striations that are approximately 1 mm in width. Thesmooth areas 311 separate thegrooves 310 at a distance of approximately 2 mm to 3 mm. - The
instrument 300 further includes a cutting ornon-cutting tip 320 and ahandle 125, which are respectively similar to thetip 120 and handle 125 of theinstrument 100 ofFIG. 1A . - The
instrument 350 ofFIG. 3B can also be used as a first category, second class hand operated instrument, according to a preferred embodiment of the present invention. It may also be used as a second or third category instrument, as explained herein. Theinstrument 350 includes an elongated,tapered shank 355 with deep transversallystriated grooves 360 with cutting edges that are separated by restrictedsmooth areas 361. In one exemplary embodiment, thegrooves 360 form transversally linear striations that are approximately 2 to 3 mm in width. Thesmooth areas 361 separate thegrooves 360 at a distance of approximately 1 mm. - The
instrument 350 further includes a cutting ornon-cutting tip 320 and ahandle 125, which are respectively similar to thetip 120 and handle 125 of theinstrument 150 ofFIG. 1B . -
FIG. 4 illustrates an exemplary hand operatedinstrument 400 that is generally similar in design and construction to theinstrument 300 ofFIG. 3A . It should be understood that theinstrument 400 can be modified, as explained herein, for use as an electrically rotating instrument. - The
instrument 400 can be used as a first category, first class instrument. It includes an elongated,tapered shank 405 with superficial transversallystriated grooves 410 with slightly cutting edges that are separated bysmooth areas 411, according to a preferred embodiment of the present invention. In one exemplary embodiment, thegrooves 410 form short, transversally linear striations that are approximately 1 mm in width. The distance between twoconsecutive grooves 410 may be adjusted so that it can be either fixed or variable, along the axial length of theshank 405. As an example only, the separation of the grooves 410 (which constitutes the width of the smooth areas 411) can vary between approximately 2 mm and 3 mm. - The
instrument 400 further includes a pointed, beveled cuttingtip 420 and ahandle 125. -
FIG. 5 illustrates an exemplary hand operatedinstrument 500 that is generally similar in design and construction to theinstrument 300 ofFIG. 3A . It should be understood that theinstrument 500 can be modified, as explained herein, for use as an electrically rotating instrument. - The
instrument 500 can be used as a first category, first class instrument. It includes an elongated,tapered shank 505 with superficial transversallystriated grooves 510 with slightly cutting edges that are separated by roughenedareas 511, according to a preferred embodiment of the present invention. In one exemplary embodiment, thegrooves 510 form short, transversally linear striations. - In a most preferred embodiment, the roughened
areas 511 are formed by sandblasting. Theinstrument 500 further includes a cutting ornon-cutting tip 520 and ahandle 125. -
FIG. 6 illustrates an exemplary hand operatedinstrument 600 that is generally similar in design and construction to theinstrument 350 ofFIG. 3B . It should be understood that theinstrument 600 can be modified, as explained herein, for use as an electrically rotating instrument. - The
instrument 600 can be used as a first category, second class instrument. It includes an elongated,tapered shank 605 with deep transversallystriated grooves 610 with cutting edges that are separated by restrictedsmooth areas 611, according to a preferred embodiment of the present invention. In one exemplary embodiment, thegrooves 610 form short, transversally linear striations that are approximately 2 to 3 mm in width. The separation distance between thegrooves 610 may be adjusted so that it can be either fixed or variable, along the axial length of theshank 605. As an example only, the separation of the grooves 610 (which constitutes the width of the smooth areas 611) is 1 mm. - The
instrument 600 further includes a pointed, cutting ornon-cutting tip 620 and ahandle 125. - 2nd Category: Instruments for Penetrating Fine and Curved Root Canals
- As illustrated in
FIG. 7 , this category comprises electrically operated rotating instruments (e.g., 700) that are preferably (but not exclusively) made for example of NiTi, from No. 10 to 20, with ashank 705 having a taper of approximately 2%. Although the illustratedinstrument 700 is shown to include a series of transversal, deep,striated grooves 710 with cutting edges, it should be understood that other embodiments can alternatively include a series of horizontally or vertically striated, deep grooves with cutting edges, that are separated by either smooth or roughened (i.e., sandblasted) restrictedareas 711, or even instruments that are completely sandblasted. - The
shank 705 of theinstrument 700 has a generally circular cross-section, and a conical cutting ornon-cutting tip 720, with a length ranging from approximately 21 to 32 mm. The circular cross section andconical tip 720 of theshank 705 helps create a space around the segment(s) of the fractured instruments that are lodged within the root canal, thus enabling the instruments of the 1st category, 1st class, to bypass the lodged fractured segment(s). - A
handle 725 secures theshank 705 to an external motorized source (not shown). - 3rd Category: Instruments which May be Used for Enlarging and Shaping Root Canals
- As illustrated in
FIG. 8 , this category comprises electrically operated rotating instruments (e.g., 800) made of NiTi from No. 20 to 40, with ashank 805 having a generally circular cross section. Although the illustratedinstrument 800 is shown to include a conical cutting ornon-cutting tip 820, with a series ofsaw teeth 810 that are separated by restrictedsmooth areas 811, it should be understood that other embodiments can further include horizontally, vertically, or transversally striated grooves. - The saw teeth configuration expels the dental debris from the root canal and lessens the rubbing force of the instrument on the walls of the root canal, especially when using files from Nos. 20 to 40, thus avoiding root canal cracks.
- The taper of the
shank 805 ranges from approximately 4% to 10%, and has a length of approximately 21 mm to 32 mm. - It is important to note that the shanks of the instruments in all the foregoing three categories may or may not be sandblasted. It is also noteworthy to indicate that the instruments of the above three categories successfully penetrate root hypercalcifications that are formed in the root canal. In addition, a file instrument No. 20 with a 4% taper, and a file instrument No. 17 with a 4% taper, have shown remarkable utility in creating a space around fractured, lodged fragments of previously used instruments, so that the instruments of the 1st category, 1st class, may be used in order to bypass these fractured instruments.
- Alternative embodiments that are contemplated by the present invention include but are not limited to the following hand operated and electrically operated instruments:
-
FIGS. 9A, 9B illustrate an electrically operatedinstrument 900 and a manually operatedinstrument 950 that is generally similar in design and function to the electrically operatedinstrument 900, and therefore only one instrument will be described in detail. The electrically operatedinstrument 900 generally includes an elongated,tapered shank 905 that defines an upper cylindro-conical section 910 and a spirally (or helically) shapedlower section 915. - The cylindro-
conical section 910 includes at its upper end, atip 920 that may be cutting or non-cutting, depending on the desired application. While in this particular illustration the cylindro-conical section 910 is illustrated as being a roughened surface, it should be understood that the cylindro-conical section 910 could include striated grooves with cutting edges separated by smooth or sandblasted areas. The length of theshank 905 preferably ranges between approximately 12 mm and 32 mm, and its width preferably varies from No. 10 to 40. The taper of the instrument preferably ranges from approximately 2% to 10%. In a preferred embodiment, theentire shank 905 of theinstrument 900 is sandblasted. -
Section 910 is intended to penetrate root canal blockages whilesection 915 serves to debride and to shape the opened path. - The
instrument 900 further includes ahandle 925 that secures one end of theshank 905, and that enables an endodontist to connect theinstrument 900 to an external rotary source (not shown) as is known or available in the field. Similarly, theinstrument 950 further includes amanual handle 955 that secures one end of theshank 905, and that enables an endodontist to safely and ergonomically hold theinstrument 950 while manually performing the treatment. -
FIGS. 10A, 10B illustrate an electrically operatedinstrument 1000, and a manually operatedinstrument 1050 that is generally similar in design and function to the electrically operatedinstrument 1000, and therefore only one instrument will be described in detail. The electrically operatedinstrument 1000 generally includes an elongated,tapered shank 1005 that defines a plurality of roughened cylindro-conical sections sections - The cylindro-
conical section 1010 of theinstrument 1000 comprise striated grooves with cutting edges separated by smooth or sandblasted areas and further includes at its forwardmost end, atip 1020 that may be cutting or non-cutting, depending on the desired application. The length of theshank 1005 ranges from approximately 12 mm to 32 mm, and its width preferably varies from No. 10 to 40. The taper of the instrument preferably ranges from approximately 2% to 10%. In a preferred embodiment, the whole instrument will be sandblasted. -
Section 1010 is intended to penetrate root canal blockages whilesection 1015 serves to debride and to shape the opened path. - The instruments illustrated in
FIG. 10 provide better penetration results than the instruments inFIG. 9 . They are preferred in case of hard hypercalcifications and resistant paste. -
FIGS. 11A, 11B respectively illustrate an electrically operated instrument 1100, and a manually operatedinstrument 1150 that is generally similar in design and function to the electrically operated instrument 1100, and therefore only one instrument will be described in detail. The electrically operated instrument 1100 generally includes an elongated,tapered shank 1105 that defines a plurality of roughened cylindro-conical sections sections - The
spiral section 1115 of the instrument 1100 further includes at its forwardmost end, atip 1120 that may be cutting or non-cutting, depending on the desired application. The length of theshank 1105 ranges from approximately 12 mm to 32 mm, and its width preferably varies from No. 10 to 40. The taper of the instrument preferably ranges from approximately 2% to 10%. - In the exemplary embodiment of
FIG. 11 , the cylindro-conical sections -
FIGS. 12A, 12B illustrate yet other alternative embodiments of an electrically operatedinstrument 1200 and a manually operatedinstrument 1250, that are respectively, generally similar in design and function to theinstruments FIGS. 10A, 10B . - The electrically operated
instrument 1200 generally includes an elongated,tapered shank 1205 that defines a plurality of roughened cylindro-conical sections sections conical section 1210 of theinstrument 1200 further includes at its forwardmost end, atip 1220 that may be cutting or non-cutting, depending on the desired application. The length of theshank 1205 ranges from approximately 12 mm to 32 mm, and its width preferably varies from No. 10 to 40. The taper of the instrument preferably ranges from approximately 2% to 10%. - In the exemplary embodiment of
FIG. 12 , the cylindro-conical sections - Having described the exemplary instruments embodied by the present invention, the methods of using these instruments will now be described in more detail, in connection with the drawings, particularly
FIGS. 13 through 18 . - Methods of Using the Instruments in Treating Root Canals
- The new root canal treatment method generally aims to bypass root obstructions resulting from fractured instruments and to penetrate hypercalcification, to bypass dental shoulders, to penetrate resistant paste, curved root canals and other obstructions resulting from a previous root treatment. More specifically, the following exemplary treatment methods will now be described in more detail:
- I—Method of treating a root canal that does not exhibit signs of a resistive path, obstruction, or blockage.
II—Method of bypassing root obstructions resulting from fractured instruments.
III—Method of penetrating root obstructions resulting from hypercalcification.
IV—Method of penetrating root obstructions resulting from curved root canals.
V—Method of bypassing root obstructions resulting from a shoulder.
VI—Method of penetrating root obstructions resulting from a previous root canal treatment. - I—Method of Treating a Root Canal that does not Exhibit Signs of a Resistive Path, Obstruction, or Blockage
-
FIG. 13 comprisesFIGS. 13A, 13B, 13C, and 13D and illustrates anexemplary tooth 1300 that does not exhibit signs of a resistive path, obstruction, or blockage. With further reference toFIG. 18 , anendodontic treatment method 1800 is performed according to the following steps: - As illustrated in
FIG. 13A , the endodontist starts atstep 1810 ofFIG. 18 , to enlarge theroot canal 1312 by selectively and sequentially using the instruments (denoted with numeral reference 1320) of the 1st category, 2nd class (e.g.,FIGS. 1B, 2B, 3B and 6 ), starting for example with a manual instrument No. 8 having an approximate 2% taper, in increasing order to No. 15 with an approximate 2% taper (1st category, 2nd class), exerting a manual force with a clockwise 90-degree rotation along the arrow F, in order to reach theapex 1333 of theroot canal 1312. - As illustrated at
step 1820 ofFIG. 18 , the endodontist further enlarges theroot canal 1312 using for example, an electrically rotating instrument (denoted with numeral reference 1330) selected from the 2nd category (e.g.,FIG. 7 ), starting with No. 10 having an approximate 2% taper, in an increasing order to No. 20, along the arrow F in order to reach the apex of theroot canal 1333. - As illustrated at
step 1830 ofFIG. 18 and inFIG. 13B , the endodontist continues to enlarge theroot canal 1312 using for example, an electricallyrotating instrument 1320, which is selected from the 3rd category (e.g.,FIG. 8 ), starting with an instrument from No. 20 to No. 25 with an approximate 4% taper to No. 25 with an approximate 6% taper whenever possible, in order to reach theapex 1333 of theroot canal 1312. In a preferred embodiment, an instrument with No. 20 having an approximate 4% taper can be used. - As illustrated at
step 1840 and also inFIG. 13C , upon completion ofstep 1830 as described earlier, the endodontist clears the widenedroot canal 1312 of any debris, as is known in the field, in preparation for the final obturation step. - As illustrated at
step 1850 and also inFIG. 13D , the endodontist obturates theroot canal 1312 with theappropriate filling material 1350, as is known in the field. - II—Method of Bypassing Root Obstructions Resulting from Fractured Instruments
- With reference to
FIG. 14 , it comprisesFIGS. 14A, 14B, 14C, 14D, 14E , and 14F, and illustrates anexemplary tooth 1400 having aroot canal 1412 within which an obstruction, such as afragment 1410 of a fractured instrument (such as a file) is lodged by a previous root canal treatment. With further reference toFIGS. 19A and 19B , thetreatment method 1900 is performed according to the following steps: - As further illustrated in
FIG. 14A , atstep 1910 ofFIG. 19A , the endodontist enlarges theroot canal 1412 by selectively and sequentially using the instruments (denoted with numeral reference 1420) of the 1st category, 2nd class (e.g.,FIGS. 1B, 2B, 3B and 6 ), starting for example with a manual instrument No. 8 having an approximate 2% taper, in increasing order to No. 15 with an approximate 2% taper (1st category, 2nd class), exerting a manual force with a clockwise 90 degrees rotation in along the arrow F, in order to reach the fracturedinstrument 1410 of theroot canal 1412. - As illustrated at
step 1920 ofFIG. 19A and also inFIG. 14B , the endodontist further enlarges theroot canal 1412 using for example, an electrically rotating instrument (denoted with numeral reference 1430) selected from the 2nd category (e.g.,FIG. 7 ), starting with No. 10 having an approximate 2% taper, in an increasing order to No. 20, in order to reach the fractured instrument in theroot canal 1412. - As illustrated at
step 1930 ofFIG. 19A and also inFIG. 14B , the endodontist continues to enlarge theroot canal 1412 using for example, an electrically rotating instrument (denoted with numeral reference 1430) selected from the 3rd category (e.g.,FIG. 8 ), starting with an instrument from No. 20 to No. 25 with an approximate 4% taper to No. 25 with an approximate 6% taper whenever possible. In a preferred embodiment, an instrument with No. 20 having an approximate 4% taper can be used to reach the fractured instrument in theroot canal 1412. - For relatively simple cases, each new instrument (whether manual or electrically operated) is capable of bypassing the obstruction after enlarging the
root canal 1412 according toabove steps - However, for more complex cases, and as illustrated by
step 1940 ofFIG. 19A andFIG. 14C , the endodontist resumesprocess 1900 by engraving a cutting 1444 beside theobstruction 1410, using new manual instruments, selected for example from the 1st category, 1st class, and preferably made of NiTi, No. 20, with an approximate 4% taper and a cutting tip (e.g., 120, 220, 320, 520 or eventually 420). The endodontist starts by exerting a manual force with a clockwise 90-degree rotation, and then withdraws the instrument by exerting an anti-clockwise rotation of the same angle, along the rotational arrow M. The relatively large cross sectional surface of thecutting tip - The endodontist then enlarges the cutting 1444 into an initial path using a manual instrument (also denoted by the numeral reference 1440) selected for example from the 1st category, 1st class, and preferably made of NiTi, No. 20 with an approximate 4% taper and a non-cutting tip (e.g. 1633 B), exerting a manual force with a clockwise 90 degrees rotation along the arrow F, in order to preserve the
initial path 1444. - As further illustrated in
FIG. 14D , and in order to further penetrate the obstructed canal through the openedinitial path 1444, the endodontist uses, atstep 1960 ofFIG. 19B , amanual instrument 1450 selected for example from the 1st category, 1st class, and preferably made of stainless steel, No. 20, having an approximate 2% taper with a cutting tip (e.g., 1633 A), for engraving anew cutting 1445, adjacent to theobstruction 1410, exerting a manual force with a clockwise 90-degree rotation along the arrow F. - Thereafter, the endodontist preferably uses, at
step 1970 ofFIG. 19B , to manually enlarge the newly opened cutting 1445 using an instrument (still denoted by 1450) selected for example from the 1st category, 1st class, and preferably made of stainless steel, No. 20, having an approximate 2% taper with a non-cutting tip (e.g., 1633 B). - The endodontist continues to enlarge the
new path 1445 using a manual instrument (still denoted by 1450) selected for example from the 1st category, 1st class, and preferably made of NiTi, No. 20, having an approximate 4% taper with a cutting tip (e.g., 1633 A), followed by No. 20 having an approximate 4% taper with a non-cutting tip (e.g., 1633 B), in order to preserve thenew path 1445. - In case the endodontist encounters difficulty in penetrating the
root canal 1412, and whenever suitable, the endodontist may use a manual instrument 1440 (FIG. 14C ) selected for example from the 1st category, 1st class, and preferably made of stainless steel, No. 20, having an approximate 2% taper with a cutting tip (e.g., 1633 A), followed by No. 20 having an approximate 2% taper with a non-cutting tip (e.g., 1633 B). - Alternatively, the endodontist may use a manual instrument 1450 (
FIG. 14D ) selected for example from the 1st category, 1st class, and preferably made of stainless steel, No. 15, having an approximate 2% taper with a cutting tip (e.g., 1633 A) in order to create a new cutting. This step is then followed by the use of a manual instrument selected for example from the 1st category, 1st class, and preferably made of stainless steel, No. 15, having an approximately 2% taper with a non-cutting tip (e.g., 1633 B), in order to preserve the newly openedpath 1445. - In the event the instruments that are collectively referenced by 1450 fail to open or enlarge the required
path 1445, the endodontist uses a smaller instrument preferably made of stainless steel, in the same sequence as described above, until theapex 1466 of theroot canal 1412 is reached (step 1980), as follows: Thepath 1445 is enlarged manually, atstep 1970, using sequentially hand operated stainless steel instruments with cutting and non-cutting tips from No. 8 or 10 until No. 20 of approximately 2% taper (1stcategory 1st class). The introduction of the instrument with a cutting tip is followed by the use of the same instrument with a non-cutting tip. Alternatively, use may be made ofNiTi instrument 1450, No. 20 with an approximate 4% taper (1st category, 1st class), first withinstrument 1450 having a cutting tip (e.g., 1633 A), then withinstrument 1450 having a non-cutting tip (e.g., 1633 B). - The endodontist starts at
step 1980 with electrically operated instruments of the 1st category, 1st class, which are preferably made of NiTi, and having a non-cutting tip (e.g., 1633 B), in an increasing order starting by using instrument no. 10 with approximately 2% taper until reaching No. 20 of approximately 2% taper. - Then, the endodontist continues with electrically operated instruments of the 2nd category, which are preferably made of NiTi, and having a non-cutting tip (e.g., 1633 B), in an increasing order instruments from No. 20 to No. 25 having approximately 2% taper.
- Finally, the endodontist completes the enlargement of the
path 1445 with electrically operated instruments of the 3rd category, which are preferably made of NiTi, and having a non-cutting tip (e.g., 1633 B), namely instrument No. 20 or 25 having approximately 4% taper. - It should be noted that the use of files (or instruments) having a beveled tip is recommended only in case the aforesaid instruments fail to engrave a cutting or path adjacent to the fractured
instrument 1410, particularly in case of difficult hypercalcification cases or in the case the cross section of the fracturedinstrument 1410 is relatively large. - As illustrated at
step 1990 and also inFIG. 14E , upon completion ofstep 1980 as described earlier, the endodontist clears the widenedroot canal 1445 of any debris, as is known in the field, in preparation for the final obturation step. - As illustrated at
step 1999 and also inFIG. 14F , the endodontist obturates theroot canal 1445 with the appropriate filling material 1446, as is known in the field. It should be noted that the obturation may be performed with or without removing thefragment 1410 of the fractured instrument. - Although the conventional art describes that the use of electrically operated files may not be proper in case of treating dental roots with fractured
instruments 1410, the present invention teaches that it is possible to directly reach the apex 1466, atstep 1999, by using electrically operated instruments with non-cutting tips, made of NiTi, afterstep 1970, in an increasing order from No. 10 with an approximate 2% taper (selected from the 1st category, 1st class) to No. 20 with an approximate 4% taper (selected from the 1st category, 1st class), followed by the sequential use of instruments selected from the 2nd and 3rd categories, as deemed appropriate by the endodontist. - Alternatively, the present invention teaches that in less difficult cases, it is possible from
step 1950 to directly reach the apex 1466,step 1999, by using electrically operated instruments with non-cutting tips, made of NiTi, starting by enlarging theinitial path 1444 with No. 20 having an approximate 4% taper (1st category, 1st class); then using in an increasing order NiTi instruments with non-cutting tip from No. 10 with an approximate 2% taper (selected from the 1st category, 1st class) to No. 20 with an approximate 4% taper (selected from the 1st category, 1st class), followed sequentially by instruments selected from the 2nd and 3rd categories, as deemed appropriate by the endodontist. - It is worth noting that the root canal is irrigated with sodium hypochloride and EDTA (Ethylenediaminetetraacetic acid) at each relevant step of
process 1900. - The following X-Rays
FIGS. 23A, 23B, 23C, 24A, 24B, 24C, 25A, 25B, 25C, 25D, 26A, 26B, 27A, 27B, 27C, 28A, 28B, 28C, 28D, 29A, 29B , 29C, 30A, 30B, 31A, 31B, 32A, 32B, 32C, 33A, 33B, 33C, 33D, 34, 35, 36A, 36B, 36C, 37A, 37B, 38A, and 38B provide supporting illustrations of this novel process 1900: -
FIG. 23A shows a broken file in tooth no. 26 blocking the totality of the root canal.FIG. 23B shows the bypassing of the broken file and reaching the apex with the new instrument according to the present invention.FIG. 23C shows the fully hermetic obturation of the treated root canal. -
FIG. 24A shows a broken file in tooth no. 46 blocking the totality of the root canal.FIG. 24B shows the bypassing of the broken file and the piercing of the hypercalcification and reaching the apex with the new instrument according to the present invention.FIG. 24C shows the fully hermetic obturation of the treated root canal. -
FIG. 25A shows a hypercalcification, a shoulder, and a broken file in the mesial canals of tooth no. 36.FIG. 25B shows the broken file.FIG. 25C shows the bypassing of the broken file, the penetration of the shoulder and the piercing of the hypercalcification in the 2nd mesial canal and reaching the apex with the new instrument, according to the present invention.FIG. 25D shows the fully hermetic obturation of the treated root canal. -
FIG. 26A shows two fractured files in the mesio vestibular canal in tooth no. 46, blocking the totality of the root canal.FIG. 26B shows the bypassing of the two broken files and reaching the apex with the new instrument according to the present invention. -
FIG. 27A shows three broken files in tooth no. 35 blocking the totality of the root canal.FIG. 27B shows the bypassing of the three broken files and reaching the apex with the new instrument according to the present invention.FIG. 27C shows the fully hermetic obturation of the root canal. -
FIG. 28A shows a broken file in tooth no. 47 blocking the totality of the root canal due to hypercalcification.FIG. 28B shows a cutting made with the new instrument according to the invention, and a second broken file.FIG. 28C shows the bypassing of the two broken files and the piercing of the hypercalcification and reaching the apex with the new instrument according to the present invention.FIG. 28D shows the fully hermetic obturation of the treated root canal. - More specifically, and as a comparative illustration, instead of using the new instruments according to the invention, a conventional file was used to enlarge the cutting and to bypass the broken file. However, the conventional file was broken, as expected, while the new instrument according to the invention has successfully bypassed the two broken files, pierced the hypercalcification, and reached the apex, without making a false canal (
FIG. 28C ). -
FIG. 29A shows two superposed broken files in tooth no. 26 blocking the third apical of the root canal.FIG. 29B shows the bypassing of the broken files and reaching the apex with the new instrument according to the present invention.FIG. 29C shows the fully hermetic obturation of the treated root canal. -
FIG. 30A shows a broken file in tooth no. 37 blocking the third apical of the root canal.FIG. 30B shows the bypassing of the broken file and reaching the apex with the new instrument according to the present invention. -
FIG. 31A shows a false canal and two broken files in tooth no. 36 blocking the apex of the root canal.FIG. 31B shows the avoidance of the false canal and the bypassing of the broken file and reaching the apex with the new instrument according to the present invention. -
FIG. 32A shows a broken file in the third apical of the mesial canal tooth no. 46 blocking the apex.FIG. 32B shows the bypassing of the broken file and reaching the apex with the new instrument according to the present invention.FIG. 32C shows the fully hermetic obturation of the treated root canal. - III—Method of Penetrating Root Obstructions Resulting from Hypercalcification
- With reference to
FIG. 15 , it comprisesFIGS. 15A, 15B, and 15C and illustrates anexemplary tooth 1500 having aroot canal 1512 that is blocked or obstructed byhypercalcification 1510. With further reference toFIGS. 20A, 20B , thetreatment method 2000 is performed according to the following steps: - As further illustrated in
FIG. 15A , the endodontist enlarges, atstep 2010 ofFIG. 20A , theroot canal 1512 of thetooth 1500 by starting with a manual instrument selected from the 1st category, 2nd class, No. 8, with an approximate 2% taper, in an increasing order to an instrument selected from the 1st category, 2nd class, No. 15, with an approximate 2% taper, exerting a manual force with a clockwise 90-degree rotation along the arrow F, until thetip 1525 of theinstrument 1520 reaches thehypercalcification 1510. - The endodontist then further enlarges, at
step 2020, theroot canal 1512 using electricallyrotating instruments 1520 selected from the 2nd category, starting with No. 10 with an approximate 2% taper, in an increasing order to No. 20 with an approximate 2% taper, until reaching the hypercalcification. - Still at
step 2020, the endodontist continues to enlarge theroot canal 1512 using electrically rotating new instruments that are selected from the 3rd category, using files from No. 20 to No. 25 with an approximate 4% taper, to No. 25 with an approximate 6% taper whenever possible. Preferred results were obtained with a No. 20 instrument with an approximate 4% taper, until reaching thehypercalcification 1510. - The endodontist then starts piercing the
hypercalcification 1510 atstep 2030, to form aninitial path 1555 therewithin, usingmanual NiTi instruments 1530 selected from the 1st category, 1st class, No. 20 with an approximate 4% taper, and acutting tip 1525. The endodontist exerts a manual force with a clockwise 90-degree rotation. The endodontist then withdraws theinstrument 1530 by exerting an anti-clockwise rotation of the same angle. The relatively large cross-sectional surface of thecutting tip 1525 avoids opening a false canal when exerting a relatively high manual force. - The endodontist continues at
step 2040 by enlarging theinitial path 1555, using a manual NiTi instrument that is selected from the 1st category, 1st class, No. 20 having an approximate 4% taper with a non-cutting tip (e.g., 1633 B), in order to preserve the openedinitial path 1555. - The endodontist then continues to step 2050, in order to enlarge the
initial path 1555 and to pierce the remainder of the hypercalcification, by using a manual stainless steel instrument selected from the 1st category, 1st class, No. 20, with an approximate 2% taper and acutting tip 1525. It is recommended to continue to manually enlarge theinitial path 1555 using a manual stainless steel instrument selected from the 1st category, 1st class, No. 20 with an approximate 2% taper and a non-cutting tip (e.g., 1633 B). - At
step 2060, the endodontist further enlarges theinitial path 1555 by first using a manual NiTi instrument selected from the 1st category, 1st class, No. 20, with an approximate 4% taper and acutting tip 1555, and then using a manual NiTi instrument also selected from the 1st category, 1st class, No. 20, with an approximate 4% taper and a non-cutting tip (e.g., 1633 B), so as to preserve theinitial path 1555. - In the event the endodontist encounters difficulty in penetrating the
root canal 1512, manualstainless steel instrument 1540 selected from the 1st category, 1st class, No. 20, with an approximate 2% taper and acutting tip 1525 is used whenever feasible. Otherwise, the endodontist uses a manualstainless steel instrument 1540 selected from the 1st category, 1st class, No. 15, with an approximate 2% taper and acutting tip 1525, in order to pierce a new path that is adjacent to theinitial path 1555. This step is followed by the use of a manualstainless steel instrument 1540 selected from the 1st category, 1st class, No. 15, with an approximate 2% taper and a non-cutting tip, in order to preserve the new adjacent path. In case theinstruments 1540 fail to open the required path, the endodontist uses smaller stainless steel instruments in the same sequence until reaching theapex 1566 of the root canal 1512 (FIG. 15C ). - Once the
initial path 1555 is enlarged, atstep 2060, theinitial path 1555 is gradually enlarged manually using sequentially hand operated stainless steel instruments with cutting and non-cutting tips from No. 8 or 10 until No. 20 of approximately 2% taper (1stcategory 1st class). The introduction of the instrument with a cutting tip is followed by the use of the same instrument with a non-cutting tip. Alternatively, if possible, a NiTi instrument also selected from the 1st category, 1st class, No. 20 with an approximate 4% taper and acutting tip 1525 followed by the same instrument with a non-cutting tip (e.g., 1633 B), may be introduced. - Once the
initial path 1555 has been enlarged to the desired dimensions, the endodontist then uses, atstep 2070, electrically operatedNiTi instruments 1540 selected from the 1st category, 1st class, and instruments of the 2nd category, with a non-cutting tip (e.g., 1633 B), followed by the use ofinstruments 1540 of the 3rd category, with a non-cutting tip. In performing thisstep 2070, the endodontist sequentially uses in increasing order theinstruments 1540 starting with instruments selected from the 1st category, 1st class, No. 10 to No. 20 with an approximate 2% taper, and then, instruments from No. 20 to No. 25 of approximately 2% taper of the 2nd category and finally instrument No. 20 or 25 with an approximate 4% taper of the 3rd category at the apex 1566. - As illustrated at
step 2080 and also inFIG. 14E , upon completion ofstep 2070 as described earlier, the endodontist clears the widened root canal of any debris, as is known in the field, in preparation for the final obturation step. - As illustrated at
step 2090 and also inFIG. 14F , the endodontist obturates the root canal with the appropriate filling material 1446, as is known in the field. - According to the another embodiment of the present invention, it is possible to directly reach the apex 1566, after
step 2060, by using electrically operated NiTi instruments selected from the 1st category, 1st class with a non-cutting tip (e.g., 1633 B), in increasing order from No. 10 with an approximate 2% taper to No. 20 with an approximate 4% taper, followed by instruments of the 2nd and 3rd categories. - According to yet another embodiment of the present invention, in less difficult cases, the endodontist may be able to directly reach the apex 1566, after
step 2040, by using electrically operated NiTi instruments selected from the 1st category, 1st class with a non-cutting tip (e.g., 1633 B), starting by enlarging the piercing with a No. 20 instrument having an approximate 4% taper. The process is resumed by using, in increasing order, instruments selected from the 1st category, 1st class, from No. 10 with an approximate 2% taper, to No. 20 with an approximate 4% taper of the 1st category, 1st class with a non-cutting tip, followed by non-cutting tip instruments of the 2nd and 3rd categories, as deemed appropriate by the endodontist. - It is worth noting that the root canal is irrigated with sodium hypochloride and EDTA (Ethylenediaminetetraacetic acid) at each relevant step of
process 2000. - The following X-Rays (
FIGS. 33 through 36 ) provide supporting illustrations of this novel process 2000: -
FIG. 24A shows a broken file in tooth no. 46 blocking the totality of the root canal.FIG. 24B shows the bypassing of the broken file and the piercing of the hypercalcification and reaching the apex with the new instrument according to the present invention.FIG. 24C shows the fully hermetic obturation of the treated root canal. -
FIG. 33A shows an incomplete root treatment of tooth no. 35 due to hypercalcification blocking the third apical of the root canal.FIGS. 33B, 33C , and 33D show the piercing of the old resistant paste and progressively piercing the hypercalcification with the new instrument reaching the apex, according to the present invention. -
FIG. 34 shows a fully hermetic obturation of tooth no. 46 after piercing a hypercalcification and passing through an accentuated curved line. -
FIG. 35 shows a fully hermetic obturation of tooth no. 47 after piercing a hypercalcification and passing through an accentuated curved line. -
FIG. 36A shows a false canal and an incomplete root treatment of tooth no. 35 due to hypercalcification blocking about half the root canal.FIGS. 36B and 36C show the progressive piercing of the hypercalcification with the new instrument reaching the apex, according to the present invention. - IV—Method of Penetrating Root Obstructions Resulting from Curved Root Canals
- As illustrated in
FIG. 13 , the instruments of the present invention may be used to penetrate root obstructions resulting from curved root canals. In this event, the instruments of the 2nd category may be used followed by the instruments of the 3rd category, until the apex of the root canal is reached, with at least an instrument No. 20 having an approximate 4% taper. In case of difficulty, instruments selected from the 1st category, 2nd class are used, starting in increasing order from No. 8 to No. 15, with an approximate 2% taper followed by the instruments of the 2nd and 3rd categories. - The following X-Rays (
FIGS. 34, 35 ) provide supporting illustrations of this novel process: -
FIG. 34 shows a fully hermetic obturation of tooth no. 46 after piercing a hypercalcification and passing through an accentuated curved line. -
FIG. 35 shows a fully hermetic obturation of tooth no. 47 after piercing a hypercalcification and passing through an accentuated curved line. - V—Method of Bypassing Root Obstructions Resulting from a Shoulder
- With reference to
FIG. 16 , it comprisesFIGS. 16A, 16B, and 16C and illustrates anexemplary tooth 1600 having aroot canal 1612 that is obstructed by ashoulder 1610. With further reference toFIGS. 21A and 21B , thetreatment method 2100 is performed according to the following steps: - As further illustrated in
FIG. 16A , the endodontist enlarges atstep 2110 ofFIG. 21A , theroot canal 1612 of thetooth 1600 by using a manual instrument selected from the 1st category, 2nd class, No. 8 with an approximate 2% taper, in increasing order to No. 15 with an approximate 2% taper, in order to reach theshoulder 1610. For the purpose of illustration only,FIG. 16A shows an enlarged view of acutting tip 1633A, whileFIG. 16C shows an enlarged view of anon-cutting tip 1633B. - The endodontist then, at
step 2120, further enlarges theroot canal 1612 using electrically rotating instruments selected from the 2nd category, starting with files No. 10 and an approximate 2% taper, in an increasing order to No. 20 with an approximate 2% taper, up to theshoulder 1610. - The endodontist continues to enlarge the
root canal 1612 atstep 2120, using electrically rotating instruments selected from the 3rd category, starting with files No. 20 to 25 with an approximate 4% taper, and continuing with files No. 25 with an approximate 6% taper, whenever possible, until theshoulder 1610 is reached. Preferred results were obtained with a No. 20 instrument with an approximate 4% taper. - Once the portion of the
root canal 1612 up to theshoulder 1610 has been widened to the desired dimensioned, the endodontist continues atstep 2130 by creating apath 1655 through theshoulder 1610 usingmanual NiTi instruments 1620 selected from the 1st category, 1st class, No. 20 with an approximate 4% taper and acutting tip 1633, by exerting a manual force in a push and pull motion along the arrow F. Thereafter, theinstrument 1620 is withdrawn. The relatively large cross sectional surface of thecutting tip 1633A avoids opening a false canal when exerting a relatively high manual force. - At
step 2140, the endodontist enlarges thepath 1655 using a manual NiTi instrument selected from the 1st category, 1st class, No. 20 having an approximate 4% taper and anon-cutting tip 1633B in order to preserve the openedpath 1655. - In case of difficulty in enlarging the
path 1655, the endodontist uses a manual stainless steel instrument selected from the 1st category, 1st class, No. 20 having an approximate 2% taper with a cutting tip to penetrate theshoulder 1610 in a push and pull motion. Thereafter, it is recommended to manually enlarge the newly openedpath 1655 using a manual stainless steel instrument selected from the 1st category, 1st class, No. 20 having an approximate 2% taper with anon-cutting tip 1633B. - Still at
step 2140, the endodontist continues to enlarge thepath 1655 using a manual NiTi instrument selected from the 1st category, 1st class, No. 20 having an approximate 4% taper and acutting tip 1633. A manual NiTi instrument selected from the 1st category, 1st class, No. 20 and an approximate 4% taper with anon-cutting tip 1633B, may be used in order to preserve the newly openedpath 1655. - In case of difficulty in penetrating the
shoulder 1610, the endodontist uses a manualstainless steel instrument 1620 selected from the 1st category, 1st class, No. 15 having an approximate 2% taper and acutting tip 1633, in order to penetrate theshoulder 1610. This step is followed by the use of a manualstainless steel instrument 1620 selected from the 1st category, 1st class, No. 15 having an approximate 2% taper with anon-cutting tip 1633B, in order to preserve the newly openedpath 1655. In case theabovementioned instruments 1620 fail to open the requiredpath 1655, the endodontist may use smallerstainless steel instruments 1620 in the same sequence until reaching theapex 1650. - Still at
step 2140, the endodontist further enlarges the openedpath 1655 manually until the introduction of stainless steel instruments selected from the 1st category, 1st class, No. 20 with an approximate 2% taper (alternatively NiTi instrument No. 20 with an approximate 4% taper) having a cuttingtip 1633A and then anon-cutting tip 1633B, is made possible. - As further illustrated in
FIG. 16C , once thepath 1655 has been enlarged to the desired dimensions, the endodontist then uses, atstep 2150, electrically operatedNiTi instruments 1630 selected from the 1st category, 1st class, 2nd category, with anon-cutting tip 1633B, followed by the use of anon-cutting tip instrument 1630 of the 3rd category. In performing thisstep 2150, the endodontist sequentially uses, in increasing order, theinstruments 1630 starting with instruments selected from the 1st category, 1st class, No. 10 to No. 20 with an approximate 2% taper, and then instruments from No. 20 to No. 25 of the 2nd category and finally instrument No. 20 or 25 with an approximate 4% taper of the 3rd category at the apex 1650. - As illustrated at
step 2160 and also inFIG. 14E , upon completion ofstep 2140 as described earlier, the endodontist clears the widened root canal of any debris, as is known in the field, in preparation for the final obturation step. - As illustrated at
step 2170 and also inFIG. 14F , the endodontist obturates the root canal with the appropriate filling material 1446, as is known in the field. - According to the another embodiment of the present invention, it is possible to directly reach the apex 1650, following
step 2140, by using electrically operated instruments selected from the 1st category, 1st class, provided with non-cutting tips, in an increasing order from files No. 10 with an approximate 2% taper to files No. 20 with an approximate 4% taper, followed by instruments of the 2nd and 3rd categories as deemed appropriate by the endodontist. - According to yet another embodiment of the present invention, in less difficult cases, after enlarging the
path 1655 by a manual NiTi instrument No. 20 (1st category, 1st class) having an approximate 4% taper and a non-cutting tip (e.g., 1633 B) the endodontist, may be able to directly reach the apex 1650 by using electrically operated non-cutting tip NiTi instruments, starting by enlarging thepath 1655 with a file No. 20 having an approximate 4% taper (1st category, 1st class) then using in increasing order, non-cutting tip instruments selected from the 1st category, 1st class, from No. 10 to No. 20 having an approximate 2% taper and then No. 20 with an approximate 4% taper (1st category, 1st class), and finally using instruments Nos. 20 to 25 having an approximate 2% taper of the 2nd category followed by instruments No. 20 or 25 having a 4% taper of the 3rd category. - It is worth noting that the root canal is irrigated with sodium hypochloride and EDTA (Ethylenediaminetetraacetic acid) at each relevant step of
process 2100. - The following X-Rays (
FIGS. 25 and 37 ) provide supporting illustrations of this novel process 2100: -
FIG. 25A shows a hypercalcification, a shoulder, and a broken file in the mesial canals of tooth no. 36.FIG. 25B shows the broken file.FIG. 25C shows the bypassing of the broken file, the penetration of the shoulder and the piercing of the hypercalcification in the 2nd mesial canal and reaching the apex with the new instrument, according to the present invention.FIG. 25D shows the fully hermetic obturation of the treated root canal. -
FIG. 37A shows a blockage in the mesial canal of tooth no. 16 due to a shoulder.FIG. 37B shows the elimination of the shoulder with the new instrument reaching the apex, according to the present invention. - VI—Method of Penetrating Root Obstructions Resulting from a Previous Root Canal Treatment
- With reference to
FIG. 17 , it comprisesFIGS. 17A and 17B and illustrates anexemplary tooth 1700 having aroot canal 1712 that is blocked or obstructed by, for example a residual,hardened paste 1710 from a previous root canal treatment. With further reference toFIGS. 22A and 22B , thetreatment method 2200 is performed according to the following steps: - As further illustrated in
FIG. 17A , the endodontist opens theroot canal 1712 atstep 2210 ofFIG. 22A using instruments 1720 selected from the 1st category, 2nd class, starting with file No. 10 with an approximate taper 2%, in order to create aninitial path 1733 in the existingresidual paste 1710, using aninstrument 1725 with a cutting tip, to a depth of approximately 2 mm to 3 mm, using an appropriate softening agent. - At
step 2220, the endodontist enlarges the openedinitial path 1733 withinstruments 1720 selected from the 2nd and 3rd categories. - At
step 2230, the endodontist pierces again theresidual paste 1710, through theinitial path 1733, using aninstrument 1720 selected from the 1st category, 2nd class, file No. 15, to an additional depth of approximately 2 mm-3 mm. - At
step 2240, the endodontist enlarges the width of theinitial path 1733 usinginstruments 1720 selected from the 2nd and 3rd categories. - With further reference to
FIG. 17C , and to step 2250 ofFIG. 22B , the endodontist pierces again the widenedinitial path 1733 using aninstrument 1730 selected from the 1st category, 2nd class, file No. 15, with a possible recourse to file No. 10 of the 1st category, 2nd class, until the apex 1750 is reached. - At
step 2260, the endodontist enlarges the openedpath 1755 with instruments selected from the 2nd and 3rd categories in preparation for the obturation step. - In the event an unexpected obstruction is faced inside the resistant paste, the aforementioned steps of
process 2200 will be used depending on the nature of the encountered obstruction, i.e. fractured instrument, hypercalcification, curved root canal or shoulder. - It should be clear that if the obstruction within the root canal includes a resistant,
residual paste 1710, theprocess 2000 described earlier in connection withFIG. 20 relating to the piercing of the hypercalcification, can be used, in the same sequence fromstep 2030 throughstep 2070. - As illustrated at
step 2270 and also inFIG. 14E , upon completion ofstep 2260 as described earlier, the endodontist clears the widened root canal of any debris, as is known in the field, in preparation for the final obturation step. - As illustrated at
step 2280 and also inFIG. 14F , the endodontist obturates the root canal with the appropriate filling material 1446, as is known in the field. - It is worth noting that the root canal is irrigated with sodium hypochloride and EDTA (Ethylenediaminetetraacetic acid) at each relevant step of
process 1900. - The following X-Rays (
FIGS. 27, 33, 37, 38 ) provide supporting illustrations of this novel process 2200: -
FIG. 27A shows three broken files with resistant paste in tooth no. 35 blocking the totality of the root canal.FIG. 27B shows the bypassing of the three broken files and the piercing of the resistant paste with the new instrument reaching the apex, according to the present invention.FIG. 27C shows the fully hermetic obturation of the root canal. -
FIG. 33A shows an incomplete root treatment of tooth no. 35 due to hypercalcification blocking the third apical of the root canal.FIGS. 33B, 33C , and 33D show the piercing of the old resistant paste and progressively piercing the hypercalcification with the new instrument reaching the apex, according to the present invention. -
FIG. 37A shows a blockage in the mesial canal of tooth no. 16 due to a shoulder and a resistant paste.FIG. 37B shows the elimination of the shoulder and the piercing of the resistant paste with the new instrument reaching the apex, according to the present invention. -
FIG. 38A shows a false canal and a resistant paste in tooth no. 37.FIG. 38B shows the avoidance of the false canal and the piercing of the resistant paste with the new instrument reaching the apex, according to the present invention. - It is to be understood that the specific embodiments of the invention that have been described are merely illustrative of certain application of the principle of the present invention. Numerous modifications may be made to the present instruments and methods described herein without departing from the spirit and scope of the present invention.
Claims (29)
1. A file for root canal treatment having a shank with a generally circular cross sectional area.
2. The file according to claim 1 , wherein the shank terminates in a tip.
3. The file according to claim 2 , wherein the tip is a generally conical cutting tip.
4. The file according to claim 2 , wherein the tip is a generally conical non-cutting tip.
5. The file according to claim 2 , wherein the shank includes a roughened lateral surface.
6. The file according to claim 5 , wherein the lateral surface contains a plurality of striated grooves.
7. The file according to claim 6 , wherein the striated grooves include any one or more of: horizontal, vertical, and transversal grooves.
8. The file according to claim 7 , wherein the striated grooves are separated by smooth areas.
9. The file according to claim 5 , wherein lateral surface contains a plurality of saw teeth.
10. The file according to claim 5 , wherein the lateral surface is sandblasted.
11. The file according to claim 2 , wherein the tip is beveled.
12. The file according to claim 2 , wherein the file is any one of: a hand operated instrument and an electrically rotating instrument;
wherein the shank is made from any one of: stainless steel with nos. ranging from 10 to 25; NiTi with nos. ranging from 20 to 25 for the hand operated instrument; and NiTi with nos. ranging from 10 to 25 for the electrically rotating instrument; and
wherein the shank has a taper that ranges between 0% and 4%, and a length that ranges from approximately 12 mm to 32 mm.
13. The file according to claim 2 , wherein the file is a hand operated instrument;
wherein the shank is made from any one of: stainless steel with nos. ranging from 6 to 20, and NiTi with nos. ranging from nos. 20 to 40; and
wherein the shank has a taper that ranges between 0% and 4%, and a length that ranges from approximately 12 mm to 32 mm.
14. The file according to claim 2 , wherein the file is an electrically rotating instrument;
wherein the shank ranges from nos. 10 to 20; and
wherein the shank has a taper that is approximately 2%, and a length that ranges from approximately 21 mm to 32 mm.
15. The file according to claim 2 , wherein the file is an electrically rotating instrument;
wherein the shank ranges from nos. 20 to 40; and
wherein the shank has a taper that ranges between 4% and 10%, and a length that ranges from approximately 21 mm to 32 mm.
16. A file for root canal treatment having a shank that includes a spiral section with an upper cylindro-conical section.
17. The file according to claim 16 , wherein the shank terminates in a tip; and
wherein the tip is any of a cutting tip or a non-cutting tip.
18. The file according to claim 16 , wherein the cylindro-conical section includes a lateral surface; and
wherein the lateral surface of the cylindro-conical section contains striated grooves.
19. The file according to claim 18 , wherein the striated grooves include any one or more of: horizontal, vertical, and transversal grooves.
20. The file according to claim 18 , wherein the striated grooves are separated by smooth areas.
21. The file according to claim 16 , wherein the spiral and cylindro-conical sections are sandblasted.
22. The file according to claim 16 , wherein the shank ranges from nos. 10 to 40; and
wherein the shank has a taper that ranges between 2% and 10%, and a length that ranges from approximately 12 mm to 32 mm.
23. A file for root canal treatment comprising:
a shank; and
wherein the shank includes a series of cylindro-conical sections that are inter-spaced with a series of spiral sections.
24. The file according to claim 23 , wherein the tip is a cutting tip.
25. The file according to claim 23 , wherein the tip is a non-cutting tip.
26. The file according to claim 23 , wherein each cylindro-conical section includes a lateral surface;
wherein the lateral surface of the cylindro-conical section contains striated grooves; and
wherein the striated grooves are formed of any one or more of: horizontal, vertical, and transversal grooves that are separated by smooth areas.
27. The file according to claim 23 , wherein the spiral and cylindro-conical sections are sandblasted.
28. The file according to claim 23 , wherein the shaft ranges from nos. 10 to 40; and
wherein the shaft has a taper that ranges between 2% and 10%, and a length that ranges from approximately 12 mm to 32 mm.
29. A root canal method for bypassing or penetrating root obstructions in a root canal, comprising:
using a file having a shank with a generally circular cross-sectional area;
wherein the obstructions result from any one or more of: a fractured instrument, root obstacles, shoulders, resistant paste, hypercalcification, and curvature within the root canal.
Priority Applications (4)
Application Number | Priority Date | Filing Date | Title |
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US14/946,716 US20170143450A1 (en) | 2015-11-19 | 2015-11-19 | Endodontic instruments and root canal treatment methods |
EP16199605.3A EP3170471B1 (en) | 2015-11-19 | 2016-11-18 | Endodontic instruments |
ES16199605T ES2869974T3 (en) | 2015-11-19 | 2016-11-18 | Endodontic Instruments |
US16/368,446 US11660164B2 (en) | 2015-11-19 | 2019-03-28 | Endodontic instruments and root canal treatment methods |
Applications Claiming Priority (1)
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US14/946,716 US20170143450A1 (en) | 2015-11-19 | 2015-11-19 | Endodontic instruments and root canal treatment methods |
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US16/368,446 Continuation US11660164B2 (en) | 2015-11-19 | 2019-03-28 | Endodontic instruments and root canal treatment methods |
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US16/368,446 Active 2038-04-28 US11660164B2 (en) | 2015-11-19 | 2019-03-28 | Endodontic instruments and root canal treatment methods |
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US16/368,446 Active 2038-04-28 US11660164B2 (en) | 2015-11-19 | 2019-03-28 | Endodontic instruments and root canal treatment methods |
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Cited By (3)
Publication number | Priority date | Publication date | Assignee | Title |
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USD837376S1 (en) * | 2016-12-15 | 2019-01-01 | Moji Bagheri | Endodontic tool |
US20210244499A1 (en) * | 2020-02-11 | 2021-08-12 | Dheyaa Obada | Laser Emitting Orthodontic Assembly |
USD1005488S1 (en) * | 2020-05-22 | 2023-11-21 | Dental Innovations, LLC | Tooth repair device |
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US20020119418A1 (en) * | 2001-02-28 | 2002-08-29 | Mani, Inc. | Dental reamer |
US20070015107A1 (en) * | 2005-07-18 | 2007-01-18 | Werner Mannschedel | Root canal instrument having an abrasive coating and method for the production thereof |
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US1022838A (en) * | 1911-10-16 | 1912-04-09 | Levi L Funk | Dental broach. |
JPS58177643A (en) * | 1982-04-14 | 1983-10-18 | 井上アタツチメント株式会社 | Instrument for forming root canal |
CH651746A5 (en) * | 1983-03-29 | 1985-10-15 | Flueckiger Et Huguenin S A | DENTAL INSTRUMENT FOR BORE CHANNELS. |
US5873721A (en) | 1993-12-23 | 1999-02-23 | Adt Advanced Dental Technologies, Ltd. | Implant abutment systems, devices, and techniques |
US6491522B1 (en) | 2000-08-09 | 2002-12-10 | Charles D. Jensen | Dental diagnostic system and method |
US6966774B2 (en) * | 2001-08-16 | 2005-11-22 | Cloudland Institute, Llc. | Endodontic instrument having notched cutting surfaces |
US6638067B2 (en) * | 2001-09-04 | 2003-10-28 | Ultradent Products, Inc. | Flocked endodontic files and other flocked devices |
US7125254B2 (en) | 2001-12-28 | 2006-10-24 | Randall Rex Calvert | Apparatus and method for root canal obturation |
US7018205B2 (en) * | 2002-05-10 | 2006-03-28 | Abelity, Llc | Barbed endodontic instrument |
US6981869B2 (en) * | 2003-04-22 | 2006-01-03 | Ruddle Clifford J | Injection molded endodontic brush |
US7094056B2 (en) * | 2003-05-01 | 2006-08-22 | Scianamblo Michael J | Endodontic instrument having reversed helix |
EP2219549B1 (en) | 2007-10-12 | 2019-04-17 | Align Technology, Inc. | Prosthodonitc and orthodontic apparatus and methods |
US20110033822A1 (en) * | 2009-08-04 | 2011-02-10 | James Bahcall | Endodontic File |
US9579166B2 (en) | 2013-08-07 | 2017-02-28 | Jeffrey I Lasner | Root canal probe tool and method of removing a broken instrument fragment from a root canal |
-
2015
- 2015-11-19 US US14/946,716 patent/US20170143450A1/en not_active Abandoned
-
2016
- 2016-11-18 EP EP16199605.3A patent/EP3170471B1/en active Active
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2019
- 2019-03-28 US US16/368,446 patent/US11660164B2/en active Active
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US6293794B1 (en) * | 1999-02-16 | 2001-09-25 | Ormco Corporation | Endodontic instrument having regressive conicity |
US20020119418A1 (en) * | 2001-02-28 | 2002-08-29 | Mani, Inc. | Dental reamer |
US20070015107A1 (en) * | 2005-07-18 | 2007-01-18 | Werner Mannschedel | Root canal instrument having an abrasive coating and method for the production thereof |
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USD837376S1 (en) * | 2016-12-15 | 2019-01-01 | Moji Bagheri | Endodontic tool |
US20210244499A1 (en) * | 2020-02-11 | 2021-08-12 | Dheyaa Obada | Laser Emitting Orthodontic Assembly |
USD1005488S1 (en) * | 2020-05-22 | 2023-11-21 | Dental Innovations, LLC | Tooth repair device |
Also Published As
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EP3170471B1 (en) | 2021-02-17 |
US20200085533A1 (en) | 2020-03-19 |
EP3170471A2 (en) | 2017-05-24 |
ES2869974T3 (en) | 2021-10-26 |
US11660164B2 (en) | 2023-05-30 |
EP3170471A3 (en) | 2017-07-19 |
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