Stacey L. Simmons, DDS
1. What rotary file system are you using?
I’ve never made it a secret that endo is not my favorite thing to do in dentistry. It’s one of those disciplines for which I did the bare minimum to get by in dental school. (Cringe!) Unfortunately, that lack of experience and the somewhat confusing details of endodontics trickled over into private practice. Up until recently, I would refer out anything more than a single-canaled tooth.
At a convention a few years ago, I meandered over to the Dentsply Sirona table and was introduced to the WaveOne Gold NiTi reciprocating endo system. As the saying goes, “Simplicity is the ultimate sophistication.” With a single-use, single-file system, my world of all things endo completely opened up. The files, paper points, and gutta-percha points all correspond with one another. There is no guesswork, which results in an efficient and predictable outcome. Boom! It’s exactly what I needed.
2. Are you using any special materials during cleaning and irrigation?
My materials are basic and nothing fancy. I use copious amounts of good ol’ fashioned sodium hypochlorite (NaOCl) and ProLube root canal conditioner (Dentsply Sirona). I irrigate and clean my file after every pass and let the materials and equipment do the majority of the work for me; the effervescent action and presence of EDTA (ethylenediaminetetraacetic acid) in the ProLube promote tissue and debris removal and help lift that nasty smear layer. Let’s be honest—there is tremendous satisfaction when you can see the mechanical and chemical removal of tissue and bacteria from the canals. It’s important to realize that the two steps are intertwined for ultimate long-term success.
3. Are you using an obturation system?
Again, I like simplicity, and depending on which file I use, there are corresponding gutta-percha points and WaveOne Gold obturators. I use ThermaSeal Plus Ribbon sealer from Dentsply Sirona in conjunction with the gutta-percha points, and I am able to get a nice fill every time. I’ve had reliable success with this system, and as long as there are no nasty curved roots or calcifications, I can now complete at least 75% of my endo in-house, which benefits my practice and, most importantly, my patients.
Clinton Timmerman, DDS, MBA, FAGD, FICOI
1. What rotary file system are you using?
I’ve been using the WaveOne Gold reciprocating system by Dentsply Sirona for the past few years with great success. I still use hand files to working length to open up the canal and create a path for the rotary file. I’ve also used the Brasseler XP-3D system, and sometimes I’ve even used a combination of the two, especially for ribbon-shaped canals. The 3D files expand and contract, allowing them to clean and shape wide areas, which would not be possible with a typical file.
2. Are you using any special materials during cleaning and irrigation?
RC-Prep by Premier is still my go-to for instrumentation, and I irrigate with 100% sodium hypochlorite and EDTA. After the final file, I make sure to irrigate with sodium hypochlorite for at least one full minute and EDTA for 30 seconds.
I use a 31-gauge needle, but I have tried and enjoyed the EndoVac from Kerr, which applies negative apical pressure as it irrigates, creating suction that prevents any irrigant from extruding out the apex. The EndoVac pulls the irrigant coronally as it removes debris along the canal.
If the tooth is necrotic, I do a final irrigation with 2% chlorhexidine (not Peridex or any other 0.12% chlorhexidine solution) for 30 seconds. Consepsis from Ultradent has been great. It is important to make sure the chlorhexidine and EDTA do not mix in the canal system because this creates a brown sludge.
3. Are you using an obturation system?
For several years, I used master cones that were the same size as my final rotary file. Since 2014, I have been using the GuttaCore obturation system by Dentsply Sirona, which I prefer over Thermafil since it contains cross-linked gutta-percha at its core, rather than black plastic encased in gutta-percha.
As for sealers, I still have EndoRez by Ultradent in my arsenal, but lately I have been using EndoSequence BC Sealer by Brasseler primarily. EndoSequence is hydrophilic, has low shrinkage, and forms hydroxyapatite when set. Its biocompatibility lessens the chances of an inflammatory response if any sealer is extruded out the apex; however, any “puff” that is apparent around the apex will most likely not dissolve. Apical healing will still occur around the sealer, and its presence is clinically acceptable.
If a clinician desires the least amount of extrusion possible and is working with a tooth that is necrotic with no intact lamina dura, then I recommend using a master cone with traditional tug-back at the apex. The Elements warm vertical obturation system by Kerr also has a master cone that has tug-back at the apex and can help limit apical extrusion. Using this, it would also be important to use a sealer that will be dissolved naturally to decrease the chances of a permanent “puff.”
