Creating a protocol for mixing and matching different endodontic files is essential to ensure optimal canal treatment. Here's a protocol for using the Minikut MB2 file as the orifice opener, the Minikut 15-.05 25mm as the glide path file, d-Finder Hand Files, the Toothsaver file 20/04 or 25/04 as the finishing file, and the EDM (Electrical Discharge Machining) file (Edmax) for very curved canals:
Endodontic File Protocol: Mixing and Matching for Optimal Results
1. Preliminary Assessment:
- Begin by assessing the tooth's clinical and radiographic characteristics to determine the complexity of the root canal system and the degree of canal curvature.
2. Selection of Orifice Opener:
- If the MB2 canal is present or suspected, consider using the Minikut MB2 (BlackJack) file as the orifice opener.
- The Minikut MB2 file can also be used as an orifice opener for all canals, not limited to MB2, thanks to its unique characteristics, including a dynamic tip and square cross-sectional geometry.
- Rotate the Minikut MB2 file at speeds up to 1000 rpm to expedite the creation of the orifice opener, especially if there is significant intra-canal calcification or cervical impediments.
3. Creating a Glide Path:
- Use the Minikut 15-.05 25mm (EZP) Rotary File as a glide path file.
- The cupped square cross-sectional geometry of the EZP file provides the strength to resist breakage during rotary negotiation procedures while preventing ledging.
- The file tip is radiused, and it has soft transitional angles to facilitate safe canal negotiation.
- Can be used as first file to length (FFL) before any coronal shape has been cut.
- Rotary negotiation with miniKUT EZP files can easily save 10-30 minutes of treatment time in a difficult molar
4. Use D finder hand files if necessary
In many cases the 15.03.25mm can be used as a FFL without the use of hand files but if a canal is narrowed by calcification and hand files are necessary the D finders are excellent in this situation.
The combination of the specially treated stainless steel and the D-shaped cross section of the D-Finder increase stiffness up to 50% compared to conventional K-files.
This property improves the penetration force which is needed especially to prepare the glide path of root canals which are narrowed by calcification.
5. Canal Shaping with Finishing Files:
- Choose between the Toothsaver file 20/04 or 25/04 for canal shaping, depending on the specific case.
- Toothsaver files are heat-treated memory-controlled Ni-Ti files designed to preserve coronal dentin conservatively.
- Consider using the VS Flexi Blue 20/06 or 25/06 for an even more conservative finish. These files have a regressive taper in the coronal direction and only cut in the bottom 3mm of the canal.
6. Handling Highly Curved Canals:
- In cases with very curved canals or complex anatomy, consider using the Edmax EDM file, an Electrical Discharge Machining file known for its exceptional flexibility and resistance to cyclic fatigue.
- The Edmax file is effective for navigating tortuous canals and is suitable for cases where greater flexibility is required.
7. Adaptation to Clinical Needs:
- The selection and sequence of these files should be adapted to meet the specific clinical requirements of each patient and case.
- Ensure that the files are used with precision, taking into consideration the patient's comfort, the need for apical cleanliness, and the preservation of tooth structure.
8. Continuous Assessment:
- Continuously assess the progress of canal preparation using radiographs and tactile feedback, adjusting the protocol as needed to ensure safe and effective treatment.
By following this protocol, endodontists and general dentists can mix and match different endodontic files to tailor their approach to the unique needs of each patient and achieve successful root canal treatments while preserving the integrity of the tooth's structure.