An Update on Root Canal Preparation Techniques and How to Avoid Procedural Errors in Endodontics

Expert consensus on irrigation and intracanal medication in root canal therapy

Chemical cleaning and disinfection are crucial steps for eliminating infection in root canal treatment. However, irrigant selection or irrigation procedures are far from clear. The vapor lock effect in the apical region has yet to be solved, impeding irrigation efficacy and resulting in residual infections and compromised treatment outcomes. Additionally, ambiguous clinical indications for root canal medication and non-standardized dressing protocols must be clarified. Inappropriate intracanal medication may present side effects and jeopardize the therapeutic outcomes. Indeed, clinicians have been aware of these concerns for years. Based on the current evidence of studies, this article reviews the properties of various irrigants and intracanal medicaments and elucidates their effectiveness and interactions. The evolution of different kinetic irrigation methods, their effects, limitations, the paradigm shift, current indications, and effective operational procedures regarding intracanal medication are also discussed. This expert consensus aims to establish the clinical operation guidelines for root canal irrigation and a position statement on intracanal medication, thus facilitating a better understanding of infection control, standardizing clinical practice, and ultimately improving the success of endodontic therapy.

Debridement Ability of TruNatomy, S-One Plus, and Other Single File Systems

BACKGROUND: Rotary nickel titanium instrument are an essential part of endodontic treatment, it is important to compare the root canal cleaning ability of these instruments. AIM: This study aimed to compare the amount of smear and debris layer remained following the use of four rotary instruments with an irrigant solution: TruNatomy (TRN), Protaper Next (PTN), S-One Plus and Wave One Gold (WOG). METHODS: A total of 80 extracted mandibular premolars were used and decoronated to the cemento-enamel junction. The roots were randomly divided into four groups of 20 specimens each. The roots were instrumented according to the manufacturer’s instructions of each file, the root canals were irrigated with sodium hypochlorite (NaOCl), Ethylene-diaminete-traacetic acid (EDTA) and Normal saline with each file use, two grooves were prepared on the buccal and lingual surfaces by disc to facilitate vertical splitting with a chisel. The presence of the smear layer and the debris layer were evaluated under Scanning Electron Microscope. RESULTS: Trunatomy remove the smear layer substantially better than PTN and S-one Plus. Wave one gold significantly removes smear layer better PTN. The amount of debris remained in TruNatomy group was significantly lower than other groups, all experimental files significantly removes the smear layer and debris layer better in the middle and coronal thirds compared to apical third. CONCLUSION: TruNatomy showed better cleaning capacity than all other experimental groups and all experimental groups demonstrated better cleanliness at the coronal and middle third of the roots.