Protaper next Root canal treatment : it’s a procedure to save an abscessed

tooth in which the pulp chamber is cleaned out , disinfected and filled with a permanent filling

to do the root canal treatment we need to- shape and clean -disinfect - irrigate -obturate because we have a war against bacteria in the root canal so we need to kill the bacteria

So to do these steps we need instruments and irrigation For irrigation we use sodium hypochlorite and for obturation we use gutta percha

The key to a successful endo treatment , is following these three steps shaping , irrigation and obturation we can't skip any of these steps

Shaping

Irrigation 3 D obturation

for shaping we have two schools , one school is saying that we need an apical taper and the other school is saying that we need an enlargement

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it’s important to have an apical taper to allow better irrigation and to prepare the canal for a three dimensional obturation

before we used the step back technique which is a good technique that involves going inside the canal till the working length and start enlarging progressively from the apical to the crown, this technique involves using of several files

in the rotary files we are using the crown – down technique which is enlarging form the crown to the apical part

benefits of crown-down technique

it helps us to eliminate the cervical constrictureit gives full tactile awareness in the apical third , which means when I enlarge in the coronal third and I introduce a manual file I can feel more the apical area because the file will not block in the coronal third because the coronal third is already enlarged it helps in irrigation efficiency because the irrigation will go deeply in the apical area and it will minimize pushing irritants in the periapical region

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why should we replace the stainless steel files with rotary nickel titanium and rotary m wire files?!

o The manual stainless steel files are k files , h files , k reamers we mainly have 2 generations

o The first generation which is the colorinox stainless steel files create some problems :- The files can create ledges , zipping and canal blockage

which will result in short obturation - They can force the extrusion of debris with the filing

motion towards the apical area - Time consuming - Less predictable shape in curved canals , when we have a

curved canal it’s very difficult to follow the curvature with stainless steel files maybe with small files we can but when the file is getting bigger it’s not easy

o So they tried to go to another generation which is called flexo files , these files are more flexible because they made the cross section triangle which was a square cross section in the colorinox so by this change we have a smaller area of metal so the file is more flexible another thing they removed the transition angle but even with these changes it wasn't

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enough and problems are still existing so they decided to change the metal

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For years they were using The pro-taper universal (files with multiple and progressive taper)

after 12 years they moved to the next generation which is the pro-taper next

We have 379 scientific publications on pro-taper 5900 kilometers of pro-taper files And more that 78 tons of files

Rotary files advantages- More elasticity - More flexibility - Better cutting efficiency - Can do shaping for 3 dimensional obturation - With less number of files- Less canal transportation - Less debris extrusion - Less post-operative pain - Faster- More predictable results

So it gives the beginner the possibility to achieve nice result like a professional

Characteristics of rotary nickel titanium files We have 2 generations of files

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Constant taper ,( the instruments available in the markets )

variable taper , (protaper) What’s the taper ?

o It’s the Coneisty of the instrument, if you take a manual k file 10 or 15 the walls of the file are not parallel , just small coneisty like a cone

o Manual files have a taper of 2% , which means diameter increases by 0.02 mm every mm

o For the pro-taper on only 1 file the instrument will start with a coneisty of 2% then after 3 mm we have 3 % 4% 6%..this what we call (variable taper) ,they made this shape to be able to reduce the number of instruments

o Every instrument in the protaper is designed to enlarge a part of the canal S1 will enlarge the coronal S2 the middle The finishers will enlarge the apical part

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for a manual k file , as we know the manual file has a taper of 2% and a tip size of 20 so when we prepare a canal with the k file , the diameter increases by 0.02 mm every mm

for the f1 , it has a taper in the final 3 mm of 7% so here the diameter will increase more ,which means more tapering so when we do irrigation the irrigant solution will go deeply and clean well

with rotary file ,it will enlarge the canal more than 2% coneisty so the purpose is give the canal a larger taper

another difference between the protaper and other files , the cutting blades which are important because when the file is rotating it will be active not passive (if its passive the file will rotate several times before cutting the dentin and then the file will get tired and might break )

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protaper next

it works with continuous rotation like protaper, there's another rotation which is called reciprocation we will not work with it

variable tapers 11 mm handle for improved accessibility in posterior

teeth which is smaller than 13 mm as it was in protaper universal

5 interments , but only 2 needed in most cases but for universal we need from 4-5 instruments

Pre-sterilized blister packaging of 3 files , can be used immediately

Intended single patient use, it means every kit for one patient this in Europe but here we can sterilize and reuse

Unique off –centered Rectangular cross section , which will give the file snake like swaggering movement while rotating which will help the file to follow the curvature of the canals

This will give us enlarged space for the debris Better centering of instruments in the canal

M-WIRE NITI

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the M-wire niti which is a special material for the fabrication of these files

M-wire is originally nickel titanium with thermal treatment process (heating and cooling) , it helped in changing the nature of the file

The advantages Improving file flexibility ,while still retaining the cutting

efficiency Greater resistance to cyclic fatigue , the leading cause

of file separation What are the files ..

-we have totally 5 files , because in the name protaper next we have the letter "x" then the files names are x1 , x2 ,x3,x4,x5 -for the protaper universal we can replace 4 files(s1,s2,f1,f2) by 2 files (x1,x2)

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We can recognize x1,x2,x3,x4,x5 easily because the color of the ring corresponding to the tip size X2 is red because the tip size is 25X3 is blue because the tip size is 30X4 is black (it has two rings)because the tip size is 40X5 is yellow (it has two rings) because the tip size is 50

X1 is also yellow but the tip size is 17,its not corresponding to the tip size

- We start shaping the canal with x1, and the final is x2

But for larger canals I may need x3 ,x4 .. - In the majority of the cases we use just x1,x2 and

rarely x3

the tapers

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In the final mm for x1 we have 4% taper, then it will increase for 5%, progressively to 6.5% ,then to 7.5% then it will decrease a little bit

We should always keep in mind the taper in the apical area

in x1 it's from 4-5% in x2 it reaches 6% which is more than

enough to allow the irrigant solution to go deeply in the apical area so 6% is the ideal

Dr. Michael J. Scianambl is the one who did the design with another 7 endodontists so the design was done by dentists and manufactured by dentsply

in x3 it reaches 7.5 taper, but with x4 the taper is reduced because 40 is already very large we can't give it 9% it's really too much so in order to increase the flexibility they reduced the taper

in x5 its 6 %

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the protaper philosophy remains the same

a single file sequence for all clinical cases, straight canals , curved canals .. for all types we have the same sequence

variable tapers for optimized crown-down technique

commonly approved apical finishing diameters

Advantages of protaper next - The advantage of protaper next is that this

instruments can cover more difficult clinical cases because its more flexible and because its more resistance to fracture its much safer with narrow ,curved and other difficult canals

- Protaper next brings improved safety because it reduced the risk of file breakage

- The studies shows that protaper next is stronger and more resistance to fracture and less canal transportation

- Less working time (shaping time) because we only need two files

- High cutting efficiency

Now how to work with protaper next ?!

We should start by preparing the access cavity, we can use several burs like round ,conical, diamond and the endo z ** endo z is very helpful in the preparation of the walls of the cavity because the tip of

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endo z is a very safe and non cutting tip, we put it in the canal in a vertical way and we pass it on the walls it will enlarge the cavity while keeping the floor of the pulp chamber very safe so there will be no risk of perforations ,stripping or any problems

**We also have the x-gates glidden we have several numbers of gates 1,2,3,4 , we can use x-gate to replace the four other gates

After preparing the access cavity it's time for negotiation the canals To negotiate the canals we have to steps

1 -Pre flaring and establishing glide path ,this step comes before using the protaper next so that we can use them safely because anatomy of the teeth is

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different from one person to another so we can't start negotiating the canals without knowing what is waiting me there , so we need to start by a manual file (k file number 10 or 8 or 6 if its thin ) but this thing is a must then I will open the path with rotary files are called path files

*So when we say pre flaring it means discovering the canal with k file*establishing glide path means to open the path for the rotary file to allow them to go and start shaping

2-Shaping and cleaning

Path files

the path files replaced all the manual procedure, in the past they used file number 10 to find the canal and they enlarged with 15 and 20 but the problem in some narrow and curved canals we can use 10 but it's not easy to introduce 15

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so they came with the idea of having files more flexible ,easier for negotiation the canals and can cause less problems

path files are 3 instruments we call them p1,p2,p3

p1 is purple , p2 is white ,p3 is yellow .. the color is not matching with the tip size

purple is number 13 ,white is 16 , yellow is 19 we have lengths 21,25,31 path files are very flexible and resistance to

cyclic fatigue more efficient than manual preparation the cross section is square and the taper is

2% , like k files but not stainless steel they are niti , to avoid the problems ledges, zipping .. etc

how can I achieve my glide path ?!! we start with k file number 10 , I can use

p1,then p2, Then p3*but if I have large and easy canal I don’t need to use path files like a canine or a palatal canal *we should use path files when we only need them *using the three path files in thin curved calcified canals is making life easier , because the files will go easily after using the path files*in majority of cases we just use p1,p2 .. the p3 file in the very thin canals

the rotation speed of path files is 300 !

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the path files should start rotation outside the canals then inside the canal we use in and out motion until we reach the working length

time needed for the path file to reach working length normally doesn’t exceed 3-5 seconds

the rotating motion will carry debris in a coronal direction ,it's not cutting or enlarging its just opening the path for the rotary files

after using file number 10 and then the path files , we need to start with protaper next we should start irrigation from the beginning of the work

the first protaper next instrument we use is x1,in the presence of sodium hypochlorite and also in the presence of glide*glide is a lubricant agent it will allow the file to go easier in the canal *the combination of glide with Naocl will help to remove the smear layer this combination is more efficient

for protaper next file the motion is brushing motion for seconds from 3-4 second ,it’s the secret of success in the protaper family

we should reach the working length with x1 before moving to the second file x2

then we remove x1 , clean it well then we should irrigate to remove the debris , after that we can use a k file number 10 to check the patency and that the debris is not blocking the canal

then after making sure we reached the working length we can move to x2 with repeating the same steps*we should always check that we have glide in the pulp chamber

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then we check the flutes of x2 if it's loaded with dentin this mean that x2 removed a good quantity of dentin , then the canal is ready for obturation

now shall I obturate after x2 or continue with the files ?!the tip size of x2 is 25 , I can take a manual file 25 and insert it passively to the working length if there is resistance then I don’t have to go larger , but if the manual file is moving easily inside the canal then I have to continue with x3 .. repeating the same steps

These are the five files, to shape the canal we need x1,x2 and the other 3 are optional

We can see the taper and the tip size in the figure above

X1 has a tip size of 17 and 4% taper in the apical third X2 has a tip size of 25 and 6% taper in the apical third X3 has a tip size 30 and 7%taper in the apical third X4 has a tip size of 40 and 6% taper in the apical third X5 has a tip size of 50 and 6% taper in the apical third

*We always need from 6-7% taper to obturate so the irrgants can go deeply

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For this system we have matching paper points and matching gutta percha that is called gutta core

These the motors that we will use These motors can be charged, we can use it with the

electricity or with the battery We have a screen we can change the settings of the motor We have 9 programs For path files we need a speed of 300 , and torque 3.5 For protaper next we need a speed of 300 for the 5

instruments and torque of 2

ConclusionProtaper next will cover more difficult clinical cases, bringes improved safety and shorten the shaping time, because of the off centered cross section , the swaggering movement and the M wire niti material

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Done by : Alaa Adas ;))

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