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18
trends DeNtal tribuNe | april-June, 2010
Current concepts in gutta-percha removal for re-treatment
Two-part series by Dr Roheet Khatavkar & Dr Vivek Hegde—Part I
Common reasons for an endo-
3. Combination of paper points
are available usually in amber-
remnants. 3,4 Paper points can
the gutta-percha by frictional
dontic failure include missed
and gutta-percha solvent
colored bottles.
also be used for retrieving sludge
heat and facilitates its removal
canals, ledge formation, perfo-
4. Rotary instruments
of soft-ened gutta-percha for-
from the root canal by its H-file
rations, separated instruments,
a. Gates Glidden drill/Peeso
Chloroform has been proven
med on the reaction of solvent
like flute design. These stainless
inadequately filled canals, coro-
reamer
to be most successful in plastic-
with gutta-percha.
steel drills are more effective
nal leakage, and error in post
b. GPX gutta-percha remover
izing gutta-percha points, and
in the coronal and middle –third
placement.
c. NiTi rotary instruments
thus facilitating its removal from
The ‘wicking technique’ is
portion of the root canals. These
5. Specialized rotary instruments
root canals during retreatment.
used, i.e., flushing the root canal
drills are available in various
For a successful orthograde
designed for retreatment
The reported adverse effects
with solvent followed by drying
sizes, ranging from ISO 25–50,
retreatment, the removal of the
a. ProTaper Universal retreat-
on the health, from exposure to
it with paper points, which helps
and more recently introduced
endodontic filling material, such
ment instruments
chloroform, have necessitated
in removing the softened gutta-
NiTi GPX removers that can be
as gutta-percha, is essential to
b. Mtwo retreatment files
the use of a less hazardous
percha along with paper points.
used in curved canals as well
allow access to the canals for
c. R-Endo retreatment files
solvent replacing chloroform. 1, 2
This technique is very useful in
(Fig. 3).
a successful debridement and
re-obturation of the root canal
6. Heat transfer devices
a. Heat carrier tips
The use of solvent softens
narrow canals or the canals with
a greater degree of curvature.
C. NiTi Rotary Instruments
system. This article deals with
the removal of gutta-percha
b. Ultrasonic tips
7. Soft tissue laser.
the gutta-percha, and then softened
gutta-percha can be easily
4. Rotary Instruments
The use of NiTi Rotary instruments
have the advantage of
based obturating material, as
an essential step in a successful
1. K-files or H-files
removed from the canals by
placing the file into the canals
A. Gates Glidden Drill and Peeso
Reamer
removing gutta-percha as well
as shaping the root canals in an
endodontic retreatment.
K-files or H-files are the basic
and applying firm pressure
The use of Gates Glidden drill
under-prepared tooth, simulta-
instruments in an endodontist’s
against the canal walls.
or Peeso reamer (Figs 2a & b)
neously. The number of studies
The first step in planning for
armamentarium, which can be
is a well-known technique to
carried out for comparing the
a tooth requiring retreatment
used to engage the mass of gutta-
Micro-debriders and openers
remove gutta-percha from the
gutta-percha removal efficacy
is – ‘Coronal disassembly’. This
percha, and by applying an
(Dentsply Maillefer) are small
coronal and middle portion of
of rotary with the hand instru-
involves removal of the coronal
outward firm-pressure mass can
files having 90-degree bend at
the root canal. 5 The non-flexible
mentation, have shown both
restoration including full cover-
be removed. This technique,
the working end and an attac-
head and lateral cutting design
techniques to be almost equally
age restoration, core build-up
however, allows for a gross
hed handle (Fig. 1). It may also
of these instruments do not
effective. 6 It has been advocated
material, and post placed into
removal of gutta-percha espe-
be used to substitute standard
allow instrumentation in the
that the use of rotary devices in
the canal. After gaining access
cially from large canals, which
K-files and H-files.
curved portion of the root canal.
endodontic retreatment should
into the pulp chamber, it is a
prerequisite for the clinician to
inspect the chamber floor for
any missed canals, which can
also be a cause of failure.
are poorly compacted allowing
files to bypass the obturating
material and ‘bite’ into the mass.
2. Gutta-percha Solvents
3. Combination of Paper
Points and Gutta-percha
Solvents:
Most of the literature shows that
Therefore, the additional use
of hand instrument is often
necessary. Due to their stiffness
and predisposition to fracture,
they are safer in the straight
be followed by hand instrumentation
to achieve optimal
cleanliness of root canal walls.
The rotary instruments reach
the whole working length easily,
Techniques for Guttapercha
Removal
The clinician can use various
A wide array of chemicals are
available today as gutta-percha
solvents, such as eucalyptus oil,
turpentine, chloroform, xylol,
gutta-percha filling material
cannot be removed completely
from the root canals. In such
cases, a solvent is flushed into
portions of the canal of anterior
and posterior teeth.
B. GPX Gutta-percha Remover
plasticize gutta-percha through
frictional heat, & remove guttapercha
quickly. Later, hand
instruments can refine and com-
options for the removal of
methylene chloride, orange-
the root canals upto the level
The GPX gutta-percha remover
plete the removal. 6 These instru-
obturating material:
wood oil, methyl chloroform,
of pulp chamber, in an effort
(Prestige Dental) is a specially
ments are recommended to be
1. K-files or H-files
endosolv E, endosolv R, and
to maximize the interaction of
designed file used in a slow-
used at rotational speed of three-
2. Gutta-percha solvent
tetrahydrofuran. These solvents
the solvent and gutta-percha
speed handpiece. It plasticizes
four times more than that of the
rotational speed which is recom-
A
B
mended for routine cleaning
and shaping procedures. The
rotary instruments also have
increased chances of fracture
in case they are forced through
the mass of gutta-percha.
DT
Fig.1: Micro-debriders and Micro-openers from Dentsply Maiellefer
Fig. 2a: Gates Glidden drills nos. 1-6 can be identified by the head-design and
rings on the latch-type attachment
Fig. 2b: Peeso reamers nos. 1-6 can be identified by the longer length of flutes
on the head-design and the rings on latch-type attachment
Editorial note: The references
will be published with part II
of this article in the next edition
of Dental Tribune India.
GPX TM · Stainless Steel Niti GPX TM · Nickel Titanium
About the authors
Packaging unit 6 6 6 6 6 6 Packaging unit 6 6 6 6 6 6
Color code Color code
Size DØ 1/100 mm 025 030 035 040 045 050 Size DØ 1/100 mm 025 030 035 040 045 050
L=21 270..... 2001 2002 2003 2004 2005 2006 L=21 270..... 1901 1902 1903 1904 1905 1906
Assortment 2000
Assortment 1900
CPX TM features a spiraled vent through which gutta-percha is extruded as it is plasterized
from frictional heat.
A latch-type nickel titanium alloy instrument for use on low speed hand pieces. CPX TM
features a spiraled vent through which gutta-percha is extruded as it is plasterized from
frictional heat.
Fig. 3: GPX Stainless Steel & NiTi instruments available for removal of gutta-percha in straight and curved canals respectively
Dr Roheet Khatavkar is a postgraduate
student in the department
of conservative dentistry
and endodontics at M A Rangoonwala
Dental College, Pune, India.
Dr Roheet can be contacted at
drkhatavkar @gmail.com.
Dr Vivek Hegde is professor and
head of the department of conservative
dentistry and endodontics at
M A Rangoonwala Dental College,
Pune, India. He can be contacted
at drvivekhegde@rediffmail.com.