Q&A: Endodontics
ChlorCid | Endo- Eze AET | Endo- Eze Handpiece |
EndoREZ | EDTA 18% Solution | File- Eze | UltraCal XS
ChlorCid & ChlorCid V
- leaving in tooth
Endo- Eze AET
- C Shaping Files
- file disinfection
- final root canal rinse
Endo-Eze Handpiece
- compatibility
- sterilization
- internal water spray
- lubrication
- speed of motor
EndoREZ
- curing , purpose of
- curing time
- depth of cure
- dissolving
- hydrophilicity
- open apices, use with
- peroxide-containing irrigants /lubricants
- photoinitiator content
- post placement waiting time
- post preparations
- quantity of canals per syringe
- removal
- retreatment
- sealing ability
- setting problems/inhibition
- shrinkage
- syringe content
- tubule penetration
EDTA 18% Solution
- final rinse of root canal
- vs . File- Eze
File- Eze
- vs. EDTA Solution
UltraCal XS
- calcium hydroxide content
- composition
- extrusion past apex
- liner or pulp cap use
- degradation over time
- pH
- recurring infection
- removal from canal
- sensitivity caused by
- syringe delivery, advantages of
Technical Q&A
Can CHLORCID be left in the tooth for a few days to kill bacteria from a recurring infection?
No. Chlorcid is a 3% sodium hypochlorite solution designed to be used during instrumentation, cleaning and shaping, but not as an interim treatment/medicament.
Back to top
What is a C Shaping File?
These files are seldom needed, but some dentists like to use them in more calcified canals as a mid-way taper between #2 and #3 shaping files .
Back to top
If an ENDO-EZE PATIENT KIT is to be saved for a subsequent appointment, how should the patient kit be disinfected?
Patient kits may be stored for use at a subsequent patient visit. The doctor should inject 1ml of UltraCid ( benzalkonium chloride) between foam and kit wall to disinfect. The doctor can then clean and autoclave the kit or seal the container and label it with patient information for the next appointment.
Back to top
What should be used for the final rinse of a root canal?
The best material for a final rinse is peroxide-free EDTA – such as our EDTA 18% solution – which is especially recommended when using a resin sealer. Alternatives to EDTA solution are bacteria-free water, local anesthetic, or Consepsis liquid. (Consepsis should only be used if sodium hypochlorite has NOT been used.)
Back to top
Which motors are compatible with the ENDO-EZE HANDPIECE?
ADEC/W&H – Compatible (plus water)
Analytic ( SybronEndo ) – Compatible
Anthrogyr – Compatible
Aseptico – Compatible
Bienaire – Compatible
J. Morita – Compatible
KAVO – Compatible
Midwest ( Dentsply ) – NOT Compatible
NSK – Compatible
Miltek ( Moyco ) Tardie – Compatible
Star ( Dentaleze ) – NOT Compatible
Tulsa ( Dentsply ) – Compatible
Any Electric Motor – Compatible
Any E-Type Motor – Compatible
Back to top
How should the ENDO-EZE HANDPIECE be sterilized?
1 – Manual disinfection:
Disinfect external surfaces by spraying or wiping with microbiologically tested surface disinfectant.
2 – Manual cleaning:
-
Wear protective gloves.
-
Make sure the speed regulating ring is set to position F or R.
-
Remove root canal file from handpiece and remove handpiece from air motor. Disconnect the air motor from the supply hose.
-
Clean handpiece and air motor externally with cloth or brush soaked in disinfectant.
Note: If there is a high calcium content in the spray water (>18dH represents 180mg CaO in 1 quart, ~1 liter water), we recommend blowing out the water tubes before sterilization. For handpice , blow through water tubes with air syringe.
3 – Sterilization:
-
We recommend autoclaving up to 135° C for 15 minutes.
Note: The air motor should be cleaned and lubricated before placing into the autoclave. Only sterilize with distilled water. For sterilization, use sterilization packaging. We recommend sterilizing after every patient.
Back to top
Will the internal water spray of the ENDO-EZE HANDPIECE work when used with another manufacturer's motor?
Yes, if the motor is capable of delivering water to a handpiece .
Back to top
Is it necessary to use Ultradent's lubricant with the ENDO-EZE HANDPIECE?
No, any handpiece lubricant can be used.
Back to top
What speed of motor should be used with the ENDO-EZE HANDPIECE?
Ideally, the motor should run at 20,000 RPM. Our handpiece has a 4 to 1 gear reduction, so it ends up running at 5000 reciprocating cycles per minute. The very minimum – and less than ideal – motor speed for using our handpiece is 10,000 RPM.
Back to top
Is light curing ENDOREZ necessary?
Since EndoREZ is a dual cure system, light curing is not necessary for total polymerization. However, curing EndoREZ will create an ultra-thin crust/barrier to help facilitate faster placement of a direct resin restoration by preventing cross-contamination between the provisional and the underlying EndoREZ . All of the material will set completely in 15-20 minutes.
Back to top
What is the cure time for EndoREZ ?
Light cure EndoREZ for 40 seconds. This will cure a depth of approximately 0.5mm. It will not cure deeper than this with a light because EndoREZ is so radiopaque that it is also light opaque. The remaining uncured material will chemically cure in 15-20 minutes.
Back to top
Can Endosolve* be used to remove residual ENDOREZ?
Endosolve will not dissolve EndoREZ .
Back to top
How is it that ENDOREZ is hydrophilic? Does it contain water?
"Hydrophilic” literally means "water loving." Many substances that contain no water are water loving (e.g. alcohol, acetone, glycol, HEMA, etc). Usually this occurs via hydrogen bonding. Varying levels of "water loving” occur . Some materials are aggressively "water loving" and are hence called "hygroscopic" – aggressive water lovers, if you will. Others are totally water loving, but not in the aggressive sense – they are miscible in any proportion (e.g. most glycols, sugar, salt, etc.) Others are minimally water loving, meaning they are soluble to only some fixed level and then water can't hold them in solution any further and the excess precipitates out (e.g. EDTA, many salts and organics, chemicals in general).
Many factors can effect the above, be it pH, temperature, percentages of various components and the like. As a general rule, polar substances are usually soluble to varying degrees in other polar substances. Water is a polar substance as are alcohol, acetone and other polar organics. Oils and many resins, for example, are nonpolar and hence not soluble in water. In general, an ionic solid has a greater solubility potential in a polar solvent such as water than in a nonpolar solvent, for example sodium chloride. Many times, nonpolar chemistries can be hydrolyzed or reacted in other ways to make them have more affinity for water. The molecule is changed for this to happen but often can still react in similar ways, example even polymerize.
Back to top
The instructions describe the use of ENDOREZ in cases with normal apical anatomy. Can ENDOREZ be used in teeth with funnel shaped or open apices? If it is possible, what are the necessary modifications to the technique?
Should the doctor encounter a large open apex, EndoREZ can be used for obturation in the following manner: Fit a cone of gutta percha into the canal for tug back, then apply a small amount of EndoREZ to the apical portion of the canal. Insert the gutta percha . Now mix the EndoREZ and deliver it into the canal through a NaviTip that is slipped alongside the gutta percha in the canal. Fill the canal as usual from the bottom up to avoid entrapment of air.
Back to top
Can ENDOREZ be used with peroxide-containing irrigants/lubricants?
Oxygen generated from peroxide can inhibit the set of resins including EndoREZ . Do not use peroxide-containing irrigants or lubricants with EndoREZ . File- Eze is a peroxide-free, EDTA endodontic file lubricant. It may be used throughout the procedure with sodium hypochlorite irrigation. Carefully read all manufacturer's instructions. Do not use any lubricant or irrigant not specifically designed for endodontic use.
Back to top
What is the photoinitiator in ENDOREZ?
Camphorquinone and a proprietary initiator.
Back to top
What is the wait time for placing a post after using ENDOREZ?
The full set of EndoREZ is necessary to facilitate post placement. The clinician will need to wait 15-20 minutes until the material is fully set.
Back to top
How do I do a post prep on the same visit when the canal is obturated with ENDOREZ?
EndoREZ takes 15-20 minutes to set hard. In order to perform a post prep the same visit, apply Ultradent DeOx to the exposed EndoREZ , remove the rubber dam, and have the patient bite on a cotton roll. Check the fill with an explorer. When the material tests hard, the post prep may proceed.
Begin the post channel with gates- glidden drills, using the single gutta percha as a guide. Use post drills to enlarge the post prep as usual.
Back to top
How many canals can be filled with a syringe of ENDOREZ?
The full syringe of EndoREZ should fill 50-90 canals. The mini obturation kit has 1/3 of the full syringe and should fill 20-30 canals. It's a wide range because it depends a lot on the doctor and the canals being filled.
Back to top
ENDOREZ sets moderately hard inside the canal. Is there any solvent that can soften the set resin in the canal?
EndoREZ is easily removed using a Gates Glidden drill or ProTaper endo removal files to gain access, followed by regular files. There are no solvents to dissolve it should a retreat be necessary.
Back to top
Is ENDOREZ retreatable?
EndoREZ is retreatable . It sets harder than ZOE - like a hard ZOE (e.g., ZOE B&T), but not as hard as other resin fillers or restoratives.
Begin by making a channel with gates- glidden drills following the gutta percha . Remove the remaining EndoREZ with files. There is no chemical solvent for EndoREZ .
Back to top
How do ENDOREZ's sealing ability and shrinkage rate compare to those of gutta percha ?
EndoREZ performs favorably. If using hot gutta percha , it is important to remember that gutta percha shrinks about 6-7% as it cools. Even with cold gutta percha and "lateral condensation," there are numerous gaps, since it has historically been used with hydrophobic sealing materials.
A study presented at the European Society of Endodontics in 2003 demonstrated that the greatest amounts of gaps occurred with lateral condensation. It showed that the EndoREZ , albeit not the best at every level throughout the canal, was, in fact, the best over all. ("Evaluation of the effectiveness of the filling of curved canals, through the use of six different techniques " by Dias et.all .)
To reduce or prevent gaps in the middle third with wide canal spaces, we are now teaching to insert additional gutta percha but not to condense laterally.
Back to top
Why does ENDOREZ sometimes not set in the root canal?
This is due to the use of peroxide-containing irrigants/lubricants such as RC Prep* or Glyde* . Oxygen generated from peroxide can inhibit the set of resins including EndoREZ . Do not use peroxide-containing irrigants or lubricants with EndoREZ . File- Eze is a peroxide-free, EDTA endodontic file lubricant. It may be used throughout the procedure with sodium hypochlorite irrigation. Carefully read all manufacturers' instructions. Do not use any lubricant or irrigant not specifically designed for endodontic use.
Back to top
If resins shrink upon polymerization, how can a resin-based obturation material seal effectively?
Remember that all resin materials should not be lumped together into one category. Why? All resin-based sealers prior to EndoRez were/are hydrophobic. The hydrophillic property of EndoREZ contributes a very important difference. A number of studies now show good sealing with EndoREZ , and even 1500 microns into dentinal tubules.
When using EndoREZ , researchers have seen unsurpassed adaptation and seal in the apical region and no shrinkage was observed there. Why? With gutta percha fit with tug-back, the dimensions of resin in the apical portion are minimal. Using the NaviTip to deliver EndoREZ to the apex adds significantly to the predictability of this apical seal.
Even up in the broader sections of the canal in the middle third, shrinkage gaps are minimal and less than what would be seen with lateral condensation with gutta percha . Professor Lambrechts , an authority on the study of the adhesive interface, explained that he really sees no clinical relevance to the micro gaps in the middle third with EndoREZ (Catholic University of Leuven , Belgium). He says that since the tubules are filled to 1500um, even adjacent to such gap, bacteria in the tubules are entombed in the set resin and the apical portion is sealed.
Again, having hydrophillic properties is a step forward for sealing potential for a few reasons:
- The capability to infiltrate and seal dentin tubules that have been treated with EDTA (of File Eze or any other) and sodium hypochlorite
- The low contact angle at which a hydrophillic material approaches even moist dentin. This improves the capability to adapt into tiny irregularities and even into accessory canals.
Back to top
How many grams of material is in an EndoREZ syringe?
The entire syringe is 6 ml or 11 gm. We measure by milliliters when loading in manufacturing.
Back to top
After cleaning and disinfecting, the root canal still contains a smear layer. How is it possible that the ENDOREZ penetrates the tubules?
Cleaning with EDTA (e.g. File- Eze ) followed by disinfecting with sodium hypochlorite, (e.g. ChlorCid ) not only removes all the smear, but also much or all of the decalcified collagen. EDTA can be used as a conditioning agent for dentin bonding. It doesn't function in the acid sense, but chelated as a base. Sodium hypochlorite removes the decalcified collagen making an even better surface for hydrophilic resin adhesion and sealing. Such is not used for restorative dentistry because it takes many minutes to be effective and it could be damaging to surrounding soft tissues. For more information about EndoREZ's tubule penetration, see entry under “ EndoREZ , shrinkage.”
Back to top
What is the difference between Ultradent’s EDTA SOLUTION and FILE-EZE?
The EDTA solution is an 18% EDTA liquid. File-Eze is 19% EDTA in a water-soluble, viscous base.
Back to top
What is the percentage of calcium hydroxide contained in ULTRACAL XS?
The calcium hydroxide in UltraCal XS is 35%, w/w.
Back to top
What is the basic composition of ULTRACAL XS?
It contains principally calcium hydroxide but some hydroxyapatite and water-soluble thickener as well plus water.
Back to top
What are the effects if UltraCal XS is accidentally extruded past the apex? Does UltraCal XS contain any ingredients that could cause problems in the sinus cavity?
UltraCal XS is biocompatible and will resorb in about 2-3 months.
Back to top
Can ULTRACAL XS be used as a base, liner, or pulp cap in place of the ULTRA-BLEND PLUS?
No. UltraCal (calcium hydroxide) is used as a temporary dressing in endodontic canals rather than a permanent filler for restorations because UltraCal may resorb back into the body in vital teeth. If it resorbs , a space is left where the UltraCal was, which could result in sensitivity. UltraBlend (calcium hydroxide and urethane dimethacrylate ) was designed as a base and liner for composite or amalgam as well as for pulp capping and will not absorb back into the body.
Back to top
Calcium hydroxide powder will be less effective when aging. Does ULTRACAL XS have the same problem?
Calcium hydroxide will react with carbon dioxide to form calcium carbonate. This is the mechanism by which it deteriorates. UltraCal XS deterioration is dependant upon the available carbon dioxide and neighboring reactants. The syringe-based delivery system will minimize exposure of unused UltraCal XS in the syringe. This will potentially help maintain the effectiveness for extended periods of time. Without exposure to CO 2 or other reactants, the UltraCal XS will remain effective.
Back to top
What is the pH of UltraCal XS?
12.5
Back to top
If ULTRACAL XS is placed in the canal where a recurring infection exists, will the bulk of this additional material in the canal increase pressure build-up by remaining bacteria?
UltraCal XS is designed to kill the bacteria, therefore preventing the buildup of pressure and infection.
Back to top
How is ULTRACAL XS removed from the canal?
The best way is to use the Citric Acid and NaviTips FX. This facilitates simultaneous scrubbing and cleaning. (UltraCal XS does not get hard in the canal; it is the same paste consistency as when initially delivered.)
If these materials are not available, use plain EDTA and endo files. Sodium hypochlorite can be used if EDTA is not available. Using these chemicals in conjunction with mechanical removal will work UltraCal XS out of the canal. Follow with paper points to ensure the material has been removed. Afterward, perform a final rinse with water to ensure all the sodium hypochlorite is removed from the canal.
Back to top
Why would a patient experience sensitivity after ULTRACAL XS is placed in the canal?
Most always this occurs at the first phase of root canal treatment. Pain often occurs at this phase whether UltraCal XS is used or not.
Back to top
* These tradenames belong to companies other than Ultradent Products, Inc.
Updated 01/18/2006
