Transcript for:
ProTaper Gold System Overview

hello and welcome to the module odo470 in the division of endodontics i'm dr buchanan and uh today we're going to be talking a little bit about rotary files this is the third lecture in the rotary course series and previously we have covered excess cavities on molars as well as working length determination and cloth so if you want to refer to your recommended textbook for more information you can go and have a look at the cleaning and shaping chapter that's chapter 14 pages 297 to 326. so what happened last time in the previous session we should have established our working length and prepared a smooth reproducible glide path on some extracted molar teeth and that should have been confirmed with a couple of size 20 iso k files that should have been inserted into the tooth up until the full working length and confirmed with a radiograph and once we've confirmed that then we're ready to clean and shape with our rotary instrumentation so what are we going to do in this session in this session we're going to cover the principles of cleaning and shaping using rotary endodontic files and the system that we're going to be using is the protaper gold system from dead spy serrano just a couple of words in engine driven endodontic files so engine driven files and by engine driven i mean either reciprocating or rotary systems so these are mechanical files files that fit onto a handpiece and and or driven by a handpiece so they're not manual you don't you don't use them by hand so engine driven files are probably these days the most popular way and most common way of shaping root canal systems in the modern world um it's not a new technology rotary systems in particular have been around for many many years already and there really are many different brands and systems available on the market today so um i had to look at an article that recently that suggested that there are over 65 rotary and reciprocating systems and i think there's probably more so there really are many of these different brands and systems the particular system that we teach is called the protaper gold system from dentsply sirona um it was or is most most likely the most commonly taught and used rotary system around the world and it has been for many years uh the system was first launched in 2001 we'll talk about its history in just a second and up until the present day many many people still use it and it's something that you will find out in private practice that is commonly available now whilst there are very many advantages to using uh our engine driven nickel titanium files to clean and shape root canal systems and i put this in my presentation and say it will really change your life and it really will if you've been just accustomed to cleaning and shaping with hand files it really is going to change the way that you view and enjoy endodontics but i must stress i think at this point that the operator or you must always have an excellent understanding of this specific system that you're using um and bear in mind when you get outside private practice you might not be using the same systems uh that we taught you here at up so just bear in mind that any system that you're going to use will have its own directions for use and it might be unique to that to that system and it might have completely different principles for use as well so the principles that we're going to teach you here are specifically for the protaper gold system or you know you can use these principles for the price like the universal system as well but really uh this presentation it only covers how to do rotary endodontic treatment with those two systems so if you're going to use something different in private practice uh it's very important that you either read up a lot on it or preferably attend a course and always be very aware of what you're using because things like speed settings talk settings and directions for use might be very different between the file systems so let's just have a little look at the history of essentially the pride cypher system from dead spy serena so the system was launched in 2001 and it was just called pro cyber and it was a it quickly became very very popular because it was really an excellent system for for cleaning and shaping the root canal system reliably and as time went by the manufacturers made slight adjustments to things like the uh the exact geometry of the file things like the tip diameters so they just made little tweaks little changes uh it was essentially still the same system but then in 2006 it was relaunched and rebranded as the protaper universal system and the price ap universal system included a couple of extra things so they included f4 and f5 uh files in gb's it included some retreatments instruments as well so picture there on the top right hand side that's a that's a d1 re-treatment file we'll talk about that in a future lecture but uh the both the protaper and the protaper universal system so from 2001 and 2006 were made from conventional uh nickel titanium so these are not stainless steel vials these files are made of nickel titanium and we use nickel titanium for rotary and reciprocating instruments because they're both very strong but but flexible as well so we have the ability to uh to go around curves with uh nickel titanium because of its flexibility so uh the conventional light eye or nickel titanium of protaper and protaper universal had a property called shape memory which meant that if you bent it and then you let it go it would revert to its original shape so you could uh you could bend these instruments by hand but they wouldn't stay bent like what you get with stainless steel hand files if you bend them over and you let them go they would straighten out again like like the picture on the on the top right and so that was the protaper universal system um in 2013 and i think this is very important uh the price type and next system was launched so price type in next is not the same as prototype and price ap universal it's a completely different file system it works in completely different principles at different speed settings at different torque settings as well okay um and why i say it's important is because the machine that we use the rotary endodontic machine it's called the um the x smart system that we have here at the university of pretoria and it has pre-settings and these uh preset values are not the same for the protaper universal or the protaper gold or the pride type in next so you must be very careful that you actually select protaper gold the system that we're working with and not prototyping next okay because it's very very important so prototyping next was was different because it had a slightly different metal um it used a metal called m wire which was basically uh an enhanced type of nickel titanium but the system was completely different from protaper universal so the system that we're using the one that you'll find in the awards and the one that we're going to teach you is called protaper gold the protaper gold files were launched in 2014. the system is essentially the same as the protaper universal system so it's not this it's not next it's the same as price ap universal uh it has a different color obviously the files are of golden color hence the name protaper gold but but the files in the system are essentially the same as protaper universal and this is made from a heat treated m wire uh nickel titanium so uh it's uh it's a completely different metal whilst it's the same files as prototype universal the metal that they're made from is completely different right so what is different about the metal essentially the difference between protaper gold and protaper universal is that's the protaper gold files so the new ones have better resistance to cyclic fatigue and what does that mean uh basically in reality it means that if the files are taken around a curve they are or more resistant to um to rotating when being placed around the curve so they can spin for a longer time around the curve before they actually fail or break which is which is something that's really important in order to treat sort of more complex anatomies they also have greater flexibility so in this graph you can quite clearly see that the protaper gold system demonstrates a lower bending torque as compared to protaper universal so this is just you know a couple of notes on the on the metallurgy of the files how the metal has improved the physical properties so this is two of the shapers and in the slide you can also see that the same is true for the finishes also both the shapers and the finishing files have a low bending torque which basically just means that they have much more flexibility and we can see that in the following video here's a video of quite a curved tooth you can see that it's got quite a severe curvature in the apical third 109 degree curvature if you if you measure the radius and here we can see the s1 instrument so that's the shaper one the first rotary file of the system and we're going to discuss the use of the s1s and the s2s the shapers and and the finishes in the next couple of slides what i want you to notice here is just how it is actually possible for for these files to go around quite severely curved routes and and that's the advantage of uh of the protaper gold system and having heat treated nickel titanium instruments so the the instruments of the modern era can can really attack this really complex anatomy and severe curvatures much better than the original instruments here we can just see the the last file so again this is true of of the shapers and the finishers right okay so let's move on let's talk a little bit about the instrument family so this is the uh the price taper gold instrument family you can see that there's seven files in the system i'm going to break down the files for you nicely as you can see there's a little bit of a difference between the files on the on the left hand side and the files in the right hand side uh they come in different shapes and and colors and we're going to go through this in great detail now and we're going to explain sort of what the characteristics and the sizing are of each file what they're used for and how you use them so the first thing that you need to understand is that there are shapers the shapers are pictured on the left hand side and finishes on the right hand side so the shapers that are available are the sx the s1 and the s2 so this just stands for for shaper so it's shaper x shaper one and shape two on the left hand side so that that has no color uh the sx and then the s1 is purple the s2 is white and then the finishes on the right hand side go from f1 to f5 these are iso coded which corresponds to the tip diameters so you'll see that if one is yellow the f2 is red the f3 is blue and then the f4 and f5 are black and yellow respectively but so we'll talk all about the uh all about these files in a little bit more detail in the next couple of slides let's start with the first file in the system the sx or the shaper x file so this is an accessory file and it's intended to be used in a similar way to gates gluten so it's essentially an orifice opener it's designed to uh open up our orifices to give us a little bit more of a coronal flair and it can also give us granule shaping in teeth with very short working lengths and we'll talk about that a little bit later so uh the the the short files so they allow us to achieve quite a large taper over a short distance here's a picture of the sx so if you have a look at the file on the on the left hand side you'll note that it doesn't have a little band um that's that's painted just above the silicone stopper you'll see that it's just got a gold handle and this is important because you need to be able to differentiate the sx from the f1 so both the sx and the f1 come with yellow silicone stoppers but it's quite easy to identify an a6 because it's quite a short file uh you'll see that it's only 19 millimeters in total so from its tip all the way up to uh to to basically the the end of the shaft where the handle of the file begins so the other end of the silicone stopper it's only 19 millimeters across its entire length okay so it's a very short file and you'll be able to uh to identify it by its length so it's short and it tapers quite uh quite severely so it's a short fat little file it's a 19 at its tip so it's got a got an iso tip diameter of 19 and it's cutting flutes are only 14 millimeters so it doesn't have that standard 16 millimeter cutting fluid that's uh that the hand files or the rest of the pricehaper gold files have and you can see that it's got quite that's a bit nice deep taper it's got a couple of uh different zones so the tip of this instrument is called a the non-working zone so it's not actually designed to be preparing or cutting in the apical third of the file it actually does most of its work uh towards the at the end of the file towards the the fat bits of the file uh and we'll demonstrate that a few in the next slide so there we go that's that's it's working zone you see that it actually only really starts working from about position d8 or d9 so it's really only meant to be doing its cutting in it's a coronal third and then the apical third is there more to guide it down the canal and we'll see that shortly in the in a quick video so here's a video of the of the sx file it's used in a brushing motion so it gets inserted into the canal and then it's basically brushed away from the apex and most of the shapers are used in in this way uh the one thing that i want you to note about this video is that this is a demonstration so i i really wouldn't be using an sx file for this long in a single canal i think we would have been finished with its uh with its shaping by now already but it's just a bit exaggerated to show you the technique and then you will see uh now when the operator removes the file in a couple of seconds that there's not going to be any debris on the in the apical portion really you see that it does most of its work there in about its middle or its coronal third okay and that's exactly how it wants to use it in a brushing motion so it's really a replacement for a gates glitter and it helps you to open up the orifices a little bit wider let's then move on to our shaper files so all the shaping files the s1 and the s2 so our shapers are designed to cut dentine in the coronal third of the canal and it does so in a crown down fashion so the s1 prepares more the coronal third and the s2 the middle third of the canal and this is important uh to understand so the active parts of the cutting blades of these files are in the coronal third in the s1 and the middle third of the s2 instruments okay the tips of these files so the apical third of these files are not meant to be working at all so uh the take home message is that these files your shaper files shape only at the top of the canal they're making the top of the canal bigger and the tip of these instruments are just to guide them down to the full working length and this now you'll start to understand why it's important for us to have a proper glide path to full working length with a size 20k file and it's absolutely essential when working this with the system that you must have a proper glide path in place these files are used in what's called a brush and follow motion so they take into length over multiple passes as needed so you don't force the file you know immediately to working length you're gently guiding the file down the canal but it's okay if you if you take a number of pulses at it so you can go down in a number of attempts you can take it to working length a number of times uh with an s1 and s2 with your shapers they're designed to be used that way um we're going to review just their sizing and and the use in a little bit and then we'll demonstrate in a short video how they're used when i say that they cut only in the coronal two-thirds this is exactly what i mean you'll you'll have a look and you'll see after you've used dual s1 and your x2 when you remove it from your canal you're going to notice that there isn't debris in the apical third because the file isn't working in the apical third the file is working in the middle third and it's coronal third and it's and it's cutting the top of the canal so it's making more space at the top and it's using a crown down approach this is just demonstrating the other end of the file so again there's no cutting in the apical third you'll see that there's no debris packed into the fruits let's look at the size of the s1 so if you look at the at the s1 the picture on the left hand side you'll see that the s1 file is purple it's got a a a little band that's cuts out of the out of the handle of the file and you can see that little band that's been cut out then gets painted with uh with a color as also you'll see it's got a little purple band that's been painted onto the file it's also got a purple stopper so these files are available in your standard sizes so you get it in 21 millimeters 25 millimeters and 31 millimeters uh and the instrument is is gold of course in in color what's important to have a look at is that the tip diameter at d0 is 18 or 18 and a half so it's an iso size 18 at its tip and it tapers up to about 1.2 millimeters over the length of the file up to position d16 for what's more or less about a seven seven percent taper the s2 is white so you can see its little cutouts and uh on the handle is is painted white it also has a white stoppers it's also available in your standard sizes 21 25 and 31 millimeter files what's important to notice here is that the diameter is a 20 and again this should give you a good indication as to why it's important to have a proper glide path to a size 20k files to allow the tips of these instruments to to progress all the way down to the end of the canal but what i want you to to note here is that whilst it also has about that uh that that seven percent taper and these files actually have variable types so they don't have a fixed typo which means that they don't increase constantly by two percent or four percent or seven percent they increase a little bit then they decrease then they increase little bits and so it's variable along the length of the file but what i want you to notice is that the the numbers from d13 up to about d16 are in light gray and what this what the light gray section indicates is where the file is smaller where it has a smaller taper than the file before it so what that means is that the file isn't actually going to prepare at that point so it's it's going to be spinning freely and not making contact with the canal walls so uh as we mentioned before that the shapers don't prep in the apical third and have a look at this s2 so it's not prepping in the apical third but it's not prepping right up at the coronal third either so what does that tell you it basically tells you that this file is preparing more or less in the middle of the canal right or that or that middle third of the canal so its most active cutting portions will be there between about d6 and d12 here's a short video just to demonstrate shaping with the s1 and s2 uh so here's an s1 in the canal what you need to notice here take note of is that it's vaping in its coronal food can you see that there's no debris being made there the file is running it is being taken to its full working length but because we've prepped a glide path it's not actually shaping down at the bottom look at all that debris that's being made up in the coronal third and that's where the shaping is happening right so that's the s1 and the situation is very similar with the s2 so if you have a look there there's no shaping let's break it down to you into slow motion there you can see that it's not shaping at all in apical third but that it's doing most of its shaping up at the coronal third as well but but a little bit more towards the middle as compared to the s1 all right so that's just more or less how these shapers work those are the shapers let's talk about the sizing and uses of the finishing files so our finishes of f1 to f5 the f stands for finishes the s stands for shapers so the finishes are designed to cut in the apical third of the canal only so remember with our shapers space has already been made in the coronal third and in the middle third so the finisher files are really to cut dentine in the apical third and to enlarge the apical third of the canal so therefore the active part of the cutting blades is in the apical third of these instruments and that means that by and large the coronal third of these files are not really meant to be working they're not making a lot of contact with the canal walls so the tip sizes of the finishing files follow iso coating as i mentioned so if one is yellow and it's a size 20 at its tip the f2 is is red and it's a 25 that it's said the f3 is blue and a size 30 at its tip and the f4 is black and a size 40 at its tip and so on and so forth so these files are meant to be taken to working length really just just once or twice so you don't use them in that same brush and follow motion that we use with our s1 and our s2 our finisher files or are meant to kiss the apex so what we mean by that is that these files are not repeatedly brushed or kept at a full working length for too long you're basically supposed to take them down to their working length keep it there for maybe a second and then withdraw the file and you can repeat this maybe once or twice just to give it that that apical shape but you really work quite quickly with uh with these files you literally just have to take them to length maybe two or three times and you don't have to stay at working length for very long okay so remember these files are spinning very very quickly compared to what you can do with your hand they're rotating at 250 or sometimes up to 300 revolutions per minute or rpm so it's doing quite a lot of work okay so you can't keep them down at the apex for too long otherwise you will risk causing transportation or zipping especially in curved canals so let's go through them one by one uh let's talk about the f1 so the f1 as you can see on the on the left hand side it's the yellow files it's got a cutout that's been painted yellow on on the handle of the file it also has a yellow stopper so it's important to be able to differentiate the f1 from the sx so the sx doesn't have that yellow paint uh on the handle of the file okay you can also have a look at the at the difference in the length so your all your finishes are available also in the standard sizes 21 25 and 31 millimeter lengths that's from the tip all the way to the to to where the handle begins all right so um the the f1 has also has a yellow stopper but you'll find that it's a little bit longer and it's got those little lighter markings that indicate length on the on the shaft of the file which the sx file doesn't have either so it's tip size at d0 it's it's a 20 and you can see that it also uh increases it probably also about a 7 taper along the length of the file remember it's also variable taper same as the shaper so it's not a fixed typer and what i want you to note there is the light gray area so you can see that this file is working from about d0 up until about d8 d9 position so it's working uh basically at the apical eights or nine millimeters in its coronal third it's got a smaller taper than than shaper one and shaper two so that portion of the file will be spinning freely in the canal okay so it's not actually going to prepare in the coronal third it only prepares in the apical third up until the size 20. the f2 uh similar to the f1 other than than than the color of course the color is red so you see it's got some red paints on it it's got a red silicone stopper also available in the in the regular lengths of the files um it's a size 25 at its tip which again corresponds to the iso size and you can see that it also increases along its length to about one millimeter at position d16 so this file is similar to the f1 it also does most of its work uh in the in the apical uh third to a half of the file although it can shape a little bit up in the uh in the coronal third as well but it's doing most of its work at the apical third the f3 is blue same as all the other files in the iso system so it's got some blue paints on the on the handle of the file it's got a blue stopper if you have a look at this file it's a size 30 iso at its tip and it's actually got quite a quite a large taper in the first three or four millimeters so it tapers almost nine percent across those first three or four millimeters and that that allows you to give it uh quite a lot of uh extra shape so it really does shape a little bit more aggressively than your f1 and your f2 file uh if you have a look at the appearance of this violet it always strikes me that's in the coronal third of the file it almost looks as though it's a little bit unwound but it isn't that's uh that's the regular shape of the file that's the way that they look and there's not necessarily something wrong with it but they just appear quite a little bit different from your f1 and your f2 ua4 is a size 40 at its tip so it's indicated by two black stripes that are painted on the handle so it's a double black with a black silicone stopper as well so it's a size 40 at its tip you can see that it increases its taper over the first three millimeters then it doesn't really work in the middle third of the file and it may actually shape a little bit in the coronal third as well so that's what's unique to an f4 these are quite large instruments so you should be able to identify them quite easily and uh sort of from your f3s f4s f5s we're probably using those on our younger patients that have larger canals then the the last file in the standard system is the is the f5 the f5 is um it's unique because it's also got a double stripe cut out of the handle which is painted yellow so the double yellow is the f5 um and it can be differentiated from the sx and the f1 by the fact that it has a black silicone stopper not a yellow silicone stopper it's got a black stopper and it's got a a double yellow color coating it's a size 50 at its tip so d0 of 0.5 millimeters and you can see again that this file is designed to cut basically in the apical half and in its coronal half from about d9 d10 onwards it's got again a smaller taper so it doesn't really prepare in the coronal portion at all and that's the last file in the finishers so how do we use the the bright side for gold instruments we need to ensure that we have a proper glide path we talked about that at length in the previous lecture we put them in a rotary machine so we use the machine that we're using is called an x-smart plus also in private practice you might find that you have different uh rotary machines but you basically put this into a into a handpiece or an endodontic rotary endodontic units that can control its speed and its torque so you can't use this on a slow hand piece you can never ever ever use this on a slow hand piece or just you know an electrical uh handpiece miser you have to use an endodontic mazer for it so you need something that can control both the speed as well as the torque of these instruments and that's very important because if you don't you're going to break them off okay so the speed at which we use these files is 250 rpm you can use that while when you're a student and and when you're still relatively inexperienced as you gain experience maybe over a couple of years if you're still using the system you could theoretically increase your speed to 300 rpm that's the manufacturer's instructions but we find that it's safer to use it and that we have less file fractures and it's easier to learn if you use it at a slightly lower speed so the speed is 250 rpm and we're using it at a torque between four and five newton centimeters that's also important because uh on the system uh on the machine the right re-endodontic machine that will give you to use as you browse through the systems and the files you'll notice that they've pre-programmed every file to have its own individual talk um i'm not quite sure why they did that because the creators of the of the system uh cliff ruddell and john west amongst others have recommended that all these files should be used at a high torque okay so we recommend using a torque of four so we're using 250 rpm and a torque four newton centimeters um in the wards although you will find on the machine that it's not set that way to start with c action you need to increase the torque up until four you always use a light pressure when working with rotary files so i always liken it to to using something like a clutch pencil you should all remember clutch pencils and use them over the years so you know when you when you push the lead out a couple of times if you give it sort of three or four clicks if you press relatively hard on that lead you can break that lead and it's the same with with endodontic files so the endo files are a lot stronger than the lead of a clutch pencil but i think it's an excellent analogy and it gives you an excellent idea of the type of force that you should be using on it so you really want to use quite light pressure with these instruments they're going to do the work for you you don't have to force them you don't have to put your your your sort of elbow or your muscles into it the um the files will do the work for you and they'll go where they need to go if you've made a proper glide path for them what i want to mention is that these instruments have a very high cutting efficiency compared to your your hand files the manual files that you're used to and as a result of that they what i'm trying to say is that they work very effectively and they make a lot of debris so this debris gets stuck in the flutes of these files and if these flutes get packed or full of debris it's going to reduce your cutting efficiency it's not going to be able to cut as well so as you're using them you do need to remove them and you have to have a piece of either piece of gauze or a cotton roll or a tissue or something like that nearby so that you can actually clean the debris out of the flutes because if you don't do that they're not going to be able to cut as well let's run through the sequence of views so first thing you're going to do is uh you've cut your excess cavity you've basically started scouting for your canals you're always going to do that with the viscous key later something like like rc prep and edta cream and your small hand files once you've located all your canals you can then move on to to open up the orifices a little bit so you can use the gates gluten to do this something like like a size 2 gates 11 should work fine in most motors alternatively you can use your sx file that we've talked about to open up the orifices a little bit wider and provide you with a little bit of shape currently already once you've opened up those orifices a little bit you can establish your your final working length so use your radiographs use your apex locator and ensure that your canals and patience and then you can proceed to create a nice glide path for us so we covered that again in great detail in the previous lecture but basically we're using our 10 our 15 and our 20 and then confirming that with a radiograph we create a glide path and we must confirm that we have a smooth reproducible glide path and at that point we can move on to our rotary files and then we start with the shaper so we start with our s1 which which is purple we take our s1 down to length we can use our brush and follow motion and to prepare the coronal third of the canal once we've taken our s1 to length and we can take multiple passes at it up until it reaches our working length we remove the file we irrigate we check our patency with a small number 10k file we then irrigate again because remember the patency file breaks up that little plug of debris in the apical third so we irrigate again to get there all that debris and then we can move on to our s2 which is white and we use that in exactly the same way we're going to use a brush and follow motion take multiple passes at us up until it it can go down to working length a number of times and that middle third of the canal has been well prepped here's a video just to demonstrate um basically again the orifice opening uh it will demonstrate a glide path with a mechanical glide path file and then how the shaper one and shaper two are used so here the operator is putting in some some icy prep that's basically uh dentsply serena's ossyprep it's called glide so you have the operator scousing for the canals with a size 10. so working length will be determined at this point as well with apex locators and a radiograph but yeah they're just verifying that that a size 10 will go to length very nicely irrigates irrigates irrigate you must always irrigate the more irrigation that you can can have the better the disinfection will be so here they're using an sx file we showed you the video earlier on this is just an abbreviated version of it this is actually more realistic about how an sx is used so it's just uh brushed away from the furcation a couple of times and there we can see that we've enlarged our orifices and it's worked in about its middle third or coronal third so when our orifice opening is done we can see that the entrance to the canal is significantly larger and now it will be easier for us to create a glide path uh in this case they're using the pro glider you'll recall the pro glider from the um glide path lecture so instead of using a 10 a 15 and a 20 here they're using a mechanical glide path file and they're actually quite lovely i use the routine in private practice see you see how quickly they work um after you've established your glide path onto the s1 so have a look at how this s1 is used so it's being taken to length gently it's not being forced to length the operator is just guiding it and you'll see it's almost getting there almost getting there it's going a little bit deeper and he's using the brush and follow motion so if the file gets stuck uh they're just pulling it away from the uh from the level of the focation and you can do this a number of times so it's shaping the coronal third there let's have a look when they remove the file have a look at the debris pattern that you see can you see that most of the work has been done in the coronal two-thirds so here we go to check your patency and then move on to your s2 file so the s2 is white and it's used in the same brush and follow motion as the s1 so you see it's being guided down and then brushed away from the location if it won't progress right and then you can see you can advance it remove it a bit advance it remove it a bit and you do this gently and you just guide it down to length up until it gets to length and with a little bit of brushing you can see that this file is worked more in its middle third and shape the middle third of the canal in both the s1 and s2 not a lot of debris at the apex at all of these files because they're not working there the next part of the sequence is our finishes so once we've created shape in our coronal third with our s1 and our s2 we can then move on to our finishes right so um we start with our f1 and now if two so if one you'll sit to the same length you will uh prepare the uh the apical third um you don't then use the brush and follow motion you're using more of a kiss the apex motion so you're taking the instrument to working length uh you can you can do that uh two or three times but you don't allow the instrument to stay at full working length for too long to avoid transportation so you take your f1 to length then you'll irrigate the canal you'll check your patency with this with a small 10k file you'll irrigate again and then you can move on to your f2 and then you can again take your f2 to full working length again with a kissing the uh the apex action the f3 4 and 5 are used as needed um so in in other words when you've finished uh shaping with your f1 and your f2 then you'll have a look in and see we're going to inspect the the tip of the instrument so the apical portion for debris to determine uh if we've finished shaping if we're not finished uh shaping the apical third we may need to use larger instruments we often use these in our younger patients and in our big canals so in something like a panel canal of an upper or a distal canal of a lower you'll very often have to go up to an f3 and then in younger patients you may need to even expand this larger to an f4 or an or an f5 it's a it's relatively uncommon in your average case so most of your cases for patients in their sort of uh 20s to their to their middle ages something like an if two should be enough for the vast majority of of canals very small canals are very calcified canals it is at times acceptable to end on an f1 but you do need to inspect again the uh the apex or the the apical third of those files to determine if the files have actually prepared in the apical third and if they haven't you need to you need to increase and the size of that apical preparation but it is possible for example in mb2 canals you will very often end on a on something like an f1 because um they're very very small canals and they're often very curved as well or you'll find that if you have a a separate disto buckle in a disto lingual canal in for example a lower six of uh of an elderly patient let's say somebody in their seventies or so where you really struggle just to get into the canals in the first place where you needed to use a size six or a size eight file you will find that you sometimes can end on an f1 if you find debris is packed in the flutes after using it so after the shapers you can reconfirm the the working length it's acceptable just to do this with an apex locator you don't have to you don't actually have to take an x-ray but after shaping the the working neck can change a little bit so it's it's advisable just to reconfirm your working length and then you can move on to your f1 so in this case you're going to see that the operator is guiding this f1 down to working legs they haven't reached working length just yet they're getting there they're getting there uh they're probably at about working length now so we'll probably take it out and take one or two or maybe a third pass at it no it looks like it's just taking two passes at it and they they remove the file and can you see that there's no debris in the apical three flutes there so the finishing is incomplete in this case we have to move up over to a larger file so after checking patency and irrigating they move on to f2 and again the f2 is being guided to full working length you can see that they're not quite there yet the stopper hasn't touched the reference points okay now we're just about there maybe one or two more passes there we go once twice to working length and there we can see that there is some some debris in the uh in the apical third but notice right at the end of the file there isn't a lot of debris packed into the flute so they decided to go a size bigger so up to the f3 the f3 will be taken down to working length it will be a little bit easier after the f1 and f2 have been taken to working length so you can see just about at working length so kissing the apex once once was enough and have a look there can you see that the debris has full those flutes and these shaping is complete so that's what we mean when we say that we want the flutes to be full of debris and and we want to see that pattern uh to ensure that we've had good shaping in apical third an alternative way that we can check it as well as we can fit our gp so in this particular case it's been prepped to an f3 so we can fit an f3 uh gp kind we must seat it positively we'll talk about that a little bit more in the in the next lecture um and then we can take a radiograph and actually confirm the size you can confirm it clinically by measuring the uh the gp and fitting it to length and you can also take a radiograph and check for something like like tank back as well so again just in some still pictures let's have a look so if we don't see a nice pattern of debris that's packed into the flute of the apical third of an f1 it means that we can't end at that length and the reason for that is if we haven't actually prepared that that's apical third it means that the canal may very well be larger than f1 at uh at that point and so it means that we haven't mechanically prepared it so we haven't mechanically disrupted any of the bacteria or the biofuels in that area but it also means that if we fit a gp and the canal is larger than f1 that that gp is going to go through the apex and we'll probably see that when we take a radiograph as well so if this is the debris pattern that you see you have to go a file size bigger so uh in this particular case as we saw in the video the operator then used the f2 and as you can see the there is some debris in the in the last three flutes there particularly right right right at the apex but it's not a consistent uh debris pattern so those flutes are not i'm not packed full of debris yet so you can see that it's done maybe a little bit of shaping and work there but it indicates that the canal may very well be a little bit larger than an f2 so for safety in this in this particular case we needed to go up another file size and so then the operator used an f3 and there you could see that the apical flutes are completely filled with debris right and that means that you that your shape is complete so that's what we want to see there so if you saw that pattern of uh of debris in the flutes within with the f2 then you could have stopped at the f2 and if you saw that pattern of uh of debris with the f1 you could have stopped at the f1 but in this case we didn't okay so we had to go up up until we uh actually had that the splits fold with debris and if the f3 doesn't look like this if the f3 looked like like the f1 or the f2 in this case you would have then had to progress even further and then you might have had to use the f4 or the f5 okay but i think that demonstrates the the principle let's quickly review the sequence so again uh when we work with our protaper gold system we need to have straight line access that's very important we need to cut a proper access cavity we must have straight line access to all our canals when we establish a glide path that's smooth and reproducible then we can start with our shapers the s1 and s2 the purple and the white file we're going to use the shapers in a brush and follow motion we can use it in multiple passes and and and we're going to advance it gently down to working length and if the file gets stuck we then brush it away from the location and we allow the file to advance down a little bit further we can do this multiple times so we can take it down four five six times to two working lengths it's okay we can use the shapers repeatedly once we've created our shape we're going to obviously check out patency we're going to irrigate between each and every file that we use we're going to put our rc prep on each and every file that we use after our shapers are complete we can move on to our finishes so shape is prep the coronal two-thirds finishes prep the apical third with our finishes so that's everything from an f1 potentially up to an f5 we're going to take the file down to the full working length and we're going to kiss the apex now what does that mean we're going to reach the apex once or twice so if we're really unsure we might take it a third time but it shouldn't be necessary to go any more than that once or twice is usually quite appropriate um so we take our finishes down to working length we'll start with f1 we'll remove it and we'll inspect the apical third and we'll look for debris in those apical fluids if we see debris we can stop there if we don't see debris we need to irrigate check our patency and move on to the next file so if an f1 doesn't have debris in the flutes we move on to an f2 if an f2 doesn't have debris in the flutes we move on to an f3 and so on and so forth up until our shaping is complete and we can confirm that when the flutes of our files are packed with debris uh and then we can fit our gps as well to confirm so again between each and every volume must check patency you must irrigate with your sodium hypochlorites because remember these these files shape the canal they're giving us a wonderful tapered shape but they're not disinfecting they will remove some infected bentine they will remove some bacteria but that's not the thing that's going to give you disinfection but this infection still comes from your sodium hypochlorites and you need to use a lot of sodium hypochlorites between each and every file remember you need at least 30 minutes contact time of sodium hypochlorites with your dentine in order to disinfect it properly so that's quite a long time so the more you can irrigate the more time you spend actually uh disinfecting the higher your chance of success will be and then always with these particular files you can always use an edta cream so something like rc prep or glide which is a viscous key lighter it's there to soften the dentine it's there to lubricate the files and then again your speed and torque settings you're using it at a speed of 250 rpm and a torque of 4 newton centimeters okay so that's covered basically the the cleaning and shaping with the price hyper gold system uh in the next lecture we will cover obturation using matching type of gp cones in the pre-clinical session we want you to complete cleaning and shaping procedures in at least one extracted melody if there is time and and if you have created an access and a good glide path on a second mailer you are allowed to prepare the second mail as well but so we would like you just to complete you'll keep cleaning and shaping and work with your protaper gold files in at least one extracted moments youth uh thank you for your attention that's the end of this presentation