It is often challenging to clean and shape curved canals. Most, if not all dentists who perform root canal treatment are familiar with this ugly feeling of breaking an instrument in the canal. I get a jolt down my spine and “butterflies” in my stomach when it happens.
To avoid these types of errors, I come up with a “game plan” and think through every case from the beginning to the end before I actually do it . It takes only a minute….
When I get a curved case, these are some of the things that go through my mind:
1. Slow down!!!!!!!!!!
2. Straight line access to make those curves gentler.
3. Lots of lubricant (RC Prep, Glyde, etc.) and irrigation (NaOCl, EDTA)
4. Use hand instruments more. (I may finish the apical third by hand, pre-curving stainless steel files or using Ni-Ti hand files)
5. Check patency more often with #6, 8 or 10.
6. Instrument in a “crown down” fashion.
7. I typically use Protaper files for rotary instrumentation, but in curved cases I will use those for coronal shaping and may choose Profile instruments (since they are landed and tend to stay centered in the canal and zip less) to finish the apical third.
8. Choose rotary files with the lesser taper as well, like .02 rather than .04 or .06.
9. Do not “push” rotary files, they will break!
10. Be more conservative with apical enlargement.
Case 1: Tooth #32
Pre-op
Post-op
Case 2: Tooth #4
Pre-op
Post-op