Endodontic treatment system

Abstract: A set of files (140A, 140B, 140C, 140D, 140E) have tip diameters which increase from 0.075 mm for file 140A to 0.175mm for file 140E in increments of 0.025mm. Each file has a flute length of 16mm. The maximum flute diameter increases proportionally from 0.235mm for file 140A to 0.975mm for file 140E. Tapers increase in 0.01 mm/mm increments from file 140A with a taper of 0.01 mm/mm to file 140E with a taper of 0.05 mm/mm. This assortment of increasing tip diameters and tapers with increasing file size allows a 0.15mm file maximal stiffness which is needed when attempting to find and enter an occluded calcified canal prior to shifting to a 0.075mm file which provides the maximum tactile response when negotiating the often tortuous terminal aspect of a canal after coronal enlargement with the larger file.

Description: This invention related to a set of endodontic files used in preparing the root canal of a human tooth for filling. A set of files as defined in the preamble of claim 1 is disclosed in FR-A-2 597 327. A relatively common but difficult dental procedure is the cleaning, shaping, and filling of the root canal of a patient's tooth. In the performance of a root canal procedure, a hole is first drilled in the tooth to access the root canal, after which root canal files are used to clean out the material present in the root canal and to impart a tapered shape to the root canal so that filling material may be inserted into the root canal to seal it. Two commonly used types of root canal files are the K-type file and the Hedstrom file. The K-type file is axially twisted and tapered and has a triangular or square cross-sectional shaft providing three or four spiral cutting edges along the tapered shaft with a conical tapered tip on the end thereof. K-type files have recently come to be manufactured with lathe-cut flutes as well. The Hedstrom-type instrument is a lathe-cut file having a round tapered shaft with one, two, or three spiral cutting flutes machined into the shaft all the way to the tip. The main difference resulting from the construction of the two types of files is that the K-type file will cut in either rotational direction, or when moved up and down, while the Hedstrom-type file will cut best when moved up and down in the root canal. When a root canal . is being cleaned and shaped, a series of files having increasing diameters is used to gradually enlarge the root canal. Each file in a set has an identical taper from one end to the other, typically 0.32 millimeters on every file over the standard 16 mm length of cutting flutes for K-type files, or 0.02 mm of taper/mm of flute length. This taper is sometimes referred to as a standard ISO (International Standards Organization) taper. Although these file sets have identical tapers, they come in a number of sizes. The size number characterizing the file is the diameter of the file at the tip in hundredths of a millimeter, and the diameter of the file at the large end is thus 0.32 millimeters greater than this tip diameter. A complete set will include sizes 06, 08, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 70, 80, 90, 100, 110, 120, 130, and 140, while sizes 08-60 will typically be used. Some manufacturers make certain half-sizes, or off-standard sizes. Hedstrom-type instruments similarly come in sets of increasing size, typically from 0.10 to 1.40 millimeter tip size, with 0.15-0.60 millimeter tip sizes being most commonly used. Both the K-type and Hedstrom files manufactured to ISO standards, whether twisted or lathe-cut, have flute pitches and frequencies which vary little or none in some sizes (large), but quite a bit in other sizes (small). This variation in flute angle or pitch is most perpendicular to the long axis of the file near the shank end, changing to a lesser angle (more in line with the long axis) as the flutes approach the file tip. One particular Hedstrom-type file has been modified to provide a safe edge by removing or dulling the cutting edges of the flutes along one side of the file. There are also ground-flute instruments which have their flutes cut into tapered wire blanks which are round in cross-section. This results in the flutes being cut across the grain of the metal, thus achieving less strength than twisted-flute files and so being inadequate in the smaller sizes. Twisted-flute files are formed by first grinding a tapering cross-sectional shape that is triangular, square, or rhomboidal down the length of the wire, in line with the metal grain. Then this tapering wire blank is twisted, causing the corners of the tapered wire blank to become spiral cutting flutes. Because of the twisting process, the metal grain is thus-aligned with the helical cutting flutes. In the smaller sizes below #15 only the twisted-flute instruments are stiff enough, with a short #15 file being typically used to initially penetrate coronally occluded canals. Attempting to add strength to the tips of smaller ground flute instruments by increasing the flute pitch angle toward the instrument tip, thereby decreasing the depth of the flute spaces and increasing the mass of metal in the more fragile tip region, creates file tips which are too stiff and inefficient in the larger sizes. Unfortunately, even twisted-flute #15 files are often not strong enough to withstand the tremendous apical forces which dentists bring to bear when attempting to negotiate calcified canal orifices. These ISO tapered #15 files often buckle in use, requiring their disposal and the use of yet another #15 file. It is typical that dentists will destroy 10-20 #15 files before they can clear to the end of these difficult canals. Root canals are seldom straight and there is always the possibility of causing irreversible damage to roots during shaping procedures, depending on the thinness of the root and severity and location of the root curvatures. Root perforation, ledging and other mistakes in root shaping procedures may occur during the preparation of a root canal using currently available instruments. At worst, these mistakes may require tooth extraction or surgical correction; at least, they may result in root weakening with follow-on problems in the future. The art of root canal shaping is one which requires great skill to prevent damage to the tooth and to create a tapered canal preparation conducive to ideal filling of the canal. The technique used with a conventional set of files having identical tapers to clean and shape the root canal is referred to as the "step-back" technique. A series of file sizes from 08 to 60 (12 instruments) are introduced into the canal from smallest to largest with each successively larger file being used further back from the end of the canal. Additionally, between 4 and 6 sizes of Gates-Glidden or Peezo burs are similarly used in this step-back manner comprising a total of 16 to 18 instruments This technique is, at best, a difficult and time-consuming method as the dentist must indirectly gauge the rate of taper in the preparation by the distance. interval of step-back of the progressively larger instruments as they fit further back from the canal terminus. As only the ISO taper of 0.02 mm/mm is currently available in standard sizes to dentists in files, irrigation cannulas, condensation pluggers, heat carriers and injection needles, paper points, filling material, and restorative posts, the current shift to canal preparations of greater taper has created great difficulties for dentists who want to enhance their root canal shaping objectives. The skills required, with these relatively non-tapered instruments and materials, to create conservative but adequately tapered shapes in root canals and to easily and ideally fill them usually comes only after treating hundreds of clinical cases. Existing irrigation cannulas are parallel-sided, with different designs of opening at their tips. These are used to wash the inside of root canal systems with solutions with the intention of debriding, disinfecting, and cleansing the canal space prior to sealing it. Unfortunately, these irrigating cannulas are limited in their ability to clean the ends of root canal systems as they are so small in -diameter. Research shows that irrigating cannulas are only effective to the extent that they can penetrate the canal, usually to midroot, leaving the important apical third of the canal unaffected. Dentists are able to overcome this problem by the use of small patency files which are used to clear debris from the end of the canal, but which also displace irrigant from this apical region of the canal during its use, allowing fresh irrigant back into the apical region after the file's withdrawal. As the files are relatively untapered (ISO 0.02 mm/mm) this irrigant exchange is limited. When the canal has been cleaned and shaped, it is dried with absorbent paper points of varying size and taper. In canals which have been tapered with burs and files in a step-back fashion, it is often necessary to use several different sizes of paper points to dry the whole length of the canal, small paper points apically, larger paper points for the middle of the canal, and sometimes still larger paper points for the cervical region of the canal. Furthermore, as the tapers of the paper points seldom match the taper of the canals, there may be moisture left on parts of the canal walls after drying procedures. There are several methods of sealing root canal systems, most of them using a rubber-like material called gutta percha. When used as a tapered gutta percha cone, this material is compacted into the canal with pluggers, or the gutta percha material may be placed as a coating on an obturating carrier, which is warmed to soften the gutta percha and placed in the canal, with the carrier compacting the material into the canal space. Currently, the shapes of filling materials and obturating carriers do not match the tapering shapes of prepared canals either. When the step-back technique of canal shaping is used, the final shape of the canal preparation can only be discerned indirectly, by the increments that each larger instrument fits further back from the terminus of the canal, a difficult skill learned only after much experience. As the prepared taper is often obscure to the clinician, it is likewise difficult to pick an appropriately tapered gutta percha point or obturating carrier with which to seal the canal. If the selected obturating device or gutta percha point is too tapered, they will bind in the canal short of its terminus, causing the crucial apical seal to be inadequate, allowing leakage and failure of the endodontic treatment. If the obturating carrier or material is too narrow, little hydraulic pressure will be exerted on the filling materials in the cervical two-thirds of the canal during condensation procedures, and lateral or accessory canals in that region of the canal may not be sealed, again increasing the chance for failure of treatment. It is generally recognized in the field of endodontics that those root canal filling methods which warm and soften the gutta percha filling material, allowing it to be thoroughly compacted into all the nooks and crannies of root canal systems, are superior to those techniques which do not thermoplasticize the gutta percha prior to condensation. A standard technique uses an appropriately tapered gutta percha cone which is fit and cemented in the prepared canal, after which a flame-heated or electrically-heated gutta percha heat carrier is used to sear off the gutta percha cone at the orifice level of the canal. By pressing the softened gutta percha into the canal with an appropriately sized vertical condensation plugger, the first wave of condensation is initiated, filling any lateral canals present in that region in the primary canal. The heat carrier is then reintroduced into the canal, penetrating the gutta percha several millimeters, heating the apical mass, and removing a portion of it so that the next wave of condensation may occur deeper in the root. These heating and compacting cycles continue until the final wave of condensation which ends 5 to 7 mm from the canal terminus. Typically it takes 3 to 7 waves of condensation to reach this end point. At this point the clinician must either place a retentive post in the coronal canal space or backfill it with gutta percha. Backfilling can be done by heating 3 to 8 small pieces of gutta percha and sequentially packing them into the canal, or by syringing alloquates of pre-heated gutta percha from a gutta percha gun and compacting them with pluggers. Downpacking with multiple waves of condensation and backfilling in the manners described require at least 7 to 10 different instruments, fairly extensive training of the dentist and chairside assistant, and 15 to 30 minutes of clinical time. Furthermore, these condensation pluggers and heat carriers lack a correlating mechanism to match their sizes to the taper of the canal preparation. Systems of the present invention differ . significantly and advantageously from the cleaning, shaping and filling technology discussed above in a number of respects. 1. Rather than using a large series of files of differing sizes but the same taper, as is the case when using standard ISO-tapered files, use of the present system often allows full root canal shaping to be accomplished with as little as a single file from its set of variably-tapered shaping files. 2. Instead of indirectly creating a tapering canal preparation with the difficult and time-consuming serial step-back shaping technique necessary with ISO-tapered files, the present system requires only that the shaping file or files be worked to the terminus of the canal, thereby completing the preparation. 3. The present system provides for variably-tapered negotiation files, allowing optimally varied stiffnesses as the tips of the instruments in the series increase in diameter. Furthermore, these files of increasing taper have small, even increases in - tip diameter allowing more passive negotiation to the terminus of constricted canals. 4. Increasing tapers of these files can be used without increasing risks of root perforation or weakening, by progressively shortening the cutting flute length as the files become more tapered. 5. One version of these tapered files can be efficiently used with rotary cutting motions without increased breakage, due to their varied flute pitch and sharpness along the length of the instruments. 6. Safe function of these files in curved canals is also gained through the use of nickel-titanium, available under the trademark Nitinol, an alloy which exhibits extreme flexibility and elastic memory. 7. Files of the present system differ significantly from conventional instruments in the pear-like shape of the file handles, a design which enhances the application of pushing and rotational forces to the file by the dentist's fingers. 8. The present system involves irrigating cannulas, paper points, filling materials and instruments, and restorative posts which are contoured to match the pre-defined canal preparations created by the variably-tapered shaping files, thereby matching corresponding ones of the shaping files. 9. The present system includes a technique whereby canals can be more simply ideally obturated in all their complexity with the aforementioned tapered filling instruments and materials used in a single inward wave of condensation, followed by a single backfilling wave to complete the fill if a post is not to be placed in the canal. The purpose of endodontic shaping procedures is to create a continuously tapering preparation which is narrowest at the end of the canal, and widest near the crown of the tooth. By using files that vary in their tapers, root canals may often be prepared with a single shaping file instead of the 16 to 18 files required by conventional ISO-tapered instruments. The present system permits ideal root canal shaping results with less training and experience. All that is required is that a shaping instrument of appropriate taper be worked to the full length of the canal. In addition to the greatly improved ease and simplicity of shaping canals with a single instrument, this provides, for the first time, a pre-defined shape throughout the full length of the canal. One of the most important advantages provided by pre-defined root canal preparations is the resultant ability to optimize cleaning and filling procedures in root canal systems. Since the files of the present system involve different tapers, the tips of the shaping files are not used to cut a path in the canal as is the case with files with standard tapers. The shaping files of the present system differ in their tip diameters. The present system provides for variably-tapered negotiation instruments with even or proportional increases in tip diameters. Such a file set has tapers which range from 0.1 mm/mm to 0.5 mm/mm, thereby imparting twice the usual stiffness in the critical initial negotiation file with a 0.15 mm tip diameter. After the canal has been penetrated to midroot by the rigid .04/.15 (taper/tip diameter), the dentist can either progress downward in size to the .03/.125, the .02/.10, and finally the .01/.075 or drop down to the .01/.075 taken to full length and then work up in the file sizes until the .04/.15 file goes to length. When the files of narrower taper are embedded at least halfway into a canal, the canal walls will then support narrower, less. robust file sizes and prevent them from buckling. Therefore this set of negotiating files should kink less upon initial entry, and provide greater tactile awareness and control of instruments in the tortuous apical regions of canals. Additionally, the 0.025 mm increases in tip size circumvent the problematic 50% jump in tip diameters between ISO-standard file sizes #10 and #15. Progressing to full length in constricted canals with this negotiating file set, from sizes .075 mm to .10 mm to .125 mm to .15 mm, is effortless as a result. A further advantage is that shaping files of the present system can be safely used in curved canals and/or thin roots in spite of their greater rates of taper. This is accomplished very effectively by the specification of progressively shorter flute lengths as files in a set have progressively greater tapers, thereby limiting their maximum flute diameters. Without this feature, the shank-end flute diameters of variably-tapered shaping files become wider and stiffer as the tapers of these instruments increase, and their potential for lateral perforation or weakening of the root increases as well. While limiting the maximum flute diameter of these increasingly tapered shaping files allows their safe use, this feature is extremely important in a broader sense. Using a single shaping file instead of the usual 15-18 instrument set means that the final shape through the full length of that canal is pre-defined. Simply limiting the maximal flute diameters of shaping files allows, for the first time in the field of endodontics, enlargement of the coronal two-thirds of a canal to an extent that is exactly adequate to clean the tiny apical regions of the canal and to maintain control of shaping and filling instruments in that region, but not a bit larger. The present system includes this feature applied to variably-tapered Hedstrom-flute shaping files and to all other types of shaping instruments as well, whether they are used by hand or with sonic, ultrasonic, or mechanical handpieces. Shaping files of the present system for use with rotary cutting motions provide for longitudinally varying the pitch and relative sharpness of cutting flutes. This overcomes the problems of potential for breakage and slowness of cutting by varying the flute pitch from an in-line reamer-like angle at the shank end of the instrument to a more perpendicular K-type flute angle at the file tip. Instead of, or in addition to the above, the relative sharpness of the cutting flutes is varied along the length of the files, being sharpest at the strong shank end to allow for aggressive cutting by the wider flutes, and dullest near the smaller, more fragile tip of the file so these flutes can easily release from the canal wall during rotation, thereby preventing file breakage which can occur when the tip binds. Functional safety when using tapered shaping files in curved canals is enhanced through the use of the alloy nickel-titanium (Nitinol). This unusual metal exhibits stress-induced phase-transformation of its crystal lattice structure resulting in characteristics of superelasticity, allowing large-diameter Nitinol files to work around root canal curvatures that would be impossible with stainless steel. Nitinol's elastic memory also allows, in one aspect of the present system, curvatures to be preset in the file during the manufacturing process. By heating and cooling files made of this metal, different curvatures can be present in the metal so that the desired shape is "remembered", allowing the file to straighten in the relatively uncurved coronal portion of canals and recurve itself when the file tip moves deeper and encounters apical root canal curvatures. When added to a modified Hedstrom-fluted taper file, a preset file bend directed toward its safe edge causes the Nitinol version of this shaping instrument to automatically seek the inside of canal curvatures with its non-cutting side, thereby effortlessly preventing lateral perforation. The present system also involves an improvement in the shape of the handle provided for files of the invention. Standard file handles conventionally have a narrowed waist portion with enlarged diameters at both ends of the handle. This is to accommodate a push-pull action in conventional use of the file. Handles in accordance with the present system have an end diameter smaller than the waist of conventional file handles, and they taper to a larger-than-conventional diameter near the file shank, where the file is embedded in the handle. Since the file is designed to cut with apically directed rotary forces, the shape of the handle enhances operator comfort and reduces the force necessary to cut the desired shape into the root structure around the original canal. This "pear-shaped" handle also enhances the use of standard ISO K-type files used with apically-directed cutting motions. In the accompanying drawings: Fig. 1 (views A through E) shows schematic views of a set of negotiating files of different tip diameters, different tapers and equal flute lengths; and Fig. 2 shows my preferred handle for the files. FIG. 1 in views A through E, shows a set of negotiation files 140 which are given the designation numbers 07/01, 10/02, 12/03, 15/04 and 17/05. The first number corresponds to tip diameter which increases from 0.075 mm for file 140A to 0.175 mm for file 140E in increments of 0.025 mm. Each of the files has a flute length of 16 mm. The maximum flute diameter increases proportionally from 0.225 mm for file 140A to 0.975 mm for file 140E. Tapers increase in 0.01 mm/mm increments from file 140A with a taper of 0.01 mm/mm to file 140E with a taper of 0.05 mm/mm. This assortment of increasing tip diameters and tapers with increasing file size allows a 0.15 mm file maximal stiffness which is needed when attempting to find and enter an occluded calcified canal prior to shifting to a 0.075 mm file which provides the maximum tactile response when negotiating the often tortuous terminal aspect of a canal after coronal enlargement with the larger file. The intended procedure with the negotiating files 140 in the set of FIG. 1 is to begin with a larger file which is suited to initial penetration and then shift to smaller files which are suited to work into the apical region after the initial opening is cleared. FIG. 2 shows the handle 52 of my preferred embodiment, formed in the shape shown between two opposed planar surfaces 76 and 84. These planar surfaces are 2 mm in diameter. From the boundary of the surface 76, the handle enlarges through a smooth curved region 78 to its maximum diameter of 6 mm at the point 80. In a section 82 between the maximum diameter 80 and the proximal end 84, the handle tapers linearly and is scored all around with a plurality of tapered grooves 83. The transverse plane at the maximum diameter 80 is spaced 2 mm from the planar surface 76 and the distance between the plane of the maximum diameter 80 and the proximal end 84 is 8 mm, the overall length of the handle 52 being 10 mm. The grooves 83 and the shape of the scored, tapered section 82 provide an enhanced gripping area for the user's thumb and fingers to facilitate applying torque to the file as it is moved into the root canal toward the apical region.

Claims: A set of endodontic files (140) for cleaning and preparing root canals in teeth, each of the files having a tip (64), a tapered flute portion (56) and a shank, the tapered flute portions being of the same length for all the files of the set, the taper of the flute portions varying from one file to another, characterised by each file which has a greater taper than another of the files in the set, having a larger shank diameter and a larger tip diameter than the said another file. The set of files of claim 1 wherein the taper varies from .01 mm/mm for the smallest diameter file to .05 mm/mm for the largest diameter file in said set. The set of files of claim 1 or 2 wherein the variation in taper from file to file is .01 mm/mm. The set of files of any of claims 1-3 wherein the variation in shank diameter from file to file is .185 mm. The set of files of any of claims 1-4 wherein the length of the flute portion of each file of said set is 16 mm. The set of files of any of claims 1-5 wherein the variation in tip diameter from file to file is .025 mm. The set of files of any of claims 1-6 wherein each file has a handle which is pear-shaped and configured to provide an enhanced gripping area to facilitate the application of torque to the file in combination with apically directed force. The set of files of claim 7 wherein the handle of each file comprises a smooth curved surface portion extending from the distal end to a maximum diameter and a scored section tapering from a plane of maximum diameter to said proximal end. The set of files of claim 8 wherein the scored section of each file handle comprises 70% to 85% of the length of the handle. The set of files of claim 8 or 9 wherein the handle of each file is 10mm in overall length and the length of the scored section is 8mm.

Inventors: BUCHANAN LEONARD STEPHEN, BUCHANAN, LEONARD STEPHEN
Applicants: BUCHANAN LEONARD STEPHEN, BUCHANAN, LEONARD STEPHEN
Application year: 1995
Main classification: A61C5
IPC codes: A61C5