Minimally invasive endodontics to reduce the risk of fracture
Featured Products Promotional FeaturesPosted by: Dental Design 17th July 2023
When carrying out root canal treatment, it is important to preserve as much of the healthy tissue as possible. When more hard tissue is removed, the likelihood of tooth fracture increases, leaving the tooth fragile and more susceptible to further issues. It is therefore important to consider the instruments and techniques you use, and how they might assist in a minimally invasive and low risk approach. If endodontic treatment leaves the restored tooth extremely weak and likely to fracture, the tooth may become reinfected and/or require further restoration/retreatment. This might mean that patients who expected their treated tooth to last for many years, may require more invasive restorative treatment sooner than they would have liked.
Loss of hard tissue
When it comes to the longevity of endodontically treated teeth, the loss of hard tissue is a major influence on the likelihood of fracture. Root canal treatment weakens the treated tooth and this increased susceptibility is caused by the loss of excessive hard tissue. Due to the nature of the procedure, additional dentine removal is expected during endodontic treatment to allow space for a post and for the fitting of crowns. However, it’s important to carefully consider the need for and the extent of additional hard tissue removal.[i]
It’s important to retain a preservative and conservative approach to dentistry, even when conducting root canal treatment, to help patients keep more of their natural hard tissue for longer. Because of this, it’s important to consider how the instruments and technology you use may assist in preserving as much of the natural tissue as possible – focussing on the ability to restore the function of the tooth, prevent infection to the root canal space, and help to prevent the remaining tooth structure from sustaining additional tissue damage.i
Risk of file breakage
During the initial treatment, ensure your techniques and instruments encourage the preservation of hard tissues. Rotating instruments come with a higher risk of file fracture whereas reciprocating systems carry a lower risk while still producing good results and shaping curved canals with a single instrument. Rotating files may fail due to torsion and fatigue. Torsional fracture may happen if one part of the instrument attaches to the root canal walls and other parts of the file continue to turn, causing the file to over twist and break. Fatigue fracture may happen if an already weakened file undergoes further stress – in this type of break, the instrument does not attach to the root canal tissue but fractures at the most curved point. The amount of stress placed on an instrument depends on the canal curvature, meaning it’s more likely to break while treating very curved canals.[ii]
Reciprocating motion as a solution
By using reciprocating motion, the torsional and cycling stresses are minimised as the instrument is turned counter-clockwise and then released in a clockwise direction. Therefore, the risk of file fracture is significantly reduced.[iii] By using techniques which take measures to lower the risks of complications, you are able to retain stronger natural hard tissue. Minimally invasive techniques are important to help minimise the destruction of the dental tissues. By using a conservative approach to endodontic treatment, you are able to preserve as much of the natural hard tissue as possible, reducing the likelihood of tooth fracture. Once the pulp chamber has been cleaned, and each root canal has been carefully identified, the preparation of the root canals can begin,iii preferably using files with a smaller diameter, and which allow you to utilise a less destructive approach.
The MicroMega One RECI from COLTENE is designed for reciprocating motion. It offers safety, resistance to cyclic fatigue and comfort of use. It is designed to deliver conservative endodontic treatment, with a diameter of just 1mm – minimising the impact on healthy hard tissue during your canal preparations. The One RECI file offers an excellent balance between flexibility, controlled memory, and cutting efficiency thanks to patented C.Wire heat treatment. One RECI files are available in a range of lengths too, and can be pre-bent making them appropriate for use in a wide range of cases.
When undertaking endodontic treatment, consider ways in which you can carry out conservative treatment, removing infected tissue while still retaining maximum healthy structures. Create a long lasting, highly functional restored tooth to help save your patients’ natural dentition and prevent them from requiring further, more invasive restorative treatment sooner than expected. Choose instruments which accommodate a minimally invasive approach and a technique which minimises the risk of file breakage.
For more on COLTENE, visit www.coltene.com,
email info.uk@coltene.com or call 0800 254 5115.
Mark Allen
Author: Mark Allen, General Manager at COLTENE
[i] American Association of Endodontists. Treatment Standards. (Accessed: 14.11.22) https://www.aae.org/specialty/wp-content/uploads/sites/2/2018/04/TreatmentStandards_Whitepaper.pdf
[ii] Van der Vyver, P. J., and C. Jonker. “Reciprocating instruments in Endodontics: a review of the literature: clinical review.” South African Dental Journal 69.9 (2014): 404-409.
http://www.scielo.org.za/scielo.php?pid=S0011-85162014000900008&script=sci_arttext&tlng=es
[iii] Bürklein, Sebastian, and Edgar Schäfer. “Minimally invasive endodontics.” Quintessence Int 46.2 (2015): 119-124. http://www.quintpub.com/userhome/qi/qi_2015_02_s0119.pdf
