Orthograde retreatment Root phase

Orthograde retreatment Root phase

1. Removal of sealing pastes 

The operating protocol is as follows:

1. Fill the channel with a solvent e.g.: Ethyl acetate-based solvents, Tetrachloroethylene-based solvents, orange oil, xylene or eugenol
2. Test the effectiveness of the solvent by pricking the material with a Hu Friedy Dg16 probe
3. Unblocking either using manual instruments:
   1. Unblock the canal entrance with a Gates drill
   2. Unblock the cervical third of the canal with a n25 H file
   3. Unblock the middle 1/3 of the canal with a n20 H file
   4. Unblock the apical 1/3 of the canal with a n15 H file
   5. Catheterize the apical part of the untreated canal using a previously curved K n 10 file
4. Unblocking using rotary instruments such as Pro Taper Universal:
   1. Unblock the canal entrance with the D1
   2. Unblock the cervical 1/3 of the canal with the D2
   3. Unblock the apical 1/3 of the canal with a D3
   4. Catheterize the apical part of the untreated canal using a previously curved K n 10 file

2. Elimination of Gutta Percha 

The solvent for gutta is Chloroform (Trichloromethane), the best way is: 

1. To open the canal orifice with a Gates drill
2. Insert a Hedstrôm file no. 25 or 30 along the gutta-percha cone without using solvent, but only by irrigating abundantly with sodium hypochlorite.
3. A back and forth action is given to the instrument while trying to engage the gutta-percha cone in its coils.

3. Removing a Thermaphil seal 

Pre-removal of the tutor facilitates the reprocessing procedure 

Some tutors have a longitudinal groove facilitating the engagement of a manual file or better a high-cone nickel titanium rotary file or even ultrasonic inserts.

4. Removing a silver cone 

• Fill the access cavity with solvent
• Introduces hand files along the silver cone
• Once the sealing cement is removed, a n°15 ultrasonic file must be introduced

5. Ultrasonic unclogging technique  

• Ultrasonic unobturating combined with visual inspection by microscope or magnifying glass will be used in cases where the canal is obturated with hard resins. 
• Inserts (ProUltraR Endo, ET20R, ET 25R, etc.) or ultrasonically mounted files of decreasing sizes will be used to descend gradually and with great care into the straight portion of the canal.
• The energy of the ultrasonic instrument produces heat and therefore allows certain inserts to move the residual gutta percha in the canal

6. Thermal and instrumental technique  

• Use only in case of gutta root canal filling
• Either the hot instrument (system B, heat carrier, Touch Heat) is inserted into the gutta mass, once the gutta has cooled, remove the instrument which brings back with it the obturation gutta
• Either the hot instrument is inserted into the mass of gutta then removed immediately, an H n 30 file is gently screwed into the softened gutta, once cooled remove the instrument which allows complete elimination of the gutta

7. Thermomechanical technique   

• The GPX or XGPR instrument for gutta percha extractor is an instrument specially designed for use on a blue contra-angle

8. Management of instrumental fractures 

8.1 The “bypass”

• The bypass technique involves passing a file alongside the fractured fragment to the working length, often using a chelating agent such as EDTA. The fragment can be loosened and removed, or it can remain stuck in the canal walls. Reaming and filling can be performed. The instrument breakage is then incorporated into the filling material without affecting the chances of healing.

8.2 Use of ultrasound 

• Widen the canal with Gates drills No. 2, 3 and 4 until contact with the fractured instrument
• Create a plateau at the fractured instrument with a flat Gates drill 
• Create a trench around the instrument using an ET 20 or ET 25 insert
• Rotate the titanium insert counterclockwise into contact with the fractured fragment. 

8.3 Use of the kit 

The protocol is:  

• Widen the canal with Gates drills No. 2, 3 and 4 until contact with the fractured instrument
• Impregnate a slow counterclockwise rotational motion with the drill bit to excavate a 4 mm deep trench around the fragment.

Insert the die until it makes contact with the fractured instrument, then tighten the punch and rotate counterclockwise to remove the instrument.   

8.4 Tube and file technique:

• Suter described a technique using a tube and an H-file. The H-file blocks
• The end of the fragment inside the tube previously positioned on the end of the fragment.
• This is an inexpensive technique that requires creating direct access to the partially released fragment. Hypodermic syringe needles or flowable composite tubes can be used. 

8.5 The laser

• A study has shown that the use of the Nd:YAG optical laser allows, under certain conditions, to vaporize the instrument. The optical fiber must be placed in contact with the fragment. However, care must be taken not to overheat the surrounding root walls.

8.6 The lasso technique

• The lasso technique is derived from orthodontics. It involves passing a metal loop inside a hollow tube in order to catch the end of the fragment with the lasso thus created. The loop is tightened by pushing the microtube and the whole thing is gently removed.

8.7 The gutta cone softened with chloroform

•  Soften a gutta percha cone by soaking it for 30 seconds in chloroform,
• Insert the softened gutta cone into the canal. 
•  Leave the cone in place for 3 minutes to harden, then gently remove it using clockwise and counterclockwise rotating movements.

8.8 Removing a fractured Lentulo paste wad:

•  It will be easily removed by screwing a large diameter 25 or 40 H file between the coils and giving it a withdrawal movement.
• It can be removed with an identical wad of paste which will be manually wrapped around the fragment and then gently remove the instrument 
• It can be removed with pliers

9. Negotiation, reshaping of the canal trajectory and canal obturation:

• The junction between the old filling and the rest of the canal is difficult to negotiate because it often presents a stop, the start of a false route, a dentin plug or calcification.
• This K n06 08 or 10 file is pre-curved at its end to allow the negotiation of apical curvatures and the passage of any stops . By small rotational movements and with light pressure, the canal lumen is sought.
• Once the canals have been exploited, proceed with the canal shaping which must be completed with a three-dimensional obturation  

Orthograde retreatment Root phase

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Orthograde retreatment Root phase