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Protaper next
Root canal treatment : its a procedure to save an abscessed
tooth in which the pulp chamber is cleaned out , disinfected and
filled with a permanent filling
to do the root canal treatment we need to
- shape and clean
-disinfect
- irrigate
-obturate
because we have a war against bacteria in the root canal so we
need to kill the bacteria
So to do these steps we need instruments and irrigation
For irrigation we use sodium hypochlorite
and for obturation we use gutta percha

The key to a successful endo treatment , is following these
three steps shaping , irrigation and obturation we can't skip
any of these steps

Shaping


Irrigation 3 D obturation


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for shaping we have two schools , one school is saying that we
need an apical taper and the other school is saying that we need
an enlargement
its important to have an apical taper to allow better irrigation
and to prepare the canal for a three dimensional obturation
before we used the step back technique which is a good technique
that involves going inside the canal till the working length and
start enlarging progressively from the apical to the crown, this
technique involves using of several files
in the rotary files we are using the crown down technique which
is enlarging form the crown to the apical part

benefits of crown-down technique

it helps us to eliminate the cervical constricture
it gives full tactile awareness in the apical third ,
which means when I enlarge in the coronal third and I
introduce a manual file I can feel more the apical area
because the file will not block in the coronal third
because the coronal third is already enlarged
it helps in irrigation efficiency because the irrigation
will go deeply in the apical area and it will minimize
pushing irritants in the periapical region




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why should we replace the stainless steel files with rotary
nickel titanium and rotary m wire files?!

o The manual stainless steel files are k files , h files , k reamers we
mainly have 2 generations

o The first generation which is the colorinox stainless steel files
create some problems :
- The files can create ledges , zipping and canal blockage which
will result in short obturation
- They can force the extrusion of debris with the filing motion
towards the apical area
- Time consuming
- Less predictable shape in curved canals , when we have a
curved canal its very difficult to follow the curvature with
stainless steel files maybe with small files we can but when the
file is getting bigger its not easy





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o So they tried to go to another generation which is called flexo
files , these files are more flexible because they made the cross
section triangle which was a square cross section in the colorinox
so by this change we have a smaller area of metal so the file is
more flexible another thing they removed the transition angle but
even with these changes it wasn't enough and problems are still
existing so they decided to change the metal





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For years they were using The pro-taper universal (files with
multiple and progressive taper)

after 12 years they moved to the next generation which is the
pro-taper next
We have 379 scientific publications on pro-taper
5900 kilometers of pro-taper files
And more that 78 tons of files

Rotary files advantages
- More elasticity
- More flexibility
- Better cutting efficiency
- Can do shaping for 3 dimensional obturation
- With less number of files
- Less canal transportation
- Less debris extrusion
- Less post-operative pain
- Faster
- More predictable results

So it gives the beginner the possibility to achieve nice
result like a professional


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Characteristics of rotary nickel titanium files
We have 2 generations of files
Constant taper ,( the instruments available in the
markets )
variable taper , (protaper)
Whats the taper ?

o Its the Coneisty of the instrument, if you take a manual k file 10
or 15 the walls of the file are not parallel , just small coneisty like
a cone
o Manual files have a taper of 2% , which means diameter increases
by 0.02 mm every mm
o For the pro-taper on only 1 file the instrument will start with a
coneisty of 2% then after 3 mm we have 3 % 4% 6%..this what
we call (variable taper) ,they made this shape to be able to
reduce the number of instruments
o Every instrument in the protaper is designed to enlarge a part of
the canal
S1 will enlarge the coronal
S2 the middle
The finishers will enlarge the apical part

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for a manual k file , as we know the manual file has a taper of 2%
and a tip size of 20
so when we prepare a canal with the k file , the diameter
increases by 0.02 mm every mm
for the f1 , it has a taper in the final 3 mm of 7% so here the
diameter will increase more ,which means more tapering so when
we do irrigation the irrigant solution will go deeply and clean well
with rotary file ,it will enlarge the canal more than 2% coneisty
so the purpose is give the canal a larger taper
another difference between the protaper and other files , the
cutting blades which are important because when the file is
rotating it will be active not passive (if its passive the file will
rotate several times before cutting the dentin and then the file
will get tired and might break )


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protaper next
it works with continuous rotation like protaper, there's
another rotation which is called reciprocation we will not
work with it
variable tapers
11 mm handle for improved accessibility in posterior teeth
which is smaller than 13 mm as it was in protaper universal
5 interments , but only 2 needed in most cases but for
universal we need from 4-5 instruments
Pre-sterilized blister packaging of 3 files , can be used
immediately
Intended single patient use, it means every kit for one
patient this in Europe but here we can sterilize and reuse
Unique off centered Rectangular cross section , which will
give the file snake like swaggering movement while rotating
which will help the file to follow the curvature of the canals
This will give us enlarged space for the debris
Better centering of instruments in the canal



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M-WIRE NITI


the M-wire niti which is a special material for the fabrication of
these files
M-wire is originally nickel titanium with thermal treatment
process (heating and cooling) , it helped in changing the nature of
the file
The advantages
Improving file flexibility ,while still retaining the cutting
efficiency
Greater resistance to cyclic fatigue , the leading cause of
file separation
What are the files ..
-we have totally 5 files , because in the name protaper next we
have the letter "x" then the files names are x1 , x2 ,x3,x4,x5
-for the protaper universal we can replace 4 files(s1,s2,f1,f2) by
2 files (x1,x2)



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We can recognize x1,x2,x3,x4,x5 easily because the color of
the ring corresponding to the tip size
X2 is red because the tip size is 25
X3 is blue because the tip size is 30
X4 is black (it has two rings)because the tip size is 40
X5 is yellow (it has two rings) because the tip size is 50
X1 is also yellow but the tip size is 17,its not corresponding
to the tip size

- We start shaping the canal with x1, and the final is x2
But for larger canals I may need x3 ,x4 ..
- In the majority of the cases we use just x1,x2 and
rarely x3





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the tapers


In the final mm for x1 we have 4% taper, then it
will increase for 5%, progressively to 6.5% ,then
to 7.5% then it will decrease a little bit
We should always keep in mind the taper in the
apical area
in x1 it's from 4-5%
in x2 it reaches 6% which is more than enough to
allow the irrigant solution to go deeply in the
apical area so 6% is the ideal
Dr. Michael J. Scianambl is the one who did the design
with another 7 endodontists so the design was done
by dentists and manufactured by dentsply

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in x3 it reaches 7.5 taper, but with x4 the taper
is reduced because 40 is already very large we
can't give it 9% it's really too much so in order
to increase the flexibility they reduced the
taper
in x5 its 6 %

the protaper philosophy remains the same

a single file sequence for all clinical cases,
straight canals , curved canals .. for all types we
have the same sequence
variable tapers for optimized crown-down
technique
commonly approved apical finishing diameters

Advantages of protaper next
- The advantage of protaper next is that this
instruments can cover more difficult clinical cases
because its more flexible and because its more
resistance to fracture its much safer with narrow
,curved and other difficult canals
- Protaper next brings improved safety because it
reduced the risk of file breakage
- The studies shows that protaper next is stronger and
more resistance to fracture and less canal
transportation
- Less working time (shaping time) because we only need
two files

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- High cutting efficiency

Now how to work with protaper next ?!

We should start by preparing the access cavity,
we can use several burs like round ,conical,
diamond and the endo z
** endo z is very helpful in the preparation of
the walls of the cavity because the tip of endo z
is a very safe and non cutting tip, we put it in
the canal in a vertical way and we pass it on the
walls it will enlarge the cavity while keeping the
floor of the pulp chamber very safe so there will
be no risk of perforations ,stripping or any
problems







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**We also have the x-gates glidden we have several
numbers of gates 1,2,3,4 , we can use x-gate to
replace the four other gates
After preparing the access cavity it's time for
negotiation the canals
To negotiate the canals we have to steps
1 -Pre flaring and establishing glide path
,this step comes before using the protaper
next so that we can use them safely
because anatomy of the teeth is different
from one person to another so we can't
start negotiating the canals without
knowing what is waiting me there , so we
need to start by a manual file (k file
number 10 or 8 or 6 if its thin ) but this
thing is a must then I will open the path
with rotary files are called path files
*So when we say pre flaring it means discovering
the canal with k file
*establishing glide path means to open the path
for the rotary file to allow them to go and start
shaping
2-Shaping and cleaning



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Path files

the path files replaced all the manual procedure,
in the past they used file number 10 to find the
canal and they enlarged with 15 and 20 but the
problem in some narrow and curved canals we can
use 10 but it's not easy to introduce 15
so they came with the idea of having files more
flexible ,easier for negotiation the canals and can
cause less problems
path files are 3 instruments we call them
p1,p2,p3
p1 is purple , p2 is white ,p3 is yellow .. the color
is not matching with the tip size
purple is number 13 ,white is 16 , yellow is 19
we have lengths 21,25,31
path files are very flexible and resistance to
cyclic fatigue
more efficient than manual preparation

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the cross section is square and the taper is 2% ,
like k files but not stainless steel they are niti ,
to avoid the problems ledges, zipping .. etc

how can I achieve my glide path ?!!
we start with k file number 10 , I can use
p1,then p2, Then p3
*but if I have large and easy canal I dont need
to use path files like a canine or a palatal canal
*we should use path files when we only need
them
*using the three path files in thin curved
calcified canals is making life easier , because
the files will go easily after using the path files
*in majority of cases we just use p1,p2 .. the p3
file in the very thin canals
the rotation speed of path files is 300 !
the path files should start rotation outside
the canals then inside the canal we use in
and out motion until we reach the working
length
time needed for the path file to reach
working length normally doesnt exceed 3-5
seconds
the rotating motion will carry debris in a
coronal direction ,it's not cutting or
enlarging its just opening the path for the
rotary files

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after using file number 10 and then the path files , we need to
start with protaper next we should start irrigation from the
beginning of the work
the first protaper next instrument we use is x1,in the presence
of sodium hypochlorite and also in the presence of glide
*glide is a lubricant agent it will allow the file to go easier in the
canal
*the combination of glide with Naocl will help to remove the
smear layer this combination is more efficient
for protaper next file the motion is brushing motion for seconds
from 3-4 second ,its the secret of success in the protaper family
we should reach the working length with x1 before moving to the
second file x2
then we remove x1 , clean it well then we should irrigate to
remove the debris , after that we can use a k file number 10 to
check the patency and that the debris is not blocking the canal
then after making sure we reached the working length we can
move to x2 with repeating the same steps
*we should always check that we have glide in the pulp chamber
then we check the flutes of x2 if it's loaded with dentin this
mean that x2 removed a good quantity of dentin , then the canal
is ready for obturation
now shall I obturate after x2 or continue with the files ?!
the tip size of x2 is 25 , I can take a manual file 25 and insert it
passively to the working length if there is resistance then I dont
have to go larger , but if the manual file is moving easily inside
the canal then I have to continue with x3 .. repeating the same
steps


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These are the five files, to shape the canal we need x1,x2
and the other 3 are optional
We can see the taper and the tip size in the figure above
X1 has a tip size of 17 and 4% taper in the apical third
X2 has a tip size of 25 and 6% taper in the apical third
X3 has a tip size 30 and 7%taper in the apical third
X4 has a tip size of 40 and 6% taper in the apical third
X5 has a tip size of 50 and 6% taper in the apical third
*We always need from 6-7% taper to obturate
so the irrgants can go deeply

For this system we have matching paper points and
matching gutta percha that is called gutta core




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These the motors that we will use
These motors can be charged, we can use it with the electricity
or with the battery
We have a screen we can change the settings of the motor
We have 9 programs
For path files we need a speed of 300 , and torque 3.5
For protaper next we need a speed of 300 for the 5 instruments
and torque of 2



Conclusion
Protaper next will cover more difficult clinical cases, bringes
improved safety and shorten the shaping time, because of the
off centered cross section , the swaggering movement and the M
wire niti material


Done by :
Alaa Adas ;))

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