Dr. Kit Weathers - Page 2 - Practical
Endodontics
This is a long article. You will
may not read it all in one sitting. Remember the RED numbers on the left of each
topic to help you return to the place you left off previously. Think of them as
Chapter #'s
The following are examples of the subjects in Dr. Weathers' newsletter "Practical Endodontics"
( 1) - EZ-Fill Obturation system LIVES UP TO
IT’S NAME !
The EZ-Fill obturation system sounded too good to be true, When I read the ad in Dentistry
Today, I almost tossed it aside, thinking that nothing so simple to use could possibly be
any good. Fortunately, however, I decided to take a chance and order the introductory kit.
The cost of the intro kit was less than $100, and for that I would be able to complete
about 40 root canals. I couldn't wait to give it a try.
As fate would have it, however, the kit arrived the day before one of our two-day,
hands-on Root Camps. I had other things on my mind, so I dropped the EZ-Fill on my desk
and promptly forgot all about it.
At the conclusion of the Root Camp, I was relaxing with fellow instructors Pat Wahl, Bill
Watson and Mike Goldstein as we discussed ways to improve the hands-on portion of our
seminar. We agreed that our biggest bottleneck was obturation.
In spite of the fact that during the hands-on portion of our seminars, two of our
instructors did nothing but assist with obturation, we still found that area the most
difficult to teach. The technique we were teaching produced excellent results, but it was
difficult for new users to master in only two days. Almost as an afterthought, Pat and
Bill told me that while I was lecturing, they had spent about two hours looking at a slide
presentation showing a new oburation technique developed by Dr. Barry Musikant. It turns
out Barry, who was attending our Root Camp, is the endodontist who developed Flexipost,
Ti-Core and many other innovative product!, for his company, EDS (Essential Dental
Systems).
I am familiar with the EDS line of products, but I didn't realize that the inventor had
been in my audience. Bill and Pat were very excited about the technique Barry had shown
them, and they asked me if I had ever heard of EZ-Fill. When I told them I had an EZ-Fill
kit sitting on my desk, we opened it, mixed up some sealer and filled a couple of
extracted teeth. The digital x-rays looked as good or better than any lateral condensation
case I bad ever seen. We all started using the EZ-Fill technique in our practices, and it
soon became apparent that this was the technique we had been seeking. Our results were so
good, and our patients, had so few post-op problems, we began teaching EZ-Fill at our
seminars. The results were unbelievable.
Our Root Camp attendees are now getting the best-looking final fills we have ever seen,
and the system is a joy to teach.
Background and Research
Let's compare EZ-Fill to thermoplasticized gutta-percha. Many leading endodontists
consider thermoplastic endodontic techniques the most advanced form of obturation. The
large number of lateral canals filled with these techniques contribute to their
popularity.
If you examine the mechanics of controlled flow of thermoplasticized gutta-percha, you
realize that the technique's strength is based on shaping the canal with files of greater
taper, and not the gutta-percha. In addition, all the thermoplastic techniques block the
coronal escape route for excess cement, and to prevent gross overfills, thermoplastic
techniques emphasize placing only a "wipe" of cement in the canal.
By itself, gutta-percha does not seal the canal as shown by Hall et al - (J Endo 22:638,-
1996). Hall's study demonstrated that, at best, 62.5% of curved canals have a cement
interface along the length of obturation. Lee, et al (J Endo 23:579; 1996) determined that
thermoplasticized gutta-percha cooled and contracted 45 minutes to 10 hours after
placement. Prolonged contraction of gutta-percha combined with a less-than-adequate cement
interface compromises the seal. The EZ-Fill technique overcomes the shortcomings of
thermoplastic gutta-percha techniques by using a bi-directional spiral filler to place
epoxy resin sealer in intimate contact with the canal walls within 2mm of the apex. A
pre-fitted gutta-percha point's apical 4mm are then coated with cement and placed in the
canal. The technique minimizes the possibility of forcing excess cement through the apex,
while ensuring maximum adaptation of cement sealer to the canal walls.
( 2) - Technique
After the canals are prepared to a tapered shape (Endo Magic files are ideal for this),
they are irrigated and dried. A gutta-percha cone is fitted in the canal until a slight
tugback is achieved. The gutta-percha cone can be a standard .02 taper, or a larger .04
taper for larger canals. In most cases, a cone that is one size smaller than the last file
used to length will fit perfectly (if the last file is a #40, I use a #35 gutta-percha
point).
After the gutta-percha point has been fitted, use the following series of steps:
Step One - Mix the EZ-Fill cement to a smooth, creamy consistency. Note: The EZ-Fill
instructions specify two drops of resin for one level scoop of powder. If you Mix to those
proportions, however, the mix will be too thick. I have found that three or four drops of
resin and 1/2 scoop of powder is about right (just keep adding powder until the mix is
creamy, and don't make it too thick),
Step Two - Place the spiral in a slow-speed handpiece (the 300 rpm handpiece designed for
Endo Magic files is perfect), and coat it with the resin cement. Insert the coated spiral
into the canal and advance slowly to working length. Apply two or three applications of
the sealer with a smooth in-and-out motion to coat the canal walls and fill the canal with
cement.
Step Three - Coat the apical 4mm of your pre-fitted gutta-percha point with the resin
cement, and slowly insert it to length in the canal.
Step Four - Using a heated instrument (or an electric device such as the Touch 'N Heat),
sear off the excess gutta-percha.
Advantages of the Technique
- No auxiliary gutta-percha cones are needed with the EZ-.Fill technique.
- EZ-Fill, an epoxy resin with a silver Content 5% higher than the original AH-26 epoxy
resin, has the same radiopacity as gutta-percha.
- The gutta-percha point is placed passively in the canal. No vertical forces are applied
after fitting to alter the position of the point.
- No stresses are applied to the root that could cause a vertical fracture.
- No shrinkage occurs with the cement or gutta-percha because all materials are applied at
room temperature.
- The bi-directional spiral drives the cement laterally to coat the canal walls, as the
apical portion of the spiral pulls cement back from the apex minimizing the possibility of
overfills.
- Unlike thermoplastic techniques, no expensive armamentarium is required.
- The time required for thorough obturation is minimal.
- Studies confirm that the sealing ability of EZ-Fill is at least equal to lateral
condensation and thermoplastic techniques
- The non-eugenol sealer is neither toxic nor inflammatory, and it does not leave residual
eugenol to interfere with the setting of composite core materials.
- A post hole can be made with a #2 Peeso reamer, if desired.
- If the tooth should ever need re-treatment, the central core of gutta-percha allows
rapid access to the apex.
( 3) - The bi-directional spiral
The biggest problem with cement-only and single-cone filling techniques is that they
involve precise placement of sealer in the apical portion of the root canal. Lentulo
spirals and injection techniques tend to force sealer to and beyond the apex resulting in
medium or gross overfills.
Users of the EZ-Fill system avoid the problem of overfills by using a bi-directional
spiral filler. This unique device spins sealer down the canal to within 3mm of the apex,
at which point, the direction of the spirals reverses, pulling sealer away from the apex.
Coating the apical 4mm of a pre-fitted gutta-percha point carries cement to the portion of
the canal not completely filled with cement. Note that it is not necessary to take the
spiral filler around bends in the apical third because the gutta-percha point easily
carries the smooth-flowing, sticky cement to the apex.
Typically, non-vital cases, especially cases with apical radiolucencies, will have a very
small 'puff" of sealer at the apex. Vital cases with an intact periodontal ligament
almost never exhibit this classic “puff”.
Whether or not a small amount of sealer flows beyond the apex does not seem to have any
bearing on the incidence of post-op pain.
When I first starting using EZ-Fill (modified AH-26 sealer), I expected to see more
post-op pain. I had heard many cases of such symptoms associated with Therma Seal (also a
modified AH-26), which is part of the Therma-fil system.
It is now my belief that post-op pain associated with Therma-fil comes from hydraulically
forcing sealer beyond the apex, as the obturator is rapidly plunged into the root canal.
In contrast, the gutta-percha point is gently and slowly introduced into the EZ-Fill
cement, which allows the excess to escape back up around the point. The cement takes the
path of least resistance, which explains why we rarely see a puff in the presence of an
intact periodontal ligament.
I always conclude my Root Camps with the following quote: “ Yesterday’s history,
tomorrow’s a mystery, but today’s a gift . . . That’s why they call it the
present!"
Well, yesterday may be history, but your obturation will not be a mystery if you use
EZ-Fill.
EZ-Fill reduces the learning curve for canal obturation. I knew we were on to something
when I started looking at the digital x-rays produced by our Root Camp attendees.
Almost without exception, dentists were showing me "text-book" perfect
obturations, the very first time they tried EZ-Fill. In all the years I've been teaching
hands-on seminars, I've never seen such consistently good results. The learning curve is
almost non-existant for new users.
The good news is, EZ-Fill works just as well in the mouth. We are seeing beautiful results
with virtually no post-op pain. Plus, the AH-26 sealer has been around for many years, has
a great track record and is endorsed by many prominent endodontists. Try it, I think
you'll like it.
An introductory package of EZ-Fill is available through the Practical Endodontics Buying
Club for $85. ( You can order from this Web Site the E-Mail order form at the end of
Kit’s presentation.)
Until next time, have a wonderful holiday season, and don't forget to “Make a Life,
Not Just a Living”.
- Kit Weathers
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