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 Instructions for use of Hero shaper files
The opinions within this web page are not ours.Authors have been credited
for the individual posts where they are. - www.rxroots.com

From: Dr.Mohammed Al Shehri
Date: Fri, 19 Mar 2010 11:25:37 +0300
Subject: AEEDC 2010 presentation

Hi Mohammed,

Congratulations on very nice presentation.
I would only add that after EDTA I always use a final flash with 2.5 % 
hypochlorite and 3 % hydrogen peroxide ( or sometimes saline followed
by metronidazole saline solution ).

I would kindly suggest that you try a single cone with 
"capillary condensation" technique of  Dr.Deyan Kosev
and use of bioceramic sealer in a same way as you have used AH Plus 
- i.e. Lentulo and also sealer over a single cone. Only take care, 
so that the tip of the cone be located 1 mm less than WL. This way 
last mm will be filled with bioceramic only. Yes, I am biased :-) , 
but bc sealer is a good tool against E. faecalis and maintains pH 12 
for at least 78 hours after filling of the canal.It also does not 
shrink at all and bonds to dentin of the canal's walls.

It is nice to see these conofocal laser electron microscopies, too 
( were these given to you by Gustavo or they were
made at your University ? ). -  Valeri Stefanov

To Valeri Stefanov:

I would only add that after EDTA I always use a final flash with 2.5 %
hypochlorite and 3 % hydrogen peroxide ( or sometimes saline followed by
metronidazole saline solution )

On what occasions do you use metronidazole saline solution? Why is it more
benefitial? What would be the concentration of the mix? - >Anne-Ly

Hi Anne, I am using Metronidazole in all non-vital cases. It has good 
antibacterial activity against anaerobic bacteria causing dental 
infections. ( it is also a part of 3x paste ). The solution I am using 
is called EFLORANE ( Krka - Slovenia ). One 100 ml bottle contains 
500 mg metronidazole, so 1ml contains 5 mg of metronidazole.
That is the solution normally used for IV applications of the drug.

Its use combined with excellent activity of iRootSP bioceramic sealer 
against Ent. faecalis allow me to have good final results. - Valeri

Hello! Thank you for the clarification.
In what method are you using EFLORANE (plain syringe irrigation, manual
dynamic agitation, US or something else?) Can you post your full
irrigation protocol in non-vital teeth? (Perhaps you have already done
that in earlier times, I have been reading ROOTS only for 5 months:) 
- Anne-Ly

Anne-Ly, I am using Metronidazole with plain syringe irrigation.

I am starting vital cases with RC Prep and non-vital cases with 
EDTA 17 % solution with  #06 K file, #08 K file and  #10 D finder
MANI - Japan file.

Starting with # 15 K file I am using 2.5 %  hypo inside chamber, while 
I am instrumenting the canal and I am irrigating with 2 ml hypo before 
use of next size file. I create glide path with hand files up to # 25
and then I use currently HERO Shaper Difficult sequence set machine files 
( Micro-Mega France good price for high quality ). At the end I am 
enlarging / instrumenting  the apical third depending on the case with
different size .02 hand K files  - # 35, 40 and up. After the canal is 
fully instrumented the final irrigation consists of 2 ml  2.5 % hypo, 
2ml EDTA 17% solution, again 2 ml 2.5 % hypo followed by 2ml 3% hydrogen 
peroxide or saline. Finally in re-treatment and non-vital cases, incl. 
those with pa lesion - 2 - 4 ml metronidazole solution
Drying with PP followed by  "capillary condensation" with bioceramic 
sealer and single-cone gutta (in certain cases
additional smaller size  .02 cones are added ).

Aim is that canal walls to be in contact with bioceramic only and most 
apical 1 mm to be filled by bioceramic only.
- Valeri

From: Valeri Stefanov
To: ROOTS
Sent: Wednesday, March 24, 2010 6:48 AM
Subject: Re:[roots] AEEDC 2010 presentation

See attached instructions for use of HERO Shaper Difficult Sequence 
files set ( Yellow ) - Valeri

Hello, I want to ask you what is the difference if we use Clorhexidin 2% at the end? - Dunia Dunia, If you mean clinical results there will be no difference. Metronidazole is 5 times cheaper :-) here and carries no risk if some of it, by incident, is spilled out inside the mouth. - Valeri Heji Valeri, Do you mean Chlorhexidin and Metronidazole antagonize -about- the same range of bacteria species? How long would you leave both of them them into the canal? I leave chorhexidine 1 minute into the canal. - Cheers, August Heji August, I can't remember saying the antibacterial activity of CHX and Metro are the same :-) ! Anyway, I doubt you will find any statistically significant difference in final outcome after using one or another as a final rinsing. If you mix CaOH with 1 % CHX and leave it in the canal for a week or more results may be different of course. Here we are talking just final rinsing of the canal. Remember I am using bioceramic sealer with excellent activity against Ent. faecalis :-)) for 78 hours after filling ! It is different from AH Plus which after hardening does not show any antibacterial activity at all. - Valeri

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Removing Niti instruments

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Ca(OH)2 extrusion

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Apico on MTA