Thursday, October 3, 2013

Ultradent Tilos - Why Sometimes Ribbon is the New Round...

Ribbon Shaped Canal.jpg
I had an interesting endo case this week (root canal for those of you who aren't practicing dentistry).
For the last 15 years or so, the big focus of endodontics has been rotary instrumentation.  That can work well in many instances, but on a situation like the one in the above photo, it can provide a less than optimal result.
What I mean by that is that rotary creates a round canal shape as the final shape before filling.  Now if the canal is small, even if it not round to start with, a round shape that is large enough can replace a small canal in an "8" shape and all will be fine.
However, in the tooth in the photo above, enlarging the canal shape to the point that the entire ribbon is round, would almost completely obliterate the remaining tooth structure.  It's either that or use a smaller rotary that will not severely weaken the tooth, and you end up with part of the canal being round, but lots of it left that has not been instrumented completely.  This means that lots of debris and bacteria remain.
In instances like this you'd like to keep the canal anatomy in as close to initial shape as possible while still cleaning and shaping properly.  This is where the Ultradent Tilos system can really come in handy.
Tilos uses reciprocating files in a special handpiece.  The simplified version is that the files go left & right (oscillating) in a "watch winding motion" which allows them to clean and shape the canal while not rotating 360 degrees.  The oscillation means a huge decrease in the number of broken files vs. rotary.  What is really nice about the Tilos system, especially in canals like the one in the picture above, is that it maintains the shape of the original canal while still allowing you to clean it and prepare it for root canal filling.  The system is easy to use and is, in many instances, probably faster than rotary systems.
Ultradent also uses bonded obturation.  They recommend a GP  point coated with a material that make s it bondable.  The point, combined with a self etching resin sealer, creates an obturation system where the sealer bonds to the canal walls and the points bond to the sealer.  The obturation, since it is bonded, leaks less both apically and coronally.
If you are a dentist that doesn't do much endo and are looking to provide more endo care in your practice but are concerned about breaking rotary files, I really think you should take a look at Tilos.  Also, if you are a dentist who, like me, does lots of endo and are looking for a more conservative walt to treat some of your more oval & ribbon shaped cases, Tilos should be on your short list for handling those cases.

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