A Step-By-Step Guide To The Endodontic Workflow

Diagnosis

The initial step in the endodontic process involves diagnosis of the issue. Typically, patients report pain or discomfort in a specific tooth or region, prompting a comprehensive examination by a dentist. During this process, the dentist must establish whether an endodontic procedure is indicated.

Various diagnostic tools and techniques are employed to assess the tooth and the surrounding structures, allowing for the identification of the underlying cause. This crucial step enables the development of an appropriate treatment plan, tailored to the individual patient's needs.

For reliable diagnosis, a radiograph is required. This can be carried out by the traditional use of an X-ray, or a CBCT in more complex cases. Henry Schein offers a full range of X-rays to meet your clinical needs:

Endofrost and a heated plugger can also be used to verify whether the patient has reversible or irreversible pulpitis.

Endofrost

A simple definition of CAD/CAM dentistry is the use of digital software to design and manufacture dental restorations and prostheses. CAD stands for computer-aided design and CAM stands for computer-aided manufacturing. The technology can be used to create crowns, dentures, inlays, onlays, bridges and veneers among other things. The speed of the CAD/CAM process allows for dental prosthetics to be designed, manufactured and delivered to the patient in quick time, sometimes the same day. The wider system of using computer assisted technologies to produce restorations is known as CEREC (Chairside Economical Restoration of Aesthetic Ceramics).

Access

Following the diagnosis, accessing the pulp chamber becomes the next critical step in the endodontic process. To do this, you may want to use a bur to gain initial access, and then to enlarge the access cavity to facilitate the cleaning and shaping of the root canal system.

This allows for the removal of any infected or damaged tissue within the pulp space, facilitating the cleaning and shaping of the root canal system. Through this meticulous approach, the dentist can successfully preserve the tooth while maintaining optimal function and aesthetics.

Henry Schein offers a wide range of burs and files to help with this step of the process.

To allow for straight line access, the Maxima Gates Glidden Drills can be used. These burs come in a variety of sizes from 0.5mm – 1.5mm, so that you can select the size that is best for the teeth you are treating.

Shaping

Now that you’ve gained access, it's time to shape the canals in order to remove the pulp and any bacteria or debris from the root canals.

You will need to work carefully and thoroughly to make sure that you get all the pulp tissue out, leaving the canals clean and free from infection. By using a careful and thorough approach, you can ensure that the tooth is well-prepared for the next steps in the endodontic process.

For the best possible shaping, you want to have a range of files available for use, so that you have a suitable solution, no matter the canal shape.

The Endoflex k-file range is flexible enough to navigate anatomy, allowing you to create a sufficient glide path, or to apically gauge.

The files can also be used alongside the BA Optima motor with a built-in Apex Locator to allow you to accurately find out the working length.

For another solution for shaping, check out EdgeEndo’s products, which include a large range of heat-treated NiTi files complete with high cyclic fatigue and flexibility – perfect for shaping canals that have more complex anatomy.

Irrigation and Debridement

Once the pulp tissue has been removed, it's time to clean and shape the root canals in preparation for filling. This step, known as irrigation, or debridement, involves using small instruments to remove any remaining pulp tissue, bacteria, or debris from the canals.

You need to make sure that the canals are well-cleaned and shaped to ensure that the filling material can be placed easily and effectively. By using a methodical approach, you can ensure that the tooth is properly prepared for the final stage of the endodontic process.

Henry Schein offers a range of irrigation solutions including Sodium hypochlorite 3% to aid disinfection and EDTA solution 17% to remove the smear layer and further enhance the disinfection process.

Henry Schein’s disposable Syringe Sterile Luer Locks are a reliable choice as they are side-vented to reduce the chance of apical extrusion and come in sizes 27g and 30g.

Irrigating needles are another great option for this step of the endodontic process. Monoject’s Endo Irrigation Needles come with a notched tip to optimise flushing of the root canal.

Drying

After the root canals have been cleaned and shaped, it's essential to dry them thoroughly before sealing and filling to maximise the longevity of the treatment. To do this, absorbent paper points are effective.

It's important to work carefully and take the necessary time to ensure that the canals are completely dry before moving on to the next stage of the endodontic process. By doing so, you can maximise the effectiveness and longevity of the filling, ensuring the best possible outcome for our patients.

To help with drying, you need paper points. In such a busy market it can be difficult to know which products you can rely on. Here are some of the solutions we recommend:

EdgeEndo paper points are easy to use and highly absorbent, perfect for the delicate work of drying the canal.
Maxima paper points have colour coded tips denoting size for ease of use.

Maxima paper points

Sealers

Just like coronal seals, sealing off the accessory and lateral canals and the apical foraman is important for reducing the chances or reinfection.

A calcium silicate sealer is a great choice as it rejuvenates the dentine by drawing out water to create Hydroxyapatite. This offers a permanent seal from the lateral canals and the apex. These sealers also tend to expand while setting, meaning you may be able to utilise the single cone technique. Calcium silicate sealers also create an Alkaline environment, aiding further disinfection for a couple of weeks after treatment.

Calcium silicate sealers that Henry Schein offers are Endosequence BC sealer, Henry Schein MTA sealer.

If a calcium silicate is not preferred, a resin-based sealer is also a great, as these sealers are not resorbing, reducing the chance of reinfection. In this category Henry Schein offers AH plus, which is ideal for NHS use or alongside heated obturation.