The success rate of root canal treatment (RCT) is closely associated with the morphology of the patient’s root canal system. Without effective treatment planning and precise surgical techniques, there are significant risks associated with anatomical variations such as curvature in the root canal system.[i] Each risk has to be carefully mitigated using the right tools and techniques to reduce the likelihood of failure.
Ledge formation
Ledge formation is the most common of all complications affecting RCT on curved canals.[ii] An endodontic ledge (EL) is a deviation from the original path of a root canal, which can be difficult to correct. EL can result in a residual bacterial load in the apical root canal, and can be directly linked to the development of apical periodontitis.[iii]
EL most often occurs when working length (WL) is lost, and the original pathway through the canal cannot be established. If WL is not maintained accurately during instrumentation, the accumulation of residual pulp tissue and dentinal debris may result in a canal block, even with continuous irrigation of 5% NaOCl and 10% EDTA.iii Additionally, using the wrong size or sequence of files, using overly rigid files or inaccurately pre-curving files can contribute to the formation of a ledge.[iv]
The right tools for the job
The CanalPro X-Move endomotor from COLTENE is an excellent choice for navigating complex root canal morphology, to prevent complications like ledge formation. The integrated apex locator in the X-Move helps ensure the canal is correctly navigable at all times.
The CanalPro X-Move has a long, slim neck and small head, and is wireless to improve visibility and access to all areas of the oral cavity. This powerful endomotor has accurate and stable torque output and variable continuous rotation and reciprocating motion modes for all common file systems. There are pre-programmed settings available for COLTENE files, including the HyFlex OGSF file sequence.
To prevent EL, clinicians are advised to use flexible nickel titanium (NiTi) files that can be pre-curved to suit the individual root morphology.iv The HyFlex EDM OGSF file sequence consists of an Orifice Opener, Glidepath File, Shaping File and Finishing File, which are all Ni-Ti files manufactured using an innovative electric discharge machining (EDM) method for added durability and strength. Their variable cross-section design delivers excellent fracture resistance and cutting performance. They are highly flexible, and thanks to the controlled memory effect, can be reliably pre-curved, reducing the risk of ledging.
Precision techniques require precision instruments. To prevent complications like ledge formation when performing RCT on curved canals, be sure you always select the right tools to get the job done safely.
For more on COLTENE, visit https://colteneuk.com/hyflex-edm-ogsf
email info.uk@coltene.com or call 0800 254 5115.
[i] Xu LJ, Zhang JY, Huang ZH, Wang XZ. Successful individualized endodontic treatment of severely curved root canals in a mandibular second molar: A case report. World J Clin Cases. 2022 May 16;10(14):4632-4639. doi: 10.12998/wjcc.v10.i14.4632. PMID: 35663087; PMCID: PMC9125298.
[ii] Berutti E, Alovisi M, Moccia E, Carossa M, De Caro G, Roccuzzo A, Pasqualini D, Scotti N. Micro-computed tomographic evaluation of endodontic ledge position in relation to canal curvatures. BMC Oral Health. 2022 Nov 10;22(1):482. doi: 10.1186/s12903-022-02531-5. PMID: 36357901; PMCID: PMC9650826.
[iii] Berutti, E., Alovisi, M., Moccia, E. et al. Micro-computed tomographic evaluation of endodontic ledge position in relation to canal curvatures. BMC Oral Health 22, 482 (2022). https://doi.org/10.1186/s12903-022-02531-5
[iv] Tamilselvi R, Kumari VA. Factors Influencing Ledge Formation and Its Management in Endodontics. May 2021. Indian Journal of Forensic Medicine and Toxicology 14(4):1193-1197
