Conservative Access on #18

TRUShape 3D Conforming Files used on Tooth #18

Pre-Op RadiographPost-Op Radiograph"… TRUShape instruments are the most safe and effective rotaries that I have ever used…"

Robert Rybicki, DDS, MS
Novi, MI


Chief complaint: The patient presented asymptomatic in #18, but reported several intermittent episodes of localized swelling over the past few years.

Exam / Diagnosis: Tooth #18 was negative to cold and within normal limits to percussion and palpation. Periodontal probings were less than 3 mm and no mobility was noted. Radiographically, calcification of the chamber was observed with a narrow s-shaped curvature of the mesial canal. Rarefaction was evident in the periapical region with normal trabecular pattern present.

Pulpal diagnosis: #18 pulpal necrosis

Periapical diagnosis: Asymptomatic apical periodontitis

Treatment options: Non-surgical root canal treatment, no treatment or extraction

Treatment – 1st visit: 1 x 1.8 cc 2% lidocaine, 1:100,000 epinephrine buffered with sodium bicarbonate was administered as inferior alveolar block. A rubber dam was placed and a conservative access was made. Four orifices were identified: MB, ML, DB, and DL.

The canal system was explored with Lexicon Hand Files – #6 C-Files and #8 K-Files and lubricant. Once a #10 K-File could be passed close to the apex, a #15 .06 Vortex Blue Rotary File was advanced to resistance in each canal. This step is extremely important as it creates a smooth and conservative glide path in the coronal 2/3 to allow subsequent instrumentation of the apical 1/3 to proceed safely and effectively.

Length measurements were obtained with an electronic apex locator (patency) and a Lexicon FlexSSK #15 file was advanced to full working length. EDTA solution was introduced and all canals were fully instrumented with #20 TRUShape 3D Conforming Files. Calcium hydroxide was placed following irrigation with 8.25% NaOCl and drying with paper points. A temporary restoration was then placed in the access opening and the patient was scheduled to be seen in two weeks for final irrigation and obturation.

“While literature does not directly show increased success rates with two-visit endodontic treatment, multi-stepping when performing conservative access / canal preps is important for case management as it allows verification of a symptom-free tooth prior to obturation and also helps disinfect areas in the canal system which cannot be mechanically cleaned,” said Dr. Rybicki.

Treatment – 2nd visit: The patient presented two weeks following the initial visit with asymptomatic tooth #18. No local anesthetic was needed and a rubber dam was placed and tooth #18 was re-entered. A cone-fit PA was obtained and separate final rinses with NaOCl, water and QMix 2in1 Irrigating Solution were conducted, each activated with passive ultrasonic irrigation.

Sealer was spun into the canals with a spiral instrument and obturation was completed using a Calamus DUAL 3D Obturation System in the continuous wave technique.

“My experience is that the TRUShape instruments are the most safe and effective rotaries that I have ever used to progress to working length after establishing a conservative initial glide path in tight / curved canals while preserving pericoronal dentin," said Dr. Rybicki. "I have a high degree of confidence that the files can be used in these situations according to the directions for use without fear of separation.”


“My experience is that the TRUShape instruments are the most safe and effective rotaries that I have ever used to progress to working length after establishing a conservative initial glide path in tight / curved canals while preserving pericoronal dentin. I have a high degree of confidence that the files can be used in these situations according to the directions for use without fear of separation.”


Dr. Robert M. Rybicki has been a practicing endodontist for more than 15 years. He is a past recipient of the AAE Foundation Endodontic Research Grant and has published research in the Journal of Endodontics. He is also a member of the AAE and ADA, among other professional associations. Dr. Rybicki earned his D.D.S from the University of Michigan before going on to complete an M.S. in Endodontics at Northwestern University. He currently maintains a private practice in Novi, MI.