00:00:00: I visited the style Italiano Endodontics Congress here in Dubai and had a chance to talk with SIA about broken file removal with CBT are pan and.

00:00:13: How to use it it's a podcast is supported by Sacrament have fun listening.

00:00:20: Music.

00:00:29: Okay welcome to Today's Show.

00:00:31: I'm sitting here today with Sarah he just had an very nice BTR pen broken file retrieval course here in just a little yeah no Congress in Dubai yeah welcome.

00:00:43: How are you good how was it cost for your fire yeah it was great course today we have more than 37 to 40 participants we had a great time they all learned how to remove program files they use the BTR pen

00:00:58: and it's correct way to remove it because you know the technique is more important to know how to set up the VCR in a correct way then,

00:01:06: try to use what are the typical mistakes you see in not setting the up the PD up and yeah many many mistakes first of all.

00:01:15: They don't place the notch the metal Notch of the needle inside the pace on the bed.

00:01:22: This is the first mistake they place it outside or maybe in a wrong place wrong way so when they tighten the grip they broke it.

00:01:31: Or maybe it's again outside this is the first one the second mistake maybe they are facing is that the needle.

00:01:40: When they close the grip they broke the the loop because they are closing the grip to the maximum,

00:01:46: you have to close the grape until you you feel that it is tightened a little bit then you can cut the rubber so some mistakes or already explained during the workshop and they were doing great,

00:01:57: you always create some space with Ultrasonics yeah to grab the fragment how much space do you usually recommend usually to be able to bless the 0.3 millimeter needle.

00:02:12: With the 0.07 we're inside the this needle we need at least one millimeter space at least when we limited in width and we need one millimeter in depth.

00:02:22: To be able to place the smallest BTR band need so at least one millimeter

00:02:28: what is your experience with the smallest diameter do you like this one or do you fear have any recommendation where we showed him go immediately for like the bigger one usually for 80% of the cases I use the yellow one the smallest one.

00:02:43: But sometimes the file is Big it's more engaged so I need the bigger one I use the gray and if the Drake,

00:02:52: cannot remove it I will go for the the biggest one which is the orange but unfortunately when we are going with bigger size with the loop we need to prepare more with Ultrasonics because the bigger Loop will not be,

00:03:06: easy to be placed around the program file if you don't prepare so we will lose again someday

00:03:12: I'm surprised that you like the smallest one actually I would always go the opposite way I kind of tend to use a biggest

00:03:21: if possible of course the biggest one first because I use the smallest one first because I want to be conservative the biggest one first maybe you have to remove a lot of the need to to to be able to place it inside,

00:03:35: around the broken file especially is that the needle is 1.0 millimeter it which is 1.0 is big.

00:03:42: Considering the diameter of the Canon so it will block the orifice it will block the vision.

00:03:48: So imagine that you need to enlarge more to be able to see the broken file the wire around the program file and to place the needle.

00:03:57: So it's a little bit difficult to start with the biggest one because you were removed too much didn't maybe you can remove it with the smallest one so I traveled the smallest.

00:04:06: It's not successful with the medium if not successful with the largest and what does not successful mean you try it and usually is a wire breaks when yes not successful retrieval with the BTR band means that the wire is Brick

00:04:18: okay so when the wire breaks that means two things the file is engaged.

00:04:24: So we need to have bigger wire so more stronger wires and also not only the file is engaged and also maybe we use the PT Albin and not correct way maybe the slider

00:04:38: we push the slider too much and we broke the

00:04:42: Loop we have to tighten the loop under microscope when we see that the loop is tightened we stop pushing the slider mode.

00:04:52: Or we have to already set the slider blocker

00:04:57: that blocks you from pushing the slider more this is sensitive but it needs a big learning curve,

00:05:06: and I can see on social media that many many people started to use BT Arbonne at the beginning but then they are now mastering the technique because it's difficult only in the beginning then

00:05:18: it will be like three seconds you set your needle and be TR and then you know directly where to put the loop and from where to cut them thin and from where to engage the other file you will know all the details

00:05:31: but you need to try more more more more I spent two years until now.

00:05:36: I spent time for removal and also I spend time for preparing with ultrasonic because I want to be.

00:05:43: As conservative as possible because broken file removal procedure is not an easy one it is the most difficult procedure in our specialty.

00:05:53: Endodontics it's the most difficult one so you are at the top of the difficulties you have a curved Canal you can shape it you have a perforation you can close it with them ta you have blockage you can open it with some files you have led you can bypass it.

00:06:06: But to remove a file is the most difficult thing in Endodontics speciality yesterday also had a lecture and I like the fact that leaving the instrument is always an option and just to observe it in cases where you probably want to achieve it yeah,

00:06:21: for sure sometimes we cannot remove sometimes we cannot bypass sometimes the case is telling you that I am going through the surgery.

00:06:29: But okay let's give it a chance before surgery let's clean very well let's up-to-date the fragment and then we will follow up the case and see,

00:06:37: maybe we will have healing despite that we have a broken file outside the tooth or maybe one millimeter only inside the kennel and three four millimeters outside over extruding from the root canal maybe we will have healing.

00:06:50: Because by the response is amazing but the root canal should be clean

00:06:54: is there any study out there which shows us but how much less success will have if we leave them broken instrument actually there is no

00:07:03: there is no precise numbers and percentage for the success rate a few reprogram file outside because you need a lot of cases with a lot of

00:07:12: years for follow-up to do such a study but it's not present but mainly mainly if the canals are clean everything outside.

00:07:21: Cannot effect that a burka files everything cannot effect but if we have failure later on we have to do the surgery.

00:07:32: Everything outside I have broken files outside I have got a better car outside I have sometimes see that outside it will not affect the success rate but it will delay the healing.

00:07:42: It will delay because there is a rotation it will delay the healing but it will not prevent the healing if the canals are.

00:07:52: Which is the most difficult part it's always the most difficult,

00:07:55: but coming back to the instruments are you two always trying to make them dance or obvious situations where you think you can remove it with the loop technique

00:08:03: give without the dancing file yes this is the difference between Loop technique and other devices other devices require.

00:08:11: To have dancing broken file in order,

00:08:14: put the loop and remove it for example I don't want to mention some names but we have many look devices and in the market you have to do the instrument dancing then you have

00:08:23: moved with the loop in my opinion if the instrument is dancing I don't need a loop to remove it because dancing I can remove it with the with only a prop,

00:08:32: if the instrument is engaged yes here I need a correct device and the correct technique to remove.

00:08:39: So in my opinion in busy Urban we don't need the instrument to be done.

00:08:44: No no no one thing was actually interesting that which was not mentioned in your lecture.

00:08:50: What are you doing with sharp edges of instruments who might like just breaks the wire before we even can engage the sharp edges during the preparation no sharp edges of the broken instruments.

00:09:03: For example there's some cases I had where I had a sharp edge and while placing the wire over the instrument the wire actually kind of broke because of the sharp edge yeah I know I understand.

00:09:18: If you have the correct space around the instrument when you insert the wire.

00:09:23: There will be no any problem but if you have a tiny space and you are inserting the water with the wire with the sharp edge it will cut okay so the.

00:09:33: The correct space the correct preparation is the key.

00:09:37: I'm staying actually I manage the problem with something else I actually like

00:09:43: Sonic tip a little bit better for creating the space okay

00:09:47: and actually something for excavation of the irrigation Solutions okay called Endo clean sets yeah from a different company the side effect of this tip is because it's a metal tip that all the sharp edges are rounded on the instrument

00:10:00: sometimes we can do it if it's according to the technique and according to the to the hands

00:10:05: with my hands maybe it will work with ultrasonic with your hand with Sonic maybe the opposite so if you find both yeah but sometimes it's according to the experience but

00:10:17: at the end space Loop grasp the move.

00:10:21: This is the most I might be any appropriate way to deal with the program files actually one thing is always you also always mentioned that the wire is from nitinol

00:10:31: I first would have fought with need to know is not optimal wire because it's flexing a bit more yeah I need I needed to be flexing,

00:10:39: I first thought it could be a drawback that it's flexing when I want to tighten it but I personally didn't experience anything like any problems with it know that the.

00:10:50: All people is thinking that nitinol is flexible wire it's not strong and stainless steel is better.

00:11:00: For Loop technique but in reality if you have stainless steel loop it's like you have a microchip technique because the loop is straight very hard not flexible so you need to remove a lot of Denton in order to place it over the program file.

00:11:15: While if you have a nickel titanium it's flexible a little bit and heated treated.

00:11:21: I showed today many cases where I could place the loop.

00:11:25: Even if I didn't prepare with Ultrasonics with over cannons because the loop the wire is flexible so I can push it a little bit it takes the shape of the canal and go just behind the program file.

00:11:38: We don't any preparation.

00:11:40: Pushing the file and you can push it because it's flexible when it's engage with it when it's just engaging the file.

00:11:49: All around you have to just close it.

00:11:52: And pull it out so that's why nitinol is better in my opinion than silence I have to to play inside the root canal if it is stiff it is strong.

00:12:01: Stanley steel it's will be better for a grasping.

00:12:05: But it will be more aggressive because I need to prepare more for such stiff wire actually I also have a lot of loop devices like you have for example versus Yugi in Taco Boy.

00:12:19: Fragment frog remover actually I like the freakmobile flow because of the 0.15 wire because

00:12:28: in rare cases I don't know why sometimes I have my files break it was very ahead of the thing then when we actually don't need any preparation we just need some very strong one and in this case I like the development of strong but here we have in BTR we have the orange tip

00:12:47: the 0.5 it's a strong and sometimes we don't need the preparation.

00:12:52: Force for such stronger engagement if you have space in my opinion we are compensating the strength of the stainless steel with the biggest wire of PTR so the biggest wire of PTR is really strong.

00:13:06: It can lift about 2.3 kilograms so we are compensating the strings but we are increasing the diameter of the wire,

00:13:15: with anything on the once you have grabbed the fragment you using an up-and-down movement can you explain that you come up by out there by yourself or when I tried

00:13:26: to remove the files from inside root canal when I first touch the file.

00:13:30: From but by BTR pen then I close the loop and try to go out directly I was not successful.

00:13:39: Because we have two or three situations it will happen first one maybe the loop will be broken the second one maybe the loop will slip off the broken file and it will go inside.

00:13:51: The needed so you will lose the loop that's the third one is maybe the needle,

00:13:56: because you pushed a lot and you are just pushing it will be it will bend and also you will lose that they needed so I try not to bring it out directly slowly slowly

00:14:09: slowly slowly up and down up and down because you need something to just,

00:14:14: this engaged so if you are doing up and down motion slowly slowly maybe it's better for for that to start this engaging the other floats around the loop and then you can remove it.

00:14:28: So a bundle motion is coming from you are trying to just a little bit release the engagement a little bit then.

00:14:36: Hopefully hopefully it will be out.

00:14:39: Also one interesting thing which was not really mentioned today who's actually placing the wire and the BTR pen are you doing it as your assistant doing it,

00:14:51: I started doing it by myself and then after 10 15 cases she is now a master.

00:14:58: Way to prepare my video that I just I told her just prettier than she is placing it she is closing the grip and she prepared the Caesar for me I cut the rapper,

00:15:08: okay you're kind under the microscope yeah and so how much time do you need for exchanging the tips no more than.

00:15:15: 10 to 15 seconds okay yes she will just release the grip remove the needle put another needle close the grill.

00:15:23: Should do a video of it make a challenge out of it if they make a challenge yeah now good easy easy

00:15:31: No actually that's compared for example to other devices super easy yeah if you compare that the technique of joining the needle to the to the bin or to the device with other devices it's.

00:15:43: Ridiculous you have to work as an electrician.

00:15:47: You would put the wire and then you you do many many things and also the ergonomics of the bend is much much more.

00:15:56: Better than other other devices because you can use your mirror and with the other hand you can just remove the file with the BTR pen while with other devices you need your assistance.

00:16:07: To close the loop here you can just cross the road puzzle with a slider,

00:16:11: you need only your two hands great thanks for the talk to you sire you so much for the inviting me I am happy to have interview with you I always be happy when I meet you.

00:16:25: Thank you so much all right.