The Technique for GT Series X Rotary Shaping Files

by L. Stephen Buchanan, DDS, FICD, FACD

The technique for using the new GT Series X shaping files is similar that used with GT Files since they are landed blade instruments, however, there are some significant differencesmost of them simplifications of the earlier method. The primary similarities are: 1) the way they need to be lightly held in the canal during shaping and allowed to walk to their stalling point. Unlike non-landed blades that need to be used in pecking motions to reduce their propensity to transport canals, landed instruments, when used at the most commonly recommended 300 RPM speed, work best in a sustained manner, 2) they do not require multiple sizes of files to cut shape in different levels of the canal, 3) they absolutely eliminate coronal over-enlargement due to their Maximum Flute Diameter limitation, 4) they exhibit the same fidelity to the original canal shape as GT Files, thereby providing pre-defined shaping outcomes (you get the same ) and allowing a truly system-based approach to obturation. The first change is in the recommended shaping objectiveswe have discovered that less is more. As I mentioned in the last issue of Roots, clinicians using GT Files have found that the extreme regularity of the tapered shapes cut with these instruments means that less taper is needed for apical resistance form than was previously thought, therefore is was possible to eliminate the 20-.08 and all of the .10 sizes. This change offers three advantages: a reduction in the number of instruments to an eight-file set, a reduction in the number of files needed to cut a given preparation, and a reduction in the possibility of file separation caused by choosing too large of a shaping objective when hidden curves are present in canals. (Figure 1) The second change is that due to the added strength of the M-Wire used to make these files and the radical increase in cutting efficiency gained through the redesign of the blade geometry, there is no longer a requirement to cut the initial shape in a crown down manner in most canals. All root canal shapes are started with a 20-.06 GTX File (the hero file in this system), and in the majority of small canals, even those with significant curvature, this initial file will cut to length in two cutting cycles. Obviously, in medium and large root canals that passively accept a #30 k-file or larger during the negotiation phase are started with a 30-.08 or even a 40-.08 GTX File. Thus two to three fewer instruments are used during initial shaping procedures.

The third, and very significant, change is in the length of each cutting cycle. This is now possible because of the larger GTX chip space which takes much longer to fill, and due to this files variable-width lands which virtually eliminate taper-lock in the canal. (Figure 2) Whereas GT Files stalled out after about 4-6 seconds of cutting, GTX Files will typically cut for 10-12 seconds before the chip spaces are packed with debris. This extended cutting time is initially somewhat uncomfortable for experienced clinicians, as most of us have seen file separations caused by cyclic fatigue when instruments were kept in the canal for too long, rotating around curved in a canal. However, with the design features of this instrument, these longer cutting cycles are not only safe, but remarkably effective. There are many factors that increase efficiency, including blade geometry and the number of files needed to cut a shape, but a commonly unrecognized issue in this regard is how long can a file cut before it must be removed, cleaned, examined, and replaced in the canal for further shaping. Again, more than half of all small canals, including those with significant curvature, are initially cut to length with a single 20-.06 GTX File used in two cutting cycles. As an aside, the file size ID is the same with the black rings on the handle (which has been shortened from 13 mms to 11 mms) designating the taper (rings x 2 = taper) and the color band indicates the tip size in ISO terms. There are GTX Obturators, gutta percha points, and paper points sized to match each GTX File, just like the GT System, although the GTX paper points are now available in sterile cell packs. Technique All canals must be negotiated to a #15 k-file size, preferably in the presence of a lubricant so that pulp tissue will not be pushed apically in small canals. Obviously all negotiation procedures are best done with an apex locator (I use the Morita Root ZX) to simultaneously determine length, although, with the landed blades of GTX Files length determination errors are easily recovered from. After all canals have been negotiated and length determined, the lubricant is washed out with the air/water syringe, the canals and pulp chamber are irrigated with 6% NaOCl, a 20-.06 GTX File is measured to the first canal length, the torque limit and speed is selected on my Aseptico DTC motor (300 RPM and the same torque limits as for

GT Files174 g-cm in this case) and shaping is begun (usually without a length determination radiographmy apex locator reading is more accurate). I spin up the handpiece before the file contacts dentin (the file is always spinning during entry, cutting, and withdrawal) and when I feel that contact I apply a light apical pressure until the file starts advancing apically. As long as it advances into the canal, however slowly, I let it continuean experience that takes some getting used to but is central to the efficient use of these files. After 10-12 seconds the 20-.06 GTX File usually stalls out, I remove it, examine the debris in the flutes to learn where it is cutting, clean it, examine the flutes for deformation, and re-insert it for another cutting cycle. As mentioned above, in the majority of canals this file cuts to length in one or two cutting cycles. When that happens, I typically finish the shape in small canals with a 30-.06 GTX Fileusually in a single cycle. In those cases where the 20-.06 resists cutting to length after two cycles, I immediately bring in the 20-.04 GTX, which nearly always finishes the initial shape. Once the 20-.04 gets there, the 20-.06 will usually follow to that depth. In the cases where a 20-.04 is needed, the 20-.06 will most commonly be my final file. Medium and large canals want to be finished with a 30-.08 or 40-.08 GTX File, unless severe curvatures are present. Thats the basic techniqueone to two files to completion, little or no crown-down shaping, and way less opportunity for file separation if new instruments are used. Obviously, canals with apical impediments, or dilacerated curvatures will need to be final shaped with GT Hand Files, and in canals with very large apical diameters one of the .12 GT Accessory files with their #50, 70, or 90 tip diameters will be brought in to finish the shape. Also, one of my favorite finishing files in the standard GT File line is the 40-.10 size with its MFD of `.25 mmsa great file to use in medium or large canals where a bit larger coronal shape is desired. The only other change in the technique is the addition of visual gauging. Whereas tactile gauging (using niti k-files as apical feeler gauges) was recommended after

the initial shape reached length to determine whether a larger tip diameter was needed to finish, I have found that I can often forgo this step until the finish file has been cut to length. I noticed that when the terminal diameter of canals was larger than .2 mms, the first 20 Series GT or GTX File that cuts to length showed no cut debris in its tip flutes, and immediately cut a 30 Series file to length without tactile gauging. (Figures 3 a, b, c) Obviously, if that file showed no tip flute debris, a 40 Series GT or GTX Files was used then. This saved a procedural step without any give-backs in the final result. When filling with GT or GTX Obturators, visual gauging is in most cases sufficient to ensure that there is apical continuity of taper to the end of the canal, however, due to the more stringent requirements of cone fit obturation techniques, I feel that it is still necessary to do tactile gauging after the final shaping file has been used. Conclusion Many clinicians do more hand instrumentation during the initial phase of treatment than I do, mostly due to their fear of separating instruments, but I find that to be difficult, time-consuming, and is nearly always unnecessary if new rotary files are used in each case. In my analyses the costs in added time and effort to do this hand work greatly overshadow the expense of using new instrumentsrememberendo procedures entail some of the lowest overhead in tools and materials. Another comment that must be made here is that despite the significant improvement in resistance to cyclic fatigue failure gained from M-Wire, it is foolish to use these or any rotary file in multiple cases. Most dentists I know who do that have cobbled together a more complicated technique with more files and more procedural steps to ensure that their files hang together in yet another tooth again totally misunderstanding the fact that the highest costs in a practice are the dentists time. For those who say they dont have enough patients to make up for the shorter treatment times, so it doesnt matter, I would say that that doctors time is better used to do patient call backs, enhance practice marketing efforts, train staff members, take more CE, or just relax and have a latte for that matter, rather than sitting in an operatory grinding it out to save $30 on a new set of files. I frankly refuse to work that hard. (Figure 4)

For more technique information:

Click here to download a set of procedural flowcharts.

Figure 1. GT Series X File Family. This reduced file set, with its .2 mm, .3 mm, and .4 mm tip sizes will shape all canals but those with huge apical diameter. Standard GT .12 Accessory Files would be used if tip diameters are needed in.5 mm, .7 mm, and .9 mm sizes.

Figure 2. GT Series X File. Note the Maximum Shank Diameter at 1 mm, the radiused tip, the consistent, more open blade angle, and the variable width lands. At the tip and shank ends the land widths are half the size of the lands in the middle region of the flutes, allowing rapid cutting without transportation.

Figure 3a. A 20-.06 GTX File after completion of initial shape (this file was the first to cut to length in the canal), showing a paucity of debris in its tip flutes.

Figure 3b. The same 20-.06 GTX File shown in the canal where it is seen that the terminal diameter is larger than the tip of the file, resulting in little or no debris cut at the end of the preparationa canal with apical discontinuity of tapera set-up for overfilling as the resistance form is non-existent.

Figure 3c. A 30-.06 GTX File after cutting to length in the same canal, showing debris to its tip, indicating that the tapered shape extends to the terminus of the canal.

Figure 4. Maxillary second molar shaped with GTX and GT Files. The mesio-buccal canals were initially shaped with a single 20-.06 GTX File, followed by a 30-.06 GTX File to complete the preparations. The disto-buccal canal required a 20-.06 and a 20-.04 GTX File to complete the initial shape due to the multi-planar curvatures and the small apical diameter, but was finished by the 20-.06 GTX File. The palatal canal was initially shaped with a 20-.06 GTX File, and after gauging revealed a .4 mm apical diameter, it was finished with a 40-.10 GT File as I wanted a 1.25 mm coronal enlargement diameter.