The restoration of one or several frontal maxillary teeth is a challenge for every

dentist, especially when using a direct approach. The patients aesthetic

expectations are great and, in many cases, the outcome heavily depends on the
protocol and the materials used. However, in my opinion, the mission of modern
dentistry is to break down barriers between conservative and prosthetic. We must do
as little invasive work as possible according to the concept of minimally invasive
restorative treatmen.t especially in young patients, whereit is crucial to operate
conservatively, restoring the teeth in a functional and aesthetic way, according to
the concept of minimally invasive restorative treatment, due to the significant
developments of the last 50 years that changed the treatment planning, bonding to
enamel and dentin.
ime is a decisive factor and is probably the most important element that can affect
success in Endodontics. An Endodontist is aware of the time he will be starting a
RCT, but never knows when the treatment will be finished, nor how much time is
required for Glidepath or if the time dedicated to disinfection is enough. So,TIME
is the game changer, but if we consider the cleaning part of RCT, it is not the
only element that can really satisfy all our requests. Why os that? Because
disinfection depends not only on the time of application of irrigants, but much
more on techniques and improvement of the protocols employed. Protocols? As
dentists we love protocols, we need rules and we wrote down protocols for shaping
and filling, but what about cleaning? Can we answer the following questions?

Do we really have a repeatable protocol for disinfection or do we consider our

liquids only as a method for removing coronal debris?

How much irrigant is needed and in which sequence?

Which kind?

Which needle and how far from the apex should we go?

If we take a look to the literature, we can find a lot of research that compares
liquids, finds alternatives to coventional irrigants and questions different
systems that can agitate and activate irrigants; but if we try to find a clinical
protocol at that time a big quest starts and you can find some real complicated
suggestions but nothing about real operative TIME and SEQUENCE.

mg. 1 - The only part of the cleaning process that we can try to protocol is the
Final Rinse (FR).It starts exactly when final shaping is performed and continues
until we decide to tridimensionally fill the Root Canal System. During FR, as
endodontist, I dedicate my full attention to the cleaning procedure and my choice
is the activation of NaOCl at 6% with Utrasounds and also EDTA during last step.
Img. 2 - But how much irrigant is required? I usually consider 10ml of NaOCl and
2ml of EDTA for each canal, extruded with a speed of 2ml/min.It means an evacuation
performed drop by drop using side vent needle with a size between 27 and 30 G.
Img. 3 - Let's now try to define a clinical protocol. It is dedicated to single,
double and pluri-radiculated teeth. 10 minutes might seem like a short time, but if
it is completely dedicated to the disinfection, it is an incredible long time and
you can feel while you check with your watch the extrusion of a liquid for a
minute. The same if you continuously activate liquids with an Ultrasonic tip.
TIME and SEQUENCE