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Endodontic therapy is a delicate dental treatment that conserves a tooth with infected, inflamed, or necrotic pulp. Among all the instruments employed in root canal treatment (RCT), endodontic excavators are ideal instruments in access and debridement phase. Even with the advent of high-technology rotary systems and ultrasonic instruments, manual endodontic excavator remains at its place as unavoidable due to tactility and versatility.
Even prior
to mechanized dentistry, infected pulpal tissues did not have any other choice
but to depend upon crude hand instruments, i.e., crude spoons and drills, for
treatment. The origin of dental excavators coincides with the overall move
towards endodontic evolution as a specialty:
•The most
frequent treatment of toothache during the 18th century was extraction.
Extraction is removal of the tooth from the jaw alveolus. Pulp removal by
access cavities had not yet been thought of.
•"cumbersome
excavators" are referred to in early 19th-century literature for
mechanical caries dentin removal.
•In mid-20th
century, spoon excavators of standard sizes were to be employed, both for
pulpal extirpation and caries.
•EXC31W and
equivalents brought a quantum leap in accuracy.
Even in technologically advanced clinics today, they are well worth their cost due to their mechanical efficiency and the level of operator control.
Endodontic
excavators, being hand instruments, are individually designed for the removal
of the pulp chamber soft tissue and debris. They possess the following
features:
•Working
End: Rounded spoon
or blade with acute cutting edges for efficient removal of the tissue.
•Shank
Design: Lengthy and
angled to reach pulp chambers far within the tooth or curved canals.
•Handle: Generally stainless steel,
well-balanced and comfortable to hold and use.
•Hardened
stainless steel to be sterilizable and durable.
•Available
in different tip sizes (i.e., 1 mm, 1.5 mm, 2 mm diameters).
•Single- or
double-ended.
•Hu-Friedy
EXC31W
•Ash #137
•Tyler 7-8 modified excavators for children
Although
rotary and ultrasonic instruments are the queens and kings of modern endodontic
instrumentation, excavators are very handy in several steps:
•Used to
gently remove pulp chamber roof after initial bur access.
•Assists to
support dentinal walls during exploration.
•Ideally
used to debride soft, necrotic pulp tissue.
•Provides
better tactile feedback than mechanical instruments.
•Spoon
excavators permit coronal tissue removal prior to initiation of shaping.
•In pediatric cases, when canals are large and rotary systems may perforate, manual excavators are ideal.
•In retreatment, excavators facilitate removal of overfills or broken GP tissue from canal orifice.
• Tactile
Feedback: As compared to rotary files, they allow clinicians to feel the
tissues.
• Selective
Removal: Best for selective removal of carious dentin or soft tissues.
• Low Risk
of Perforation: Low risk of perforation when compared to high-speed burs.
• Cost-Effectiveness: Cost-effective and reusable, and hence the lifesaver in economically constrained settings.
•
Sterilization:
Sterilize always before use.
•
Angulation: Correct
angulation not to gouge chamber floor.
• Stroke
Motion: Gentle
scraping motions never stab firmly.
• Magnification: Use under dental loupe or microscope to be more precise.
• Use in Moist Environment: Maintain chamber wet to avoid dentinal wall tearing.
Rotary
instruments are better during the biomechanical shaping stage but are no
replacement for excavators. Why excavators cannot be avoided:
• Blind
but quick: Rotaries
are guided by radiographic and visual feedback. Excavators have tactile
perception.
•
Retreatments: In
event of failure of root canal treatment, canal form is irregular in most
cases. Spoon excavators are better able to deal with the variation.
•
Anatomical Variability:
The hand instruments are utilized to assist with the initial access when flare
or calcification of molars' canals exists prior to NiTi files.
• Canal
anatomy is less well-defined.
•
Over-instrumentation damages permanent tooth buds.
• More
delicate, finer spoon excavators are safer, easier to control.
• Easy,
quick removal of tissue.
• Assists in preserving delicate root structure.
• Reduced anxiety since it's quieter and less obtrusive than motor tools.
•
Restricted Reach:
Unable to debride apical third of canals successfully.
•
Operator Fatigue:
Regular manual usage might be tiring during lengthy procedures.
•
Sterilization Requirements:
Requires proper sterilization so they don't cause cross-contamination.
• Not Suitable for Highly Curved Canal Shapes: Poor outcomes in highly curved or highly constricted canals.
In spite of these drawbacks, careful selection and used in conjunction with other instruments can counteract most of the problems.
•
Elimination of compacted material from orifices.
•
Elimination of softened GP following solvent application.
• Prevention
of excessive overaggressive removal of subjacent dentin or posts.
Evidence
confirms them to be effective in the retention of dentin in comparison to
rotary retreatment systems capable of softening microcracks or over-enlarging.
Even though
the plain shape of the excavator remains unchanged since centuries ago, a few
new advancements are:
•Ergonomic
Forms:
Silicon-coated handles for reduced fatigue.
•High-Visibility
Tips: Colored tips
or tips with laser marks for maximum visibility within chambers.
•Hybrid
Models: Tip-specific
ultrasound instruments allowing manual scraping.
With
increasingly accepted minimally invasive endodontics, there will be greater
demands for precise easy-to-use manual instruments.
•
Sharpening: Sharpen
stones on regular schedules using the correct angles.
• Handle
Inspection: Inspect
for rust and cracking in stainless steel.
• Autoclaving: Sterilize strictly after each use.
A properly maintained quality endodontic excavator will last for years without losing its traits.
Few pair of
common fallacies about the use of excavators are:
Facts: With new endodontic practice, hand
instruments are employed.
Facts: They are still used by progressive
clinics all over the world for primary removal of pulp.
Truth: Ultrasonics are less discriminatory
or non-tactile in tissue removal.
Endodontic
excavators are well-trained for dental students:
•Hand
facility skills
•Sensitivity
awareness through tactile awareness
•Precession
access before access to canal systems
Institutes
still require these instruments for initial learning before instructing
advanced rotary sets.
Endodontic
excavators remain the universal constant in the dentist's box, old design
happily converging in new purpose. Their simplicity is their greatest virtue:
tactility, precision, and frugality making them a essential instrument,
especially in opening formative stages of root canal therapy.