The braiding technique

In this article, we are going to explain the Braiding Technique, a predictable way to remove materials from inside root canals. 

For this technique, we will use Hedstroem files, and is especially indicated to remove plastic carriers during retreatments.

We will see the technical procedure and some clinical cases with video, picture and X-ray.

As we know, the success of a root canal treatment consists in preventing or solving apical periodontitis. For this, we must achieve a correct shaping, disinfection and obturation of the root canals.

During a root canal retreatment, the objective is the same, to clean and fill the root anatomy in three dimensions. With the difference, that usually during a retreatment, we find materials inside the canals that we must remove in order to obtain an adequate treatment.

Within a previously treated tooth, we can find various materials: cements, gutta-percha, pastes, plastic carriers, broken instruments, etc.

Depending on the material/object we are facing, and our knowledge, equipment, and skills, we can use different techniques to achieve our goal.

In this article, we will describe an old technique, called braiding technique, but that can be very useful in some specific cases, especially when what we have to remove from the inside of the canal are plastic carriers.

Carrier-based obturation systems have been used for many years to obturate root canals, such as Thermafill, Soft-Core, Simplifill, Guttacore, etc.

Many factors influence the removal of the plastic carrier, on the part of the operator (knowledge, skills and equipment), such as the anatomy of the canal, as well as the length and size of the carrier.

In general, the greater the width of the canal (eg, oval canals), the easier will be to remove the carrier, since we can easily bypass it with manual files.

In cases in which the canal is round and the carrier is very embedded within, it will be more difficult to remove it.

One of the complications that we can find in these cases is the fracture of the middle/apical part of the carrier, which will make it more difficult to remove it, since the canal becomes narrower each time, the carrier will be more embedded and we will have less vision and poor access to it.

In my opinion, the key in these cases is always to try to remove the gutta-percha that surrounds the carrier, create a space between it and the canal wall and try to overcome it with manual files.

In order not to weaken the root dentin, we must try to enter through the gutta-percha, not to penetrate at the cost of damage the dentin from the root canal wall.

The use of solvents to soften the gutta-percha may be helpful.

Once we have achieved that space, we will try to overcome it to release it from the canal and be able to extract it.

To pull materials from the canal, we can use elements such as Hedstroem files (because of their cross section they help us to pull) or instruments such as Micro opener (same section as the Hedsroem file).

The braiding technique consists in: 

- We will place three Hedstroem files surrounding the carrier.

• We will rotate them (braiding movement) to trap the instrument between the files.
• We will pull the three at the same time to try to remove the carrier together with the files

- Sometimes, the carrier is surrounded by the 3 files and other times, even though it is not anchored by them, the force we exert when pulling makes it come coronally.

- Once we have managed to remove the plastic carrier, we will have access to the apical part of the canal to achieve an adequate conformation of the root canal.