A case featuring Mani Silk

Dr. Rich Mounce discusses a new anatomy-based, efficient, safe, and predictable system

case-mounce-bioThis article was written to describe the clinical use of the new and novel Mani Silk (MS) nickel-titanium instrumentation system, now available in North America. MS is unique and a welcome addition to the endodontic marketplace.

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MS is:

  1. Anatomy based. MS is packaged into Simple (relatively straight canals), Standard (moderate curvature, no calcification), and Complex pack configurations (moderate to severe curvature and/or calcification present) to treat the anatomy encountered. Clinically, the tooth is assessed, and the matching MS is chosen to address the given anatomy with a minimum number of files (three total).
  2. Heat treated from the tip of the file through the first 10 mm of the cutting flutes — providing increased fracture resistance and flexibility where needed.
  3. “Teardrop”-shaped in cross section. This design channels debris out of the canal efficiently and centers the file (maintaining the canal path) while minimizing transportation. In addition, the teardrop cross-section decreases the “screwing in” effect and simultaneously improves tactile sensation.
  4. Easily integrated for use with the entire spectrum of Mani stainless hand files.

 

case-mounce-figure1aMani Silk system description
MS packs have three files: The Simple pack configuration contains .08/25, .06/25, and .06/30 instruments. The Standard pack contains a .08/25, .06/20, and .06/25 instruments. The Complex pack contains the .08/25, .04/20, and .04/25 instruments. These three canal packs can shape virtually any canal. MS instruments are also available (3 files/pack) in the following individual sizes: .04/20, .04/25, .04/30, .04/35, .04/40, .06/20, .06/25, .06/30, .06/35, .06/40, and .08/25. All pack configurations and individual sizes are available in 21 and 25 mm. Orifice openers are also available in 18 mm lengths. MS is rotated at 500 rpm and 300 g-cm torque. Any torque-controlled endodontic motor can power MS. MS instruments have a constant taper (.08, .06, .04). The file is electropolished for increased fatigue fracture resistance.

Mani Silk clinical technique
After straight-line access and removal of the cervical dental triangle with the MS orifice opener (.08/25), the canal is negotiated and the glide path created. After glide path preparation, MS is utilized as a two-file system (after the use of the orifice opener) that can either be rotated or reciprocated (clockwise). case-mounce-figure1bWhen using the Simple pack, the .06/25 is followed by the .06/30. When using the Standard pack, the .06/20 is followed by the .06/25. When using the Complex pack, the .04/20 is followed by the .04/25. Specifically, for each of these sequences, the two files listed above are successively alternated until the desired taper is achieved to the true working length. If clinicians wish to prepare a larger apical diameter, they are able to do so using the individual sizes available for this purpose (.04/30, .04/35, .04/40, .06/30, .06/35, .06/40).

 

 

 

Case study

case-mounce-silk-mani-figure1dIn the case illustrated in Figure 2, straight-line access was prepared through the existing initial malgam. The canals were negotiated with Mani K files (Nos. 6, 8, 10, 15, 20) and Mani Medium Files (Nos.12, 17).

case-mounce-figure2As an aside, where needed, Mani D Finders are an excellent option for negotiation of severely curved and calcified canals as Mani D Finders are much stiffer than standard K files. Both Mani K files and D Finders can be reciprocated by use a reciprocating handpiece like the ER-10 (NSK). Specifically, in the case illustrated, the Mani No. 6 K file was inserted to the apex first, followed by the Nos. 8, 10, 12, 15, 17, 20 Mani hand files and reciprocated with the ER-10 (NSK) to prepare the glide path.

 

 

case-mounce-figure1eAfter glide path preparation, an MS Standard Pack was used to shape this case. The .06/20 and .06/25 were alternated until the .06/25 reached the true working length. The master apical diameter was subsequently prepared with the .06/30. Insertion of MS is gentle, passive and to resistance, taking approximately 3 seconds and shaping approximately 4-6 mm of canal space per insertion. After every insertion of MS, the canal was recapitulated with a No. 6 Mani K file, irrigated copiously, and the flutes of the file wiped. The used MS files were discarded per the manufacturer’s instructions.

case-mounce-figure1cCanals can be obturated with MS using any clinically acceptable method. In this case, the tooth was obturated with the vertical compaction of warm gutta percha delivered through an E&Q Master Obturation Unit (MetaBiomed). After obturation, the remaining amalgam and all caries were removed. The preparation was microetched (Danville Materials) and bonded with Rock Core (Danville Materials) dual-cure build core material.

This case study has discussed the use of the new and novel Mani Silk nickel-titanium instrument system. Emphasis has been placed on hand file negotiation of canals using Mani K and Mani Medium K files, the importance of achieving and maintaining patency, and glide path preparation to utilize Mani Silk in simple, predictable, and safe endodontic canal shaping.
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