Milton Syringe...Instructions for Use

The Milton Syringe is simply the most accurate method yet devised for injecting cement into a root canal.

Since the degree of accuracy in any syringe is determined by the inside diameter (bore) of the syringe, the Milton syringe was made very small, slightly larger than the outside diameter of the 30 gauge needle used to fill it.

In fact the Milton is so small it must be filled with another syringe.

To use the Milton syringe you must also have a Precision Endodontic Syringe and the 30 gauge needles used with it.

The driver on the Milton precisely fits the barrel/needle.

Each millimeter travel of the driver extrudes a very precise amount of cement.

So small in fact that you can actually decide in advance how big the puff of cement at the apex will be or how short of the apex you want cement. Instructions for Filling:

1. First fill the Precision Endo Syringe and apply the 30 gauge needle.
2. Insert the 30 gauge needle into the back end of the Milton Syringe all the way to the hub.
3. Extrude cement from the Precision Endo Syringe until cement flows throught the apical end of the Milton Syringe.

   At this point continue forcing cement through the Precision Endo Syringe and put your finger over the apical end of the Milton Syringe and the cement will force the Milton Syringe off the 30 gauge needle.

4. Now insert the end of the Milton driver about 5 mm into the back end of the Milton Syringe.

   The tip of the driver has been sharpened to make it easier to find the opening of the Milton Syringe.

5. Cement should now be flowing from the apical end of the Milton Syringe.

Determining Driver Travel:

• Put a rubber stop on the Milton Syringe.
• Insert the Milton Syringe into the canal until it binds snuggly.
• Slide the rubber stop until it aligns with the same landmark you used to measure the canal.
• Remove Milton Syringe and measure the distance rubber stop to end of Milton is then subtracted from your previously determined apical length, i.e.

  the distance from landmark to apex.

• Next look up on the table supplied with THIS syringe across the top for the size of the apex and down for the distance from the apex.

  This will tell you exactly the distance you will need to move the driver on the Milton Syringe to exactly fill the truncated cone that is the canal from the wedge point to the apex.

Sealing and Filling the Apex:

• Reinsert the Milton Syringe to the previous point.
• Grasp the driver with a hemostat exactly the distance from the end of the syringe as determined from the chart.
• Slowly push the plunger inward extruding the cement into the apex.
• Verify the position of the cement in the canal with an xray.

  If it is short reinsert the Milton Syringe to its previous place and move the driver a millimeter at a time until cement reaches the apex.

A few salient points:

• The apex must be patent.

  The small amount of air that is trapped between the end of the Milton Syringe and the apex must be expelled through the apex.

  If you do not have a patent apex, the air will be compressed and cement will be pushed back as the air expands once the Milton Syringe is removed.

• If you do not have a patent apex, the case is simple.

  Enlarge the canal to size 30 as deep as you have prepared it, insert the 30 gauge needle on the Precision Endo Syringe and fill from the end of your prep to the coronal area as you withdraw the needle.

  If the apex is NOT patent, there is no danger of cement flowing through the apex.

• The canal at the wedge point must be round.

  It is a good idea to hand prepare a portion of the canal with a #40 standard tapered file.

  The Milton Syringe should wedge about 5mm from the depth prepared with the #40.

• In a tooth with two canals and one common apex, wedge a file in one canal while filling the other.

  Otherwise the cement will flow down one canal and up the other without sealing the apex.

  Once the apex is sealed then use the Precision Endo Syringe to back fill the canal that had the file in it.

• If the Milton Syringe needs to be refilled, reinsert the 30 gauge needle from the FRONT end and repeat the process of filling.

E-mail your comments to drjack@BetterEndo.com