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. 2024 May 4;13(9):2703. doi: 10.3390/jcm13092703

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© 2024 by the authors.

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).

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Buckling resistance activation test (BRAT) negotiation of calcified canals graphic explanation (A). Long-shafted bur access cavity preparation (B). Continuous chelation concept irrigation and D-finder negotiation test (C). Long-shafted access bur of smaller diameter insertion without activation (tactile feedback) (D). Single-stroke activation of the bur (Tactile Controlled Activation) (E). Continuous chelation concept irrigation and D-finder negotiation test. If there is no negotiation, continue to the next step (F). EDM or Active tip file placement inside the access dimple without activation (G). Activation of the EDM file at 500 rpm/3 NCM and application of vertical axial pressure against the calcified canal entrance (long press release twice) (H). Continuous chelation concept irrigation and D-finder negotiation test. If there is no negotiation, continue to the next step (I). EDM or Active tip file placement deeper inside the dedicated access dimple without activation (J). Activation of the EDM file at 500 rpm/3 NCM and application of vertical axial pressure against the calcified canal entrance (long press release twice). As the file goes deeper inside the root, the buckling resistance of the file increases because the lateral walls will not allow the file to buckle and succumb. The axial pressure is transported to the file tip, allowing the file to penetrate (K). Continuous chelation concept irrigation and D-finder negotiation test. If there is no negotiation, continue to the next step (L). EDM or Active tip file placement deeper inside the dedicated access dimple without activation (M). Activation of the EDM file at 500 rpm/3 NCM and application of vertical axial pressure against the calcified canal entrance (long press release twice) (N). Continuous chelation concept irrigation and D-finder negotiation test (O,P). If there is no negotiation, repeat the previous steps. Horizontal light blue arrows: file is engaged in the lateral canal walls, vertical black arrows: direction and force of file movement, Blue drops: irrigation.