Endodontics II Root canal treatment (RCT) - Instr Methods Technique fej lenka.roubalikova(5)tiscali.cz Accessto the pulp chamber Penetration to the pulp chamber and removal of its roof Orifices of root cd ials must be seen clearly > The instrument goes through to the root canal without bending > Walls of the endodontic cavity are divergent lenka.roubalikova@tiscali.cz ________ ■.:■ Access lenka.roubalikova@tiscali.cz Access lenka.roubalikova@tiscali.cz Opening of the pulp chamber Dia trepan Dia round burs balls Steel round burs lenka.roubalikova@tiscali.cz Removal of the roof of the pulp chamber Dia trepan Safe ended tips Batťs instruments Fissur bur lenka.roubalikova@tiscali.cz Finding of the root canal orifice lenka.roubalikova@tiscali.cz Finding and opeing of rot canal orifices Endodontic probes Microopeners / 1 .... ■:,;■ íl IIII II Ultrasound tips CANAL BLUE C€ Rounded burs - balls Miller's burs I As i, Gates Glidden's burs i \ •j t ť\ II I 111 ■*« :- J!i» \ t5 lenka.roubalikova@tiscali.cz Peeso - Largo ♦***%. lenka.roubalikova@tiscali.cz Gates - Glidden: Blunt, non active tip Programm point of breakage lenka.roubalikova@tiscali.cz Opening of the root canal orifice Ni-Ti instruments E.g: Profile O.S., ProTaper SX, IntroFile etc. ^-JJI> ^uUhv* ährfi lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz Removal of contents of root cana1 Emoval of soft content -pulp, cotton,paperpoint Wider canals only Risks: breakage of the instrument Breaking of spurs and their pushing out Canal shaping Reamers (penetration Files (enlargement lenka.roubalikova@tiscali.cz Reame K -reamer = Kerrův pronikač Triangl or square wire spun Symbol lenka.roubalikova@tiscali.cz Ream B laded part Shank Stopper Grip lenka.roubalikova@tiscali.cz * Blades Space for dentin chips Reamer Blades Space for dentin chips Rotation - reaming achtion - panetration lenka.roubalikova@tiscali.cz Rotation (clockwise) - penetration Application of plastic material (contraclockwise) lenka.roubalikova@tiscali.cz Files 1. K-file 2. K-flexofile, flexicut, flex-R 3. K-flex lenka.roubalikova@tiscali.cz Wire triangl or square Symbol is always square lenka.roubalikova@tiscali.cz K-file Filin Also rotation 45° lenka.roubalikova@tiscali.cz K-flexofile. flexicut. flex-R Triangle wire always Flexibility Like K-file lenka.roubalikova@tiscali.cz Rhombus Two blades in action Enough space for dentin chips Flexibility, effifacy K-file a reamer: rozdíl a i' l yx^Jf lenka.roubalikova@tiscali.cz Ring lenka.roubalikova@tiscali.cz [-file H- file No rotation!! Pull motion only!! Risk of breakage in small sizes lenka.roubalikova@tiscali.cz ISO Diameter of the tip Length of the cutting part lenka.roubalikova@tiscali.cz d, -do = 16 mm lenka.roubalikova@tiscali.cz \ 0,02 mm na 1mm 0,04mm na 1 mm lenka.roubalikova@tiscali.cz Niti alloy 56 % nickel. 44% ti ms* n lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz Canal shaping and cleaning Basic rules Elimination of infection simplify the shape 6% tape, 3 more in comparison to the apical size lenka.roubalikova@tiscali.cz Canal cleaning □ Elimination of infection Mechanically — instrumentation, irrieation Chemically — irrigiation, temporary root canal filling lenka.roubalikova@tiscali.cz Canal shaping Koronální flaring (Weine 1982, Peřinka 2003) lenka.roubalikova@tiscali.cz Increasing size Slow speed 600-800/min Torque control Lubrication lenka.roubahkova@tiscah.cz Simple canals Gates Glidden K-File 15 Gates Glidden 50 lenka.roubahkova@tiscah.cz Narrow canals lenka.roubahkova@tiscah.cz Velmi úzké kk - jenom ručně !!!! Hand instruments till 50 Gates Glidden K-File 15 Gates Glidden 50 NiTi systém - decreasing size speed 250 - 300 rpm Torque control Lubrikacation lenka.roubalikova@tiscali.cz Importance Protection against fracture Better cleaning of coronal part Efektivní výplach a transport drti Effective irrigation Better conditions for measurement of working length Better conditions for apical preparation Less risk of complication lenka.roubalikova@tiscali.cz Shaping technique Rotation -45 K- file lenka.roubalikova@tiscali.cz Shaping technique Rotace 45 tlak and pull motion K- file lenka.roubalikova@tiscali.cz Risk of ledging Zip, elbow effect Via falsa Shaping technique Filing H- file Risk of periapical infection infection Risk of plug lenka.roubalikova@tiscali.cz Shaping technique Balanced force K- flexofile 90-180° file (?) 180-270( lenka.roubalikova@tiscali.cz Jednoduchá rotace ve směru hodinových ručiček, lehký tlak apikálně lenka.roubalikova@tiscali.cz Filin lenka.roubalikova@tiscali.cz Balanced force tchniaue Methods of shaping Rotation and filing combined K - reamer H-file lenka.roubalikova@tiscali.cz Methods o Circumferential filing f shaping \ \\ L\ \ A lenka.roubalikova@tiscali.cz Dr. Sedlmaver Methods ( Step back Vytvoření zarážky prevence schůdků lenka.roubalikova@tiscali.cz )f shaping H-file K-file K-flexofile 2% kónus 30 u apexu 0,30 mm 35 1 mm od apexu 0,35 mm 40 2 mm od apexu 0,40 mm 45 3 mm od apexu 0,45 mm 6% kónus 30 u apexu 0,30 mm 30 1 mm od apexu 0,36 mm 30 2 mm od apexu 0,42 mm 30 3 mm od apexu 0,48 mm lenka.roubalikova@ Apikální hranice opracování )tiscäui.cz El Methods opf shapin Modified double flared with balanced force U lann: ncal ĎreĎaration balanced force W4 lĚSnS^mMMSMMSMxm^ lenka.roubalikova@tiscali.cz Flex Master organizer Crown down Apical preparation -*i 21 mm Arbaitateil Röntgensichtbane Tiefen ma ikiěrungen 16 mm Arbeitsteil Rill hi mii J""" ««■■M ^^|j -» -* . >- ■TL 5'5" Ö"S 3UD5= 35/.0*— -ac'-oa 2&/.oe= _ 2&/.£K7= . o o o X-—-e--------©-—-X ItfM- 1Sŕ.D5= a/.DG_ Progressiver Schneidenabatand Nicht schneidende Spitze ? Working length A distance between the referent point and apical constriction lenka.roubalikova@tiscali.cz X-ray apex Foramen apicale Apical constriction Perionontal ligament Root cement Methods X- ray IrtlWHlISlii m lenka.roubalikova@tiscali.cz Safe length I 20 C 22 -24. P 20. M 18. 20 118. C 20. P 18. M 18 lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz Povrchová desinfekce prístroje Slizniční elektroda (retní klip) a úchytka na kořenové nástroje se běžně sterilizují Přístroj nenecháme zbytečně zapnut Baterii dobíjíme lenka.roubalikova@tiscali.cz H V i Epoxide r^Base (powder, paste) Bismuth oxid Titanium dioxide Hexametylentetramine .vej ^ Catalyst (liquide, paste) Bisphenoldiglycidylether lenka.roubalikova@tiscali.cz resin Epoxidové pryskyřice ^ Hydrophilic (good penetration i^SP2ASS£K root ^No dissolution > Antibacterial lenka.roubalikova@tiscali.cz Epoxidové pryskyřice mmmmsm r Difficult removal ^ Initiatiory roxicity wm m WMmmfmaiMfMiMffimzmMa D lenka.roubalikova@tiscali.cz Polyketone ^ Base Zinc oxide aaaBaaa Hexametvlentetramine ^ Lequid Bisphenolglycidylether and other components lenka.roubalikova@tiscali.cz Polyketonové pryskyřice (Výhody a nevýhody Advantages Good adhesion No contraction No dissolution Disadvantages Not remo\ Products: Diaket, Diaket A (3M ESPE) lenka.roubalikova@tiscali.cz Methacrylate resins Endo ReZ OJltradentí - UDMA 7or injection — sinele cone tec1 Ml Bis- GMA, etoxy bif- GMA, hydrophilic bifunctional methacrylate s mmm^sjjjXĚnĚĚ^nssE^mEm silica. Sealer in combination with Resilon lenka.roubalikova@tiscali.cz Glasionomer sealers Jase (powder) Aluminium silicate glass > Liquid Polyacrylic acid, üolvmaleic acid, tartaric acid m lenka.roubalikova@tiscali.cz Glasionomer sealers (Advantages and disadvantages Advantages: Curing under wett conditions, chemical bonding to hard dental tissues, no staining Disadvantages Short working time, difficult removal, porous Products T OCO) lenka.roubalikova@tiscali.cz Silicon based sealers Polyvinylsiloxane (ev. in mixture with powdered guttapercha Biocompatibility Hydro fillic wppü \MWlWMffl!mMwMtImL Wml" lenka.roubalikova@tiscali.cz Root canal fillings - forms > Points (Cones' > Materials for injection ^ Plastic materials lenka.roubalikova@tiscali.cz Lentulo Compactors Bau Others lenka.roubalikova@tiscali.cz Instruments earners Lentulo > delivers pastes >L5 -2 mm ahead > at most for Ca (OH)2 lenka.roubalikova@tiscali.cz Compactors Spreader Pointed Vertical introduction Lateral c mdensation technique • lenka.roubalikova@tiscali.cz Compactors EE Not pointed Vertical introduction Vertical condensatuion - compaction lenka.roubahkova@tiscah.cz Paste only Shrinkage, difficult removal lenka.roubalikova@tiscali.cz p ^ Warm lateral condensation lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz Vertical condensation Obtížnější kontrola pracovní délky Možná extruze sealeru lenka.roubalikova@tiscali.cz Thermafil Guttapercha on the carrier 1 ■ lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz 1--------'— w guttapercha carrier sealer í k Jíjjo * 1. Two!,. ^^^^ Pf^S v^S/ ^9 žSt ^j Pi! | Q| ^h ^h' (J) ^ft^l =ffl Ě 1 i lenka.roubalikova@tiscali.cz Thermafil, Soft Core etc * 1 lenka.roubalikova@tiscali.cz