Endodontics II. Healing potential of dental pulp PeriodontitPeriodontitisis AcuteAcute CChronichronic enoseenosealal,, subperiostsubperiostalal,, submusubmucouscous phasephase…….. C CAcuteAcute ChronicChronic GangrGangraeaenanaNeNecrosiscrosis Dia trepan Dia balls Burs Access Dia trepan Fissure bur Batt (safe ended tips), Snesení stropu dřeňové dutiny, vytvoření „usnadňující formy“ Location of root canals Ball burs Millerś burs Gates Glidden Peeso – Largo Location and shaping Endodontic probes Microopeners Uz tips Dye Reading of the bottom Wrong Correct Wrong WorkingWorking lengthlength DistanceDistance betweenbetween referentialreferential point onpoint on toothtooth crowncrown anan apicalapical constrictionconstriction LR Apical morphology 1. X-ray apex 2. Apical foramen 3. Apical constriction 4. Periodontal ligament 5. Root cementum 6. Dentin Podle Guldenera a Langelanda LR Apical constriction LR WhyWhy RTCRTC terminatesterminates inin apicalapical constrictionconstriction?? SmallSmall apicalapical communicationcommunication LessLess riskrisk ofof damagedamage pofpof periodontiumperiodontium PreventionPrevention ofof overfillingoverfilling PrevenPreventiontion ofof apiapicalcal transporttransport ofof infectedinfected metarialmetarial PossibilityPossibility ofof goodgood removalremoval ofof debrisdebris GoodGood compactioncompaction ofof guttaperchaguttapercha L X-ray apex Skutečnost LR PrinciplePrinciple ofof apexlocatorsapexlocators EndometrieEndometrie mearurement of impedance LR LR LR LR LR LR LR Root canal shaping Hand instruments Power driven instruments Material – stainless steel - nickeltitanium alloy NiNickeltitaniumckeltitanium alloyalloy 56 %56 % ninicckkeell, 44%, 44% titantitaniiuumm,, 60%60% ninickeckell, 40 %, 40 % titantitaniumium FlexibilityFlexibility MMemoryemory effecteffect CuttingCutting effecteffect FraFracturesctures d1 d2 d2=d1+0,96 0,06mm na 1 mm 30 0,30 mm 35 1 mm 0,35 mm 40 2 mm 0,40 mm 45 3 mm 0,45 mm 30 0,30 mm 30 1 mm 0,36 mm 30 2 mm 0,42 mm 30 3 mm 0,48 mm 2% taper 6% taper Apical size and taper BiggerBigger tapertaper Flaring Irrigation effectivity Good approach to apical area Good conditions for 3D root canal filling DisadvantagesDisadvantages Loss of hard dental tissue Hihger risk of stripping ApicalApical –– coronalcoronal directiondirection ControlledControlled rotationrotation Low rpm Moment of rotation Torque control Motor, handpiece Systems of power driven endodontics ProTaper MTWO Wizard Revo S Tilos Oscillation Reciproc Reciprocative movement Rotation BasicBasic rulesrules ofof powerpower drivendriven endodonticsendodontics Controlled movement Keep the sequency The instrument moves befor ingoing to the root canal Irrigation, lubrication No pressure Movement up and down Working cycle 10 – 15 s IrrigationIrrigation debridementdebridement desinfection CANTATORE G. Irrigation Canalaire: avantages potentialisation et sequence operatoire Endo Contact 1999 - 5:13-21 Irrigation NaOCl