Phases of the endodontic treatment l.Diagnosis (patient's history, clinical examination, x-ray). 2. Consideration 3. Local anaesthesia 4. Removal of old fillings and caries, restoration of the tooth if necessary 5. Dry operating field 6. Access to the pulp chamber Phases of the endodontic treatment 7. Opening of the root canals (coronal flaring 8. Root canal shaping and cleaning (irrigation^ 9. Root canal filling 10. X- ray 11. Restoration Access - opening of the pulp chamber Round Burs lenka.roubalikova@tiscali.cz 5 Preparation of the endodontic cavity -facilitating form Dia trepan Instruments with safe ended tips), Acc. to Batt Fissure burs lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz 7 Root canal access ii II11 b II t Endodontic probes Microopeners Ultrasound lenka.roubalikova@tiscali.cz 8 Opening of the root canal orifices lenka.roubalikova@tiscali.cz Peeso-Largo burs 9 lenka.roubalikova@tiscali.cz 10 Gates - Glidden: lenka.roubalikova@tiscali.cz 11 Extraction of the content of the root canal - exstirpation Pulpextraktor - made of soft wire lenka.roubalikova@tiscali.cz Canal shaping - instruments lenka.roubalikova@tiscali.cz 15 lenka.roubalikova@tiscali.cz Reamer Cuting edges Space for chips Clockwise rotation lenka.roubalikova@tiscali.cz Files 1. K-file 2. K-flexofile, flexicut, flex-R - file 3. K-flex 4. H-file, S-file lenka.roubalikova@tiscali.cz K file K-file Filing and (or) rotation Straight canals 45° - 90°) ISO norma > Diameter > Length of the cutting part > Taper lenka.roubalikova@tiscali.cz 06 pink 08 gray 10 purple 15 white 45 white 20 yellow 50 yellow 25 red 55 red lenka.roubalikova@tiscali.cz 26 Hand instruments Made of stainless steel Taper is 2% (higher taper is for NiTi instruments — these are for power driven endodontics). lenka.roubalikova@tiscali.cz Instrumentation Reaming action (45°clockwise and contraclockwise) K - reamer lenka.roubalikova@tiscali.cz Instrumentation Rotation 45° slight pressure and pull motion K - reamer K- file lenka.roubalikova@tiscali.cz Instrumentation Filing — push and pull motion. The instrument is in action during pull motion H- file K - file lenka.roubalikova@tiscali.cz Circumferential filing H- file The instrument is inserted into the root canal The working length is reached The instrument is pulled out- action Afterwards the instrument is rotated without any action in order to be in contact with the root canal wall Pull motion is applied again . lenka.roubalikova@tiscali.cz Circumferential filing The purpose — root canal shaping around the root canal with respect to its natural shap mostly oval. lenka.roubalikova@tiscali.cz Balanced force technique ■ K file The instrument is inserted into the root canal — the size of the instrument one size bigger than the instrument that can be inserted on complete working length. Rotate with this instrument clockwise 90 - 180 ° Follow with slight pressure forward and rotate contraclockwise till 270° Pull the instrument out of the root canal rotating clockwise again. lenka.roubalikova@tiscali.cz Step back method We use endodontic instruments of increasing size during root canal shapin The rigidity of instruments increases with the size. It can cause ledge in root canal wall and difficulties with reaching the working length. Therefore we reduce working length of instruments for 1mm. This we do from the 4th instrument we use. See next slide. lenka.roubalikova@tiscali.cz p back Example: the apical size at the beginning is ISO 15 20working lenghth 25 working lenghth 30 working length 35 1 mm less 40 2 mm less 45 3 mm less Step back intracanal complications —ledge especially when the root canal is curved, extrusion of the filling material lenka.roubalikova@tiscali.cz