Pulpextractor
Exstirpation
Canal shaping
> Reamers (penetration)
> Files (shaping)
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Reamer
K -reamer
Triangl or square wire spun
Symbol
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Reamer
Rotation (clockwise) - penetration
Application of plastic material (contraclockwise)
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Files
1. K-file
2. K-flexofile, flexicut, flex-R
3. K-flex
4. H-file, S-file
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Kfile
Wire triangl or square
Symbol is always square
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K-file
Filing
Also rotation
45° - 90°
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K-flexofile, flexicut, flex-R
Triangle wire always
Flexibility
K- flexofile a flex - R file: non cutting tip and first blades are blunt
Like K-file
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K- flex
Rhombus
Two blades in action
Enough space for dentin chips
Flexibility, effifacy
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K-file a reamer: rozdíl
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= Hedstroem file Ring
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No rotation!!
Pull motion only!!
Risk of breakage in small sizes
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> Diameter of the tip
> Length of the cutting part >Taper
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Initial flaring
Working length
• Dostance between the referential point and apical constriction
• Radiographically
• Apexlocators
• Combination
Why apical constriction
• Small apical communication
• Minimal risk of damage of periodontium
• Prevention of overfilling
• Prevention of extrusion of infection
• Good decontamination
• Godd condition for root canal filling
Radiogram
X-ray with inserted root canal instrument
Safe length: average length of teeth reduced for 2 - 3mm
Tooth with clinical crown
Procedure
• Instrument ISO 15 introduced into the root canal, stop at the referential point
• Estimation of location of apical constriction (1 - 1,5 mm distance from x-ray apex.
If diference in the radiogram more than 23 mm - repeat
If 2 mm or less - add to the safe length
Safe length
• Maxilla:
11 20
12 18 C22-24 P20
M 18 mkk,20 P
Safe length
Mandible
118
C20 -22
P18
M18
Endometry, odontometry
• Endometry
edevices based on measurement of electrical resistance
L1L
lenka.roubalikova@tiscali.
RAY P EX" 6
1 s» —f -,J—-
RAYPEX 6
Měření- apikální zoom
Irrigation
Irrigants
• Sodium hypochlorite (1,5 - 5,5%)
• Chlorhexidin (0,12% - 0,2%)
• EDTA - etylendiaminotetraacetic acid 17%
ifif
m
"7-
LEI       5.0kV     X300      10/um     WD 7.8mm
Irriga
Sodiumhypochlorite 2-6%
Oxidation a chloration Dissolving efect
Bad smell, irritant.
Syringe and cannula
Activation of irrigation
• Increased effectivity Vibration
Increasing of temperature Decomposition of irrigants - dissociation
Shaping techniques
• Rotation -45
K - reamer
K- file
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Shaping techniques
Rotace 45° pressure and pull motion
K - reamer
K- file
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Risk of ledging Zip, elbow effect Via falsa
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Shaping techniques
• Filing
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H-file K-file
Risk of periapical infection infection Risk of plug
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Shaping techniques
Balanced force
90-180"
K- flexofile
K —file (?)
180-270'
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Reaming
Filing
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Balance forced technique
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Methods of shaping
• Rotation and filing combined
K - reamer H-file
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Methods of shaping
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Dr. Sedlmaver
Methods of shaping
• Combination of rotation and filing
Start with rotation
Finishing with filing
Suitable for straihgt root canals
Methods of shaping
• Step back method
Increasing size with decreasing length. Insertion of root canal instrument - WL Next - 1 mm shorter
Taper
Final flaring with
the smallest instrument
H- File nebo K - Flexofile.
Method modified double flae
• I. Opening of root canal
- Coronal third
• II. Apical preparation
Cathetrization,measurement, shaping till ISO 30 -balanced force. Master file - MAF (till WL)
• III.Step back
• Final flaring (MAF)
Root canal filling
Good coronal, Middle Apical seal.
Quality guidelines for endodontic treatment, European Society of of Endodontology (ESE), 1994
Ideal root canal filling (Grossman 1988)
1. Easy mixing
2. Sufficient working time
3. Good seal
4. X- ray contrast
5. Easy removal
6. No shrinkage
7. Long term volume stability
8. No bacterial growing
9. No permeability for fluids
10. Biocompatibility
11. No staining
Classification of root canal fillings
> Solid
> Semisolid
> Pastes
Guttapercha
Dried juice of the Taban tree (Isonandra percha) (gutta)
1,4 - polyisoprene Crystallin structure (60%) Brittle
* Beta phase
• Alpha phase 42-49 °C
- plastic
- Gamma phase 56 - 62° (amorfní) Cooling process
very slowly (less than 0,5°C) - alpha phase normal cooling- beta phase
Composition of guttapercha materials in endodontic
Guttapercha 19%-22% Zinc oxide 59 - 79% Heavy metal salts 1% - 7% Wax or resin 1% - 4%
Resilon
(Pent r o n)
> Thermoplastic synthetic polymer
> Points or material for injection
Composition: Polyester polymers Bioactive glass
Radioopaque fillers (bismuthum oxichlorid a and baryum sulphate)
>No good seal
>Silver cones - corrosion
Chemically curing materials
(their consistency is paste, cements)
Importance
Filling of the spaces between the solid Seal of the root canal filling
Sealers
Zinc Oxide-Eugenol Chloropercha Calciumhydroxide Resins
Glasionomer Silicone
Zinc - Oxid Eugenol
Powder: Zinc oxide
Liquid: Eugenol Acidic resins
Good adhesivity, antimicrobial effect, cytotoxicity? Resorbable, no compatible with adhesive materials)
Zink Oxid Eugenol sealers
Pulp Canal Sealer (Kerr, USA)) Tubuli- Seal (Kerr, USA) Caryosan (Spofa Dental, CR)
Chloropercha
Powder
Canadian balsam Resins
Guttapercha Zinc oxide
Liquid:
Chloroform
Resins
Chloropercha
Vlastnosti:
Good adhesivity
Shrinkage
Toxicity
Calciumhydroxide sealers
Base ( powder) Calcium hydroxide Zinc oxide
Other components and vehicula
Calcium hydroxide sealers
Catalyst (paste) Zinc stearat Titanium dioxide Baryum sulphate or
Eugenol,. Eukalypt Other components...
Kalciumhydroxide sealers
> Increase of the healig potential of periapical tissues
> Antibacterial effect
> Easy manipulation But!
Resorbable if not homogeneus
Not suitable for the single cone technique
Resins
>Rezorcin formaldehyd (toxic, obsolete) > Epoxide >Polyketone >M eta cry I ate
Epoxide resin
>Base (powder, paste) Bismuth oxid Titanium dioxide Hexametylentetramine (Silver)
> Catalyst (liquide, paste) Bisphenoldiglycidylether
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Root canal filling
Epoxid resin (advantages)
> Long working time
> Hydrophilic (good penetration) >Good adhesion to the root canal walls
> Volume stability >No dissolution >Antibacterial
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Epoxid resins (disadvantages)
> Difficult removal
> Staining
> Initiatiory toxicity
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Polyketone
> Base Zinc oxide Bismuth phosphate Hexametylentetramine
> Liquid
Bisphenolglycidylether and other components
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Polyketon resins
Advantages Good adhesion No contraction No dissolution
Disadvantages High stickness Not removable
Products: Diaket, Diaket A(3M ESPE)
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Methacrylate resins
Endo ReZ (Ultradent) - UDMA
For injection - single cone technique
Epiphany (Pentron)
Bis- GMA, etoxy bif- GMA, hydrophilic bifunctional methacrylates
Calcium hydroxide, baryum sulphate, baryum glass silica.
Sealer in combination with Resilon
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Glasionomer sealers
>Base (powder) Aluminium silicate glass
> Liquid
Polyacrylic acid, polymaleic acid, tartaric acid
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Glasionomer sealers (Advantages and disadvantages)
Advantages:
Curing under wett conditions, chemical bonding to ha dental tissues, no staining
Disadvantages
Short working time, difficult removal,
porous
Products
Ketac Endo (3M ESPE), Endion (VOCO)
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Silicon based sealers
Polyvinylsiloxane (ev. in mixture with powdered guttapercha
Biocompatibility Hydrofillic
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Calcium hydroxide
>Alcaline
> Antibacterial
>Stimulation of hard tissue formation
> Haemostatic and antiphlogictic
Calcium hydroxide
>Alcaline
> Antibacterial
>Stimulation of hard tissue formation
> Haemostatic and antiphlogictic
Calcium hydroxide
Temporary root canal filling
Subbase Component of sealers
Mode of action
> Realease of hydroxyl ions
> Long term alkalinization
> Stimulation of hard tissues formation
Kopkapan, C.:Curriculum Endodontie, p. 377-385, Quintessenz, Berlin 2003
Calcium hydroxide
• Short term action 1-2 weeks
Desinfection, haemostasis
Calcium hydroxide
• Midie term action 2-3 months
Apexification
Chronic form of apical periodontitis
Calcium hydroxide
• Long term action 3 months and more
Prevention of resprption
Lentule 2 mm less than WL !!!!!
Apexit® Plus
Instruments
• Paste carries - lentulo
• Compactors
• Compactors - carriers
• Others
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>delivers pastes
>1,5 - 2 mm ahead
> for sealers
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Compactors
Spreader
Pointed
Vertical introduction
(cold, warm)
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Piu
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Use of a selected Plugger to ensure homogeneity of
Filling techniques
Cold Warm
Shrinkage, difficult removal
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Single cone technique
• Easy
• Fast
• Good control of WL
• Standard round preparation - risk of leakage
Wesselink, P.: Root filling techniques, Textbook of Endodontology; p. 286-299, Blackwell Munksgaard 2003, Oxford
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Lateral compaction
Standard cold technique
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LATERAL CONDENSATION
(compaction)
Standardized and non-standardized Paper Points and Gutta Percha Points
F1 F2  F3 F4 F5    F1    F2    F3   F4 F5
Lateral Condensation
A sealer is placed in the canal followed by a fitted gutta percha Master Point compacted laterally by a tapering Spreader to make room for additional accessory points
IT
Heated spreader Better 3D filling
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Core-Carrier (PP) - Gutta-Percha
Filling Technique
Obturators compatible with
instruments
Use of a selected Plugger to ensure homogeneity of
WARM VERTICAL COMPACTION
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Fast technique
Possible extrusion of sealer
Risk of thermal damage of PL
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Warm Vertical Compaction Continuous Wave Technique
Complications of endodontic
treatment
Local Regional Systemic
Zipping a elbow
Local complications
Reasons
Insufficient irrigation and recapitulation
Loss of the working length
Solution
Repeated careful instrumentation with a thin instrument
Irrigation is not effective in this c&se111
Ledging
Reasons
The instrument is not bended in advance!
No control of the WL
No recapitulationLoss of the WL
Solution
The instrument must be bended in advance
Careful but complete rotation
Finishing with the fine filing
No NiTi!!!
Ledging
Zipping a Elbow
The instrument is not bended in advance!
Rotation in curved canals
Reasons
Bad orientation in morphology - no diagnostic Instruments are nod bended Rotary NiTi with a big taper
>. Oblast isthmu
Stripping
Bend the instrument and eventually blunt it!
FVil£IJjrS DJ xliS TOOL fiilJJilJ jusiriiiiisii'j;
Insufficient coronal flaring
Old root canal instrument
Aggresive force
Incorrect movement of the root canal instrument
Solution
Enlargement of the root canal till the instrument
Ultrasound tips
Rotating root canal instrument - caution!
Bypass
Leaving in
Surgical treatment
Fractured instrument
Via falsa
• Perforation of the bottom of the pulp chamber or the coronal part of the root canal
• Perforation in the middle part of the root canal
• Apical perforation
#». • •    • • • t»
MfA (Mmofnl Jnoxidc Aggi Root Canal Repair Material
Contents: I gram (I treatment)
0120
Regional complications
Pištěl
Systemic complications
Systemic complications
> Periostitis
> Inflammation of soft tissues (face, neck)
>Gulp of the instrument (X ray, remnant diet, information)-
> Aspiration of the instrument -
Caution!
Always find the loss instrument