Irrigation Irrigants • Sodium hypochlorite (2 - 6%) • Chlorhexidin (0,12% - 0,2%) • Physiological solution • EDTA - 17% (ethylendiaminotetraacetic acid) Root canal filling • Power driven - lentulo Slow rpm (do 1000/min), in action when pulling out • Hand - cold and warm techniques using guttapercha and sealer Cold techniques: - Single cone technique - Lateral compaction Warm techniques: warm lateral compaction, vertical compaction, injection and others. Lentulo Function of root canal filling nal lenka.roubalikova@tiscali.cz 5 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 lenka.roubalikova@tiscali.cz 7 Classification of root canal fillings > Solid > Semisolid > Pastes lenka.roubalikova@tiscali.cz 8 Guttapercha Dried juice of the Taban tree (Isonandra percha) (gutta) 1,4 - polyisoprene Crystallin structure (60%) Brittle lenka.roubalikova@tiscali.cz 9 Guttapercha * Beta phase • Alpha phase 42-49 °C - plastic - Gamma phase 56 - 62° (amorfni) Cooling process very slowly (less than 0,5°C) - alpha phase normal cooling- beta phase lenka.roubalikova@tiscali.cz 10 Composition of guttapercha materials in endodontic Guttapercha 19%-22% Zinc oxide 59 - 79% Heavy metal salts 1% - 7% Wax or resin 1% - 4% lenka.roubalikova@tiscali.cz 11 Sealers Chemically curing plastic materials Good adhesion to root canal walls as well as solid cones X- ray contrast Biocompatibility lenka.roubalikova@tiscali.cz 12 Sealers Zinc Oxide-Eugenol Calcium hydroxide Resins Glasionomer Silicone lenka.roubalikova@tiscali.cz 13 Sealers Importance Filling of the spaces between the solid cones i Seal of the root canal filling lenka.roubalikova@tiscali.cz 14 Zinc - Oxid Eugenol Powder: Zinc oxide Liquid: Eugenol Acidic resins Good adhesivity, antimikrobial effect, cytotoxic, resorbable) lenka.roubalikova@tiscali.cz 15 Zink Oxid Eugenol sealers Pulp Canal Sealer (Kerr, USA)) Tubuli- Seal (Kerr, USA) Caryosan (Spofa Dental, CR) lenka.roubalikova@tiscali.cz 16 Calciumhydroxide sealers Base ( powder) Calcium hydroxide Zinc oxide Other components and vehicula lenka.roubalikova@tiscali.cz 17 Calcium hydroxide sealers Catalyst (paste) Zinc stearat Titanium dioxide Baryum sulphate or Eugenol,. Eukalypt others lenka.roubalikova@tiscali.cz 18 Calcium hydroxide 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 lenka.roubalikova@tiscali.cz 19 Resins >Rezorcin formaldehyd > Epoxide >Polyketone >Metacrylate lenka.roubalikova@tiscali.cz 20 Rezorcin-formaldehyd resins Toxicity N2, Endomethason, Riebler's paste, Foredent lenka.roubalikova@tiscali.cz 21 Epoxide >Base (powder, paste) Bismuth oxid Titanium dioxide Hexametylentetramine (Silver) > Catalyst (liquide, paste) Bisphenoldiglycidylether lenka.roubalikova@tiscali.cz 22 EpoxJd resin (odvontoges) > Long working time > Hydrophilic (good penetration) >Good adhesion to the root canal walls > Volume stability >No dissolution >Antibacterial lenka.roubalikova@tiscali.cz 23 Epoxid resin (disadvantages) > Difficult removal > Staining > Initiatiory roxicity lenka.roubalikova@tiscali.cz 24 Polyketone > Base Zinc oxide Bismuth phosphate Hexametylentetramine > Liquid Bisphenolglycidylether and other components lenka.roubalikova@tiscali.cz 25 Polyketon resins Advantages Good adhesion No contraction No dissolution Disadvantages High stickness Not removable Products: Diaket, Diaket A (3M ESPE) lenka.roubalikova@tiscali.cz 26 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 lenka.roubalikova@tiscali.cz 27 Glasionomer sealers >Base (powder) Aluminium silicate glass > Liquid Polyacrylic acid, polymaleic acid, tartaric acid lenka.roubalikova@tiscali.cz 28 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 Ketac Endo (3M ESPE), Endion (VOCO) lenka.roubalikova@tiscali.cz 29 Silicon based sealers Polyvinylsiloxane (ev. in mixture with powdered guttapercha Biocompatibility Hydrofillic Further investigation desirable. lenka.roubalikova@tiscali.cz 30 Root canal filling • A cone inside the sealer - core material Guttapercha Resilon Silver cones Custom cones lenka.roubalikova@tiscali.cz 31 Root canal filling Guttapercha Trans isomer of polyisoprene 2 crystalline forms (alpha, beta) Beta - room temperature Alpha after heating Various process of cooling Extremly slow cooling: Aplha phase recrystalize. 65°. Less shrinkage, more dimensionally stable lenka.roubalikova@tiscali.cz 32 Root canal filling Guttapercha 20% gutta-percha 65% zink oxide 10% radioopacifiers 5% plasticizers lenka.roubalikova@tiscali.cz 33 Root canal filling Guttapercha Cones: conventional and standardized sizes Conventional: dimension of the tip and body Standardized cones are designed to match the taper of the instrument. lenka.roubalikova@tiscali.cz 34 Root canal fillings - forms > Points (Cones) > Materials for injection > Plastic materials lenka.roubalikova@tiscali.cz 35 Instruments • Lentulo • Compactors • Compactors - carriers • Others lenka.roubalikova@tiscali.cz 36 Lentulo >delivers pastes >1,5 - 2 mm ahead >at most for Ca (OH). lenka.roubalikova@tiscali.cz 37 Compactors Spreader Pointed Vertical introduction lenka.roubalikova@tiscali.cz 38 Piu lenka.roubalikova@tiscali.cz 39 Filling techniques Cold Warm Paste only Shrinkage, difficult removal lenka.roubalikova@tiscali.cz 41 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 lenka.roubalikova@tiscali.cz 42 lenka.roubalikova@tiscali.cz 45 Vertical condensation (compaction) lenka.roubalikova@tiscali.cz 49 Injection • Rychla technika • Mozna extruze sealeru • Teplo lenka.roubalikova@tiscali.cz 50 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! 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)- cough > Aspiration of the instrument (induce emesis, x-ray, evaluation)