Endodontic treatment - from acces to the working length Phases of the endodontic treatment * Investigation, diagnostic radiogram, consideration (local, regional, systemic factors) * Removal of old fillings, carious dentin, temporary restoration - contours of treated tooth. * Dry operating field * Preparation of the access (endodontic cavity) Phases of the endodontic treatment Opening of root canals Initial flaring and removal of content of root canal WL (working length) Root canal shaping and cleaning (irrigation) Rekapitulation Drying Filling Radiogram Postendodontic treatment Opening of root canal orificies Shapes of endo cavities See special material on is a Number of root canals 7 First upper molar-4 root canals 9 3 7 8 Instruments Ball burs Find of root canals Endodontic probes, microopeners Ultrasound tips Opening of root canals Peeso - Largo lenka.roubalikova@tiscali.cz 13 'v IH 1 1 i JB i m Dia trepan Opening of the pulp chamber Access Steel round burs lenka.roubalikova@tiscali.cz 14 Preparation of the endodontic cavity . ■ 'J* 1 1 i M i m Dia trepan Safe ended tips Batt's instruments Fissur bur lenka.roubalikova@tiscali.cz 15 Finding of the root canal orifice Finding and opeing of rot canal orifices Endodontic probes Microopeners CANAL BLUE mt 0155 ■-._ • Wufre'kinjii indAatoc " Karicsorwoer uxmvm . flooi Cm* Ucrtor ■ Cane* «dlo*x fj^M VOW GmbH P0 Bo. 830954 • 8»«» WUKhWGmtlttl Ultrasound tips Dye lenka.roubalikova@tiscali.cz 17 Finding and opening of root canal orifices lenka.roubalikova@tiscali.cz Peeso TsLargo lenka.roubalikova@tiscali.cz 19 Programm point of breakage lenka.roubalikova@tiscali.cz Ultrasound Pulpextractor Dental pulp Exstirpation Canal shaping > Reamers (penetration) > Files (shaping) lenka.roubalikova@tiscali.cz 23 Reamer K -reamer Triangl or square wire spun Symbol lenka.roubalikova@tiscali.cz 24 lenka.roubalikova@tiscali.cz 25 lenka.roubalikova@tiscali.cz 26 Reamer Rotation (clockwise) - penetration Application of plastic material (contraclockwise) lenka.roubalikova@tiscali.cz 27 Files 1. K-file 2. K-flexofile, flexicut, flex-R 3. K-flex 4. H-file, S-file lenka.roubalikova@tiscali.cz 28 Kfile Wire triangl or square Symbol is always square lenka.roubalikova@tiscali.cz 29 K-file Filing Also rotation 45° - 90° lenka.roubalikova@tiscali.cz 30 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 lenka.roubalikova@tiscali.cz 31 K- flex Rhombus Two blades in action Enough space for dentin chips Flexibility, effifacy 32 lenka.roubalikova@tiscali.cz 33 = Hedstroem file Ring lenka.roubalikova@tiscali.cz H-fil No rotation!! Pull motion only!! Risk of breakage in small sizes lenka.roubalikova@tiscali.cz 35 ISO > Diameter of the tip > Length of the cutting part >Taper lenka.roubalikova@tiscali.cz 36 Working length • Distance 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 Safe length Averige length of the tooth less 2 mm • Maxilla: 11 20 12 18 C22-24 P20 M 18 mkk,20 P Safe length Averige length of the tooth less 2 mm • Mandible 118 C20 -22 P18 M18 Procedure • Instrument ISO 15 inserted 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 Endometry, odontometry • Endometry edevices based on measurement of electrical resistance L1L RAYPEX® 6 ľ. w: RAYPEX 6 feL 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)