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. Preendo.
* 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
Access
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
Dia trepan
Dia balls
Preparation of the endodontic cavity
Dia trepan
Safe ended tips Batt's instruments
Fissure bur
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Find of root canals
iL
Endodontic probes, microopeners
Ultrasound tips
Opening of root canal orificies
Opening of root canals
Peeso - Largo
The pulp chamber correctly open
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Opening of the pulp chamber
Steel round burs
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Finding of the root canal orifice
Finding and opeing of rot canal orifices
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Finding and opening of root canal orifices
lenka.roubalikova@tiscali.cz PeeSO isLargO
Programm point of breakage
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Ultrasound
Pulpextractor
Dental pulp
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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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 and reamer: the difference
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= Hedstroem file Ring
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H-fil
No rotation!!
Pull motion only!!
Risk of breakage in small sizes
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ISO
> Diameter of the tip
> Length of the cutting part >Taper
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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 2 mm -repeat
If 2 mm or less - add to the safe length
Endometry, odontometry
• Endometry
edevices based on measurement of electrical resistance
L1L
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)