Endodontic treatment - root canal shaping 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 Access Rozšíření vchodu do kanálku Shapes of endo cavities See special material on is Number of root canals Instruments Dia trepan Dia balls Nalezení a rozšíření vstupu do kořenových kanálků 12 i rtl n II íí ll 11 li t Endodontické sondy, microopenery CANAL BLUE (tor 01H * Wurio**ra»l- Reamers (penetration) > Files (shaping) lenka.roubalikova@tiscali.cz 25 Reamer K -reamer Triangl or square wire spun Symbol lenka.roubalikova@tiscali.cz 26 lenka.roubalikova@tiscali.cz 27 lenka.roubalikova@tiscali.cz 28 Reamer Rotation (clockwise) - penetration Application of plastic material (contraclockwise) lenka.roubalikova@tiscali.cz 29 Files 1. K-file 2. K-flexofile, flexicut, flex-R 3. K-flex 4. H-file, S-file lenka.roubalikova@tiscali.cz 30 Kfile Wire triangl or square Symbol is always square lenka.roubalikova@tiscali.cz 31 Filing Also rotation 45°-90° lenka.roubalikova@tiscali.cz 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 33 K- flex Rhombus Two blades in action Enough space for dentin chips Flexibility, effifacy 34 K-file a reamer: rozdíl lenka.roubalikova@tiscali.cz = Hedstroem Ring lenka.roubalikova@tiscali.cz No rotation!! Pull motion only!! Risk of breakage in small sizes lenka.roubalikova@tiscali.cz > Diameter of the tip >Length of the cutting part >Taper lenka.roubalikova@tiscali.cz 38 lenka.roubalikova@tiscali.cz 39 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 Měření- apikální zoom Irrigation Irrigants • Sodium hypochlorite (1,5 - 5,5%) • Chlorhexidin (0,12% - 0,2%) • EDTA - etylendiaminotetraacetic acid 17% 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 lenka.roubalikova@tiscali.cz 66 Shaping techniques Rotace 45° pressure and pull motion K - reamer K- file lenka.roubalikova@tiscali.cz Risk of ledging Zip, elbow effect Via falsa 67 Shaping techniques • Filing lenka.roubalikova@tiscali.cz H-file K-file Risk of periapical infection infection Risk of plug 68 Shaping techniques Balanced force 90-180" K- flexoflle K —file (?) 180-270' lenka.roubalikova@tiscali.cz 69 Reaming Filing lenka.roubalikova@tiscali.cz 71 Balance forced technique lenka.roubalikova@tiscali.cz 72 Methods of shaping • Rotation and filing combined K - reamer H-file lenka.roubalikova@tiscali.cz 73 Methods of shaping lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz 75 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)