Power driven endodontics History • Stainless steel – no rotation, oscillation, translation, combination – risk of perforation, ledging. • Nickel titanium alloy – rotation, reciprocation, oscillation Ni Ti instruments Controlled rotation NiTi alloy 56 % Ni, 44% Ti, 60%Ni, 40 % Ti Flexibility Memory effect Effectivness Fractures ? Martensitic transformation Austenit Martensit Heating or releasing of bending stress – back to austenit Contemporary trends • Treatment of the wire ➢Heating ➢Mechanical forming Increasing: effectivness Decreasing: the risk of the fracture • Design (taper, shape of the cutting part) Controlled rotation Low rpm Torque control Handpieces – no complete control Gear Electromotor: 128:1 Air motor: 64:1 Motors • Controlled rotation • Reciprocation • More programms • Dr ś choice Motors: More programms Drś choice Motor & Apex Locator SAFER with an Endo motor − Torque control & auto reverse limit risk of file breakage − Auto reverse / stop at the apex mode limits the risk of over-preparation* SPACE SAVING & CONVENIENCE Endo motor and apex Locator in one device 3 MODES OF USE: ▪ Motor alone ▪ Apex locator alone ▪ DUAL mode - Motor and apex locator combined X-SMART DUAL: twice as SMART SIMPLE TO USE −Automatic start / stop when the file enters / is withdrawn from the canal - Programmable - Intuitive keyboard - Large LCD screen * Follow the recommended clinical sequence X-SMART DUAL: twice as SMART Large LCD screen Intuitive control panel Insulated contra-angle 9 programmable settings On / Off button on the motor handpiece Torque: 0.6~5.5 Ncm Speed: 100 – 800 rpm File progression “The cordless version of X-SMART ▪ freedom of movement ▪ Safe – torque control, auto ▪ Miniature contra-angle as X-SMART ▪ User friendly – featuring LCD display + very explicit and intuitive control panel ▪ Ergonomic fits well in the hand, anti-slip grip X-SMART EASY : cordless and usercordless version of X-SMART friendly Miniature contra-angle head The X-SMART EASY on its charging base SELECT (torque /speed / auto reverse) INCREMENTS +/- REVERSE FORWARD Torque 0.6-4 Ncm Speed 100-800 rpm Auto reverse ON/OFF • Niti alloy enables using of higher taper (4%, 6%) d1 d2 d2= d1 + 0,32 0,02 mm /1mm d1 d2+ 0, 64 d2 0,04mm /1 mm d1 d2 d2=d1+0,96 0,06mm /1 mm Higher taper Coronal flaring Higer effect od irrigation Good approach to apical part Good conditions for 3D filling 30 at the apex 0,30 mm 35 1 mm from the apex 0,35 mm 40 2 mm from the apex 0,40 mm 45 3 mm from the apex 0,45 mm 30 at the apex 0,30 mm 30 1 from the apex 0,36 mm 30 2 from the apex 0,42 mm 30 3 mm from the apex 0,48 mm 2% taper 6% taper Shape of the apical Classification of instruments acc. to the taper • Fixed taper • Variable taper - Progressive - Regressive Resistance maximal opening of the root canal, approach to the apical part Flexibility, penetration, small shaping Progressive taper Regressive Taper Finishing Files Stability in the apical part VARIABLE TAPERED INSTRUMENTS - Variable Taper: - Prevents screw-in effect - Allows increased apical tapers (Finishing Files) Flex master organizér Flex Master organizér Crown down: Modrá Červená sekvence Žlutá Apikální preparace: Zelená sekvence Apical - coronal System ProTaper • Universal • Gold • Next System ProTaper • Universal • Gold Shape the coronal and the middle third of the canal Shaping Files (S1 & S2 – Accessory Sx) Shaping Files Variable Increasing Taper (Eiffel Tower shape) S1 19 20 18 Sx S2 S2 Finishing Files F1, F2, F3, F4, F5 Shape the Apical part of the canal F3 F2 F1 Finishing Files (Variable Decreasing Taper) F4 40-6% F5 50-5% 20-7% 25-8% 30-9% 3mm - Cutting blade (no radial land) : Efficiency Morphology Concave : F3, F4, F5Convexe : S1, S2, SX, F1, F2 - Triangular concave cross-section : Flexibility - Triangular convexe cross-section : Resistance Characteristics « Triangular » Cross-Section - Safe non cutting tip : acts as a guide Characteristics Radial land Short instrument with high taper 19 For Relocating Canal Orifice (only when needed) Sx is used with a brushing motion to relocate the orifice and insure a straight line access Dr. WJ Pertot Dr. WJ Pertot SCOUTING THE CANAL : ProFinder Files 10,13,17 OR NiTi ROTARY INSTRUMENTS : Pathfiles K-File 008 or 010 Then hand instruments to the level they are accepted in the canal. Stainlesssteel Stainlesssteel C+ File 08,10,15 If needed, use SX with a brushing motion to relocate the orifice of the canal and create a straight line access (don’t use Sx deep in the canal) Use S1 with a brushing motion and enlarge the canal, no deeper than the level of the penetration of the scouting file (to make sure that the tip of S1 is never blocked) Using Pathfile, go to working length that you established right before Determine WL Apex Locator 1 2 After going to length with a stainless steel file size 15, use : S1 to working length with a brushing motion. Using Pathfile this step is skipped When S1 reaches working length, use : S2 to working length with a brushing motion When S2 reaches working length, use : F1 to working length. CAUTION ! NEVER USE A BRUSHING ACTION WITH THE FINISHING FILES !!! When a finishing file reaches the working length, It is immediately withdrawn. Gaugethe diameter of the foramen with stainless steel files and if the foramen is larger than 20, use F2, F3, F4 or F5 to working length, according to the real apical diameter. CAUTION ! NEVER USE A BRUSHING ACTION WITH THE FINISHING FILES !!! When a finishing file reaches length, it is immediately withdrawn. Rotary Instruments sequence VIDEO Dr. Ludovic Pommel Basic rules of power driven endodontics - rotary Controlled rotation Following sequences Abundant irrigation No pressure Movement up and down Touch apical constriction and going back 10-15s work in one phase, cleaning and checking the instrument One file endodontics The instrument releases within the elastic phase Elastic Limit Dr. Ghassan Yared, Canada Reciprocation - benefits NiTi instruments in reciprocation Plastic phase • Simplicity • Ony one instrument for one tooth • Sterile – single use • Safety • Minimized risk of fracture • No risk of contamination • Users friendly Reciprocation - benefits • Regressive taper Wave One RECIPROC® Compatibility – paper and gutta cones • Sterile • For single use • No autoclaveable Remnants of tissue after cleaning and sterilisation Dr. David Sonntag, University of Düsseldorf Choice of the instrument • Hand instrument ISO 30: 50 • Hand instrument ISO 20: R40 • Hand instrument ISO 10: 20, 25 • The hand instrument must reach the WL without any bending Nástrojem pohybujeme nahoru a dolů s amplitudou max 3 mm Po 3 amplitudách vytahujeme nástroj a čistíme Pracujeme za mokra Dosáhneme 2/3 odhadnuté pracovní délky Provedeme měření apexlokátorem Pracovní postup s reciprokačními nástroji Ruční nástroj dosáhne pracovní délku bez předehnutí Preparace může být zakončena R 25 Gradual curvature tooth 25 Dr. Ghassan Yared Gradual curvature tooth 37 Dr. Ghassan Yared Ruční nástroj iSO 10 dosáhne pracovní délku pouze s předehnutím → ruční preparace ISO 15 If the ISO size 15 hand ISO 15 dosáhne pracovní délku bez předehnutí – R 25 Nedaří – li se, ruční preparace. Abrupt curvature tooth 47, root canal preparation was finished manually Dr. Ghassan Yared Pracovní postup s reciprokačními nástroji Basic rules of power driven endodontics - reciprocation • Movement in amplitudes: up/down 3 mm • Cleansing of instruments each 3amplitudes • Reach the apical constriction and go out ! Combination of reciprocating and rotary movement Oscillation (AET - ENDO EZE