Endodontic treatment - from acces to the working length Phases of the endodontic treatment * Investigation, diagnostic radiogram, consideration (local, regional, systemic factors) * Preendodontic treatment Preendodontic treatment Removal of old fillings, carious dentin, temporary restoration - contours of treated tooth. Gingivectomy or elongation of clinical crown if necessary. * Dry operating field - rubber dam See presentation Dry operation field Access 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 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 lenka.roubalikova@tiscali.cz 10 Find of root canals iL Endodontic probes, microopeners Ultrasound tips Opening of root canals Peeso - Largo Finding of the root canal orifice lertia.roubalikova@tiscali.cz Gates — Glidden: Tupá, neaktivní vodící špička Naprogramované místo zlomu lerfl6a.roubalikova@tiscali.cz Opening of root canal orificies X-GATES Velikost hrotu : Gates 1 Místo zlomu Maximální prumer - Gates 4 Dřík: Gates 3 Ni-Ti nástroje S velkou konicitou (kónusem) Např.: ProFile O.S., ProTaper SX, IntroFile í Ultrasound The pulp chamber correctly open lenka.roubalikova@tiscali.cz 30 Finding and opeing of rot canal orifices lenka.roubalikova@tiscali.cz 31 Finding and opening of root canal orifices lenka.roubalikova@tiscali.cz Peeso 32Largo Programm point of breakage lenka.roubalikova@tiscali.cz Pulpextractor Dental pulp Exstirpation Initial flaring - glide path - Learn the morpholoogy of root canals Minimize the risk of fractures Hand instruments C- file, pathfinder, Flex -O-File, Flexicut nstruments should be precurved Manual preftaring: Decreases separation of NITI Instruments Decreases their torsional stress Increases their life span ProFinder File Regressive taper Silicone grip, regressive taper length from tip 0 1 l 3 4 5 G ? 8 9 10 11 12 13 14 IS IS 111» | I I I I I I I I I I I I Canal shaping > Reamers (penetration) > Files (shaping) lenka.roubalikova@tiscali.cz 42 Reamer K -reamer Triangl or square wire spun Symbol lenka.roubalikova@tiscali.cz 43 lenka.roubalikova@tiscali.cz 44 lenka.roubalikova@tiscali.cz 45 Reamer Rotation (clockwise) - penetration Application of plastic material (contraclockwise) lenka.roubalikova@tiscali.cz 46 Files 1. K-file 2. K-flexofile, flexicut, flex-R 3. K-flex 4. H-file, S-file lenka.roubalikova@tiscali.cz 47 Kfile Wire triangl or square Symbol is always square lenka.roubalikova@tiscali.cz 48 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 50 K- flex Rhombus Two blades in action Enough space for dentin chips Flexibility, effifacy 51 K-file and reamer: the difference lenka.roubalikova@tiscali.cz = Hedstroem file Ring lenka.roubalikova@tiscali.cz H-fil No rotation!! Pull motion only!! Risk of breakage in small sizes lenka.roubalikova@tiscali.cz 54 ISO > Diameter of the tip > Length of the cutting part >Taper lenka.roubalikova@tiscali.cz 55 06 lenka.roubalikova@tiscali.cz 56 Stainless steel * Niti alloy 56 % nickel, 44% titanium, 60% nickel, 40 % titanium flexibility memory effect Cutting effifacy? lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz 63 lenka.roubalikova@tiscali.cz 64 lenka.roubalikova@tiscali.cz 65 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 Canal shaping and cleaning • Basic rules > Elimination of infection > Enlargement till the apical constriction -simplify the shape >6% tape, 3 more in comparison to the apical size > Gangraena - clean chips lenka.roubalikova@tiscali.cz 77 Canal cleaning □ Elimination of infection Mechanically - instrumentation, irrigation Chemically - irrigiation, temporary root canal filling lenka.roubalikova@tiscali.cz 78 Canal shaping Coronal flaring (Weine 1982, Peřinka 2003) I t 'V A lenka.roubalikova@tiscali.cz 79 NiTi systém — decreasing size 1 speed 250 - 300 rpm Torque control Lubrikacation lenka.roubalikova@tiscali.cz 83 Importance • Protection against fracture • Better cleaning of coronal part (effective transport of debris) • Effective irrigation • Better conditions for measurement of working length • Better conditions for apical preparation • Less risk of complication lenka.roubalikova@tiscali.cz 84 Shaping technique Rotation K - reamer K- file lenka.roubalikova@tiscali.cz 85 Shaping technique Rotace 45° tlak and pull motion K - reamer K- file Risk ofledging Zip, elbow effect Via falsa - perforation lenka.roubalikova@tiscali.cz 86 Shaping technique • Filing - push and pull motion. The file is in action durinh the pull motion H- file S- file K - file Risk of periapical infection Risk of plug lenka.roubalikova@tiscali.cz 87 Balanced force technique - 1st step • Insertion of the instrument one ISO size bigger than apical size of the root canal untill the instrument come to the contact with the root canal wall. Rotation 90 - 180°Very slight pressure - the instrument is reaching the WL. Balanced force technique - 2nd step step • Rotation of the instrument conmtraclockwise 180 -270°, pressure forward. Dentin chips are broken. Balanced force technique - 3rd step • The instrumentid id being pulled out and is rotating clockwise - the debris is being removed. Shaping technique K- flex- O- file K - flex- R - file 180-270 lenka.roubalikova@tiscali.cz 91 Methods of shaping • Filing around the roor canal -circumferentially. The shape of the root canal is kept. lenka.roubalikova@tiscali.cz 92 lenka.roubalikova@tiscali.cz 93 Dr. Sedlmaver Methods of shaping Step back H-file K-file Apical stop K-flexofile Prevention of the ledge lenka.roubalikova@tiscali.cz 94 Taper Final flaring with the smallest instrument H- File nebo K - Flexofile. Methods of root canal shaping Modified double flared with balanced force 1. Coronal flaring) 2. Apical preparation balanced force 3. Step back 4. Final flaring (filing) lenka.roubalikova@tiscali.cz 96 Method modified double flae • I. Opening of root canal - Coronal third - coronal flaring • II. Apical preparation Cathetrization,measurement, shaping till ISO 30 -balanced force. Master file - MAF (till WL) • III.Step back • Final flaring (MAF) lenka.roubalikova@tiscali.cz 100 lenka.roubalikova@tiscali.cz 101 lenka.roubalikova@tiscali.cz 102 lenka.roubalikova@tiscali.cz 103 lenka.roubalikova@tiscali.cz 104 2% kónus 30 u apexu 0,30 mm 35 1 mm od apexu 0,35 mm 40 2 mm od apexu 0,40 mm 45 3 mm od apexu 0,45 mm Apikální hranice lenka.roubalikova@tiscam.cz 105 6% kónus 30 u apexu 0,30 mm 30 1 mm od apexu 0,36 mm 30 2 mm od apexu 0,42 mm 30 3 mm od apexu 0,48 mm opracování We always combine hand and powerdriven instruments Hand instruments • Initil flaring - preshaping • Recapitulation • Difficult part of the root canals • Measurement of the apical size