Root canal treatment
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. It is preendo.
* Dry operating field
* Preparation of the access (endodontic cavity)
Phases of the endodontic treatment
Opening of root canals
Initial flaring and removal dental pulp or necrotic materiál from the root canal
WL (working length)
Root canal shaping and cleaning (irrigation)
Recapitulation
Drying
Filling
Radiogram
Postendodontic treatment ^-
Access opening
Shapes of endo cavities See special material on is
Number of root canals 7
a
3
Maxillary molars have usually 4 root canals ? Mandibulary molars hace 3, 4b or 2 root canals
Opening of the pulp chamber Access
Tungsten carbide round burs
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Preparation of the endodontic cavity
Dia trepan
Safe ended tips Batt's instruments
Fissur bur
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inding and opening of root canal orifices
Ultrasound tips
Opening of root canals
Peeso - Largo
Opening of the root canal
Finding of the root canal orifice
Gates - Glidden: Blunt, non active tip
Program mpoint of b
Ultrasound
Pulpextractor
Exstirpation
Canalshap
> 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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K-file
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 a reamer: a difference
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H-file
= 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
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
• 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
Apical zoom
Irrigation
Irrigants
• Sodium hypochlorite (1,5 - 6%)
• Chlorhexidin (0,12% - 0,2%)
• EDTA - etylendiaminotetraacetic acid 17%
Irriga
Sodiumhypochlorite 1,5 - 6%
Oxidation a chloration Dissolving efect
Bad smell, irritant.
Irrigants
• Chlorhexidin (0,12% - 0,2%)
Good antimicrobial efect, but no dissolving effect
Irrigants
* EDTA - etylendiaminotetraacetic acid 17%
* Chelator, removes inorganic parts of smear layer, week antimicrobial effect
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Syringe and cannula
• Blunt, side apertures,smallest ISO 35
• No pressure
Activation of irrigation
• Increased effectivity Vibration
Increasing of temperature Decomposition of irrigants - dissociation
Shaping techniques
• Rotation -45
K - reamer
K- file
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Shaping techniques
Rotation 45° pressure and pull motion
K - reamer
K- file
Risk of ledging Zip, elbow effect Via falsa
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Shaping techniques
Filing
H-file
K-file
Risk of periapical infection infection Risk of plug
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Shaping techniques
Balanced force
90-180"
K- flexofile
K —file (?)
180-270'
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Methods of shaping
• Rotation and filing combined
K - reamer H-file
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Methods of shaping
• Combination of rotation and filing
Start with rotation
Finishing with filing
Suitable for straihgt root canals
Methods of shaping
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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.