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) radixretrakspona [USEMAP] 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 • • [USEMAP] trepanace Access opening [USEMAP] Shapes of endo cavities See special material on is [USEMAP] Number of root canals Maxillary molars have usually 4 root canals Mandibulary molars hace 3, 4b or 2 root canals [USEMAP] lenka.roubalikova@tiscali.cz 7 diatrepan Dia trepan diakulicky kuličky Dia round burs – balls vrtáčekkulička Opening of the pulp chamber Access Tungsten carbide round burs [USEMAP] lenka.roubalikova@tiscali.cz 8 diatrepan Dia trepan Fissur bur battovy Safe ended tips Batt´s instruments fissurka Preparation of the endodontic cavity [USEMAP] lenka.roubalikova@tiscali.cz 9 Finding and opening of root canal orifices microopenery sondy uzšpičky Endodontic probes Microopeners Ultrasound tips [USEMAP] Opening of root canals kuličky millery gatesgliddeny peesolarga1 Ball burs Miller‘s burs Gates Glidden‘s burs Peeso – Largo [USEMAP] cavity_access_z_set.tif cavity_acces_set.jpg Access kits [USEMAP] lenka.roubalikova@tiscali.cz 12 chudarek1 chudarek2 0613234012_62 The wall is weakend The pulp chamber correctly open [USEMAP] preshaping01 Opening of the root canal • [USEMAP] 0614203717_1 0614203717_5 0614203717_7 Kopie preshaping1 Gates Glidden, Peeso - Largo [USEMAP] 15 Finding of the root canal orifice FO 20 pré preshaping01 FO 20 post Kopie preshaping1 [USEMAP] 16 Gates – Glidden: Blunt, non active tip Programm point of breakage gates 0614203717_7 [USEMAP] Ultrasound [USEMAP] 18 dren Pulpextractor 0614211119_3 C:\Users\Elite\Desktop\vajbar pulpa.jpg Soft wire Prickles like harpune Insertion Rotation Exstirpation histol [USEMAP] lenka.roubalikova@tiscali.cz 19 Canal shaping • Ø Reamers (penetration) Ø ØFiles ( shaping) [USEMAP] lenka.roubalikova@tiscali.cz 20 Reamer • •K -reamer •Triangl or square wire spun • •Symbol reamer [USEMAP] lenka.roubalikova@tiscali.cz 21 Reamer reamer reamerdetail Bladed part Shank Stopper Grip Blades Space for dentin chips [USEMAP] lenka.roubalikova@tiscali.cz 22 Reamer reamerdetail 20° Blades Space for dentin chips Rotation – reaming achtion - panetration [USEMAP] lenka.roubalikova@tiscali.cz 23 Reamer • •Rotation (clockwise) – penetration • •Application of plastic material (contraclockwise) [USEMAP] lenka.roubalikova@tiscali.cz 24 Files 1.K-file 2.K-flexofile, flexicut, flex-R •3. K-flex •4. H-file, S-file 1. 1. 1. • • [USEMAP] lenka.roubalikova@tiscali.cz 25 K file •Wire triangl or square kfile Symbol is always square [USEMAP] lenka.roubalikova@tiscali.cz 26 K-file • • •Filing •Also rotation •45° – 90° kfiledetail 40° [USEMAP] lenka.roubalikova@tiscali.cz 27 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 • [USEMAP] lenka.roubalikova@tiscali.cz 28 K- flex • Rhombus Two blades in action Enough space for dentin chips Flexibility, effifacy [USEMAP] lenka.roubalikova@tiscali.cz 29 • reamer a kfile K-file a reamer: a difference [USEMAP] lenka.roubalikova@tiscali.cz 30 H-file •= Hedstroem file • •Ring hedstrom1 hfile [USEMAP] lenka.roubalikova@tiscali.cz 31 H- file • hedstroemdetail 60° No rotation!! Pull motion only!! Risk of breakage in small sizes [USEMAP] lenka.roubalikova@tiscali.cz 32 ISO ØDiameter of the tip ØLength of the cutting part ØTaper reamer [USEMAP] 33 06 08 10 15 45 20 50 25 55 30 60 35 70 40 80 Úzký svislý Size – diameter at the tip [USEMAP] 34 d1 d2 d2= d1 + 0,32 Taper 2% 0,02 mm na 1mm d1 – d2 = 16 mm [USEMAP] Working length • Distance between the referential point and apical constriction • •Radiographically • Apexlocators • Combination flexmaster LR [USEMAP] 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 LR [USEMAP] Radiogram •X-ray with inserted root canal instrument • •Safe length: average length of teeth reduced for 2 – 3mm • •Tooth with clinical crown [USEMAP] 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 [USEMAP] • G:\Endodoncie\endodoncie\endodoncie\jana01.jpg G:\Endodoncie\endodoncie\endodoncie\jana07.jpg [USEMAP] Safe length • Maxilla: •I1 20 •I2 18 •C22-24 •P20 •M 18 mkk,20 P [USEMAP] Safe length • Mandible •I 18 •C20 -22 •P18 •M18 [USEMAP] Endometry, odontometry • •Endometry edevices based on measurement of electrical resistance LR [USEMAP] LR [USEMAP] odsatuitekutiny mereniapexlokatorem mereniapexlokatorem1 LR [USEMAP] RAYPEX® 6 RAYPEX® 6 [USEMAP] Apical zoom • • • • • Start 5 [USEMAP] Obsah obrázku kontejner Popis byl vytvořen automaticky Obsah obrázku spotřebič Popis byl vytvořen automaticky • • [USEMAP] Irrigation q Removal of debris q Decontamination [USEMAP] Irrigants • • • Sodium hypochlorite (1,5 – 6%) •Chlorhexidin (0,12% - 0,2%) •EDTA – etyléndiaminotetraacetic acid 17% • • [USEMAP] Irrigants •Sodiumhypochlorite • • 1,5 – 6% -Oxidation a chloration -Dissolving efect • -Bad smell, irritant. [USEMAP] Irrigants • • •Chlorhexidin (0,12% - 0,2%) •Good antimicrobial efect, but no dissolving effect [USEMAP] Irrigants • • •EDTA – etyléndiaminotetraacetic acid 17% • •Chelator, removes inorganic parts of smear layer, week antimicrobial effect • • [USEMAP] nesnadne1 [USEMAP] aet3 [USEMAP] acko [USEMAP] Syringe and cannula •Blunt, side apertures,smallest ISO 35 • •No pressure • • DSC_0100 [USEMAP] Activation of irrigation • Increased effectivity • • Vibration • •Increasing of temperature • •Decomposition of irrigants - dissociation [USEMAP] [USEMAP] lenka.roubalikova@tiscali.cz 59 Shaping techniques •Rotation – 45° • K – reamer K- file [USEMAP] lenka.roubalikova@tiscali.cz 60 Shaping techniques •Rotation 45° pressure and pull motion • K – reamer K- file Risk of ledging Zip, elbow effect Via falsa [USEMAP] lenka.roubalikova@tiscali.cz 61 Shaping techniques •Filing H- file K – file Risk of periapical infection infection Risk of plug [USEMAP] lenka.roubalikova@tiscali.cz 62 Shaping techniques • Balanced force K- flexofile K – file (?) 90-180° 180 – 270° [USEMAP] lenka.roubalikova@tiscali.cz 63 Methods of shaping • Rotation and filing combined • •K - reamer •H- file • [USEMAP] Methods of shaping •Combination of rotation and filing • •Start with rotation •Finishing with filing •Suitable for straihgt root canals [USEMAP] lenka.roubalikova@tiscali.cz 65 Methods of shaping •Circumferential filing • Rotation Circumferential filing [USEMAP] lenka.roubalikova@tiscali.cz 66 nastroje1 Dr. Sedlmayer [USEMAP] Methods of shaping •Step back method • •Increasing size with decreasing length. •Insertion of root canal instrument – WL •Next – 1 mm shorter •… [USEMAP] • weinekonus Taper Final flaring with the smallest instrument H- File nebo K - Flexofile. [USEMAP]