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 - superelasticity Contemporary trends ◼ Treatment of the wire ➢ Heating ➢ Mechanical forming Increasing: effectivness Decreasing: the risk of the fracture ◼ Design (taper, shape of the cutting part, centralization) Shape ◼ Core ◼ Cutting part ◼ Space for the transport of dentin chips lenka.roubalikova@tiscali.cz9 CORE CUTTING EDGES lenka.roubalikova@tiscali.cz10 Grooves after the grinding Tip Radial land – flat „edges“ Sharp edges 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and apex locator combined X-SMART DUAL: twice as SMART SIMPLE TO USE −Automatic start / stop when the file enters / is withdrawn from the canal - Programmable - Intuitive keyboard - Large LCD screen * Follow the recommended clinical sequence X-SMART DUAL: twice as SMART Large LCD screen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 user cordless 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 18/0 3/20 24 © Dentspl y Maillefe r / 41 INIITIAL FLARING – GLIDE PATH C- File ProFinder File Regressive taper Silicone grip Stability VARIABLE TAPERED INSTRUMENTS - Variable Taper: - Prevents screw-in effect - Allows increased apical tapers (Finishing Files) 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 stee 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 Power driven instruments in creating of the glide path ◼ Pathfile ◼ Proglider file Progressive taper 2% - 8% „glide path" M-wire RotaryAlways combination with hand Dr. Ludovic Pommel Gold instruments – upgrade 18/0 3/20 24 © Dentspl y Maillefe r / 71 * * ProTaper Ultimate Slider Sterilní NiTi nástroj •Flexibilní nástroj, který si zachovává účinnost řezání díky NiTi materiálu M-WIRE ProTaper Ultimate Shaper • Sterilní NiTi nástroj • Metalurgicky ošetřeno tepelným zpracováním GOLD • Větší účinnost řezání ProTaper Ultimate Finishers • Sterilní NiTi nástroje • Metalurgicky ošetřeno tepelným zpracováním GOLD, poskytuje větší flexibilitu a vyšší odolnost vůči cyklické únavě ProTaper Ultimate Finishers Sterilní NiTi nástroje Metalurgicky ošetřeno tepelným zpracováním BLUE Speciální sekvence pro široké a rovné kanálky Basic rules of power driven endodontics - rotary Initial flaring Controlled rotation Following sequences Abundant irrigation No pressure Movement up and down 10-15s work in one phase, cleaning and checking the instrument Recapitulation Touch apical constriction and going back Check apical size after the preparation One file endodontics Wave one…. 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 M - wire (Dentsply Tulsa Dental) Před broušením tepelné ošetření ◼ Výhody: ◼ Vysoká flexibilita ◼ Menší riziko cyklické fraktury Wave ONE GOLD Příkladem je Reciproc, Reciproc Blue: 3 velikosti nástrojů RECIPROC RECIPROC® RECIPROC® VDW.SILVER® RECIPROC® motorC ◼ Endo motor ◼ Reciprokační systémy ◼ RECIPROC®, WaveOneTM ◼ Rotační systémy ◼ Mtwo®, FlexMaster®, ProTaper®, K3TM, Gates, Dr.`s Choice 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 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 ! Rotary instruments for glide path ◼ Pathfile ◼ Proglider file progressive taper 2% - 8% „glide path" M-wire Controlled rotation Always combination with hand instruments Reciprocating instrument for glide path ◼ Gold Glider File Progresssive taper 2%-6% Gold wire Reciprokační pohyb Twisted adaptive files (Kerr) ◼ Grinding twisting, electrogalvanic treatment ◼ Rotation – reciprokation according to the loading ◼ Sequences for various root canals Kompletní systém SM3SM3SM2 SM2 ML1 ML1 ML3ML3 ML2ML2 Malé 1 barevný pruh Střední / Velké 2 barevné pruhy Žádné plnění pro SM1 Oscillating instruments – AET technique ◼ Tilos ◼ Special handpiece Basic rules for all systems ◼ No pressure ◼ Short periods ◼ Checking the instrument ◼ Recapitulation ◼ Do not shape too much the apical constriction ◼ Measure the apical size at the end ◼ Abundant irrigation Reciproc Blue R Pilot Unicone Plus AET (anatomic endodontic technique) ◼ Tilos ◼ Special handpiece AET ◼ Oscillation 30° ◼ Combination with hand preparation – glide path, recapitulation and the shaping of apical part ◼ The middle part is shaped using oscillating instrumets ◼ Combination of stainless steel and NiTi Instruments for reendo ◼ Special design – variable taper – regressive ◼ Active tip lenka.roubalikova@tiscali.cz 112 Good selection and lege artis work