Endontics

8/12/2019 Endontics

1/109

BASIC

ENDODONTICS

8/12/2019 Endontics

2/109

Someone once asked

Which is worse

Ignorance or Apathy

The answer came

I dont know and I dont care

8/12/2019 Endontics

3/109

This presentation is not for them.This is about developing

Expertise

Through the rays of knowledgefor those that aspire to become

The Best.......

8/12/2019 Endontics

4/109

......Dentists!

8/12/2019 Endontics

5/109

8/12/2019 Endontics

6/109

8/12/2019 Endontics

7/109

Overview o f the Lectu re

Diagnosis

Essential analysis

Instruments/ Armamentarium Access Opening

Locating canals

BMP/ CMP

Irrigation & intracanal medicaments

Obturation

8/12/2019 Endontics

8/109

Diagnosis

Past medical history (Diabetes, Valv Hrt Disease )

Past dental historyAttempted RC, Old RCT done,Separated instrument, swelling extent & recurrence

Chief complaint

Subjective Symptoms (type of pain)

Objective Symptoms

8/12/2019 Endontics

9/109

Objective Symptoms

Visual & Tactile inspection

Percussion

Palpation

Mobility and depressibility

Radiograph

Anesthetic test

Electric pulp test

Thermal test

Test cavity

8/12/2019 Endontics

10/109

Visual Inspect ion

8/12/2019 Endontics

11/109

Anesthetic test forlocalisation of pain

8/12/2019 Endontics

12/109

8/12/2019 Endontics

13/109

Extensive caries: save or extract?

8/12/2019 Endontics

14/109

Pulp Stones, Calci f ication

8/12/2019 Endontics

15/109

Obliterated pulp chamber

8/12/2019 Endontics

16/109

Number, shape of canals,roo ts ...

Radix entomolaris

8/12/2019 Endontics

17/109

Shape and leng th o f roo ts

8/12/2019 Endontics

18/109

Roo t reso rpt ion , furcat ion

involvement

8/12/2019 Endontics

19/109

Cracked tooth

8/12/2019 Endontics

20/109

Tear drop radiolucency vertical #

8/12/2019 Endontics

21/109

8/12/2019 Endontics

22/109

Vertical root fracture

8/12/2019 Endontics

23/109

Radicu lar cyst

8/12/2019 Endontics

24/109

Per iodontal status

8/12/2019 Endontics

25/109

8/12/2019 Endontics

26/109

Steps in RCT

Pre endodontic buildup

Access opening

Locating and negotiating canals

Working length determination

Establishing glide path ( more relevant forrotary)

Cleaning and shaping

Obturation

8/12/2019 Endontics

27/109

Pre-endodon t ic Bui ldup

Removal of old restoration and caries

Reduce cusps to create point of reference

Rebuild with GIC/ flowable composite

Four walls to isolate, (rubber dam) confineirrigants, prevent fracture in betweenappointments

8/12/2019 Endontics

28/109

Pre-endodon t ic bu i ldup

8/12/2019 Endontics

29/109

Access Cavi ty

Goals

Straight line access to the canals

Complete deroofing of the chamber

Removal of coronal pulp

Shape should aid in locating all canals

Balance with the following constraints

Conservation of tooth structure

Retention and esthetics of final restoration

Possibility of functional restoration of the tooth

8/12/2019 Endontics

30/109

Access cavi ty prep

8/12/2019 Endontics

31/109

Access p rep

8/12/2019 Endontics

32/109

Bur o r iented along the long axis

8/12/2019 Endontics

33/109

Bur angulat ion

8/12/2019 Endontics

34/109

Complete Deroo f ing

8/12/2019 Endontics

35/109

Deroof ing

8/12/2019 Endontics

36/109

Special Bu rs for deroo f ing

Endo Access Bur Endo safe-end Bur(SSwhite)

8/12/2019 Endontics

37/109

Access opening v ideo

8/12/2019 Endontics

38/109

Pulp removal f rom chamber

Excavating pulp tissue in chamber

Hemorrhage control

Removal of calcifications eg. Pulp stones

Use hypochlorite

8/12/2019 Endontics

39/109

Locating Canals

De-roofing and removing dentinal ledges

Know anatomy and read xray

Read Dentinal map

Use Sharp explorer tip, No. 10 K file

Small round burs

Special Ultrasonic tips

Magnification aids / Microscope

8/12/2019 Endontics

40/109

8/12/2019 Endontics

41/109

Attached pulp s tones

Removing, attached, detached pulp stones

Troughing for hidden orifices

8/12/2019 Endontics

42/109

8/12/2019 Endontics

43/109

C i l f

8/12/2019 Endontics

44/109

Common apical foramen

8/12/2019 Endontics

45/109

L i l l i l i

8/12/2019 Endontics

46/109

L ingual canal in lower can ine

8/12/2019 Endontics

47/109

Midd l M i l i l l

8/12/2019 Endontics

48/109

Midd le Mesial in lower mo lar

8/12/2019 Endontics

49/109

8/12/2019 Endontics

50/109


8/12/2019 Endontics

51/109


Clean ing and Shap ing

8/12/2019 Endontics

52/109

Clean ing and Shap ing

Cleaning is debridement / removal of vital ornecrotic tissue, bacteria with their byproducts &dentinal debrisfrom canal system

(Irrigation & disinfection are integral parts ofdebridement )

Shaping is preparing the canal for completeobturation

All techniques perform the above concurrently

8/12/2019 Endontics

53/109

Obtaining straight line access

8/12/2019 Endontics

54/109

Obtaining straight line access

Orif ice Shap ing & en largement

8/12/2019 Endontics

55/109

Orif ice Shap ing & en largement

Danger Zone mind it!

8/12/2019 Endontics

56/109

Danger Zone.... mind it!

M

Estab l ish g l ide path

8/12/2019 Endontics

57/109

Estab l ish g l ide path

Carefully negotiate canal with small files, andreestablish the path

Glide path is a smooth tunnel from canal orificeto physiologic terminus, minimal size super looseno. 10 file ( can even be no. 15, 20)

Very important for safe rotary instrumentationsince most rotary Niti are designed to follow apath not create one

Path Files

8/12/2019 Endontics

58/109

Path Files

Path files are designed to create glide path

Working Length Determ inat ion

8/12/2019 Endontics

59/109

Working Length Determ inat ion

Prep should end at the

Physio log ic term inus / ap ical

constr ic t ion / cemento-den t inaljunc t ion

Physio log ic term inus vs

R di h i t i

8/12/2019 Endontics

60/109

Radiog raph ic term inus

C:\Documents and Settings\Kavita\MyDocuments\Downloads\endo presentation\apex

locator.htm
http://c/Documents%20and%20Settings/Kavita/My%20Documents/Downloads/endo%20presentation/apex%20locator.htmhttp://c/Documents%20and%20Settings/Kavita/My%20Documents/Downloads/endo%20presentation/apex%20locator.htmhttp://c/Documents%20and%20Settings/Kavita/My%20Documents/Downloads/endo%20presentation/apex%20locator.htmhttp://c/Documents%20and%20Settings/Kavita/My%20Documents/Downloads/endo%20presentation/apex%20locator.htmhttp://c/Documents%20and%20Settings/Kavita/My%20Documents/Downloads/endo%20presentation/apex%20locator.htmhttp://c/Documents%20and%20Settings/Kavita/My%20Documents/Downloads/endo%20presentation/apex%20locator.htmhttp://c/Documents%20and%20Settings/Kavita/My%20Documents/Downloads/endo%20presentation/apex%20locator.htmhttp://c/Documents%20and%20Settings/Kavita/My%20Documents/Downloads/endo%20presentation/apex%20locator.htmhttp://c/Documents%20and%20Settings/Kavita/My%20Documents/Downloads/endo%20presentation/apex%20locator.htmhttp://c/Documents%20and%20Settings/Kavita/My%20Documents/Downloads/endo%20presentation/apex%20locator.htmhttp://c/Documents%20and%20Settings/Kavita/My%20Documents/Downloads/endo%20presentation/apex%20locator.htmhttp://c/Documents%20and%20Settings/Kavita/My%20Documents/Downloads/endo%20presentation/apex%20locator.htmhttp://c/Documents%20and%20Settings/Kavita/My%20Documents/Downloads/endo%20presentation/apex%20locator.htmhttp://c/Documents%20and%20Settings/Kavita/My%20Documents/Downloads/endo%20presentation/apex%20locator.htmhttp://c/Documents%20and%20Settings/Kavita/My%20Documents/Downloads/endo%20presentation/apex%20locator.htmhttp://c/Documents%20and%20Settings/Kavita/My%20Documents/Downloads/endo%20presentation/apex%20locator.htmhttp://c/Documents%20and%20Settings/Kavita/My%20Documents/Downloads/endo%20presentation/apex%20locator.htmhttp://c/Documents%20and%20Settings/Kavita/My%20Documents/Downloads/endo%20presentation/apex%20locator.htmhttp://c/Documents%20and%20Settings/Kavita/My%20Documents/Downloads/endo%20presentation/apex%20locator.htm

8/12/2019 Endontics

61/109

8/12/2019 Endontics

62/109

Techn iques fo r C & S

8/12/2019 Endontics

63/109

Techn iques fo r C & S

Step back

Crown Down

Manual

Rotary

Step-Back Preparat ion

8/12/2019 Endontics

64/109

p p

Crown Down Technique

8/12/2019 Endontics

65/109

q

Start with the largest files from the upper part of the root canaland goes down with decreasing or smaller files

ADVANTAGES:

Do not have to go to the WL from the start

Less chance of ledge formation, or canal blockage

Reservoir for irrigants.

DISADVANTAGES:

Not taught in the colleges.

More steps than the protaper technique.

Manual Preparat ion Instruments

8/12/2019 Endontics

66/109

p

Reamers K file

Flexoreamer

Flexofile

H file

Niti flexfile

Protaper Hand files

8/12/2019 Endontics

67/109

Cutting tip. In curved canals ledging easily occurs with even

small reamer sizes if instruments are not pre-curved.

Reamers are excellent instruments in straight canals butpoorly adaptable to curved canals.

8/12/2019 Endontics

68/109

for the preparation of straight canals. It prepares dentin effectively both in filing

motion (up and down) and when rotated.

In slightly curved canals :

Small resistance : Continuous rotation

Greater resistance : Balanced forceCurved canals : pre-curve

The use of filing motion in curved canals can cause transportation and ledging, and is

not recommended.

The K-file

8/12/2019 Endontics

69/109

Prepared from round steel wire by

grinding.

Cutting edge close to right angle.

Hfile = Ledge fileOnly Up- down motion.

Must fit loosely in the canal.

Used 1-2 mm shorter than apical

prep.Above 25 no. 3-4 mm shorter.

Pre-curved in curved canals.

Hedstroem File

Files must be inspected for possible earlier damage to the

instrument and discarded immediately if an asymmetry in

8/12/2019 Endontics

70/109

the cutting area is found.

8/12/2019 Endontics

71/109

Nitiflex file

Rotary Ins truments

8/12/2019 Endontics

72/109

ProtaperGreater Taper

Profile

Race

Endo sequence

K3 files

Light Speed (LSX)

Pro Taper: Recommended use

8/12/2019 Endontics

73/109

1. Work instruments to light resistance and neverforce them.

2. Only use instruments in a well irrigated and

lubricated canal.

3.The appropriate finishing file passively follows thecanal to the desired length then is immediately

withdrawn.

4. Use in constant rotation at a speed of 250-350

rpm.

5. Clean flutes frequently and check for signs of

distortion or wear.

8/12/2019 Endontics

74/109

Pro Taper: Design and Structure A progressively tapered file engages a smaller zone of dentine which

reduces torsional loads, file fatigue and the potential for breakage.

8/12/2019 Endontics

75/109

, g p g

Improve flexibility, cutting efficiency and typically reduces the number of

recapitulations needed to achieve length, especially, in tight or more

curved canals.

ProTaper instruments are prepared from round nickel-titan wire by

grinding.

Cross-section of the instruments shows a triangular structure with three

cutting points and no radial lands.

ProTaper instruments have a non-cutting tip to guide the instrument in

the canal and reduces the risk for ledge formation.

The convex triangular cross-section reduces the contact area between

the file and dentine.

This greater cutting efficiency has been safely incorporated through

balancing the pitch and helical angles.

8/12/2019 Endontics

76/109

Rotary Protaper Video

8/12/2019 Endontics

77/109

Other rotary systems

Race (Reamer with Alternating Cutting Edges)

8/12/2019 Endontics

78/109

The cross-section of the RaCe instruments is a convex triangle,

with the exeption of the two smallest instruments,

#15/02 and #20/02 (taper 02), which both have a square cross-section.

special attention has been focused on achieving a smooth metal (NiTi) surface

Each RaCe instruments has a constant taper ranging from 02 taper to 10 .

8/12/2019 Endontics

79/109

K3: Design and StructureEndoSequence: Design and Structure

Great Taper: Design and Structure

Light speed sys tem

(tapered vs non-tapered)

8/12/2019 Endontics

80/109

( p p )

http://www.discusdental.com/endo_videomedia.php

Must, irrespective of techniqueRecapitulation, apical patency
http://www.discusdental.com/endo_videomedia.phphttp://www.discusdental.com/endo_videomedia.phphttp://www.discusdental.com/endo_videomedia.phphttp://www.discusdental.com/endo_videomedia.phphttp://www.discusdental.com/endo_videomedia.php

8/12/2019 Endontics

81/109

p , p p y

Colonization of Bacteria

Obliteration to RCF

Densely packed dentinal debris

Lightly packed dentinal debris

Type of Apical PreparationApical stop Apical seat Open apex

8/12/2019 Endontics

82/109

8/12/2019 Endontics

83/109

Ledging, Zipping, Transportation

8/12/2019 Endontics

84/109

Hour glass preparation

8/12/2019 Endontics

85/109

The standardized preparation technique resulted in

procedural errors when used in a curved canal.

I r r igat ion

8/12/2019 Endontics

86/109

Lubricate canal to avoid instrument separation

Dissolve the pulp remnants

Washing out debris created by instrumentation

Kill or remove the micro-organisms in rootcanal and biofilm

Clean the smear layer

Canal should be wide enough for irrigant toreach apex,

Most common ly used i rr igants

8/12/2019 Endontics

87/109

Naocl 5.25% or 3% (bactericidal, cytotoxic,dissolves organic tissuel)

EDTA (17%) liquid, gel (removes smear layer,lubrication)

Chlorhexidine 0.2% (bactericidal)

H202

Saline

Distilled water

Side venting irrigating tips

Most commonly used i r r igants

8/12/2019 Endontics

88/109

Newer del ivery sys tems

8/12/2019 Endontics

89/109

Endovac ( improves exchange of irrigant,eliminates air lock, avoids accidents)

Vibringe (passive ultrasonic irrigation)

In tracanal Med icaments

8/12/2019 Endontics

90/109

Ca(OH)2Chlorhexidine gel 2%

Antibiotics

Phenolic compoundsMetapex: Ca(OH)2 + Iododform

Obturat ion

8/12/2019 Endontics

91/109

The success of endodontic treatment depends onmeticulous root canal preparation.

What you take out is more important thanwhat you put in

This does not mean that root canal obturation isless important.

Hermetic Seal

8/12/2019 Endontics

92/109

The purpose of obturation is to seal and prevent: Microbes from entering & reinfecting the canal

Tissue fluids from percolating back & providinga culture medium for residual microbes

Coronal seal equally important

Obtu ratat ion

8/12/2019 Endontics

93/109

Patient asymptomatic Canals shou ld be relat ively dry

Ap ical gauging & Master cone select ion

Conf irm wi th rad iograph

Requirements o f RC f il l ing

material

8/12/2019 Endontics

94/109

Should be easily introduced in canal

Should not shrink

Should seal laterally as well as apically

Impervious to moisture

Bactericidal or at least discourage growth

Radiopaque

Should not stain tooth

Should not irritate periapical tissues (inert,biocompatible)

Quickly sterilisable

Easily removable if necessary

8/12/2019 Endontics

95/109

Techniques

Lateral condensat ion (co ld gu tta-percha)

8/12/2019 Endontics

96/109

Lateral condensat ion (co ld gu tta percha)

Vert ical condensat ion(Schilder)(warm gutta-percha)

Sectional method

Compaction method (Mcspadden method)

Metal core obturation (silver cone, SS file) Single gutta-percha point and sealer

Chemically plasticised gutta percha

Thermoplasticised technique : Down pack (sys tem B) & b ack f i ll wi th in jectable

gp(obtura)

Gutta percha carrier systems( thermafill, simplifill)

LATERAL CONDENSATION1.MASTER CONE GP WHOSE SIZE CORRESPOND TO THE LAST LARGEST NO.FILE USED TO SHAPE THE CANAL TILL WL IS CHOSEN.

8/12/2019 Endontics

97/109

2 FIT AND LENGTH OF THE GP IS CONFORMED WITH A X-RAY.

3 ADDITIONAL SMALLER GP POINTS ARE THEN FILLED IN BY MAKING SPACEWITH SPREADERS.

ADVANTAGES OF THE TECHNIUE:

TAUGHT IN COLLEGES IN INDIA AND IS BEING USED BY MOST OF THEDENTISTS.

LESS INVENTORY NEEDED AS COMPARE TO WARM GP TECHNIQUE.

LESS EXPENSIVE.

DISADVANTAGES:

ACCESSARY CANALS ARE NOT OBTURATED.

SPACE LEFT B/T THE GP POINTS.

Lateral Condensat ion

8/12/2019 Endontics

98/109

Lateral condensation video

8/12/2019 Endontics

99/109

Vert ical Condensation (Sch i lder)

8/12/2019 Endontics

100/109

Thermop last ic ised GPSystem B, Obtura

8/12/2019 Endontics

101/109

y ,

8/12/2019 Endontics

102/109

Down pack Back fill video

8/12/2019 Endontics

103/109

Carr ier based techn ique

(Thermafi l l)

8/12/2019 Endontics

104/109

THERMAFIL OR THE WARM GPTECHNIQUE

METHOD:

8/12/2019 Endontics

105/109

METHOD:

SIZE AND THE LENGTH OF THE THERMAFIL TO BE USED IS DETERMINED BY THE VERIFIER

HEAT THE GP IN THE THERMA PREP.

APPLY THE SEALER IN THE ROOT CANAL

FILL THE ROOT CANAL WITH WARM GP.

PLASTIC CARRIER IS SEPARATED USING A BUR

ADVANTAGES:

ALL ACCESSARY CANAL ARE FILLED.

NO SPACE LEFT UNFILLED IN THE CANAL.

DISADVANTAGES:

CAN LEAD TO THE OVER-OBTURATION OR FILLING BEYOND THE APICAL FOREMEN.

EXCESSIVE VERTICAL FORCE CAN LEAD TO ROOT FRACTURE.

Roo t canal Sealan ts, propert ies

8/12/2019 Endontics

106/109

Zinc Oxide EugenolZinc Oxide Resin

Endomethasone

Ca(OH)2 basedParaformaldehyde

Diaket ( polyvinyl resin)

Methacrylate based (Epiphany)

Epoxy resin (AH26, AH plus)

Sealan t pu ff desirab le or no t?

8/12/2019 Endontics

107/109

Desirable Obturat ion !

8/12/2019 Endontics

108/109

RC Compl icat ions and

8/12/2019 Endontics

109/109

Management.......fo r next t im e