Successful endodontics

DIAGNOSIS

Biomechanical Preparation
 cleaning & shaping
 microbial control.

Root canal obturation

Cleaning
Is the removal of all potential irritants from the root canal. This includes:
Infected material Organic Remnant Microbes

This goal is achieved through: 1) proper instrumentation 2) Use of irrigants

Role of irrigant in cleaning & shaping.

Flushing out gross debris. Prevent dentin mud formation. Remove smear layer. Antimicrobial effect. Lubrication cutting efficiency. Bleaching.

Types of irrigant:
Saline. Sodium hypochlorite. Hydrogen peroxide. Organic acid irrigants. Calcium hydroxide. Chlorohexedin gluconate.

Shaping:
Refers to the specific shape ,(which is a continuously tapering, and funnel shaped preparation from the canal orifice to the

apical constriction), given to the canal to be compatible with the filling material.

Biological objectives for cleaning & shaping:

Totally clean root canal system. Avoid pushing debris beyond the apex. Confine all your instrument within the root canal. Do no harm.

Mechanical objective for cleaning & shaping: echanical shaping:

1. Develop a continuous tapering conical form,
from the canal orifice to the apical foramen.

2. Make the canal narrower apically with the

narrowest terminus. cross section diameter at its

3. Make preparation in multiple planes. 4. Never transport foramen. 5. Keep the apical foramen as small as practical.

Principles of root canal cleaning and shaping.

1- Totally clean the root canal system. 2-Assume curvature in all canals. 3- pre-curving of files.

4- Avoid aggressive apical Instrumentation

Alter Canal path

Forcing debris byond the apex

Root apex fracture

5- Avoid overzealous canal shaping

6- avoid apical blockage.

 Etiology.  Effect.
Canal diameter

Depends On.
File motion Proximity of file tip

 How to avoid

2 3 5 1

    

Convenience form. Resistance form. Retention form. Extension. Toilet of the cavity.

Watch-Wind

H- File

30-60 B-F

Techniques of RC Preparation

Basic Consideration during Cleaning and Shaping 1-Never files a dry canal. Copious Irrigation before during and after each file. 2-The exact working length must be established at first. 3- regular checking of stopper position at the established WL 4-Use clean instruments to re-enter the canal. 5- Never forces an instrument if it binds.

Basic Consideration during Cleaning and Shaping

6- Use instrument in sequence without skipping sizes. 7-Duplicate a curve in each instrument before entering the curved canal. 8 -Maintain a patent apical constriction following each file size. 9- After the access opening preparation, the airwater syringe must never be used till the end of treatment forcing drug, airetc., through the apical foramen 10-When an interacanal instrument has been severely bent or weakened it should be discarded.

1. Apical-coronal
 Standardized
 Step-back  Balanced force (Roane)

2 - Coronal-Apical
Crown- down pressureless . Step down Double- flared. Canal master

3 Combination (Hybrid tech). 4 Automated

Engine driven e.g. Profile & Lightspeed Sonic Ultrasonic

5 laser aided.

Instrumentation starts at the apex and go back to coronal portion.

1) Standarized technique.

2) Step-back technique. Step-

Complete apical preparation with master apical file # 25

Stepping-Back 3-4 sizes larger than MAF

Each file is 1mm shorter than the previous one

 Is the procedure of returning to the original working length of the tooth with the master apical file after each step-back file

Coronal Flaring with GG drills #1,2,3 or H-file

PreCurving the instrument

K- Reamer #15

K-File #15

Typical sizes for instrumentation:

Maxillary anterior teeth Mandibular anterior teeth Single canal bicuspids Buccal canals of maxillary molars and mesial canals of mandibular molars with moderate curves. Maxillary molar (palatal canal) Severely curved fine canals Severely curved large canals #60-80 #35-50 #35-40

#25-35

#50-60 #20-25 #35-45

3) Balanced Force Tech. (Roane Tech.)

Flex-R file in clockwise/anticlockwise rotational motion

-Modified tip - Triangular cross-sec. - Anti-clockwise effic.

45

60

80

25

30

40

Apical preparation is termed Apical control Zone By carrying the preparation to the radiographic apex.

Modified Balanced Force

Advantages of Balanced force prep.

1- little or no measurable apical transportation. 2- less deviation from the original canal curvature. 3- Modified preparation allow easier preparation with less extruded debris and less apical transportation.

Disadvantages
1- excessive clockwise rotation than 90 working load, instrument tip locked into canal wall instrument separation. 2- large radicular shaping with GG may cause strip perforation

Instrumentation starts at the coronal portion and go on to the apex.

Advantages of early radicular access in coronal apical preparation techniques:

 Elimination of microbes and infected dentin.  Better and deeper penetration of irrigant.  Instrument approach apical 1/3 with less strain and better tactile sense.  Provides more tactile sense in the apical 1/3.  Less extruded debris.  Less time for preparation.  Less chances of apical blockage.

1)Crown1)Crown-down pressureless technique.

Crown Down Pressure-less Tech.

Radicular Access Length

Coronal Flaring

Crown-Down Preparation

2) Step down Tech.

2) Step down Tech.

Flaring of coronal 2/3

Apical preparation

Stepping back

Step-Down

Double Flared Tech. Double flared tech.

File gently

Crown Down prep. till WL without rotary GG

Crown Down prep. till WL without Rotary GG.

Apical Preparation

Stepping-Back

Crown Down Pressure-less Tech.

2) Step down Tech.

Canal Master Tech.

* Smooth flexible non-tapered shaft. * Short cutting head. * Non-cutting pilot tip. * Intermediate sizes

#50

#80

Middle and cervical thirds of the root canals are instrumented with Canal Master rotary .instruments to a point of curvature

#20

Canal Master hand instruments are used for apical preparation with #20 - #40 or #50

#50

Canal Master hand instruments are used for 0.5 mm step-back technique

Canal Master Tech.

Advantages 1- Ledges, perforation, Zipping. 2- Maintain original canal curve.
3- round cross-section. Disadvantage *Instrument separation

Advantage of mechanical instrumentation:

Less Effort. Canals are enlarged quickly. Debris is removed easily. Canals are more uniform and smoother.

Disadvantage of mechanical instrumentation:

Greater chance for canal ledging. Greater chance for canal perforation. Greater chance for instrument breakage. Loss of tactile sensation.

Rotary NiTi instruments:

The unique properties of NiTi alloy have allowed instruments to be manufactured for use in a rotary handpiece and these have been shown to be effective in canal preparation.
flexibility

Dec. ledges& perforations

Dec. inst. separation

S S

Rotary Instrumentation using Ni-Ti instrument

Step-back Hand Instrument

Rotary NiTi instruments:

Profile. Protaper. Light speed. Great taper. Quantec. K3 Rotary

Variable Tapers

PROFILE

PROFILE O.S. : Angle Taper from 5 to 8%

PROFILE 0.6 : Angle Taper 6%

PROFILE 0.4 : Angle Taper 4%

ISO Standard : Angle Taper 2%

PROFILE PROFILE Motor and Speeds

Stable speed : 150 350 r.p.m.

LASER-ASSISTED CANAL PREPARATION

 The 308-nm excimer laser was used successively for preparation of root canals as it has a good transmission through water. Advantages. Disadvantages .

Intracanal dentin surfaces (apical third) under SEM1500X- laser parameters: A Dentin surface lased e Erbium :YAG 100 mJ and 15 Hz. Effective debris removal.

Erbium:YAG

Control B Control; unlased dentin surface. ND:YAG C Nd:YAG reduced to 80 mJ and 10 Hz. Note melted and recrystalized dentin surface.

Problems encountered in R.C. Cleaning and Shaping

(Instrumentation Errors)
Underinstrumentation. Overinstrumentation. Apical foramen perforation. Ledge formation. Change in canal curvature. Apical transportation Zipping. Root Perforation. Loss of WL Instrument separation breakage. Canal can not be negotiated.

Inadequate filing in coronal 2/3 Insufficient enlargement of apical 1/3

1-Underinstrumentation

Failure

2- Overinstrumentation

Root Fracture

3- Apical foramen perforation

4- Ledge Formation
Is an artificially created irregularity in root canal wall that prevents the placement of instrument to WL.

Etiology
1- straight instrument 2- large # inst. In curved canal 3- forcing inst. e apical pressure 4- Skipping

Management
- Bypassing it. if can not - instrument to ledge level

5- change in original canal curvature 6- Apical foramen transportation zipping

Outside wall of the curve. Inner side wall of the curve

7- Root Perforation

Perforation In apical 1/3 - Etiology - Diagnosis - Management

Root perforation

These problems may be overcome by:

1. Reducing the area of instrument actively engaged in cutting.

2. Reducing uncontrolled forces on canal

wall:
     

Precurving the file. Use of smaller files. Use of intermediate files (golden sizes). Use of flexible files ( flex file , NITI files ). Use of preflaring techniques. Anticurvature filing

Anticurvature Filing
Filing preferentially away from the inner curve or furcal aspect (site of potential perforation) Filing safety zones with more strokes than furcal wall 3:1

8- File short of determined WL

Etiology:
1- apical blockage 2- lack of recapitulation 3- canal ledge 4- fractured instrument 5- change stopper position 6- skipping instrument sizes

Prevention

Old files

Etiology

H-file in reaming Large # in fine canal Skipping sizes

Management of Fractured instruments

 may be removed with special extractor mechanically.

Management of Fractured instruments

 It may be bypassed if it is not too far inside the canal.

Management of Fractured instruments

If it can not be bypassed (more apically located), the canal is prepared to the point of breakage and filled to this point.

1010- Canal can not be negotiated to WL.

EDTA Plus EDTA

Laser canal prep.

(

Adv.

Root canals prepared with laser irradiation were cleaner than that prepared with hand instruments and the smear layer was removed.

Dis

The main limitation of the laser is the fiber which carried the laser beam in one parallel direction so, The main effect of the laser is kept concentrated at the apical foramen resulting in damaging effect on the periapical tissues. While the lateral walls of the canal are affected only by reflected and scattered part of irradiation with minimal indirect effect.