Endodontics

Instruments

Endodontics
1987 the American Association of Endodontists defines Enodontics as
the field of dentistry concerned with the morphology, physiology and
pathology of the human pulp and the periradicular tissues.
Scope:
1. differential diagnose and treatment of pulpal and periradicular disease
2. vital pulp therapy - pulp capping
3. Root canal therapy pulpectomy, non-surgical treatment of root canal
systems with or without periradicular pathosis of pulpal origin,
obturation of the root canals
4. selective surgical removal of pathological tissues resulting from pulpal
pathosis
5. intentional replantation and replantation of avulsed teeth
6. surgical removal of tooth structures such as apicectomy, root
amputation, hemisection
7. Internal bleaching
8. Retreatment of previously endodontic treated teeth
9. Coronal restoration posts placement and core build- ups

Endodontic treatment
Diagnostic phase cause of disease is
established
- treatment plan is prepared
Preparatory phase cleaning and shaping the
root
canal in purpose to remove its
content
- root canal is shaped to receive a
three- dimensional filling
Obturatory phase root canal is filled with an
inert
material to ensure a tight sealing

Indications
All teeth can be treated
endodontically

Contraindications
True
False

True contraindications
1. Insufficient periodontal support
Advanced periodontal disease
Bone resorption -lost of
periodontal support -> loose
2. Inadequate crown-root ratio

True contraindications
3. Caries of the root and furcation
4. Internal resorption with perforation

5. Vertical root fracture

False contraindications
1. Fractured instruments
Possibility to bypass the instrument=> clean
shape
fill
Instrument blocking the apex => endodontic
surgery -> creating a flap-> obturation
through the flap

False contraindications
2. The presence of calcifications
Pulp inflamed -> calcified -> dies
Direction corono-apically
The apical third is negotiable
Useful tool operating surgical
microscope
- ultrasound inserts
designed for endodontic treatment

False contraindications
3. Extreme curvatures of root canals
Precurved files
Fine files
Microscope
4. Difficulties of retreatment
Silver points on the root canals
5. Size of the periapical lesion
Up to 2cm2 =granuloma
Bigger then 2cm2 = cists
treatment

lesions of endodontic
etiology -> endodontic

True indications
Age
Health condition diabetes
- leukemia
- cancer
- heart diseases
Pregnancy temporization legal
issues

Instruments
Classiffied by way of action in:
Hand instruments
Mechanic- rotativ instruments
Classified by purpose:
Instruments for examination
Instruments for cleaning and shaping
Instruments for obturation

The files
Files are hand instruments used for
cleaning and shaping the root canal
Tip
Working part
Shaft
Handle
system
16mm

Length - 21, 25, 31mm

Number of the file is given by the diameter of the tip
Nr. 20 = diameter of the tip of 20/100 mm
Taper 2% (0.02)
= for each mm the diameter
ff the file is increasing by
20/100 mm=0.02mm

ISO
Standardization
Stopper

Pro File 29

Instruments for cleaning and

shaping
K - files

Cross section - quadrangular which

increases its resistance to torsion and
flexion

Uses: - mechanical preparation of

root canals
Tip is cutting with aggressive transition
angle danger in producing ledges
Very efficient in cutting because of the
square cross section inconvenient
produce large amount of debris which
can be plugged in the apex
For being efficient they need to be in
contact with the dentinal wall

Motions of K files
Filing - push and pull motion
Reaming - clockwise rotation
Watch winding motion
30- 60 clockwise followed by
30 60 counterclockwise while the
instrument is pushed forward in the canal

Balanced forced technique

Engaging = 90 clockwise+ insertion
360 counterclockwise at the same depth
Disengaging = 90 clockwise + retraction

The tip of the instruments is

transformed from a cutting into a
non-cutting tip
The purpose of such a design is to
guide the tip through curvatures and to
reduce the risk of ledging
and perforation.

Chateterism files C-files

K files of small diameter 0.06,
0.08, 0.10
Used for:
Initial negotiation and
exploration of the root canals
Explore the location of the canal
orifices
Rectangular cross section->
extremely resistant to flexion
Tip pyramidal allow better
negociation of calcified canals
Smooth surface-> less friction

Reamers
Triangular/rectangular in
cross section
Tipp cutting
Number of blades from
the number of blades of a
K file
Less cutting efficient
Less debris
Used:
Straight root canals
Removal of debris
Enlargement of root canal

Reamers motions
Rotation moderate pressure
- straight root
canals
Passive insertion to a depth
permitted by the canal
diameter and a quarter
clock-wise rotation with
simultaneous extraction of a
few millimeters. =>cutting
action during the withdrawal
phase. Repetitive
Not 360o rotation => risk of
fracture

Hedstroem file H-file

Low resistance to flexion

Risk of fracture
-> file should fit loosely
in the root canal
-> precurved in curved canals
-> never rotated

The cutting angle of the blades

(helical angle) against the dentine
is, close to 90 making this
instrument particularly aggressive
when using the push and pull
(filing) action.
The design of the blades is however
also responsible for the structural
weakness of the Hedstroem files,
when used in a rotational manner.
The efficient cutting action of the HFiles seems to be superior of that of
K-Files usefull for circumferential
filing motion of canals with oval or
eliptical cross-section.
Motion filing push and pull action
Active when removed in contact with
the walls

Barbed broaches
hooks

Use removal of pulp tissue en

masse from the root canal
Predisposed to fracture
Fracture occurs if: - the instruments
tip - engages the canal wall and
is rotated
- is inserted
to deep in the canal hooks
bend in, removal they bend out
and fracture
Insertion 2/3 of the root canal
Rotation 180 removal without wall
contact
Use in large canals C, mand M
distal canal, upper M palatal
canal

Rotary instruments
Steel - Gates Glidden drills
- Paeso Reamers
Ni-Ti rotativ instruments Pro File
Pro Taper
Lightspeed
Quantec
Hero Shaper
K3

Gates Glidden drills

Attached to the low speed

handpiece
Use - for eliminating interferences
from the coronal third of the canal
Long shank
- preparation for the coronal
third of the root canal
The Gates drills must be used
passively on withdrawal from the
canal with a brush like
Handle with notches
circumferential movement and
Indicating the size
their use must always be
preceded by preflaring of the
canal using hand instruments.
Non cutting tip
An active use of the Gates Glidden
drills is not recommended
because they can lead to the
Eliptical flame shaped
formation of ledges and
extremity
dangerous structural weakening
that in the curved and thin canals
can cause stripping.

Instruments used for obturation

Endodontic condensers (pluggers) and spreaders are smooth tapered metal
instruments used to compress and compact the gutta-percha material either
laterally or vertically within the prepared root canal space according to either
the lateral or vertical condensation of gutta-percha filling techniques.
Pluggers - flat-ended tip used for compression
Spreaders - tapered
- pointed tips for lateral packing of the material.
Finger spreaders - similar in design to K-type files
- less force during condensation
- decrease probability to induce root fracture
Hand spreaders - the operative head at various angles to the shaft,
- delivered in standardized sizes corresponding to the
K files: are colour
coded
.

Forceps and pliers