Professional Documents
Culture Documents
The root canal system must be: Cleaned of its organic remnants Shaped to receive a three dimensional filling of the entire root canal space
The canal is
Irrigation
An ideal irrigant: Is nontoxic Dissolves vital and necrotic tissue Is bactericidal Lubricates the canal Removes the smear layer
Sodium hypochlorite
Sodium Hypochlorite
Prolube
Prolube
Facilitates placement of file Entraps debris Aids in removal of the smear layer
EDTA
Instruments
Instruments differ according to:
Metal Taper Tip design Cross sectional geometry Length of cutting blades Sizing
Metals
Nickel titanium Excellen flexibility Stainless steel Less flexible
Metals
Metals
Taper
Definition
Increase in diameter per unit length
What is Taper?
D16
D1
D16
D1
What is taper?
Taper
Taper of instruments in U of M file kit
Stainless steel files 0.02 taper OS variable tapers ranging from 0.05 to 0.08 Series 29 rotary Profiles 0.06 taper NiTi hand files 0.04 taper
Tip Design
Non-cutting tip Bullet nose (60 degree) tip Smooth transition angle where tip meets flat radial lands
Tip Design
Designed to follow a pilot hole Guides instrument through canal during preparation
Tip Design
Cross-sectional geometry
Three radial lands Each contains bidirectional cutting edges Keep instrument centered in the canal Cutting edges scrape dentin
Radial lands separated by three ushaped flutes Provide space for accumulation of debris Moves debris out of canal
Sizing of instruments
ISO sizes Number refers to tip diameter in tenths of mm The tip diameter increases by 0.05 mm from sizes 10 to 60, then by 0.10 mm
Sizing of instruments
% increase in diameter from #10 to #15 file is 50% Difference between #55 and #60 is only 9%
Sizing of instruments
Series 29 Progressive 29% increase in tip diameter Instruments are better spaced More instruments in smaller sizes and fewer large instruments
Allows more effective irrigation Removes majority of tissue and microbes before apical third is approached Reduces change in working length during apical preparation
Orifice shapers 0.06 taper rotary Profiles 0.04 taper hand Profiles
Clinical Procedure
Estimate working length Parallel radiograph Estimated working length is the distance from the reference point to the radiographic apex
Parallel Radiograph
Clinical Procedure
Clinical Procedure
Explore canal patency
Ensure that canal is negotiable to radiographic apex Small file #10 K-file May need to precurve these SS files
Clinical Procedure
Files used in a push/pull or quarter turn pull motion Never rotate these files through 360 degrees
Clinical Procedure
Clinical Procedure
Clinical Procedure
Clinical Procedure
Actual WL determination
Preparation should terminate at Apical constriction 1 mm short of radiographic apex
Clinical Technique
Actual WL determination
Clinical Procedure
Actual Working Length Determination
Clinical Procedure
Clinical Procedure
Apex Locator
Clinical Procedure
Clinical Procedure
This technique applies only to teeth ranging from 18 23 mm in length
Coronal third measurement is WL minus 8 mm Middle third measurement is WL minus 4 mm Apical third measurement is WL
Coronal third measurement is working length minus 8 mm Prepared using Profile orifice shapers
Irrigation
Repeat the steps described for largest OS Move to next smallest OS Continue this sequence until working length minus 8 mm is reached
Return to largest OS This will now extend further into the canal than it did previously Repeat this sequence until this (the largest) OS reaches WL minus 8 mm
Never force any instrument apically Irrigate after every instrument Use copious amounts of Prolube
Measure working length minus 4 mm on the largest 0.06 taper series 29 rotary file Set green rubber stop at that length Lubricate the canal with Prolube
Advance file in 1 mm increments When resistance is encountered retract file while still rotating Copious irrigation with NaOCl
Measure working length on #15 file Set rubber stop at that length Lubricate the canal with Prolube
Advance size 15 file to working length Rotate file through 360 degrees Irrigate copiously with NaOCl after each file
Advance size 20 file to working length Continue through sequence, seating each file to working length
The largest file that extends to working length is the Master Apical file (MAF) For large canals minimum MAF #40 - 50 For small canals minimum MAF #35 - 40
Mission accomplished