by:Ruffalyn P.

dela Cruz
OUTLINE:
Introduction
Instrument for access cavity preparation
Basic instrument pack
Burs
Rubber Dam
Instruments for root canal preparation
Hand Instruments in endodontics
Power-assisted root canal instruments
Measuring instruments,gauges and stands
Instruments for retrieving broken instruments and posts
Instruments for filling root canals
Lateral condensation
Vertical condensation
Thermoplasticized injectibleible Gutta-percha
Gutta-prcha carrier device
Sterilization of endodontic instrument




It is now widely accepted that
successin root canal treatment depends
upon thorough cleaning and shaping of
the root canal system and the
placement of the root canal filling of
gutta-percha and insert sealer.

Instrument for access cavity
preparation
Basic instrument pack
1.Endodontic explorer is a double ended, extra-
long, sharp instrument design to help the
location of canal orifice and probing for
fractures on the pulp chamber floor.
2.Endodontic excavator is required to scoop out
the pulp chamber contents and flick away pulp
stones during access cavity preparation.
3.Mouth mirror is best suited for visibility deep
with in the pulp chamber

4.Endodontic locking tweezer are ideally
suitable in handling of paper points, gutta percha
points and root canal instruments.
5.Briault and periodontal probes are necessary
for the initial assessment of the tooth for caries
and localized periodontal condition.
6.Flat plastic instrument and endodontic pluggers
are needed to place interappoinment
restorations .
7. Endodontic ruler the 0.5 mm ruler is
convenient instrument w/c measures files,
Gutta-percha cones etc.

8.Irrigating syringe is important to deposits
endodontic irrigants in the pulp chamber.
Luer-lok type is the syringe of choice.
The barrel tip- prevents the needle dislodgement
occuring during irrigation.
Whilst-the tip itself is notched to prevent
accidental forcing of irrigant into the periapical
tissues.


Burs
Several types of burs will be required to
accomplish good access preparation.
1.Friction grip tapered fissure burs ,are used in
the initial stages of access preparation to
established the correct outline form.

2.Round burs,normal and extra long ,are
used to lift the roof off the pulp chamber
and eliminate overhanging dentin. The
longer and smaller sizes can be used to
find calcified canals.

3.Safe-ended burs or tungsten carbide bur,
both with a non-cutting tip, is used to taper
and smooth the accesss cavity preparation.
The non-cutting tip prevents gouging on the
floor of the pulp chamber.

4.Gates-Glidden bur is a one piece rotary
cutting instrument with a bud-shaped cutting
point mounted on the fine shaft, now widely
used in all root canal preparation techniques.
Three main uses:
a. The coronal 2/3 of molar canals are generally wider less
curved than the apical 3
rd,
therefore these parts can be
quickly and safely prepared with Gates Glidden burs.
b. The Gates-Glidden bur is useful for removing gutta-
percha from a canal during post-space preparation or during
retreatment.
c. The bur may be used to widen the canal when an
instrument has fractured within it, to aid retrieval of the
broken instrument.
Rubber dam
Is purchased in 150mm squares, and comes in
various thicknesses. The thicker the material has the
advantages of a tight fit around the neck of the
tooth, thus providing hermetic seal, w/out the use
of floss ligatures. The thicker the material does not
tear easily.
The rubber dam is used to:
1.Protect the patient from inhalation or ingestion of
instruments, medicaments and debris.
2.Provide a clean, dry field of operation free from salivary
contamination.
3. Prevent the tongue and cheeks from obstructing the operating
field
4. Prevent the patient from rinsing the mouth and interfering
with the efficiency of the treatment.
Instruments for applying rubber dam
1. Rubber dam punch several types of punch
are available and most are able to punch five or
six holes ranging in diameter from 0.5 to
2.5mm. The size of hole that is punched is
important:the ease of application with large
hole must be balanced by seal at the cervical
margin.
The important consideration in a punch is
that it cuts a clean hole in the rubber.
2. Rubber dam Forceps the forceps are use
to place, adjust and remove the rubber dam
clamp.




3. Lubricants and floss if more than 1
tooth is to be isolated, it is sometimes
difficult to pass the rubber between the
teeth. If the contact point is tight but
smooth, the use of the lubricant on the
undersurface of the dam is very helpful.
Dental floss - apart from preventing the
ingestion or aspiration of the clamp, dental
floss is particularly useful for accessing the
condition of the mesial and distal contact
areas, and thus for facilitating the passage
of the rubber sheet beneath them.
4. Rubber dam frame The rubber dam must
be stretched over the patients mouth, so as
not to obscure the operators vision and to
provide patient comfort. Rubber dam frames
are available in a variety of shapes and size.




5.Rubber dam clamps clamps have two
uses: first, they anchor the dam to the tooth,
and second, they retract the gingiva. In
endodontics, only anchorage is of concern.

Clamp is consists of a pair of jaws joined by a spring bow. They
maybe wingless or winged.
The latter have a protrusion attached to each jaw. The wings
are use to attach the rubber dam to the clamp so that both
clamp and rubber may be applied to the tooth together.
Clamps may be retentive or bland.

Retentive clamps are
design to make a four-
point contact with the
tooth and have a narrow,
curved and slightly inverted
jaws, which may displace
gingival tissue to grip the
tooth below the level of
greatest circumference.
They are very useful on
partly erupted teeth.

Bland clamps have flat
jaws w/c grip the tooth
around its entire
circumference and because
of their flatness, they are less
likely to impinge on the
gingiva. However , they can
only be used where a tooth
is fully erupted and has a
cervical constriction that
prevents the clamp from
slipping off the tooth.
Method of applying the rubber dam
In root canal treatment , it is sufficient to
isolate only 1 tooth and this makes rubber dam
application more simply. Essentially, there are
two method of application:
1. In the first, the rubber dam is attached to
the clamp and frame before it is place on the
tooth.
2. In the second, the clamp is attached to
the tooth before the dam is placed over the
clamp.
Instrument for root canal preparation
-Hand Instruments are group according to their usage by the ISO
(International Organization for Standardization). ENDODONTIC
INSTRUMENT STANDARDIZATION. In 1959, a new line of
standardized instruments and filling material was introduced.

1. A formula for the diameter and taper in each size of instrument
and filling material was agreed on.
2. A formula for a graduated increment in size from one
instrument to the next was developed.
3. A new instrument numbering system based on instrument
metric diameter was established.

-This proposals have been widely accepted, and the endodontic
hand instruments; i.e. files, reamers and barbed broaches, are
standardized in relation to size, colour coding and physical
properties.
Barbed broaches are made from soft steel
wire. The cuts are made eccentrically around the
shaft so that it is not weakened excessively at any
one point.
Barbed broaches are mainly used for the removal
of the pulp tissue from root canals, but also for
the removal of the cotton wool dressings.

Provided the instrument is loose within
the canal and the barb is used to engage
soft tissue only, the risk of fracture is
minimal
The barbed broach must always be fitted loosely in the canal. The barbs
of a tightly fitted broach will engage the dentinal walls on the
withdrawal stroke, greatly increasing the likelihood of instrument
fracture.
are instruments that ream
(twisting)specifically, a sharp-edged tool
for enlarging or tapering holes.
Design & Structure
A reamer is manufactured from a triangular or
square steel wire that is twisted to give the typical
shape of a reamer. The angle between the long-
axis and the cutting blade is small, which is why
preparation by reamer is effective only in
rotating motion.
The tip of the instrument is cutting which makes
a reamer suitable for the preparation of straight
canals only without the risk of ledging.

Endodontic reamers cut by being tightly
inserted into the canal, twisted clockwise
one quarter- to one half-turn to engage
their blades into the dentin, and then
withdrawnpenetration, rotation, and
retraction.


Sizes & Codes
Reamers come in sizes 06 140, all with a
taper of 0.02. Reamer design is identified by
the triangle symbol on the handle.

Safety tips
Reamers can be rotated only using
moderate pressure. Use of force, particularly
with smaller sized instruments, may result in
distortion of the helical structure and
ultimately in fracture. Each instrument
should be checked for symmetry by rotating
it against an even background before
introducing it into the canal.

The tighter spiral of a file establishes a
cutting angle (rake) that achieves its primary
action on withdrawal, although it will cut in the
push motion as well. The cutting action of the
file can be effected in either a filing (rasping) or
a reaming (drilling) motion.
TYPES OF FILES:
a. K-files
b. Flexofile
c. Flex-R/ Flexoreamers
d. Hedstrom and Safety Hedstrom
e. Nitiflex-file
a. K-file are manufactured from square or
sometimes triangular steel wire that is twisted
to give the typical shape of a K-file. The angle
between the long-axis and the cutting blade is
greater than in a reamer, and therefore
preparation by a K-file is effective both in
rotary and filing motion.






K-file: Sizes & Codes
K-files are produced in sizes 06 140, all
with a taper of 0.02. K-file design is
identified by the square symbol on the
handle.

K-file: Recommended use
The K-file is suited for the preparation of straight
canals. It prepares dentin effectively both in filing
motion (up and down) and when rotated. In slightly
curved canals the recommended techniques are
continuous rotation (lower picture) when the
resistance is small and balanced force (upper picture)
against greater resistance. Compared to reamers, the use
of continuous rotation is limited because of the
screwing effect typical of K-files.

K-file: Safety tips
K-files can be rotated only using
moderate pressure. Use of force, particularly
with smaller sized instruments may result in
distortion of the helical structure and
ultimately in fracture. Balanced force
technique and filing instead of continuous
rotation should be used with sizes 06 15 to
minimize fracture risk. Each instrument
should be checked for symmetry by rotating
it against an even background before
introducing it into the canal.

b. Flexo file has a rhomboid-shaped
and twisted instrument has a series of cutting
flutes with alternate sharp cutting edges and
obtuse non-cutting edges. The cutting
efficiency is greater than many brands of k-
files, due to its increase flexibility and ability
to remove debris as its alternating blades
provide a reservoir for debris. Flexofile is well
suited for the preparation of evenly curved
canals without the risk of ledge formation. A
disadvantages of this file is its quicker loss of
cutting efficiency.

Sizes & Codes
Flexofiles come in sizes 15 40, all with a taper of
0.02. K-file design is identified by the square symbol on the
handle.
Flexofiles can be best distinguished from normal K-files
by the size code at the top of the instrument: in flexofiles
the color of the number is the same as the color of the
handle.
Recommended use
. The flexofile prepares dentin effectively both in filing
motion (up and down) and when rotated. In slightly curved
canals the recommended techniques are continuous
rotation (lower picture) when the resistance is small and
balanced force (upper picture) against greater resistance. Use
of continuous rotation is limited as compared to reamers
because of the screwing effect typical of K-files.

Safety tips
Flexofiles can be rotated (balanced force) only
using moderate pressure. Use of force, particularly with
smaller sized instruments, may result in distortion of the
helical structure and ultimately in fracture. Every
instrument should be checked for symmetry by rotating it
against an even background before introducing it into the
canal.
c. Flex-R file/flexoreamer
Design & Structure
- Flexoreamers are manufactured from a
triangular steel wire that gives sharper cutting
blades and more room for debris than the
conventional K-file w/c is twisted to give the
typical shape of a reamer. The angle between the
long-axis and the cutting blade is small, and
therefore preparation by flexoreamer is effective
only in rotatory motion.
- The tip of the instrument is non-cutting
(bat-tip, inactive tip) making flexoreamer well
suited for the preparation of evenly curved canals
without risk of ledging.



Sizes & Codes
Flexoreamers come in sizes 15 40, all with a taper of
0.02. Reamer design is identified by the triangle symbol on
the handle.
Flexoreamers are best distinguished from normal
reamers by the size code at the top of the instrument: in
flexoreamers the colour of the number is the same as the
colour of the handle.
Recommended use
The flexoreamer is well suited both for straight canals
and slightly curved canals. It prepares dentin in rotation but
not if used as a file. The cutting efficiency and usability of
flexoreamers are excellent. In slightly curved canals the
recommended techniques are continuous rotation (upper
picture) when the resistance is small and balanced force
(lower picture) against greater resistance.

Safety tips
Flexoreamers can be rotated only using
moderate pressure. Use of force, particularly with
smaller sized instruments, may result in distortion of
the helical structure and ultimately in fracture. Every
instrument should be checked for symmetry by
rotating it against an even background before
introducing it into the canal.

Design & Structure
Hedstrom files are manufactured from
round steel wire by grinding. The angle between
the long-axis and the cutting blade is close to
right angle, which is why preparation by
Hedstrom files is effective only when using a
filing motion (up and down movement).
Sizes & Codes
Hedstroms come in sizes 08 140, all with a
taper of 0.02. H-file design is identified by the
circle symbol on the handle.

Recommended use
Hedstrom can be used
both in straight canals
and curved canals. The
hedstrom prepares dentin
effectively only when
using a filing, up and
down motion. In curved
canals, files (sizes 20/25
and bigger) must be pre-
curved to correspond to
the shape of the curve. H-
files must always fit
loosely in the canal to
avoid risk for fracture

Safety Hedstrom file- features a non-
cutting safety side along the length of the
blade w/c reduces the potential for strips
perforations. A millimeter scale is etch on to
the shaft of the instrument to facilitate
length control. The instrument has a good
cutting efficiency in either a filling or
reaming action. Therefore it could be
classified as a hybrid design.
Safety tips
Hedstrom files show a greater risk for
fracture than reamers and K-files if used in a
wrong way. However, correctly used H-files
rarely fracture. Hedstrom must always fit
loosely in the canal and they must never be
rotated. In curved canals Hedstrom-files are
pre-curved to correspond to the shape of the
canal. Before introducing them into the canal,
all Hedstrom files must be inspected for possible
earlier damage to the instrument and discarded
immediately if an asymmetry in the cutting area
is found.


Design & Structure
NiTiflex-files are manufactured from nickel-
titan wire that is ground to give the typical
profile of a K-file. The angle between the long-
axis and the cutting blade is bigger than in
reamers, and therefore preparation by NiTiflex-
file is effective both in rotating motion and in
filing motion (up and down movement).
The tip of the instrument is non-cutting
(bat-tip) which makes the NiTiflex-file well
suited for the preparation of curved canals
without the risk of ledge formation.

Sizes & Codes
NiTiflex-files come in sizes 15 60, all with a taper
of 0.02. K-file design is identified by the square
symbol on the handle.NiTiflex-files can be best
distinguished from normal K-files by the code that in
NiTiflex-files is printed with two colors.
Recommended use
NiTiflex-file is suited to be used both in straight
canals as well as in curved canals. The NiTiflex-file
prepares dentin both in filing motion (up and down)
and when rotated. In curved canals the recommended
techniques are continuous rotation when the resistance
is small and balanced force against greater resistance.
Use of balanced force instead of continuous rotation is
easier because of the K-file design, which causes a
screwing effect in continuous rotation. The use of filing
motion in curved canals can cause transportation and
ledging, and is not recommended.


Safety tips
NiTiflex-files can be rotated only using
moderate pressure. Use of force may result in
fracture also with bigger sized instruments.
NiTiflex-files are super-elastic and always return
to their original shape (= elastic memory),
which makes it difficult or impossible to detect
weakened structure by visual observation.
Fracture risk is best controlled by correct use
and by using the instrument no more than ten
times

Power-assisted root canal instruments
Reciprocating handpieces
Specifically design handpieces providing a
mechanical action to a root canal cutting. They
are designed to reduced the time spent in canal
preparation.
a. Giromatic- the 1
st
mechanized handpieces,it
accepts barbed-broach-type files and three sided
files.
b. M4 Safety handpiece- it has a simplified chuck
mechanism activated by thumb pressure to
accommodate a plastic-handled root canal
instrument. The handpiece lets the instrument glide
along the walls of the canal by mimicking
commonly used hand movements.

c. Canal Finder system- is consist of a contra-angle
handpiece powered by a micromotor, producing a
reciprocal screwing action w/c enables the file to
cleave, rather than abrade the canal wall, and
advance along the path of least resistance,
maintaining the original pathway.

Ultrasonic Instrumentation
a. Cavi-Endo- the 1
st
ultrasonic unit specially
design for endodontic use. The machine is
modified cavitron w/c contains irrigants
reservoir thats supplies a continous flow of
sodium hypochlorite through a specially
designed handpiece on to the energized file.

b. Piezoelectric- these units is supplied with a
multifunctional handpiece, into which
different tips are fitted. This unit is
additionally used for the location of calcified
canals, removal of broken instrument s,
removal of cemented posts, and for root end
cavity preparation during periradicular
surgery.
Sonic Instrumentation-The Endo MM1500 was
developed as a sonic vibratotory handpiece to be
attached to the turbine line of a dental unit. The
sonic instrumentation avoids transportation of
curved canals in the smaller sizes.
Nitimatic system has a hand piecerun by an
electric motor which provides load-torque
compensation and constant speed even at a very
low speed.
- in using Ni-Ti instruments is to prevent heavy
hand pressure and binding. If you use light hand
pressure, the binding is minimal. You will remove
less tooth structure at any one time, but will be
compensated for it by increasing the number of
instrumentation cycles.

Measuring instrument, gauges and stands
The importance of instrumentation to a
known canal length cannot be overstressed.
A rubber stops-provides the simplest and
most positive stop instrumentation and some
files have already a stopper.
A ruler-is necessary to set the stop, or
alternative measuring devices have been
developed to make the procedure easier.
Stand- is useful as the instruments can be
placed in order, and are easily accessible at the
chairside.
Instrument for retrieving broken
instrument and posts
As prevention is much easier than the removal
of a fractured instrument from the root canal,
all root canal instrument should be used
carefully. When an instrument fractures, it
may be possible to remove it w/ one of
number of different instrument.
1. Forceps-can be used to removed a broken
instrument only if the end of the fractured
instrument is visible and not jammed firmly
within the canal.
2.Cancellier kit- if the obstruction is loose but
not free, cancellier extractors are simply hollow
pluggers, can be used to fit over the
obstruction. A single drop of cyanoacrylate
glue depositsed into the cancellier sticks the
instrument into the extractor, it is retrieve.


3.Post remover- these devices exerts a strong
pull on the post and there is a risk of tooth
fracture. Atraumatic post removal can be
achieved with a n ultrasonic scaler tip.

4.Masserann kit-can be used to free obstruction w/c
is jammed in the canal. The principle of this
method consists of freeing around the periphery of
broken post using hollow trepan burs, the trench
created around the broken instrument reduces the
resistance of the fragment to removal and create
space for the insertion of 2
nd
instrument in the kit
w/c grips and extracts the broken instrument.
Instrument for filling root canals
LATERAL CONDENSATION
Hand spreader- are design to facilitate the
placement of accessory gutta-percha points
around a well fitting master gutta-percha point
during the lateral condensation method.
Finger spreader- these instrument is colour-
coded to match the standardized or gutta-
percha points. Their short length affords a high
degree of tactile sense and allows them to
rotate freely around their axis, thus freeing the
instrument for easy removal.

VERTICAL CONDENSATION
Schilder pluggers-consist of long-handled
instruments w/c are larger diameter than spreaders
and have a blunt end; they are used to pack
thermally softened gutta-perchainto the root
canal.
Thermoplasticized injectable Gutta-
percha





Obtura II heated Gutta-percha System
the heated delivery gun extrude gutta-percha
through the fine needle, the temperature is
controlled by the main unt.






Hygenic Ultrafill system Canullae filled
with Gutta-percha are heated in the main
unit, when the gutta percha is softened , the
canulla is loaded into the delivery syringe.




Thermafil obturator the mould heated
gutta-percha is placed to root canal file, the
plastic carrier is coated with gutta-percha
which carry gutta percha to the canal.






Inject-R-Fill. A stainless steel tube contains
gutta-percha which is design for backfilling the
canal after the apical parthas been plugged by
gutta-percha during vertical condensation, w/c
is after heating the is forced out of the tube by
pressure from the handle.






J S Quick-fill- a thermocompactor
instrument precoated with gutta-percha.
X-ray film
Dental radiographs, commonly referred to as X-
ray films, or informally, X-rays, are pictures of
the teeth, bones, and surrounding soft tissues to
screen for and help identify problems with the
teeth, mouth, and jaw.

Film holder
is a device which holds one or more pieces of
photographic film, for insertion into a camera or
optical scanning device such as a dedicated film
scanner or a flatbed scanner with film scanning
capabilities.
X-ray Machine

-a device used to
generate X-rays.
These devices are
commonly used by
radiographers to
acquire an x-ray
image of the inside
of an object (as in
medicine or non-
destructive testing)
STERILIZATION
Sterilization of endodontic instrument
While it is generally recognized that the aim of
root canal preparation is to eliminate infection
from a canal, it is very important that all instrument
used in the root canal should be sterile, or at least
have been sterilized between patients. Various
method have been advocated.
Sterilization Sterilization is the destruction or
complete removal of all forms of micro organisms.
Disinfection Disinfection is the destruction of
many microorganisms but not usually the bacterial
spores.
General Principles
Universal precautions use of mouth mask,
head cap, protective eye were gloves are
recommended.
Hand washing and care of hands



PRE-STERILIZATION CLEANING
- Bio-films of vegatitive form of bacterias
spores and the organic matter formed on the
surface of the instrument have to be washed
with the suitable disinfectant before
proceeding with the sterilization process.

Pressure steam(autoclaving) sterilization.
Long cycle of 15 min 121 degree
Celsius and 15 lbs pressure.
Short cycle of 7 min 134 degree Celsius and
30 lbs pressure.
Advantage of autoclaves - Most rapid and effective
methods for sterilization of commonly used dental
equipments and root canal files.
Disadvantages of Autoclaves Can cause rusting of
carbon steel instruments.
Dental burs can be autoclaved after dipping it
into 2 % sodium nitrite sol.

Dry Heat Sterilization
Hot air oven
Dry heat at 160 degree Celsius is commonly
used for this purpose. Microbial inactivation by
dry heat is primarily an oxidation process.
Employed for sterilization of glassware, glass
syringes, oily injection as well as metal
instruments.
Cotton wool and paper points can be placed
in a metal boxes and sterilized and sealed
afterwards until used.
Gas sterilization
Using ethylene oxide gas131 degree
celsius 20 pounds pressure is use for this
purpose. Heat sensitive plastic instrument are
sterilized by this method. Because water is
absent from this method, cotton wool and
paper points do not get wet and so do not
need to de dried; also metal instrument do
not corrode.


Sterile packs - increasingly, disposable items are
produced in sterile blister packs; these were
initially confined to syringes, needles, scalpel
blade and sutures but now include some filles
and paper points.
Glass bead/salt sterilizer used for
sterilization of endodontic files.This method
is effective, provided the instrument to be
sterilized is held in the heat conducting
material for a minimum of 10 sec.

Chemical disinfectant - useful for those
items w/c would be damage by methods of
sterilization. Disinfectant such as sodium
hypochlorite and glutaraldehyde may be
used to wipe over working surface of
instrument.