Armamentarium

ENDODONTICS Equipment
Friday, February 19, 2021 11:23 AM 1. Burs
a. fissure burs
HISTORY ▪ used in the initial stage of access preparation to establish the correct outline form.
1904 b. round burs
• Frank Billings directed the attention of dentistry and medicine to the apparent relationship between oral sepsis ▪ used to lift the roof of the pulp chamber and eliminate overhanging dentine.
and bacterial endocarditis. c. non-end cutting bur
• Five years later, one of his students, E.C. Rosenow ▪ used to lift lid of pulp chamber and refine cavity.
○ developed the theory of “focal infection” in studying the bacterial aspects of root canal therapy. 2. Front surface mirror
○ demonstrated that streptococci were present in many diseased organs and that they could cause ○ best suited for visibility deep within the pulp chamber.
infection at some distant site by hematogenous spread, which means that its origin is in the blood or 3. Root canal explorer
spread through the bloodstream. ○ used to probe and detect canal openings within the pulp chamber.
○ distinguished two types of foci: 4. Endodontic excavator
▪ Primary- in the skin and mucosa ○ larger than conventional excavator. Its shape allows curettage of the pulp chamber when
▪ Secondary - which develop from the former by metastasis. conventional one will not reach the floor of the chamber, and it is used as a surgical aid to
○ believed that organisms could migrate from an apical granuloma to reach peripheral organs and cause excavate periapical lesion.
other diseases. 5. Barbed broach
○ an extirpating instrument.
1909 ○ used to remove the intact pulp, snag the pulp to facilitate removal, retrieve a paper
• Mayrhofer published a work linking the nature of pulpal infection with specific microorganisms. The results point/cotton pellet trapped in the canal, and loosen debris in the necrotic canal.
indicated that streptococci were present in about 96% of the cases studied. 6. K-reamer
• In October of that year, William Hunter, an English physician, and pathologist gave a lecture on focal infection ○ manufactured by twisting a square or triangular blank by machine.
at the University of Montreal. ○ used in shaping the canal.
○ Its impact was such that for more than twenty years, it blocked not only research in Endodontics but also 7. K-file
its teaching and its practice. ○ instruments that can be manufactured by twisting a square or triangular blank by machine,
○ Hunter is particularly against prosthetic dentistry because of poorly constructed prosthetic restorations the blank is twisted into a tighter series of spiral compared to a reamer.
that lead to septic conditions. ○ more flexible than a reamer.
▪ he referred to it as the worst anemia cases because diseases like gastritis, colitis, etc., are 8. Gates-Glidden drills
worsened by oral sepsis. It was therefore believed that the extraction could cure all systemic ○ used in preparing the coronal two thirds of molars canals, removing gutta-percha from the
diseases of teeth. canal during post space preparation or during retreatment, and widening the canal when an
▪ As a result, American dentists managed to remove any devitalized teeth for almost 40 years. Even instrument has fractured within it.
those with some reconstruction, large filling, inlays, crowns, or bridges, and even essential teeth 9. Peeso reamer drills
were removed. ○ not flexible or adaptable, if not used with care can perforate canal functions.
▪ Fortunately, a small group of dentists did not stop seeking improvement of their current procedures ○ used in removing gutta-percha from the canal during post space preparation or during
using aseptic techniques, bacteriological and histological methods, and X-rays for diagnostic retreatment.
purposes.
▪ And because of their great efforts, the principle of preserving the pulpless tooth survived. Medicine
The common medicines used in endodontics are analgesics and antibiotics. Analgesics are used for
It was not until the late 1940s or early 1950s that the cumulative laboratory research and clinical evidence was treating odontogenic pain patients. Acetaminophen, which belongs to analgesics, is often used as an
sufficient to confirm that the devitalized tooth did not play any role in the causation of systemic disease. alternative analgesic in patients who cannot tolerate the Nonsteroidal Anti-inflammatory Drugs (NSAID)
class of analgesics. On the other hand, antibiotics are used to prevent or treat infections from spreading
Thus, the theory of focal infection fell, and faith was restored in endodontic treatment and reduces swelling.

Endodontic Techniques and Tips

DISEASE AND TREATMENT According to Allan S. Deutsch, DMD, “A leading endodontist shares his keys to successful procedures.”
Disease Treatment Prior to achieving successful endodontic shaping, obtaining proper endodontic access is key.
Tooth Decay There are possible treatments for this kind of cases This is accomplished by identifying the location of chamber roof, piercing it, and removing the entire roof
• one of the most common cases seen among children. and one of these is dental fillings. When the decay is without jeopardizing the floor of the pulp chamber, which can lead to a perforation if violated.
• chronic infectious disease of children that are caused removed from the tooth, the dental fillings provide a
by a great deal amount of sugar intake from food and tooth colored restoration for a child’s smile. Canal Scouting
drinks.
• The bacteria produces acid which damages the surface The best clue for knowing where to relieve the secondary dentin is the color of the floor. The recessed
of the tooth. Actually, saliva can help repair the damage pulp presents as darkened dentin. The clinician will not find a canal where the dentin is getting lighter.
but if there is already too much damage, then saliva
cannot really help to repair the damage anymore. As this darkened dentin is uncovered, you may find that it takes the shape of a “Y” or square
Tooth sensitivity tooth-colored fillings. configuration in molars, with the canals most likely to be found at the greatest extension of each
• “dentin hypersensitivity • done if tooth decay is found. configuration.
• pain or discomfort in the teeth as a response to certain Fluoride treatments After access to the floor of the pulp chamber is gained, the next step is to find the orifices of the canals
stimuli, such as hot or cold temperatures. • strengthen the teeth of the children and to also that are branching from the floor. In maxillary molars, the canal most likely to be missed is MB2.
• may be temporary or a chronic problem, and it can help them avoid having sensitivities. In mandibular molars, practitioners often overlook distolingual and middle mesial canals.
affect one tooth, several teeth, or all the teeth in a Dental sealants
single individual. • for children with permanent teeth.
• Cause: poor brushing habits. Cavities, enamel • lead to cleaner and healthier teeth Glide Path Creation
erosions, sinus infections, loose or cracked fillings, and • After preparing straight-line access to the canal orifice, use a small SafeSider instrument to
• it is advisable for children learning proper
many more. explore the canal.
dental hygiene and this lasts about 10 years
• The first SafeSider that typically use by hand is a size 08 to determine the working length with the
with no side effects.
help of an apex locator.
Malocclusion jaw surgeries • Then use the SafeSider in sizes 10, 15, and 20 to verify patency and confirm a smooth,
• known to be having the “crooked teeth” or a “poor bite.” • correct the underlying bone disharmony. reproducible glide path.
• Either of the lower or upper teeth are slightly forward. retainers or braces • Always irrigate and enlarge the glide path to a minimum 20/02 preparation.
Gum disease cannot be cured but it can be treated.
• gums are often swollen and red, and they recede from • root planning (debridement) Endodontic Instrumentation
the teeth and bleed easily after flossing. In the presence of an irrigant, follow the glide path and shape the wider extensions of oval canals with
• caused by poor brushing and flossing habits that allow the Tango-Endo 30/02 shaping instrument (single blue band on the latch head).
plaque. Use a gentle inward pecking motion, with short amplitude strokes of 2 to 3 mm until the working length is
reached.
Reversible Pulpitis (Pulp Hyperemia) • Early insertion of filling Clean the flutes frequently during instrumentation and inspect for unwinding or abnormalities.
• Mild to moderate inflammatory condition of the pulp • Desensitization of neck of teeth where gingival Then use the Tango-Endo 30/04 finishing instrument (double blue band on the latch head) in the same
• caused by noxious stimuli in which the pulp is capable recession occurs manner as described above).
of returning to the uninflamed state following removal of • Cavity varnish or base application before insertion Confirm the Tango-Endo finishing instrument reaches the apical measurement. Move the instrument
the stimuli. of filling continuously against the canal walls until there is no resistance.
• Care in cavity preparation and polishing The Tango-Endo instrumentation system works with any obturation system (ie, vertical, lateral
• If primary cause is not corrected, extensive pulpitis condensation, master point, thermoplastic).
may result in death of pulp. Due to its superior apical sealing ability,they with EZ-Fill® Xpress root canal cement (Essential Dental
Systems) and the Bi-Directional spiral (Essential Dental Systems).
Acute Pulpitis • Drainage of exudate from pulp chamber.
The result is a final shape that reflects the original canal anatomy without excessive tooth structure
• Extensive acute inflammation of the dental pulp is a • Pulpotomy & placing calcium hydroxide over being removed mesiodistally or inadequate removal of tooth structure buccolingually.
frequent immediate sequela of focal reversible pulpitis, entrance of root canal.
• may occur as an acute exacerbation of a chronic • Root canal treatment.
inflammatory process • Extraction of tooth. Instrument Movement
Chronic Pulpitis • Root canal therapy • Tango-Endo instruments are specifically designed to be used in the Tango -Endo reciprocating
• Persistent inflammatory reaction in pulp with little or • Extraction of tooth. handpiece. The handpiece is a 4:1 reduction with a 45º equal arc of reciprocal motion.
non constitutional symptoms. • Because the instruments are designed as modified reamers, they widen or enlarge an existing
hole.
Hyperplastic Pulpitis (pulp polyp) • Extraction of tooth • That is exactly the situation that we encounter in endodontics treatment —widening the existing
• Overgrowth of pulp tissue outside the boundary of pulp • Pulp extripation. root canal to clean and shape it.
chamber as protruding mass. • The Tango-Endo instruments are specifically designed for maximum cutting efficiency and
• development of granulation tissue, covered at times reduced instrument breakage when used in their equally 45º reciprocating motion handpiece.
with epithelium and resulting from long standing low • The Tango-Endo handpiece also has the added benefit of fitting on an E -Type attachment. It can
grade irritation fit on any E-Type electric motor or airline. Therefore, the dentist does not have to purchase
Symptomatic Irreversible Pulpitis dental history and thermal testing are the primary expensive equipment to begin.
• based on subjective and objective findings that the vital tools for assessing pulpal status.
inflamed pulp is incapable of healing and that root canal
treatment is indicated.
• difficult to diagnose because the inflammation has not
yet reached the periapical tissues, thus resulting in no
pain or discomfort to percussion.
Asymptomatic Irreversible Pulpitis

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Asymptomatic Irreversible Pulpitis
• clinical diagnosis based on subjective and objective
findings indicating that the vital inflamed pulp is
incapable of healing and that root canal treatment is
indicated.
• no clinical symptoms and usually respond normally to
thermal testing but may have had trauma or deep
caries that would likely result in exposure following
removal

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