h Endodontic Armamentarium 2 Drg. Widi PrasetiaElectronic Apex Locators (EAL) * Working Length Determination * Working length > the distance from a coronal reference point to the point at which canal preparation and obturation should terminate * EAL: electronic device used in endodontics to determine the position of the apical constriction * and thus determine the length of the root canal space.History of EAL’s [issnseirscs | * First investigated by Custer (1918). The idea was revisited by Suzuki in 1942 who studied the flow of direct current through the teeth of dogs>consistent values in electrical resistance between an instrument in a root canal and an electrode on the oral mucous membrane and speculated that this would measure the canal length * Sunada (1962) constructed a simple device that used direct current to measure the canal length. It worked on the principle that the electrical resistance of the mucous membrane and the periodontium registered 6.0 k Q in any part of the periodontium regardless of the persons age or the shape and type of teeth * Using direct current caused instability with measurement, and polarization of the file tip altered the measurement.Mode of Action Prabe holderFirst Generation od EAL’s * Resistance type * Measures opposition to the flow of direct current or resistance * Pain was often felt due to high currents in the original machine * unreliable when compared with radiographs, with many of the readings being significantly longer or shorter than the accepted working lengthSecond Generation of EA's =< * Impedance type * Impedance is comprised of resistance and capacitance and has a sinusoidal amplitude trace. * The property is utilized to measure distance in different canal conditions by using different frequencies * Disadvantage: * electro-conductive materials gives inaccurate readings. The root canal has to be free of electro- conductive materials to obtain accurate reading * required calibration and complicated calculations * required coated probes instead of normal endodontic instrument, no digital readout was present and it was * very difficult to operate EndoanalyzerInvestigator ‘Accuracy (%) Device Compared with quam Inoue (1973) 2 Sono-Explorer Tooth length O'Neill (1974) 8 Sono-Explorer Tooth length Seidberg et al. (1975) 48 Sono-Explorer RM 6 Tactile sense RM Blank et al. (1975) 89 ‘Sono-Explorer Tooth length 85 Endometer Tooth length Chunn et a (1981) 6 Forameter Tooth length Berman & Fleischman Consistently Neosono-D Tooth length (1984) accurate Trope et al. (1985) 90.6 Sono-Explorer Mark ill RM Inoue & Skinner (1985) 57.7 Sono-Explorer Mark Ill RM Wu et al. (1992) 75 Sono-Explorer Mark Ill Tooth length Kaufman et al. (1989) 56 Dentometer Ingles method “4 Sono-Explorer Mark ll Ingles method McDonald & Hoviend 93.4 Endocater Tooth length (1990) Keller et al. (1991) 61.7 Endocater Tooth length RM, ra urement. Ingles method = radiographic. yraphic measurement. Tooth length = real or extracted tooth length meas-Third Generation of EAL’s * Frequency dependent comparative impedance Type *similar to the 2nd generation EALs except that they use multiple frequencies to determine the distance from the end of the canal. * more powerful microprocessors to process the mathematical quotient and algorithm calculation required to give accurate readings.The Accuracy study for the Endex Investigator Accuracy (%) Test condition Compared with Fouad et al. (1993) In vitro ~ NaOCl Mayeda et al. (1993) In vivo Frank & Torabinejad (1993) In vivo Felippe & Soares (1994) In vitro Arora & Gulabivala (1995) In vivo Pratten & McDonald (1996) 82 (#0.5 mm) _In vitro Lauper et al. (1996) 93 (20.5 mm) In vivo Ounsi & Haddad (1998) 85 (2 In vitro Weiger et al. (1999) 59 (x In vitro - NaOCl De Moor et al. (1999) 100 (20. In vitro Martinez-Lozano et al. (2001) 68 (= In vitro Tooth length Tooth length RM Tooth length Tooth length RM and tooth length Tooth length Tooth length Tooth length Tooth length Tooth length RM, radiographic method.Table 3 The properties of the Root ZX Investigator Variable tested ‘Accuracy (6) Compared with ‘Sample (7) Clinical accuracy permanent teeth in vitro Ceerw et al. (1995) ‘Accuracy in vitro b 100205 mm) Tooth length ° White et af. (1996) ‘Accuracy in vitro 8420.5 mm) Tooth longth 51 Ounsi & Naaman (1999) Accuracy in vitro 85 (40.5 mm) Tooth length 9 ‘Accuracy in the presence of irigants Shabahang et al. (1996) Accuracy in vivo 96:05 mm) Extracted tooth length 28 McGinty et al. (1996) erigants and accuracy in vitro No difference Tooth length 16 between irigants Weiger et af. (1989) Irigants and accuracy in vitro - NaOCl 85 (40.5 mm) Tooth length a Jenkins et al (2001) Various irigamts and accuracy in vitro. —No.difference Tooth length ey Meares & Steiman (2002) Accuracy with NaOCl in vitro $3 (20.5 mm) Tooth length 0 No ditference Clinical accuracy permanent teeth in vivo Vajrabhaya & ‘Accuracy in vivo 100205 mm) Extracted tooth length 20 Tepmongkol (1997) Pagavino et al. (1998) Accuracy in vivo- SEM. 83 (20.5 mm) Extracted tooth length 29 100 (21.0 mm) Dunlap et a1 (1986) Accuracy vital versus necrotic ia vivo 82 (20.5 mm) Extracted tooth length 3¢ MeDonald ot al. (1998) Accuracy in vivo 95 (20.5 mm) Extracted tooth longth 29 Wolk ot 91. (2003) ‘Accuracy in vivo 8120.5 mm) Extracted tooth length 32 Minor diameter Clinical accuracy in primary teeth Katz et a. (1996) ‘Accuracy in primary teeth - in vitro 100 [205 mm) Extracted tooth length 20 Mente et al. (2002) ‘Accuracy in resorbed primary teeth in vitro 98 (21.0 mm) Tooth length 26 Kietbassa et al. (2003) Accuracy in primary teeth ~ in vivo 64 (21.0 mm) Extracted tooth length 77Forth Generation of EAL’s ~ * Ratio Type apex locators which determine the impedance at five frequencies and have built in electronic pulp tester. * These devices not process the impedance information as a mathematical algorithm, but instead take the resistance and capacitance measurement and compare them with a database to determine the distance to the apex of the root canal. * Disadvantages: * need to perform in relatively dry or in partially dried canals. In some cases, this necessitates additional drying. Also in heavy exudates or blood it becomes inapplicableFifth Generation of EAUs oe * Dual Frequency Ratio Type * To cope with associated problems associated with previous generations of apex locators * measures the capacitance and resistance of the circuit separately * supplied by diagnostic table that includes statistic of the file * have best accuracy in any root canal condition (dry, wet, bleeding, saline, EDTA, NaOCl) * provides with a digital read out, graphic illustration and an audible signal. * The built in pulp tester can be used to access tooth vitalitySixth Generation of EAL’s Ee * Adaptive Apex Locators * A major advantage of adaptive apex locator is eliminating necessity of drying and moistening of the canal + Adaptive apex locators continuously define humidity of the canal and immediately adapts to dry or wet canal. * This way it is possible to be used in dry or wet canals, canals with blood or exudateOther use of EAL’s * To detect root perforations to clinically acceptable limits * Determine the location of root and pulpal floor perforations * To detect horizontal fractures * To confirm suspected periodontal or pulpal perforations during pinhole preparation * Recognize any connection between the root canal & periodontal membrane such as root fracture, cracks & internal or external resorption. [ria] Caution: Electronic apex locators have the potential to interfere with cardiac pacemakers.Engine Driven Ni-Ti Instruments * Mechanical Properties: * Elastic behavior within certain limit * Memory shape > ability of the alloy to completely recover its original shapeProTaper system Conventional (untreated) Ni-Ti Instruments * First introduced in 2001 * incorporates varying, progressive tapers along the cutting flutes of the same instrument * combined with a convex triangular cross-section, allows the instruments to work in a specific area of the canal during crown-down preparation, reducing file contact with the dentin walls and, consequently, reducing stress on the instrument * 2006: ProTaper Universal: increased flexibility to reduce interment fractures* Changing percentage tapers over the length of its cutting blades * convex, triangular cross-sections. * changing helical angle and pitch over their cutting blades anda non-cutting * Modified guiding tip* Shaping Intruments (Sx, $1, $2) * $x: (auxiliary shaping instrument) + No identification ring, gold colored + Over all length 19 mm * DO diameter 0.19 mm, D14 1.20 mm * Shaping the canal coronally + S1: * DO: 0.17 mm and D14 1.20 mm +2: * DO: 0.2 mm and D14 1.20 mm * Finishing Instruments (F1, F2, F3) * DO diameters and apical tapers of 20/07, 25/08 and 30/09 * Dto D.each instrument has a decreasing percentage taper.HO 15 s2_ Ft st st 82 NaoctProTaper Next’ Shaping O17 025 030fa) Tr 25/08 rr lag 40/08 eeeWi ; gy 20/07 SMALL 25/07 PRIMARY, 35/06 MEDIUM 45/05 A ARGEXp-Endo Shaper —— * Universal NiTi instrument reaching a final dimension of at least 30/.04. * Available in 21 mm, 25 mm & 31 mm. * Able to start treatment at ISO diameter 15 to achieve a final diameter of ISO 30 with a single instrument. * Taper can be increased from .01 to at least .04 using only one instrument. > Minimal stress applied. * Creation of turbulence enabling easy, efficient removal of debris. * Superelasticity, extreme flexibility and agility of the instrument.Conventional instrument Compacted debris EBB stress applied to the canal wall Space available within the canal lumina (46%) XP-endo Shaper HH! Debris (no compaction) EBB Stress applied to the canal wall ‘ Space available within the canal lumina (84%) ——