Armamentarium of root

canal preparation and

obturation
DR DIAN AGUSTIN WAHJUNINGRUM, DDS.,ENDOD
DEPARTMENT OF CONSERVATIVE DENTISTRY
UNIVERSITAS AIRLANGGA
2019
Purposes
To understand :
 instrument of root canal endodontic preparation
 Physical aspect of root canal endodontic preparation
 Function of instrument
 Material of root canal obturation
 Function of material root canal obturation
 CLASSIFICATION OF ENDODONTIC
INSTRUMENTS
ISO - FDI (Federation Dentaire International)
Grouped rootcanal instruments according to their method of use:
 Group I : Hand use only for example, K and H-files, reamers,
broaches, etc.
 Group II : Latch type Engine driven: Same design as group
I but can be attached to handpiece.
 Group III : Drills or reamers latch type engine driven for
example, Gates-Glidden, Peeso reamers.
 Group IV : Root canal points like gutta-percha, silver point,
paper point.
Grossman’s Classification
Function of Instruments:
 Exploring: Smooth broaches and endodontic explorers. (To locate
canal orifices and determine patency of root canal)
 Dibriding or extirpating: Barbed broaches (To extirpate the pulp
and other foreign materials from the root canal)
 Cleaning and shaping: Reamers and files (used to shape the
canal space)
 Obturating: Pluggers, spreaders and lentulo spirals
(To pack gutta-percha points into the root canal space).
Alloys Used for Manufacturing Endodontic Instruments

a. Carbon steel
b. Stainless steel
c. Nickle-titanium .
a. Carbon steel: These alloys contain less-than 2.1 percent of
carbon.
Advantage: They have high hardness than stainless steel
instruments.
Disadvantages
• Prone to corrosion, so cannot be resterilized
• Prone to rust.
Example: Barbed broach.
Alloys Used for Manufacturing Endodontic Instruments

b. Stainless steel instruments

These are corrosion resistant instruments. They contain 18 percent
chromium, 8-10 percent nickel and 0.12 percent carbon.
Advantage: Corrosion resistant
Disadvantages:
• Stiff in nature
• Prone to fracture
• Prone to distortion
Example: K-file, H-file, reamer
Alloys Used for Manufacturing Endodontic Instruments

c. Nickel titanium
These instruments contain 55 percent nickel and 45
percent titanium.
Advantages:
• Shape memory
• Super elasticity
• Low modulus of elasticity
• Corrosion resistant
• Softer
• Good resiliency
• Biocompatibility
Alloys Used for Manufacturing Endodontic Instruments

Disadvantages of NiTi files

• Poor cutting efficiency.
• NiTi files do not show signs of fatigue before they
fracture.
• Poor resistance to fracture as compared to stainless
steel.
Manufacturing of Hand Instruments
A hand operated instrument reamer or file begins as a round
wire which is modified to form a tapered instrument with cutting
edges. These are manufactured by two techniques:

a. By machining the instrument directly on the lathe for

example H-file and NiTi instruments are machined.

b. By first grinding and then twisting. Here the raw wire is

ground into tapered geometric blanks, i.e. square, triangular
or rhomboid. These blanks are then twisted counterclockwise
to produce cutting edges.
Basic endodontic instrument
DIAGNOSTIC AND EXPLORING
BASIC DIAGNOSTIC and
EXPLORING
Endodontic plier:

 Nonlocking and locking pliers for gutta-percha

and absorbent points. The working part has
grooves for holding of points.
endodontic spoon excavator

Function
"larger than conventional excavator" its shape allows
curettage of the pulp chamber when
conventional one will not reach the floor of the
chamber, and used as surgical aid to excavate
periapical lesion
Root canal explorer

Function
Used to probe and detect canal openings within the
pulp chamber
Endodontic ruler

 Used for measuring the length of instruments

Endodontic block or Transfer sponge

 used to organize and hold endodontic finger and

rotary instruments during procedures;
 Reduces the possibility of percutaneous injuries
when handling endodontic finger and rotary
instruments
Basic endodontic instrument
ACCESS OPENING
HAND PIECES AND BURS
FUNCTION

 several types of burs will be used to accomplish

good access preparation.
 Fissure burs are used in the initial stage of access
preparation to establish the correct outline form
 Round burs are used to lift the roof of the pulp
chamber and eliminate overhanging dentine
 Tapered Non end-cutting bur is used to 'lift lid' of
pulp chamber and refine cavity
Basic endodontic instrument
SHAPING
Purpose

 Shaping root canal

 Remove infected soft and hard tissue
 Give disinfecting irrigants access to the apical
canal space
 Create space for the delivery of medicaments
and subsequent obturation
Instruments
Instruments differ according to:
 Metal
 Taper
 Tip design
 Cross sectional geometry
 Length of cutting blades
 Sizing
Metals

Nickel titanium Stainless steel

Excellent flexibility Less flexible

Conforms to canal Straightens and

curvature transports canal

Plastic deformation Permanent deformation

Metals

Stainless steel files demonstrate permanent deformation

Metals

Nickel titanium files demonstrate plastic deformation

Taper

Definition

Increase in diameter per unit length

What is Taper?

D16 D1

2%

0.32 mm diameter increase

D16 D1

4%

0.96 mm diameter increase

Tip Design
Cross-sectional geometry
 Radial lands separated by three u-shaped
flutes
 Each contains bidirectional cutting edges
 Cutting edges scrape dentin
 Keep instrument centered in the canal
 Provide space for accumulation of debris
 Moves debris out of canal
Cross sectional geometry
Cross sectional geometry

• Not
Self-
Self-Threading

• Gentle Planing
Action
Cross-sectional geometry
 Radial lands separated by three u-shaped
flutes
 Each contains bidirectional cutting edges
 Cutting edges scrape dentin
 Keep instrument centered in the canal
 Provide space for accumulation of debris
 Moves debris out of canal
Length of cutting blade

 Traditionally 16 mm
 Orifice shapers – 10 mm
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
STANDARDIZATION OF ENDODONTIC INSTRUMENT:
Ingle and Levine in 1958 recommended.

- 3 features

a) Diameter and width

b) Length of cutting blade

c) Taper

D1---1/100th of mm
D2---D1+0.32mm Taper is 0.02mm/mm of length
Standardization of Endodontic Instruments

• Instruments are numbered from 10-140. There is increase in (5)

units up to size 60 and in (10) units till size 140.
• Each number should represent diameter of instrument in 100th
of millimeter at the tip.
• Working blade shall begin at tip (D1) and extend 16 mm up the
shaft (D2). D2 should be 0.32 mm greater than D1, ensuring that
there is constant increase in taper, i.e 0.02 mm per mm of
instrument.
Standardization of
Endodontic Instruments
Standardization of Endodontic Instruments
• The nickel titanium rotary instruments have other variable
tapers of 0.04 and 0.06. For every millimeter of length, the
diameter increases by 0.04 or 0.06 mm. These greater tapers
make these more aggressive in creating marked flaring
preparation.
• Instruments are available in following lengths: 21, 25, and 31
mm. Shorter instruments afford improved operator control and
easier access to posterior teeth, to which limited opening
impairs access. The 25- and 31-mm instruments are used for
longer roots.
 Instruments are color coded

For narrow Root canals- size 06, 08 , 10 are used pink ,grey purple
Instruments handles should be color coded for their easier recognition (Pink, grey, purple,
white, yellow, red, blue, green, black………….)
For example
HAND USED ROTARY
MANUAL INSTRUMENT: INSTRUMENT
ENGINE INSTRUMENT:
 Reamer
 K-File  Gates Glidden
 Flexo Reamer  Peeso Reamer
 Flexo- File  Engine Driven Reamer
 Hedstroem File  Engine Driven Ni-Ti File
 Nickel-titanium
Broaches
• Oldest endo instrument
• Function : used for removal of pulp tissue
: used for removal of cotton or paper points from Root canal
• Barb height is large
• As the barb comes out of instrument, broach is a weaker
instrument compared to rasp
• Taper is 0.007 to 0.01 mm/mm
• Barb are Fine and longer
• Broachs should not be used beyond middle 3rd of Root canal and
also entangle in Root canal and get separated
The braded broach comes in different sizes, and the selection of
suitable size is very important, it should fit loosely inside the canal,
when braded broach size is larger than the canal size, the hooks of
B.B engaged in the dentinal wall of the canal and stick there
"Jammed broach" and with drawing it becomes difficult and might
fracture inside the canal, if the dentist faced by Jammed broach, the
broach should be removed vertically without twisting. The B.B must
only be used in the straight part of the canal
Broaches, Debridment

For extirpation debris, paper point, pulp tissue and

material root canal
H- File machined instrument
• It resembles ‘Christmas tree’ appearance.

[cone over cone]

• used to remove loose broken instrument

• Circular in cross section.

• Spiral grooves

• Cuts only when the instrument is pulled

• Cuts very aggressively

• Used in straight cannels

• Less flexibility

• Fractures when used in torque motion

 REAMER

Reamer ISO :06-140 2%

1. Reamers are K-type instruments (manufactured by Kerr
company), which are used to ream the canals. They cut by
inserting into the canal, twisting clockwise one quarter to half
turn and then withdrawing, i.e.penetration, rotation and
retraction.
2. Reamers have triangular blank and lesser number of flutes
than files
File
Files are the instruments used during cleaning and shaping of
the root canals for machining of the dentin. Since Kerr
manufacturing company was first to produce them, the files
were also called K-files.
Files are predominantly used with filing or rasping action in
which there is little or no rotation in the root canals. It is placed
in root canal and pressure is exerted against the canal wall and
instrument is withdrawn while maintaining the pressure
File Versus Reamer
Files Reamer
 Square c.s
 triangular c.s
 Tighter flutes
 loose spirals
 Flute more, 1,5-
2/mm  Flute less. ½-1/mm
 Resists fracture
better  Cutting efficiency is 2.5
times more sharpness
 Maintains keen
edge  less number of flutes
 lost rapidly
 Flexibility more cause of
 Flexibility less less work hardening
 Rasping and
penetration motion  Rotation and retraction
(pull and push)
 Preparation shape:
 Preparation shape: round
usually ovoid
 Transport of debris:  Transport of debris:
Poor cause of better cause of space
tighter flutes present in flutes
Type of file
1. K Files
 They are triangular, square or rhomboidal in cross-
section, manufactured from stainless steel wire,
which is grounded into desired shape.
 Tighter twisting of the file spirals increases the
number of flutes in files (more than reamer).
 Triangular cross-sectioned files show superior
 cutting and increased flexibility than the file or
reamers with square blank
2. K-flex Files
 It was realized that square blank of file results in total decrease
in the instrument flexibility. To maintain shape and flexibility of
these files, K-flex files were introduced.
• K-flex files are rhombus in cross section having two acute
angles and two obtuse angles.
• Two acute angles increase sharpness and cutting efficiency
of the instrument.
• Two obtuse angles provide more space for debris removal.
Also the decrease in contact of instrument with canal walls
provide more space for irrigation.
• They are used in filing and rasping motion.
3. Hedstrom Files (H-files)

Hedstrom files have flutes which resemble successively triangles

set one on another.
• They are made by cutting the spiral grooves into round,
tapered steel wire in the same manner as wood screws are
made.
• Hedstrom files cut only when instrument is withdrawn because
its edges face the handle of the instrument.
• When used in torquing motion, their edges can engage in the
dentin of root canal wall and causing H - files to fracture.
3. Hedstrom Files (H-files)
• Hedstrom files should be used to machine straight canals
because they are strong and aggressive cutters. Since they lack
the flexibility and are fragile in nature, the H-files tend to
fracture when used in torquing action.
 Slow Speed Engine driven Stainless Steel
instruments
 Gates Glidden drills – safe tip
 Orifice opening
 Deeper penetration into straight canals
 Removal of lingual shoulder
 Gates-Gliddens are available in a set from 1 to 6 with the
diameters from 0.5 to 1.5 mm.
 They should be used at the speed of 750-1500 rpm. in brushing
strokes.
 Safety design of Gates-Gliddens is that its weakest part lies at the
junction of shank and shaft of the instrument. If its cutting tip jams
against the canal wall, fracture occurs at the junction of shank
and the shaft but not at the tip of the instrument. This makes the
easy removal of fractured drill from the canal.
Uses of Gates-Glidden Drills
1. For coronal flaring during root canal preparation
2. During retreatment cases or post space preparation for
removal of gutta-percha.
3. Widen the canal when an instrument has fractured within it.
If used incorrectly, for example using at high rpm, incorrect
angle of insertion, forceful drilling, the use of Gates-Glidden
can result in procedural accidents like perforations, instrument
separation.
 Slow Speed Engine driven Stainless Steel
instruments
 Peeso reamers
 Post space preparation
 Use safe-tipped to prevent lateral perforation
 They are rotary instruments used mainly for post
space preparations.
• They have safe ended non-cutting tip.
 Their tip diameter varies from 0.7 to 1.7 mm.
• They should be used in brushing motion.
 Disadvantages of using peeso reamers are:
1. They do not follow the canal curvature and may
cause perforation by cutting laterally.
2. They are stiff instruments.
3. They have to be used very carefully to avoid
iatrogenic errors.
Glide path

Hand use/manual
Rotary/endo motor

 Glide-path is a smooth radicular tunnel from canal orifice to

physiologic terminus (foramina constriction). Its minimal size
should be a “super loose No. 10” endodontic file.
 Creating an.02 tapered glide path is critical for the safe and
effective use of nickel-titanium rotary shaping instruments
Glide path

 can increase the lifespan of rotary instruments with a reduced

risk of instrument fracture, maintain the original canal anatomy
with less modification of canal curvature and fewer canal
aberrations
 guide for endodontic mechanics
Instruments
for root canal filling
Purpose

 To prevent bacteria and bacterial elements from

spreading from (or through) the canal system to
the periapical area
 the fully instrumented root canal has to be
provided with a tight and long-lasting obturation.
 A root canal filling material should, therefore,
prevent infection/reinfection of treated root
canals.
 Together with an acceptable level of
biocompatibility (inert material) this will provide
the basis for promoting healing of the periodontal
tissues and for maintaining healthy periapical
conditions.
Instruments for root canal filling
 Lentulo spiral filler/rotary paste filler
 Function and features
 • Small flexible instrument used to place materials
into the canal
 • Fits into the conventional handpiece
 • Use with caution as it can be easily broken
 • Different sizes available
Lentulo spiral filler/rotary
paste filler Function and features
• Small flexible instrument
used to place materials into
the canal
• Fits into the conventional
handpiece
• Use with caution as it can
be easily broken
• Different sizes available
Finger spreader
Function, features and precaution
 • Used to condense gutta percha into the canal
during obturation
 • Finger instrument with a smooth, pointed, tapered
working end
 • Disposed of in the sharps’ container
Varieties
 Can be of the hand instrument type (lateral
condenser)
Endodontic plugger
Function
 Working end is flat to facilitate plugging or
condensing the gutta percha after the excess
 has been removed by melting off with a heated
instrument
Varieties
 • Different sizes of working ends are available
 •Available as hand or finger instruments
 Gutta percha points
Function and features
 •Non-soluble, non-irritant points that are condensed
into the pulp chamber during obturation
 • Standardised type: follows same ISO classification
as endodontic files
 • Non-standardised: have a greater taper than the
standard ISO type
Varieties

 • Can be packaged in single dose or bulk packages

 • Different sizes with different tapers available
OBTURATING MATERIALS
Core Obturation Materials

Historically, a variety of materials have been

employed to obturate the root canal, falling into
three broad categories:

solids

semisolids
pastes(seale
rs)
 Sealers

 Sealers fill the space between

the canal wall and core
obturation material and may
fill lateral and accessory
canals, isthmuses, and
irregularities in the root canal
system.
 Obturating materials
 Ideal properties of root canal filling materials:
 Antimicrobial
 Biocompatible.
 Good flow
 Adhesive in nature
 Dimensionally stable
 Not affected by moisture
 Radio-opaque
 Good handling
 Easily removed, post prep or retreat
 Does not stain dentine
 Cheap
The most popular sealers are grouped by
type:

Zinc oxide- Calcium

eugenol hydroxide
formulations sealers

Glass-
Resins
ionomers

Regardless of the sealer selected, all are toxic

until they set. For this reason, extrusion of sealers
into the periradicular tissues should be avoided.
 Sealers
based on calcium hydroxide

An easy, effective
method of sealer
application. The file
covered with sealer will
be inserted and spun
counterclockwise to
coat the canal walls.
Indications for the use of calcium
hydroxide include:

As a temporary dressing
for canals where filling
has to be delayed.

To promote apical
In the treatment of
closure in immature
resorption.
teeth.

In the management of
perforations.
Indications of calcium
hydroxide sealer
Apexification - treatment procedure by
which closure of root apex is promoted by
calcium hydroxide, in teeth where loss of
vitality has occurred before normal growth
and development of the tooth was
completed.

Apexogenesis - treatment procedure by

which the preservation of the radicular pulp
tissue allows continuing development and
apical maturation of teeth with open
apices.
Acceptable methods of placing the sealer in
the canal include the following:
Placing the sealer on the master cone and pumping
the cone up and down in the canal
Placing the sealer on a file and spinning it counter
clockwise
Placing the sealer with a lentulo spiral
Using a syringe
Activating an ultrasonic instrument

The clinician should use care when placing sealer in

a canal with an open apex to avoid extrusion.
 Solid materials

Silver cones met many of the criteria for

filling materials but suffered from several
deficiencies.

When
leakage
occurred
and the
points
contacted
tissue fluids,
they
corroded,
further
increasing
Semisolid material
Gutta-percha, a semisolid
material, is the most widely used
and accepted obturating
material.

Typical composition of
gutta-perchacones.
Resin

Resin-based obturation
system contains primer,
sealer, and cones. The
cones resemble gutta-
percha and can be
placed using
lateral or warm vertical
compaction. Pellets are
available for
thermoplastic injection.
 Root filling techniques

Solid core techniques

Single Lateral
cone compacti
on

Softened core techniques

Warm
lateral Injection-
compacti molded
on gutta-
percha
Warm Thermom
vertical ec- Core
compacti hanical carrier
on compact
ion
Thank you