Endo

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Overview of basic endo techniques

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Endo

  1. 1. Determining and Defining Endodontic Excellence Access
  2. 2. Mb2 Move
  3. 3.  the
  4. 4.  mesial
  5. 5.  wallUltrasonic Sybron
  6. 6.  Mini
  7. 7.  Endo P5
  8. 8.  unit BUC
  9. 9.  1 Carr
  10. 10.  tips
  11. 11. Trough the line
  12. 12. Trough the lineFissure/fusion line observed. Used MunceDiscovery Burs to trough and extendpreparation - the “line” became visible.
  13. 13. #6 ‘C’-file to explore the “line” for MB2
  14. 14. After coronal shaping
  15. 15. DB1 DB1 DB2 DB1 DB2
  16. 16. Nor does it understand single file endoNature is not beholden to insurance codes
  17. 17. Micro-etch the floorcontinuously duringaccess preparation -satinize it - it ensuresmaximum optics anddifferentiation - theorientation of theMB2 is within limits -MESIAL
  18. 18. Mandibular Molars
  19. 19. Middle Mesial Canal 1 - 15% of cases
  20. 20. Access is about the radicular area of the root canal space,not simply geing into the canal, no maer how elastic afile, it can’t go where it won’t fit
  21. 21. Off axis orientationmandates crowndown approach - glidepath - large to smalltapers, small to largetip size - NEVER rushwith nickel-titanium -no maer the design,no maer the brand,no maer themetallurgy, theirsuper-elasticity haslimits
  22. 22. One file cannot possiblydo all canal systems...it’s a dangerous andslippery slope... There isno reason to rush tojudgment, took the toothyears to calcify, you needto soften, debride,disinfect - shape is but acomponent of the finalresult - Michaelangelo didnot care the Piata withone chisel...
  23. 23. Working Length
  24. 24. Constriction Dilaceration Dr. R. Walton
  25. 25. Apical ramifications are myriad - to market thesuggestion that one file alone can do everyonecanal is disingenuous at and solipsistic at it’s mostvenal 26
  26. 26. Determining and Defining Endodontic ExcellenceElectronic Apex Location
  27. 27. Radiographic Terminus is deceptiveOvoid
  28. 28. Working Length
  29. 29. Elements Diagnostic Unit 20 out of 24 were at 0.5mmDr. J. Vera
  30. 30. Down to ‘0.0’: “patency”
  31. 31. Up to ‘0.5’: “WL”
  32. 32. Elements Diagnostic Unit 20 out of 22 were at 0.5mmDr. J. Vera
  33. 33. Radiographic ConfirmationConfirm thelength(s) witha radiograph#20 hand file to WL(glide path)!!!!!!!!!!!!
  34. 34. Obturation Level SuccessVital
  35. 35.  teeth:
  36. 36.  (n=25)
  37. 37.  Success:
  38. 38.   1.22 +/-0.14mm short
  39. 39.  Failure:
  40. 40.   0.20 +/- 0.20mmApical
  41. 41.  periodontitis:
  42. 42.  (n=98) Success:
  43. 43.  
  44. 44.  0.56 +/-0.13mm short Failure:
  45. 45.  
  46. 46.  
  47. 47.  1.67 +/-0.30mm For
  48. 48.  every
  49. 49.  mm
  50. 50.  loss
  51. 51.  of
  52. 52.  WL
  53. 53.  from
  54. 54.  RA,
  55. 55.  the
  56. 56.  odds
  57. 57.  of
  58. 58.  failure
  59. 59.   increase
  60. 60.  by
  61. 61.  14%. Chugal
  62. 62.  et
  63. 63.  al,
  64. 64.  2003
  65. 65. Determining and Defining Endodontic ExcellenceDebridement Disinfection
  66. 66. The NiTi Revolution needed an Evolution ….really??
  67. 67. Why do Rotary Instruments Break ? Torque
  68. 68.  
  69. 69.  Fatigue
  70. 70.  
  71. 71.  
  72. 72. Minimizing FractureNever
  73. 73.  use
  74. 74.  a
  75. 75.  rotary
  76. 76.  where
  77. 77.  a
  78. 78.  hand
  79. 79.  file
  80. 80.  has
  81. 81.  not
  82. 82.  been
  83. 83.  first.“glide
  84. 84.  path” coronal apical
  85. 85.  hand
  86. 86.  file
  87. 87.  to
  88. 88.  WL
  89. 89.  to
  90. 90.  a
  91. 91.  size
  92. 92.  #20
  93. 93. Canal Anatomy(Type II Canals) ⬆ pressure requiredCanals
  94. 94.  that
  95. 95.  come
  96. 96.  together
  97. 97.   at
  98. 98.  sharp
  99. 99.  angles
  100. 100. Canal Anatomy ⬆ pressure requiredS-shaped
  101. 101.  canals
  102. 102. Minimizing FractureOne
  103. 103.  File
  104. 104.  Endo?
  105. 105. Canal Anatomy ⬆ pressure requiredCurved
  106. 106.  canalswhich
  107. 107.  changedirection
  108. 108.  abruptly-short
  109. 109.  radius
  110. 110.  curves!
  111. 111. NiTi Rotary Review
  112. 112.  the
  113. 113.  literaturehttp://www.ncbi.nlm.nih.gov/pubmed/15186247http://www.ncbi.nlm.nih.gov/pubmed/15088034http://www.ncbi.nlm.nih.gov/pubmed/15329568 Plug into your browser
  114. 114. New TorqueControl Source
  115. 115. Confirm Apical Patency Glide PathStraight
  116. 116.  line
  117. 117.  access
  118. 118.  to
  119. 119.  the
  120. 120.  coronal
  121. 121.  1/3Patency
  122. 122.  to
  123. 123.  size
  124. 124.  #15
  125. 125.  hand
  126. 126.  fileApical
  127. 127.  glide
  128. 128.  to
  129. 129.  a
  130. 130.  #20
  131. 131.  hand
  132. 132.  file
  133. 133.  
  134. 134.  
  135. 135.  
  136. 136.  Use
  137. 137.  of
  138. 138.  the
  139. 139.  M4
  140. 140.  reciprocating
  141. 141.  handpiece
  142. 142.  with
  143. 143.  the
  144. 144.  #10-
  145. 145.   #20
  146. 146.  
  147. 147.  hand
  148. 148.  file
  149. 149.  is
  150. 150.  strongly
  151. 151.  recommended
  152. 152.  to
  153. 153.  ensure
  154. 154.  a
  155. 155.  smooth
  156. 156.   apical
  157. 157.  glide
  158. 158.  path
  159. 159.  before
  160. 160.  rotary
  161. 161.  instrumentation
  162. 162.  begins.
  163. 163. Apical Finishing“Apical
  164. 164.  Gauging”
  165. 165.  assess
  166. 166.  apical
  167. 167.  diameter
  168. 168.  of
  169. 169.  canal gauging,
  170. 170.  narrow
  171. 171.  diameter how
  172. 172.  do
  173. 173.  you
  174. 174.  know
  175. 175.  the
  176. 176.  apical
  177. 177.  canal
  178. 178.  is
  179. 179.  really
  180. 180.  ‘clean’?
  181. 181. M.-K. Wu, D. Barkis, A. Roris, P. R. Wesselink. Does the first file to bind correspond to the diameter of the canal in the apical region? International Endodontic Journal Volume 35, Issue 3, pages 264–267, March 2002AbstractAim The aim of this study was to determine whether the first file that binds at the working length corresponds tothe canal diameter.Methodology Two similar groups (n = 10) of mandibular premolars with curved canals were selected on the basisof their morphology. Following access and pulp tissue removal, the first instrument that bound in each canal at theworking length was determined. In one group the instrument used was a K-file, in the other group a Lightspeedinstrument was used. After fixing the instruments in place, the apices were ground to the level of the workinglength and the diameters of both the instrument and the apical canal were recorded.Results In 75% of the canals, the instruments bound at one side of the wall only; in the other 25%, the instrumentdid not contact the wall. In 90% of the canals, the diameter of the instrument was smaller than the short diameterof the canal; this discrepancy was up to 0.19 mm. No significant difference in discrepancy was found betweeninstruments (P 0.05).Conclusions Neither the first K-file nor the first Lightspeed instrument that bound at the working length accuratelyreflected the diameter of the apical canal in curved mandibular premolars. It is uncertain whether dentine can beremoved from the entire circumference of the canal wall by filing the root canal to three sizes larger than the filethat binds first.
  182. 182. Apical Finishing (enlargement)
  183. 183. Apical Finishing (enlargement)
  184. 184. Apical Finishing #25 How do you knowwhen you are done?
  185. 185. Based
  186. 186.  on
  187. 187.  morphometric
  188. 188.  analysis
  189. 189.  of
  190. 190.  human
  191. 191.  teeth…⋯Kerekes
  192. 192.  
  193. 193.  Tronstad
  194. 194.  1970’s
  195. 195. Determining and Defining Endodontic Excellence Irrigation
  196. 196. Final Irrigation
  197. 197.  NaOCl
  198. 198.  EDTA
  199. 199.  2%
  200. 200.  CHX
  201. 201.  (cone-fit)Ultrasonic
  202. 202.  Activation
  203. 203.  w/Irri-Safe
  204. 204.   (~30
  205. 205.  sec/canal) EndoVac,
  206. 206.  PAD,
  207. 207.  PIPS
  208. 208.  -
  209. 209.  stay
  210. 210.  tuned
  211. 211. Hand syringe Ultrasonic Delivery
  212. 212. Hand syringe - level 1.0 mm Ultrasonic Delivery - level 1.0 mm
  213. 213. Hand syringe -level 2.0 mm Ultrasonic Delivery - level 2.0 mm
  214. 214. Comparison of the Cleaning Efficacy of Different Final Irrigation TechniquesAbstract IntroductionThe aim of this study was to evaluate the removal of dentin debris from artificially made grooves in standardized rootcanals by 6 different final irrigation techniques.MethodsConventional syringe irrigation, manual dynamic activation (MDA) with tapered or nontapered gutta-percha (GP)cones, the Safety Irrigator system, continuous ultrasonic irrigation (CUI), and apical negative pressure (ANP) irrigationwere testedex vivo in 20 root canals with a standardized, debris-filled groove in the apical portion of one canal wall.After each irrigation procedure, the groove was photographed, and the residual amount of dentin debris was scored.ResultsThere was no significant difference between the MDA with a nontapered GP cone, the Safety Irrigator, and the ANPirrigation. These techniques produced better cleaning efficacy than syringe irrigation (P .005) but significantly worsethan the MDA with a tapered cone (P .05). CUI was significantly better than all the other techniques tested in thisstudy (P .001).ConclusionsCUI was the most effective technique in dentin debris removal from the apical irregularities, and syringeirrigation alone was the least effective. MDA technique was more effective with a tapered GP cone than witha nontapered one. Jiang LM, Lak B, Eijsvogels LM, Wesselink P, van der Sluis LWM - J Endo 26, April 2012

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