Don’t Look Back
Determining andDefining Endodontic    Excellence
Mb2               Move
 the
 mesial
 wallUltrasonic             Sybron
 Mini
 Endo             P5
 unit             BUC
 1             Carr
 tips
Trough the line
Trough the line
Trough the lineFissure/fusion line observed. Used MunceDiscovery Burs to trough and extendpreparation - the “line” became ...
#6 ‘C’-file to explore the “line” for MB2
After coronal shaping
DB1      DB1        DB2              DB1              DB2
DB1      DB1        DB2              DB1              DB2
DB1      DB1        DB2              DB1              DB2
Nor does it              understand               single file                  endo  Nature is    notbeholden to insurance ...
Nor does it              understand               single file                  endo  Nature is    notbeholden to insurance ...
Micro-etch thefloorcontinuouslyduring accesspreparation -satinize it - itensures maximumoptics anddifferentiation -the orie...
Mandibular Molars
Middle Mesial Canal  1 - 15% of cases
Access is about the radicular area of the rootcanal space, not simply getting into the canal,no matter how elastic a file, ...
Access is about the radicular area of the rootcanal space, not simply getting into the canal,no matter how elastic a file, ...
Off axisorientationmandates crowndown approach -glide path - largeto small tapers,small to large tipsize - NEVER rushwith ...
One file cannotpossibly do all canalsystems...it’s a dangerousand slippery slope...There is no reason torush to judgment,to...
Working   Length
Working   Length
Dilaceration Dr. R. Walton
Constriction               Dilaceration                Dr. R. Walton
Apical ramifications are myriad - tomarket the suggestion that one file alonecan do everyone canal is disingenuous atand sol...
Determining andDefining Endodontic    Excellence  Electronic Apex
Radiographic Terminus     is deceptiveOvoid
Working   Length
Working   Length
Elements Diagnostic       Unit         20 out of 24 were at         0.5mmDr. J. Vera
Down to ‘0.0’: “patency”
Up to ‘0.5’: “WL”
Elements Diagnostic       Unit         20 out of 22 were at         0.5mmDr. J. Vera
RadiographicConfirmationConfirm thelength(s) witha radiograph#20 hand file toWL (glidepath)!!!!!!!!!!!!
Obturation Level  SuccessVital
 teeth:
 (n=25)
 Success:
 1.22 +/-0.14mm short
 Failure:
  0.20 +/- 0.20mmApical
 periodontitis:
 (n=98) Success:
 
 0.56 +/-0.13mm short Failure:
 
 
 1.67 +/-0.30mm For
 every
 mm
 loss
 of
 WL
 from
 RA,
 the
 odds
 of
 failure
 increase
  by
 14%.                                                                                                                     ...
 et
 al,
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    1. 1. Don’t Look Back
    2. 2. Determining andDefining Endodontic Excellence
    3. 3. Mb2 Move
    4. 4.  the
    5. 5.  mesial
    6. 6.  wallUltrasonic Sybron
    7. 7.  Mini
    8. 8.  Endo P5
    9. 9.  unit BUC
    10. 10.  1 Carr
    11. 11.  tips
    12. 12. Trough the line
    13. 13. Trough the line
    14. 14. Trough the lineFissure/fusion line observed. Used MunceDiscovery Burs to trough and extendpreparation - the “line” became visible.
    15. 15. #6 ‘C’-file to explore the “line” for MB2
    16. 16. After coronal shaping
    17. 17. DB1 DB1 DB2 DB1 DB2
    18. 18. DB1 DB1 DB2 DB1 DB2
    19. 19. DB1 DB1 DB2 DB1 DB2
    20. 20. Nor does it understand single file endo Nature is notbeholden to insurance codes
    21. 21. Nor does it understand single file endo Nature is notbeholden to insurance codes
    22. 22. Micro-etch thefloorcontinuouslyduring accesspreparation -satinize it - itensures maximumoptics anddifferentiation -the orientation ofthe MB2 is withinlimits - MESIAL
    23. 23. Mandibular Molars
    24. 24. Middle Mesial Canal 1 - 15% of cases
    25. 25. Access is about the radicular area of the rootcanal space, not simply getting into the canal,no matter how elastic a file, it can’t go where itwon’t fit
    26. 26. Access is about the radicular area of the rootcanal space, not simply getting into the canal,no matter how elastic a file, it can’t go where itwon’t fit
    27. 27. Off axisorientationmandates crowndown approach -glide path - largeto small tapers,small to large tipsize - NEVER rushwith nickel-titanium - nomatter the design,no matter thebrand, no matterthe metallurgy,their super-elasticity haslimits
    28. 28. One file cannotpossibly do all canalsystems...it’s a dangerousand slippery slope...There is no reason torush to judgment,took the tooth yearsto calcify, you needto soften, debride,disinfect - shape isbut a component ofthe final result -Michaelangelo didnot care the Piatawith one chisel...
    29. 29. Working Length
    30. 30. Working Length
    31. 31. Dilaceration Dr. R. Walton
    32. 32. Constriction Dilaceration Dr. R. Walton
    33. 33. Apical ramifications are myriad - tomarket the suggestion that one file alonecan do everyone canal is disingenuous atand solipsistic at it’s most venal 26
    34. 34. Determining andDefining Endodontic Excellence Electronic Apex
    35. 35. Radiographic Terminus is deceptiveOvoid
    36. 36. Working Length
    37. 37. Working Length
    38. 38. Elements Diagnostic Unit 20 out of 24 were at 0.5mmDr. J. Vera
    39. 39. Down to ‘0.0’: “patency”
    40. 40. Up to ‘0.5’: “WL”
    41. 41. Elements Diagnostic Unit 20 out of 22 were at 0.5mmDr. J. Vera
    42. 42. RadiographicConfirmationConfirm thelength(s) witha radiograph#20 hand file toWL (glidepath)!!!!!!!!!!!!
    43. 43. Obturation Level SuccessVital
    44. 44.  teeth:
    45. 45.  (n=25)
    46. 46.  Success:
    47. 47.  1.22 +/-0.14mm short
    48. 48.  Failure:
    49. 49.   0.20 +/- 0.20mmApical
    50. 50.  periodontitis:
    51. 51.  (n=98) Success:
    52. 52.  
    53. 53.  0.56 +/-0.13mm short Failure:
    54. 54.  
    55. 55.  
    56. 56.  1.67 +/-0.30mm For
    57. 57.  every
    58. 58.  mm
    59. 59.  loss
    60. 60.  of
    61. 61.  WL
    62. 62.  from
    63. 63.  RA,
    64. 64.  the
    65. 65.  odds
    66. 66.  of
    67. 67.  failure
    68. 68.  increase
    69. 69.   by
    70. 70.  14%. Chugal
    71. 71.  et
    72. 72.  al,
    73. 73.  2003
    74. 74. Determining andDefining Endodontic Excellence Debridement Disinfection
    75. 75. The NiTi Revolution needed an Evolution ….really??
    76. 76. The NiTi Revolution needed an Evolution ….really??
    77. 77. Why do Rotary Instruments Break ? Torque
    78. 78.  
    79. 79.  Fatigue
    80. 80.  
    81. 81.  
    82. 82. Minimizing FractureNever
    83. 83.  use
    84. 84.  a
    85. 85.  rotary
    86. 86.  where
    87. 87.  a
    88. 88.  hand
    89. 89.  file
    90. 90.  has
    91. 91.  not
    92. 92.  been
    93. 93.  first.“glide
    94. 94.  path” coronal apical
    95. 95.  hand
    96. 96.  file
    97. 97.  to
    98. 98.  WL
    99. 99.  to
    100. 100.  a
    101. 101.  size
    102. 102.  #20
    103. 103. Canal Anatomy(Type II ⬆ pressure requiredCanals
    104. 104.  that
    105. 105.  come
    106. 106.  together
    107. 107.  at
    108. 108.   sharp
    109. 109.  angles
    110. 110. Canal Anatomy ⬆ pressure requiredS-shaped
    111. 111.  canals
    112. 112. Minimizing FractureOne
    113. 113.  File
    114. 114.  Endo?
    115. 115. Canal Anatomy ⬆ pressure requiredCurved
    116. 116.  canalswhich
    117. 117.  changedirection
    118. 118.  abruptly-short
    119. 119.  radius
    120. 120.  curves!
    121. 121. NiTi Rotary Review
    122. 122.  the
    123. 123.  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
    124. 124. New TorqueControl Source
    125. 125. New TorqueControl Source
    126. 126. Confirm Apical Patency Glide PathStraight
    127. 127.  line
    128. 128.  access
    129. 129.  to
    130. 130.  the
    131. 131.  coronal
    132. 132.  1/3Patency
    133. 133.  to
    134. 134.  size
    135. 135.  #15
    136. 136.  hand
    137. 137.  fileApical
    138. 138.  glide
    139. 139.  to
    140. 140.  a
    141. 141.  #20
    142. 142.  hand
    143. 143.  file
    144. 144.  
    145. 145.  
    146. 146.  
    147. 147.  Use
    148. 148.  of
    149. 149.  the
    150. 150.  M4
    151. 151.  reciprocating
    152. 152.  handpiece
    153. 153.  with
    154. 154.  the
    155. 155.  #10-
    156. 156.  #20
    157. 157.  
    158. 158.   hand
    159. 159.  file
    160. 160.  is
    161. 161.  strongly
    162. 162.  recommended
    163. 163.  to
    164. 164.  ensure
    165. 165.  a
    166. 166.  smooth
    167. 167.  apical
    168. 168.   glide
    169. 169.  path
    170. 170.  before
    171. 171.  rotary
    172. 172.  instrumentation
    173. 173.  begins.
    174. 174. Apical Finishing“Apical
    175. 175.  Gauging”
    176. 176.  assess
    177. 177.  apical
    178. 178.  diameter
    179. 179.  of
    180. 180.  canal gauging,
    181. 181.  narrow
    182. 182.  diameter how
    183. 183.  do
    184. 184.  you
    185. 185.  know
    186. 186.  the
    187. 187.  apical
    188. 188.  canal
    189. 189.  is
    190. 190.  really
    191. 191.  ‘clean’?
    192. 192. Apical Finishing“Apical
    193. 193.  Gauging”
    194. 194.  assess
    195. 195.  apical
    196. 196.  diameter
    197. 197.  of
    198. 198.  canal gauging,
    199. 199.  narrow
    200. 200.  diameter how
    201. 201.  do
    202. 202.  you
    203. 203.  know
    204. 204.  the
    205. 205.  apical
    206. 206.  canal
    207. 207.  is
    208. 208.  really
    209. 209.  ‘clean’?
    210. 210. 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 to the canaldiameter.Methodology Two similar groups (n = 10) of mandibular premolars with curved canals were selected on the basis of theirmorphology. Following access and pulp tissue removal, the first instrument that bound in each canal at the working lengthwas determined. In one group the instrument used was a K-file, in the other group a Lightspeed instrument was used. Afterfixing the instruments in place, the apices were ground to the level of the working length and the diameters of both theinstrument 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 instrument did notcontact the wall. In 90% of the canals, the diameter of the instrument was smaller than the short diameter of the canal; thisdiscrepancy was up to 0.19 mm. No significant difference in discrepancy was found between instruments (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 be removedfrom the entire circumference of the canal wall by filing the root canal to three sizes larger than the file that binds first.
    211. 211. Apical Finishing(enlargement)
    212. 212. Apical Finishing(enlargement)
    213. 213. Apical Finishing(enlargement)
    214. 214. Apical Finishing(enlargement)
    215. 215. Apical Finishing How do you #25know when you are done?
    216. 216. Based
    217. 217.  on
    218. 218.  morphometric
    219. 219.  analysis
    220. 220.  of
    221. 221.  human
    222. 222.  teeth…⋯Kerekes
    223. 223.  
    224. 224.  Tronstad
    225. 225.  1970’s
    226. 226. Determining andDefining Endodontic Excellence Irrigation
    227. 227.  NaOCl
    228. 228.  EDTA
    229. 229.  2%
    230. 230.  CHX
    231. 231.  (cone-fit)Ultrasonic
    232. 232.  Activation
    233. 233.  w/Irri-Safe
    234. 234.   (~30
    235. 235.  sec/canal) EndoVac,
    236. 236.  PAD,
    237. 237.  PIPS
    238. 238.  -
    239. 239.  stay
    240. 240.  tuned
    241. 241. Final Irrigation
    242. 242.  NaOCl
    243. 243.  EDTA
    244. 244.  2%
    245. 245.  CHX
    246. 246.  (cone-fit)Ultrasonic
    247. 247.  Activation
    248. 248.  w/Irri-Safe
    249. 249.   (~30
    250. 250.  sec/canal) EndoVac,
    251. 251.  PAD,
    252. 252.  PIPS
    253. 253.  -
    254. 254.  stay
    255. 255.  tuned
    256. 256. Hand syringe Ultrasonic Delivery
    257. 257. Hand syringe - level 1.0 mm Ultrasonic Delivery - level 1.0 mm
    258. 258. Hand syringe - level 2.0 mm Ultrasonic Delivery - level 2.0 mm
    259. 259. 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 root canalsby 6 different final irrigation techniques.MethodsConventional syringe irrigation, manual dynamic activation (MDA) with tapered or nontapered gutta-percha (GP) cones, theSafety Irrigator system, continuous ultrasonic irrigation (CUI), and apical negative pressure (ANP) irrigation were testedex vivoin 20 root canals with a standardized, debris-filled groove in the apical portion of one canal wall. After each irrigationprocedure, 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 ANP irrigation.These techniques produced better cleaning efficacy than syringe irrigation (P .005) but significantly worse than the MDAwith a tapered cone (P .05). CUI was significantly better than all the other techniques tested in this study (P .001).ConclusionsCUI was the most effective technique in dentin debris removal from the apical irregularities, and syringe irrigationalone was the least effective. MDA technique was more effective with a tapered GP cone than with a nontapered one. Jiang LM, Lak B, Eijsvogels LM, Wesselink P, van der Sluis LWM - J Endo 26, April 2012
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