Endosonics / /certified fixed orthodontic courses by Indian dental academy

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  • 1. ENDOSONICS AND SONICS INDIAN DENTAL ACADEMY Leader in Continuing Dental Education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. PHYSICS BEHIND ULTRASONICS www.indiandentalacademy.com
  • 3. www.indiandentalacademy.com
  • 4. PHYSICS BEHIND SONICS www.indiandentalacademy.com
  • 5. www.indiandentalacademy.com
  • 6. BIO PHYSICAL EFFECTS OF ENDOSONICS www.indiandentalacademy.com
  • 7. CONTENTS Introduction History Classifcation Differences between sonics and ultrasonics Endosonics Classification Principles of endosonics Endosonic preparation Endosonic mechanical energy Endosonic chemical energy Endosonic disinfection Clinical procedure Endosonics obturation www.indiandentalacademy.com
  • 8.  Sonics Introduction Different types of sonic instruments Clinical procedure Comparative conclusion of automated devices Endosonics in Retreatment Classification Different types of ultrasonic tips Endosonics in Periapical surgery Isthmus prepartion Retropreparation Ultrasonic tips in restorative dentistry Conclusion References www.indiandentalacademy.com
  • 9. INTRODUCTION Endodontics has entered the high tech era with advances in ultrasonic biotechnology. Endosonic endodontics combines ultrasonic energy with flow through activated irrigation to effectively,efficiently and easily shape,debride,cleanse and disinfect the root canal system www.indiandentalacademy.com
  • 10. HISTORY Introduced to endodontics by Richman in 1957. Developed and promoted by Howard Martin and Walter Cunningham in 1976 www.indiandentalacademy.com
  • 11. CLASSIFICATIONBased on the frequency of vibration and the source of power Ultrasonics Sonics www.indiandentalacademy.com
  • 12. ULTRASONICS Generates vibration above the audible range powered by means of electric currents passing through a lamellar arrangement of metal plates Alternating attractive and replusive forces between the plates affect the mechanical vibratory movements, which are then transferred to the instrument. www.indiandentalacademy.com
  • 13. SONICS Produces vibrations below the audible frequency range by means of compressed air, which activates a rotor and shaft assembly as a source of vibration. www.indiandentalacademy.com
  • 14. HOW THESE SYSTEMS DIFFER FROM ROTARY AND HAND PROCEDURES The cutting of dentin is facilitated by a mechanical device that imparts a sinusoidal motion to the instrument by the transfer of vibrational energy along the shaft The term ultrasonic instrumentation has been used to describe these types of systems www.indiandentalacademy.com
  • 15. SIMILARITY BETWEEN SONIC AND ULTRASONIC Is in imparting vibrational type of movement for the root canal instrument which they acitvate www.indiandentalacademy.com
  • 16. DIFFERENCES BETWEEN SONIC AND ULTRASONIC Source of power Frequency of vibration Type of handpiece Root canal instruments used www.indiandentalacademy.com
  • 17. ENDOSONICSwww.indiandentalacademy.com
  • 18. CLASSIFICATION Based on the source of power and frequency of vibration (a) Magnetostrictive (b) Piezo-electric www.indiandentalacademy.com
  • 19. DIFFERENCES BETWEEN MAGNETOSTRICTIVE AND PIEZO ELECTRIC 20 to 25K Hz  30 to 35 KHz vibrations vibrations Generates heat  Does not generate Requires cooling heat system by flow of  Does not require water cooling system Requires compressed  Built in pump in its air and special tube body connections to the handpiece www.indiandentalacademy.com
  • 20. PRINCIPLES OF ENDOSONICS Transducer element in the endosonic insert transforms the electrical energy of the cavitron into the acoustic mechanical energy necessary to cause the vibratory/oscillatory waves that energize the files and diamonds The resulting sound wave carries the vibratory energy along the entire length of the instruments and causes a reciprocal movement in these files/diamonds www.indiandentalacademy.com
  • 21.  It is this reciprocal excitation of the endosonic files/diamonds which shapes the root canal system The operator no longer acts as the moving force but only as a guide while the ultrasonic energy waves causes the instruments to move in the proper filing motion The energy wave enables the instruments to remove contaminated dentin, debris and tissue www.indiandentalacademy.com
  • 22.  The endosonic insert is unique in it’s design in that it allows the traditional endodontic irrigant NaOCl to used The solution will follow a precurved file thus allowing the deepest penetration into the canal and leads to complete irrigation of the root canal system. In actuality the root canal system has been transformed into an ultrasonic bath www.indiandentalacademy.com
  • 23. ENDOSONIC PREPARATION Preparation of the root canal is a chemo-mechanical procedure whose purpose is to remove necrotic debris, and contaminated dentin from the root canal. In addition the denitst must eliminate/reduce the pathogenic bacterial component via a process of disinfection while also preparing the canal for three dimensional obturation www.indiandentalacademy.com
  • 24. ENDOSONIC MECHANICAL ENERGY The ultrasonic wave energy is a mechanical vibratory action. The file motion used in ultrasonic root canal preparation is essentially a push-pull action enhancing dentin removal more effectively than hand instruments in the same time frame and with greater control Circumferential movement of the files is also advocated to achieve the smooth tapering canal shape that is considered optimal for obturation www.indiandentalacademy.com
  • 25.  A side-to-side action or lateral movement activates the irrigant solution which improves its disinfecting and cleaning qualities. The clinical importance of this is improved control of the obturation technique, ease of apical obturation and less extrusion www.indiandentalacademy.com
  • 26. ENDOSONIC CHEMICAL ENERGY The activation of the endodontic irrigant is vital to the effectiveness of the endosonic system The irrigation solution NaOCl will penetrate the root canal system more effectively due to the ultrasonic activation of the solution which can only be achieved when it undergoes ultrasonation. This can not be achieved with sonic systems www.indiandentalacademy.com
  • 27.  Ultrasonics vibration is unparalleled in its ability to enhance cleaning with irrigants. Ultrasonic activation of NaOCl has been shown to be most effective in the apical third of the canal owing to the greater amplitudes of vibratory movement at the file tip www.indiandentalacademy.com
  • 28.  The prinicipal effects of ultrasound in solution are: (a) Cavitation (b) Acoustic steaming Cavitation occurs when ultrasound generates a bubble in the irrigant which grows to a critical point and then undergoes the implosion effect ( Internal collapse) with the concomitant release of a shock wave and tremendous force with a vacuum effect www.indiandentalacademy.com
  • 29.  Cavitation- the growth and subsequent violent collapse of a small gas filled preexisting inhomogeneity in the bulk fluid. (JOE 1987)o Cavitation, a process by which bubbles formed from the action of the file, become unstable, collapse, and cause a vacuum-like ‘implosion.’ A combined shock, shear and vacuum action results (Ingle 4th edition) www.indiandentalacademy.com
  • 30.  The main debriding action of ultrasonics was initially thought to be by cavitation. It allows for deep penetration into all ramifications of the canal and draws out all the debris. Guy’s Hospital in London thoroughly studied the mechanisms involved and questioned the role that cavitation and implosion play in the cleansing Endodontics process. They believe that a different physical phenomenon, “acoustic streaming,” is responsible for the debridement www.indiandentalacademy.com
  • 31. ACOUSTIC STREAMING Acoustic steaming creates small, intense, circular fluid movement ( i.e., eddy flow ) around the instruments (Cohen 8th edition) Acoustic streaming- the rapid movement of particles of fluid in vortex-like motion about a vibrating object. (JOE 1987) www.indiandentalacademy.com
  • 32. Ultrasonically engerized file creates currents ofstreaming of irrigant within the root canal www.indiandentalacademy.com
  • 33.  The eddying occurs closer to the tip than in the coronal end of the file, with an apically directed flow at the tip. Acoustic streaming increases the cleaning effect of the irrigant in the pulp space through hydrodynamic shear stress Increased amplitude occuring at smaller file sizes enhances the acoustic streaming. This has proven to be of great value in the cleaning of the root canals because conventional irrigation solutions do not penetrate small spaces well. www.indiandentalacademy.com
  • 34.  Cavitation does not play a role in root canal debridement. Acoustic streaming appeared to exert a more important role in root canal debridement. (JOE 1987) www.indiandentalacademy.com
  • 35. ENDOSONIC DISINFECTION MECHANICAL DISINFECTION:o Is the physical removal of necrotic debris, predentin and contaminated dentin.o Endosonic diamonds/files plane the dentin walls smooth and remove the detritus which acts a substrate for bacteria.Also eliminates many of the ramifications which house and trap debris.o Another form of mechanical disinfection is the high volume irrigant flow that has the capacity to flush debris and bacteria from the canal. www.indiandentalacademy.com
  • 36. CHEMICAL DISINFECTION: Cavitational effects clean the canal system of any organic pabulum that would acts as a substrate for bacterial growth Acoustic microstreaming causes a radiating pressure that shears bacterial cells, making them more vulnerable to irrigant action The physical chemical activation of the irrigant is also due to ultrasonation increasing the release of free radicals and the formation of hypochlorous acid and energy release catalyzing the solution into a more active formation www.indiandentalacademy.com
  • 37. ENDOSONIC CLINICAL TECHNIQUE Initial root canal preparation is made using hand instruments with no.15 instrument Smallest endosonic file no.15 is used with handpiece held in the pen grasp Depressing the foot control to the first position energizes the file while depressing the control fully causes the irrigant to flow. Movement of the file is light, smooth, short, push-pull stroke up and down first followed by a circumferential movement www.indiandentalacademy.com
  • 38.  The sequence of energized filling and irrigation is carried on through endosonic files no.20 and no.25 with all files used in the canal for at least one minute per instrument Upon completion of endosonic filing the endosonic diamond is utilized in the canal Diamonds are also used with a push-pull motion followed by circumferential movement. They are also used for at least one minute per instrument www.indiandentalacademy.com
  • 39.  One starts with no.25 diamond which feel tight within the canal gradually works it down the canal and will feel tight within the canal and gradually works it down the canal and will feel it becoming loose within the canal confines The diamond is used to taper and smooth the straighter portions of the canal- cervical and middle areas The circumferential movement will round, taper and smooth the canal The diamond is safe ended to avoid any further apical enlargement www.indiandentalacademy.com
  • 40.  After the canal has been prepared by the endosonic files/diamonds the apical 1 to 3mm should undergo recapitulation with no.20 or no.25 hand files to the established working length A properly prepared endosonic canal maintains the original canal outline with sufficient flare coronally ending in a prepared minimal apical opening with smooth, tapering walls which will make obturation extremely easy to accomplish. www.indiandentalacademy.com
  • 41.  Endosonic files and irrigation were used to debride the apical and middle thirds, while the files/diamonds with irrigant debride the middle and cervical thirds of the canal It has also been recently shown that a final irrigation, prior to obturation, of 1-3 minutes with NaOCl will give the cleanest canals achievable This was shown to be superior to NaOCl and EDTA together and demonstrated numerous tubules and lack of smear www.indiandentalacademy.com
  • 42. ENDOSONIC IRRIGATION IN INTERNAL RESORPTION In this clinical condition endosonic irrigation is used. Endosonic irrigation disinfects the resorption site and helps in proper cleaning of the site www.indiandentalacademy.com
  • 43. ENDOSONICS IN OBTURATION A gutta percha cone was used as master cone. Ultrasonic tip was used as a spreader and energized along the gutta percha. Accessory cones were placed and were compacted using ultrasonic tip as a spreader and then compacted with finger pluggers. Finally hand plugger was used to compact them vertically. www.indiandentalacademy.com
  • 44.  Obturation of internal resorption cavities with 4 different techniques: An in-vitro comparative study Studies have shown that Lentulospiral gave the best result for sealer placement at different levels from the apex in comparison to K file and ultrasonic file. www.indiandentalacademy.com
  • 45. Piezon unit with an endosonic insert and irrigant bottlewww.indiandentalacademy.com
  • 46. DIFFERENT TYPES OF ENDOSONIC UNITS Satelec P5 MTS-1 and Piezo-Electric Systems NSK MiniEndo Enac www.indiandentalacademy.com
  • 47. SONICS SYSTEM www.indiandentalacademy.com
  • 48. SONIC SYSTEM Like the air rotor handpiece, it attaches to the regular airline at a pressure of 0.4 MPa. The air pressure may be varied with an adjustable ring on the handpiece to give an oscillatory range of 1,500 to 3,000 cycles per second. Tap water irrigant/coolant is delivered into the preparation from the handpiece. Sonic endodontic handpiece available today is the Micro Mega 1500 (or 1400) Sonic Air Endo System (Medidenta/ Micro Mega) www.indiandentalacademy.com
  • 49.  Walmsley et al., in England, studied the oscillatory pattern of sonically powered files. They found that out in the air, the sonic file oscillated in a large elliptical motion at the tip. When loaded, as in a canal, however, they were pleased to find that the oscillatory motion changed to a longitudinal motion, up and down, “a particularly efficient form of vibration for the preparation of root canals www.indiandentalacademy.com
  • 50. SONIC INSTRUMENTS RispiSonic Shaper Sonic Trio Sonic (also called in Europe the Heliosonic and the Triocut File) www.indiandentalacademy.com
  • 51. RISPI SONIC Developed by Dr. Retano Spina in Italy Resembles the old rat-tail file Has 8 cutting blades Safe-ended noncutting tips ISO sizes range from 15 to 40 www.indiandentalacademy.com
  • 52. SHAPER SONIC Developed by Dr. J. M. Laurichesse in France Resembles a husky barbed broach. Has 16 cutting blades Safe-ended noncutting tips ISO sizes range from 15 to 40 www.indiandentalacademy.com
  • 53. TRIOSONIC Also called the Heliosonic and the Triocut File Resembles a triple-helix Hedstroem file Safe-ended noncutting tips ISO sizes range from 15 to 40 www.indiandentalacademy.com
  • 54. CANAL PREPARATION These instruments must be free to oscillate in the canal, to rasp away at the walls, and to remove necrotic debris and pulp remnants. To accommodate the smallest instrument, a size 15, the canal must be enlarged to the working length with hand instruments through size No. 20. The sonic instruments, with the 1.5 to 2.0 mm safe tips, begin their rasping action this far removed from the apical stop. This is known as the “sonic length.” www.indiandentalacademy.com
  • 55.  As the instrument becomes loose in the canal, the next-size instrument is used, and then the next size, which develops a flaring preparation. The sonic instruments are primarily for step- down enlarging, not penetration. www.indiandentalacademy.com
  • 56. CONCLUSIONS OF DENTAL SCHOOL IN WALES Dummer et al. found the Rispi Sonic and Shaper Sonic files to be the most successful, the Trio Sonic less so The Shaper Sonic files widened the canals more effectively than the Rispi Sonic files, whilst the Heliosonic [Trio Sonic] files were particularly ineffective…” www.indiandentalacademy.com
  • 57. RECOMMENDATIONS OF RESEARCH GROUP AT TEMPLE UNIVERSITY They recommended that the Shaper Sonic files be used first and that the remaining two-thirds of the canal be finished with the Rispi Sonic. Ehrlich et al. compared canal apical transport using Rispi,Sonic and Trio Sonic files versus hand instrumentation with K files. They found no difference in zipping among the three instruments. www.indiandentalacademy.com
  • 58.  Tronstad and Niemczyk also tested the Rispi and Shaper files against other instruments. They reported no complications(broken instruments, perforations, etc) with either of the Sonic instruments Miserendino et al. also found that the “Micro Mega sonic vibratory systems using Rispi Sonic and Shaper files were significantly more efficient than the other systems tested.” www.indiandentalacademy.com
  • 59. COMPARATIVE CONCLUSION OF AUTOMATED DEVICES It appears safe to say that no one automated device will answer all needs in canal cleaning and shaping. Hand instrumentation is essential to prepare and cleanse the apical canal, no matter which device, sonic or ultrasonic, is used. The sonic unit Micro Mega 1500 reportedly enlarges the canal the fastest when Rispi or Shaper files are used, whereas the Canal Finder System, using A-style files, leads in instrumenting narrow curved canals. www.indiandentalacademy.com
  • 60.  Finally, the ultrasonic CaviEndo and Enac units, using small K files and half-strength sodium hypochlorite for an extended time (3 minutes), seem to débride the canal best. No technique without sodium hypochlorite kills bacteria, however. One must evaluate one’s practice and decide which device, no device, or all three best suit one’s needs. www.indiandentalacademy.com
  • 61. ULTRASONIC INSTRUMENTS IN RETREATMENT www.indiandentalacademy.com
  • 62. APPLICATIONS Root canal obstructions Identification of missed and hidden canals Removal of posts Removal of core materials Removal of obturating materials Removal of broken instrument tips www.indiandentalacademy.com
  • 63. DESIGNS OF ULTRASONIC TIPS Simple curves to multiangled bends Long and slender or short and sturdy End cutting or side cutting Made of Stainless steel or Titanium alloys Stainless steel may be coated with Zirconium nitride or diamond grit Desgined to function dry or with water ports to increase the cooling and washing effect www.indiandentalacademy.com
  • 64. CLASSIFICATIONThe different ultrasonic systems havebeen broadly classified as follows:(1) Access refinement tips(2) Vibratory tips(3) Bulk removal tips(4) Troughing tips www.indiandentalacademy.com
  • 65. CT TIPS First ultrasonic tips for endodontic surgery; the CT tips made of stainless steel Designed by Dr.Gary Carr First available in early 1990 These were set of 5 instruments www.indiandentalacademy.com
  • 66. KiS TIPSIntroduced in the year1999 by Dr.Syngcuk KimDramatically increasescutting efficiency due totheir diamond coating.Diamond Coating provides amicro-rough surface of theinner wall of the retroprepared cavity www.indiandentalacademy.com
  • 67.  Location of irrigation port which is on the tip rather than on the shaft Slightly longer than other microsurgical instruments for better access. www.indiandentalacademy.com
  • 68. PROULTRA TIPSExists in two types namely Proultra endo 1-8 Proultra surgical endo tips 1-6 These tips are designed by Dr.Clifford J. Ruddle www.indiandentalacademy.com
  • 69. PROULTRA ENDO Remove intracanal obstruction materials Disassemble dental restorations and cores Trough and chase for calcified or hidden canals Dislodge posts and broken instruments Efficiently eliminate pulp stones www.indiandentalacademy.com
  • 70. PROSURGICAL ENDO TIPS Tip-1 A universal instrument with a tip angle of 80º designed for anterior roots Tip-2 Greater diameter than that of tip of 1 and is used for larger apical canals Tip-3 A double-angled 75º instrument for roots of mandibular left and maxillary right posterior www.indiandentalacademy.com teeth
  • 71. Tip-4 A double-angled 110º instrument for roots of mandibular left and maxillary right posterior teeth Tip-5 A double-angled 75º instrument for roots of mandibular right and maxillary left posterior teethTip-6 A double-angled110º instrument forroots of mandibularright and maxillary www.indiandentalacademy.comleft posterior teeth
  • 72. CPR TIPS Diamond coating enhances cutting efficiency Remove intra-canal obturation materials Water port allows to cut wet or dry and reduces heat generation Identifies hidden and calcified canals Efficiently eliminate pulp stones and obstructions www.indiandentalacademy.com
  • 73.  CPR 1-5 are diamond coated and active along the side of the tips CPR 3D,4D,5D are 15, 20 and 25mm in length respectively . These instruments are used in the coronal, middle and apical third of canals and their selection depends on the depth at which they need to be operated. www.indiandentalacademy.com
  • 74. CPR TITANIUM SERIES Remove Intracanal obstruction materials Dislodge posts and broken instruments The flexibility and strength of Titanium allows these Instruments to follow the anatomy of the Root Canal Allows for deep canal instrumentation www.indiandentalacademy.com
  • 75.  CPR tips 6(red),7(Blue),8(Green), are used in deeper part of a straight canal which are 20,24 and 27mm long respectively These instruments should be used with light touch www.indiandentalacademy.com
  • 76. BUC TIPS Designed by L. Stephen Buchanan BUC-1: The Tapered fine diamond grit - cutting and refining line angles, smoothing access walls, cutting MB troughs BUC-2: The Planer Disk Tip, medium diamond grit - planing pulp chamber floors and safely plane attached pulp stones out without cutting the chamber floor. www.indiandentalacademy.com
  • 77.  BUC-2a: Smaller Disk-used for corners of molar and bicuspid access preps. 1mm in diamater BUC-3: The Sharp Tipped, fine diamond grit - very active tip for cutting into calcified roots and around posts www.indiandentalacademy.com
  • 78. BK 3 TIPS BK-3 surgical tips have three bends for easy access to any preparation including MB2 canals.  BK-3’s provides increased visibility and can finish an entire prep with one tip.  Water is directed down the three bends and is able to reach the surgical site. BK-3s are for use with any application. These tips should be used at low power levels www.indiandentalacademy.com
  • 79. ACCESS REFINEMENT TIPS Access cavity preparation is the most important phase of endodontic therapy Recently, a combination of access refinement ultrasonic tips and magnification has revolutionized the basic concept of access cavity preparation. There are many advantages to using ultrasonic tips rather than burs to refine the access cavity to locate the underlying anatomy www.indiandentalacademy.com
  • 80. Advantages are: No handpiece head to obscure vision and, therefore, the progressive cutting action can be observed directly and continuously under the microscope. The size of ultrasonic tips is smaller than the smallest burs; therefore, the dentine can be brushed off in smaller increments and with greater control. The process allows for exposure of any missed or hidden canals or recesses containing necrotic pulp tissue without gutting down the tooth structure www.indiandentalacademy.com
  • 81.  Another advantage of ultrasonic instruments over burs is the production of-cavitation within the cooling water that flows over the tip of the ultrasonic instrument. Cavitation may be described simply as bubble activity in a liquid, which is capable of generating enough shock waves to cause disruption of remnants of necrotic pulp tissue -and any calcific deposits. Therefore, it is no wonder that access cavities prepared with ultrasonic instruments have a thoroughly washed out and clean appearance www.indiandentalacademy.com
  • 82. www.indiandentalacademy.com
  • 83.  A number of tips are available to refine the access cavity. The uncovering of the floor of the pulp chamber can be accomplished with the help of the CPR 2D or BUC 1 tips. If the dark, colored floor of the pulp chamber is not visible, it usually is obscured by pulp stones or tertiary dentine deposits The pulp stones sometimes can be vibrated or teased out by the CPR 2D or BUC 1 tips at other times, they can be planed with the help of a BUC 2 tip —a process similar to planing the root surface. www.indiandentalacademy.com
  • 84. VIBRATORY TIPS Removal of intraradicular posts has always been a challenge when performing endodontic retreatment. This procedure also has been fraught with unwanted consequences, such as root fracture or perforation. The implementation of ultrasonic energy has provided the clinician with an important adjunctive method for removal of posts. A number of studies have shown conclusively that the use of ultrasonic vibration significantly reduces the amount of tensile force required to dislodge both the cast and prefabricated posts. www.indiandentalacademy.com
  • 85.  The VT , Osada Enac ST09, and CPR 1 are examples of such instrument tips. The tips of these instruments are spherical or flat and are placed against the post to transmit vibration They are activated at the maximum intensity and moved circumferentially until the post loosens or dislodges. If this method does not loosen and free the , post then alternate methods must be used. www.indiandentalacademy.com
  • 86.  These tips should not be placed directly on ceramics because it may cause severe damage to the prosthesis The inability to remove posts by vibration alone is dependent on many factors such as the type of luting agent, the length and type of the post, and the type of core buildup The core buildup around the post should be removed before applying the vibratory tip. www.indiandentalacademy.com
  • 87.  In some cases, the troughing tip should be used around the post and then vibratory tips should be reapplied to obtain the maximum benefit Posts luted with zinc phosphate cement can be dislodged readily by ultrasonics because of microcrack formation in the cement However, posts luted with resin cements fail to dislodge by ultrasonic vibration, probably due to the lack of the micro-fracture propagation in these materials www.indiandentalacademy.com
  • 88. BULK REMOVAL TIPS Bulk removal tips are extremely sharp and sturdy tips that are operated at moderate or maximum intensity of the ultrasonic unit. BUC 1 and CPR 2D are examples of tips that fall into this category. These tips are designed primarily to remove dentine and core material quickly and expeditiously before subjecting the root canal obstruction to vibratory or troughing procedures. www.indiandentalacademy.com
  • 89. TROUGHING TIPS Troughing tips are used to create a sufficiently deep trough around posts to maximize the benefits of subsequently applied vibratory or extraction forces. In the past, troughing around the root canal obstruction was performed with trephine drills. www.indiandentalacademy.com
  • 90.  This process was extremely destructive and frequently led to the gutting down and perforation of root trunks. Now with the help of ultrasonic tips, troughing around root canal obstructions can be performed in a predictable and controlled manner www.indiandentalacademy.com
  • 91. REMOVAL OF BROKEN INSTRUMENT TIPS MICROSONICS An ultrasonic instrument is selected based on the depth of the broken file and space availability It is activated at the lowest power setting and used dry so that the clinician has constant vision between the energized tip and the broken instrument www.indiandentalacademy.com
  • 92.  The selected CPR instrument is moved lightly in a CCW direction around the obstruction except when removing reverse-screw files This ultrasonic action sands away dentin and trephines around the coronal few millimeters of the obstruction The obstruction begins to loosen, unwind and spin Gently wedging the energized tip between the tapered file and the canal wall oftentimes causes the broken instrument to abruptly “jump out” of the canal www.indiandentalacademy.com
  • 93. ENDOSONICS IN ENDODONTIC SURGERY www.indiandentalacademy.com
  • 94. ROLE IN PERIAPICAL SURGERY After resecting the root surface in periapical surgery ultrasonic tips are used to carve Isthmus Retropreparation of root surface www.indiandentalacademy.com
  • 95. ISTHMUS PREPARATION WITH ULTRASONIC TIPS Is the only way to carve an isthmus. Requires a careful and delicate approach, because the isthmus is located in the thinner portion of the root which can be easily be perforated or stripped. The ultrasonic tip with a diameter of less than 0.2mm is the best tip to treat the isthmus without causing procedural mishaps. www.indiandentalacademy.com
  • 96.  Occasionally the dental surgeon encounters an incomplete isthmus. It is helpful in this case to provide a guideline for the ultrasonic tip by creating a shallow groove along the isthmus line with a microexplorer. This is called “ Tracking Groove” The ultrasonic tip is first activated without water coolant to make a tracking groove connecting the two canals, which are usually oriented buccal to lingual. The groove is produced quickly by gently guiding the tip along the isthmus www.indiandentalacademy.com
  • 97.  However before proceeding with the preparation of the isthmus to the full depth the tracking groove should be examined at 12x to 16x magnification for correct postioning Once the correct position is confirmed the isthmus is fully prepared with a water-cooled Kis 1-tip or CT-1 tips. The length of the active portion of the tip is 3mm with 0.2mm diameter width The entire tip length must be used to prepare the isthmus. www.indiandentalacademy.com
  • 98. RETROPREPARATION OF ROOT SURFACE Five requirements that a root-end preparation must fulfill: The apical 3 mm of the root canal must be freshly cleaned and shaped. The preparation must be parallel to and coincident with the anatomic outline of the pulp space. Adequate retention form must be created. All isthmus tissue, when present, must be removed. Remaining dentin walls must not be weakened. www.indiandentalacademy.com
  • 99. ADVANTAGES OF ULTRASONIC TIPS OVER MICROHEAD BURS Better access, especially in difficult-to-reach areas (e.g., a lingual apex) More thorough debridement of tissue debris Conservative preparations tracing the long axis at a precise depth of 3 mm Precise isthmus preparations with parallel canal walls for better retention of filling materials www.indiandentalacademy.com
  • 100. ULTRASONIC ROOT END PREPARATION This procedure is accomplished under the microscope at low-to-mid magnifications (4 x 16 x). First, a number of appropriate tips are preselected, depending upon the location of each apex. Second, the resected root surface, stained with methylene blue, must be critically examined at high magnification (16 x to 25 x) to see the microanatomy. Third, at low magnification (4 x to 6 x), the selected ultrasonic tip is positioned at the apex www.indiandentalacademy.com
  • 101.  It is important at this stage that the tip is positioned parallel with the long axis of the root. To accomplish this the surgeon must examine the position of entire tooth at low magnification (4 x), including the crown and root eminence and compare this with the position of the ultrasonic tip. Failure to make this comparison will risk an off-angle root end preparation or perforation. Fourth, the ultrasonic tip is activated and the apical canal is retroprepared with copious water coolant to a depth of 3 mm www.indiandentalacademy.com
  • 102.  If an ultrasonic tip is pressed too firmly it is dampened to deactivatation thus a light sweeping motion using short forward-and backward and up and down strokes is all that is needed for effective cutting action. Depending on the canal configuration a typical 3mm retropreparation should take less than 1minute with KiS tips www.indiandentalacademy.com
  • 103.  Once the retropreparation is completed the cavity preparation is inspected with a micromirror at high magnification of 16x to 25x. www.indiandentalacademy.com
  • 104.  Layton and associates did an in vitro study evaluating the integrity of the resected root- end Surfaces, following root-end resection and after root-end Preparation, with ultrasonic Instrumentation at low and high frequencies The results indicated that root end resection alone may result in dentin crack formation regardless of the type of root-end preparation. www.indiandentalacademy.com
  • 105.  Their data also indicated that more dentin cracks occurred when the ultrasonic tip was used on the high frequency setting than on the low-frequency setting That more cracks resulted following ultrasonic root-end cavity preparation, regardless of the frequency setting, than after root-end resection alone. www.indiandentalacademy.com
  • 106. ULTRASONIC TIPS IN RESTORATIVE DENTISTRY-SL TIPS SL (Surface Lesion) tips have been designed to accomplish restorative, preventive procedures while conserving sound tooth structure Designed by Dr.Cherilyn G. Sheets and Dr. Jacinthe M. Paquette in conjunction with the Newport Coast Facial Institute www.indiandentalacademy.com
  • 107.  SL-1: For access to disto-buccal areas of the upper left molars and the lingual aspect of lower right molars SL-2: accessibility to cervical areas and interproximal areas SL-3: Useful for conservative treatment of occlusal surfaces of posterior teeth SL-4: For conservative correction with its 0.5mm tip for early decalcification or stain removal on occlusal surface www.indiandentalacademy.com
  • 108. CONCLUSIONCurrently endosonics have wider applications in endodontics. The multiple effects of endosonics are physical, Chemical and biological actions. Thus is developed theEndosonic Ultrasonic Synergistic System www.indiandentalacademy.com
  • 109. REFERENCESPathways of Pulp – Cohen 4th, 6th,8theditionsEndodontic practice-Ingle 4th editionDCNA-Modern endodontic practiceJOE-1987Current trends in Endodontology- Dr.A.Parmeswaran, Dr.B.P.RajanFACE-1 Tooth Resorption- Dr.M.R. Srinivasan www.indiandentalacademy.com
  • 110. www.indiandentalacademy.com