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Técnicas de Instrumentación Manual
Prof. Raúl Aponte Rendón
Saber Endo
Colegio de Odontólogo de Carabobo
Cuando introducimos un instrumento metálico
en el interior de un conducto curvo, la
tendencia del mismo a enderezarse dete...
Se produce un primer efecto palanca por apoyo de
la lima en la cara externa de la curva en la porción
más apical, y acción...
Cuando la instrumentación es excesiva o
inadecuada, este efecto puede llegar a provocar un
desgarro en el tercio medio del...
“Stripping”
Al proseguir en exceso la instrumentación, la parte
apical del conducto se va desplazando hacia la
cara externa, como una ...
zip
Elbo
w
La suma de los dos efectos acabará por provocar
un mayor ensanchamiento en la porción apical,
con una zona más ...
TRANSPORTE APICAL
TECNICAS DE INSTRUMENTACIÓN
MANUAL
9
1. Convencional.
2. Fuerzas Balanceadas.
3. Step Back (Telescopica - Paso Atras - Retroceso -
Escalonada)
4. Crown Down (C...
Tiene la finalidad de intentar preparar el conducto hasta alcanzar
un tamaño uniforme usando instrumentos sucesivamente má...
15 2520 30 35
CONVENCIONAL
1. Preparación para conductos radiculares curvos.
2. Movimiento rotatorio modificado.
3. Instrumentos especiales con punta...
Pretende no transportar el conducto ni ápice, así como
impulsar el mínimo de bacterias hacia el ápice, y mantener
permeabl...
1.PENETRACION 2.CORTE 3.LIMPIEZA
180°  120° x2
TECNICAS BALANCEADAS
FUERZAS BALANCEADAS
GG:IV
GG:III
GG:II
Calibres Grandes 40 a 45
FUERZAS BALANCEADAS
FUERZAS BALANCEADAS
“TODOS LOS CONDUCTOS TIENEN ALGUNA CURVATURA. INCLUSO LOS
CONDUCTOS QUE PARECEN RECTOS, POR LO GENERAL...
Step Back, Paso Atrás o Telescópica.
Permite la formación de un cono apical debido a la
utilización de instrumentos de diá...
“IDEADA PARA EVITAR LA TRANSPORTACIÓN DE
LA ZONA APICAL EN CONDUCTOS CURVOS.”
“TODOS LOS CONDUCTOS TIENEN ALGUNA CURVATURA...
FASE I FASE II
STEP BACK
15 252010 35 454030
25
FASE III
Preparación a nivel de la
constricción apical, formación del
stop apical.
FASE I
15 252010
Limas K K Flex
Convencional
STE...
15 aL 25
10 15 20 25
STEP BACK
25
25
30
35
40
45
19 mm
18 mm
17 mm
16 mm
20 mm
FASE II
STEP BACK
30 aL 45
30 35 40 45
STEP BACK
SECUENCIA DURANTE LA
PREPARACIÓN
INSTRUMENTACIÓN
INSTRUMENTACIÓNRECAPITULACIÓN
RECAPITULACIÓN
IRRIGACIÓN
IRRIGACIÓN
FASE III
Fase de refinamiento o conclusión de la
preparación.
Alisa las paredes del conducto
disminuyendo los pequeños esc...
CORONO APICALES
Hipótesis de Crown Down
• Reducción del transporte de restos al periápice.
• Reducción de la deformación d...
El acceso a la zona apical no es difícil porque
el diámetro sea pequeño, si no por las
dificultades del paso de la lima a ...
Si eliminamos los contactos con las paredes de los
conductos, en los dos tercios coronarios, la lima
accederá al tercio ap...
CORONO APICALES
1. Step Down.
2. Doble Conicidad.
3. Crown Down sin presión.
Canalda C, y Brau, E. Endodoncia Técnicas Clí...
CROWN DOWN
GG:IV
GG:III
GG:II
80
70
60
55
35
50
45
40
Disminuyendo el
diámetro hasta llegar a
LT.
HIBRIDA O COMBINADA
Cuatro Fases:
1. Pre - Ensanchamiento (Coronal y Medio)
2. Conformación Coronal y Medio (Crown Down)
3...
TÉCNICA HIBRIDA
Pre-Ensanchamiento (Coronal y Medio)
GG:IV
GG:III
GG:II
80
70
60
55
50
45
Coronal y Media (Crown Down)
TÉCNICA HIBRIDA
Apical ( Convencional - Fuerzas Balanceadas)
15 2520 30 35
180°  120° x2
TÉCNICA HIBRIDA
Apico Coronal. (Step Back Modificada)
TÉCNICA HIBRIDA
PREGUNTAS
 Técnica Híbrida de Instrumentación Manual. (Doble Conicidad)
 Técnica Híbrida de Instrumentación Manual. (Doble Conicidad)
 Técnica Híbrida de Instrumentación Manual. (Doble Conicidad)
 Técnica Híbrida de Instrumentación Manual. (Doble Conicidad)
 Técnica Híbrida de Instrumentación Manual. (Doble Conicidad)
 Técnica Híbrida de Instrumentación Manual. (Doble Conicidad)
 Técnica Híbrida de Instrumentación Manual. (Doble Conicidad)
 Técnica Híbrida de Instrumentación Manual. (Doble Conicidad)
 Técnica Híbrida de Instrumentación Manual. (Doble Conicidad)
 Técnica Híbrida de Instrumentación Manual. (Doble Conicidad)
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Técnica Híbrida de Instrumentación Manual. (Doble Conicidad)

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Conocimientos de las Técnicas de instrumentación para poder realizar la técnica de instrumentación híbrida o doble conicidad.

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Técnica Híbrida de Instrumentación Manual. (Doble Conicidad)

  1. 1. Técnicas de Instrumentación Manual Prof. Raúl Aponte Rendón Saber Endo Colegio de Odontólogo de Carabobo
  2. 2. Cuando introducimos un instrumento metálico en el interior de un conducto curvo, la tendencia del mismo a enderezarse determina que se produzcan unos apoyos desiguales, que provocan la deformación de dicho conducto. Veamos cómo se producen. DEFORMACIONES DE LOS CONDUCTOS POR EFECTO DE LA INTRUMENTACIÓN
  3. 3. Se produce un primer efecto palanca por apoyo de la lima en la cara externa de la curva en la porción más apical, y acción del instrumento sobre la cara interna de la curva algo más a coronal.
  4. 4. Cuando la instrumentación es excesiva o inadecuada, este efecto puede llegar a provocar un desgarro en el tercio medio del conducto, con sangrado profuso. Es lo que la literatura anglosajona denomina “Stripping”.
  5. 5. “Stripping”
  6. 6. Al proseguir en exceso la instrumentación, la parte apical del conducto se va desplazando hacia la cara externa, como una cremallera (en inglés, ”ZIP”) que se abre. Un zip excesivo podrá llegar a provocar un neoforamen. zip
  7. 7. zip Elbo w La suma de los dos efectos acabará por provocar un mayor ensanchamiento en la porción apical, con una zona más estrecha algo más a coronal, dando lugar a un “elbow” o acodadura, que dificultará la obturación del sistema de conductos.
  8. 8. TRANSPORTE APICAL
  9. 9. TECNICAS DE INSTRUMENTACIÓN MANUAL 9
  10. 10. 1. Convencional. 2. Fuerzas Balanceadas. 3. Step Back (Telescopica - Paso Atras - Retroceso - Escalonada) 4. Crown Down (Corono Apical) TECNICAS DE INSTRUMENTACIÓN MANUAL Canalda C, y Brau, E. Endodoncia Técnicas Clínicas y Bases Científicas. Madrid. Masson 2006.
  11. 11. Tiene la finalidad de intentar preparar el conducto hasta alcanzar un tamaño uniforme usando instrumentos sucesivamente más grandes hasta la longitud de trabajo. Limas K K Flex CONVENCIONAL
  12. 12. 15 2520 30 35
  13. 13. CONVENCIONAL
  14. 14. 1. Preparación para conductos radiculares curvos. 2. Movimiento rotatorio modificado. 3. Instrumentos especiales con puntas de Batt. (inactiva). 4. Dirigir el instrumento sin sufrir modificaciones. ROANE JB, SABALA C, DUCANSON M. The 'Balanced Force‘ concept for instrumentation of curved root canals. J Endod 1985; 11: 203-11 FUERZAS BALANCEADAS
  15. 15. Pretende no transportar el conducto ni ápice, así como impulsar el mínimo de bacterias hacia el ápice, y mantener permeable el conducto. FUERZAS BALANCEADAS ROANE JB, SABALA C, DUCANSON M. The 'Balanced Force‘ concept for instrumentation of curved root canals. J Endod 1985; 11: 203-11
  16. 16. 1.PENETRACION 2.CORTE 3.LIMPIEZA 180°  120° x2 TECNICAS BALANCEADAS
  17. 17. FUERZAS BALANCEADAS GG:IV GG:III GG:II Calibres Grandes 40 a 45
  18. 18. FUERZAS BALANCEADAS
  19. 19. FUERZAS BALANCEADAS “TODOS LOS CONDUCTOS TIENEN ALGUNA CURVATURA. INCLUSO LOS CONDUCTOS QUE PARECEN RECTOS, POR LO GENERAL ESTÁN CURVOS EN CIERTO GRADO”
  20. 20. Step Back, Paso Atrás o Telescópica. Permite la formación de un cono apical debido a la utilización de instrumentos de diámetros crecientes de forma escalonada , después de configurar un stop apical.- Clem 1969- Describió por primera vez este concepto. APICO CORONALES
  21. 21. “IDEADA PARA EVITAR LA TRANSPORTACIÓN DE LA ZONA APICAL EN CONDUCTOS CURVOS.” “TODOS LOS CONDUCTOS TIENEN ALGUNA CURVATURA. INCLUSO LOS CONDUCTOS QUE PARECEN RECTOS, POR LO GENERAL ESTÁN CURVOS EN CIERTO GRADO” Buchanan STEP BACK
  22. 22. FASE I FASE II STEP BACK 15 252010 35 454030 25 FASE III
  23. 23. Preparación a nivel de la constricción apical, formación del stop apical. FASE I 15 252010 Limas K K Flex Convencional STEP BACK
  24. 24. 15 aL 25 10 15 20 25 STEP BACK
  25. 25. 25 25 30 35 40 45 19 mm 18 mm 17 mm 16 mm 20 mm FASE II STEP BACK
  26. 26. 30 aL 45 30 35 40 45 STEP BACK
  27. 27. SECUENCIA DURANTE LA PREPARACIÓN INSTRUMENTACIÓN INSTRUMENTACIÓNRECAPITULACIÓN RECAPITULACIÓN IRRIGACIÓN IRRIGACIÓN
  28. 28. FASE III Fase de refinamiento o conclusión de la preparación. Alisa las paredes del conducto disminuyendo los pequeños escalones. Permite la convergencia continua desde el ápice hasta la porción coronal. 25 STEP BACK
  29. 29. CORONO APICALES Hipótesis de Crown Down • Reducción del transporte de restos al periápice. • Reducción de la deformación de los conductos. Fairbourn DR et al. J Endodon 1987 Ruiz-Hubbard EE et al. J Endodon 1987 Myers GL y Montgomery S. J Endodon 1991
  30. 30. El acceso a la zona apical no es difícil porque el diámetro sea pequeño, si no por las dificultades del paso de la lima a lo largo del todo el conducto. CORONO APICALES
  31. 31. Si eliminamos los contactos con las paredes de los conductos, en los dos tercios coronarios, la lima accederá al tercio apical con menos tensiones, y disminuirá el riesgo de deformaciones. CORONO APICALES
  32. 32. CORONO APICALES 1. Step Down. 2. Doble Conicidad. 3. Crown Down sin presión. Canalda C, y Brau, E. Endodoncia Técnicas Clínicas y Bases Científicas. Madrid. Masson 2006.
  33. 33. CROWN DOWN GG:IV GG:III GG:II 80 70 60 55 35 50 45 40 Disminuyendo el diámetro hasta llegar a LT.
  34. 34. HIBRIDA O COMBINADA Cuatro Fases: 1. Pre - Ensanchamiento (Coronal y Medio) 2. Conformación Coronal y Medio (Crown Down) 3. Permeabilidad Apical - Conductometria 4. Conformación Apical (Convencional - Fuerzas Balanceadas) 5. Conformación Apico Coronal. (Step Back Modificada)
  35. 35. TÉCNICA HIBRIDA Pre-Ensanchamiento (Coronal y Medio)
  36. 36. GG:IV GG:III GG:II 80 70 60 55 50 45 Coronal y Media (Crown Down) TÉCNICA HIBRIDA
  37. 37. Apical ( Convencional - Fuerzas Balanceadas) 15 2520 30 35 180°  120° x2 TÉCNICA HIBRIDA
  38. 38. Apico Coronal. (Step Back Modificada) TÉCNICA HIBRIDA
  39. 39. PREGUNTAS

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