Cleaning & Shaping

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Cleaning & Shaping

  1. 1. Cleaning & Shaping<br />Dr. Ashraf Refai<br />BDS MSc DD HMD<br />Lecturer of Endodontics<br />Al-Azhar University / MIU<br />www.arefai.edublogs.org<br />
  2. 2. Why Should We Clean & Shape?<br />Any Ideas???<br />
  3. 3. Objectives of Cleaning & Shaping<br />
  4. 4. Mechanical Objectives<br />Create a continuous taper with the narrowest part apically and the widest part coronal.<br />Preserve the natural curvature of the canal<br />Preservation of the apical foramen<br />Creation of an apical stop (seat)<br />Objectives of Cleaning & Shaping<br />
  5. 5. Biological Objectives<br />Total removal of organic and inorganic debris in root canal system<br />Disinfection of the root canal system<br />Do no harm the tooth or the periodontium<br />Objectives of Cleaning & Shaping<br />
  6. 6. Outline Form<br />Resistance Form<br />Retention Form<br />Extension For prevention<br />Toilet of Cavity (Irrigation)<br />Principles of Radicular Cavity Preparation<br />
  7. 7. Canals are wider in one dimension and not the other<br />The cross-section of the canal is rarely rounded<br />There are high percentages of extra canals<br />Lateral & Accessory canals do exists<br />All canals have a degree of curvature<br />Complex Anatomy that Should be Considered<br />
  8. 8. The Myth of the GeometricallyTapered & Straight Canal<br />
  9. 9. Preparation for Root CanalEnlargement<br />
  10. 10. Proper coronal cavity preparation<br />Tooth Length Determination<br />Apical Constriction<br />(o.5 to 1mm) <br />Minor Diameter<br /> Major Diameter<br />Preparation for Root Canal Enlargement<br />
  11. 11. Radiographic Method (Ingle’s Method)<br />Tentative length<br />Reduction of estimated length<br />Placement of the instrument in the canal<br />Exposure of a radiograph<br />Adjustment of the length<br />Retake the radiograph (If necessary)<br />Methods of Tooth Length Determination(Preparation for Root Canal Enlargement)<br />
  12. 12. The Radiographic Method<br />
  13. 13. The SLOB RULE<br />SLOB<br />Buccal<br />Opposite<br />Lingual<br />Same<br />
  14. 14. Apex Locators<br />Used in combination with the radiographic techniques<br />Methods of Tooth Length Determination(Preparation for Root Canal Enlargement)<br />
  15. 15. How Does it Work???<br />
  16. 16. Different Apex Locators<br />
  17. 17. Pulp extirpation & tissue debridement<br />Irrigation (Chemical)<br />The rule is<br />As much as you can<br />As many times as you can<br />Preparation for Root Canal Enlargement<br />
  18. 18. Functions of an Irrigant<br />To physically flush debris<br />Tissue solvent<br />Antibacterial agent<br />Lubricant<br />Irrigation (Preparation for Root Canal Enlargement)<br />
  19. 19. Irrigation (Preparation for Root Canal Enlargement)<br />
  20. 20. Types of Irrigants<br />Sodium Hypochlorite (NaOCl)<br />Preferred irrigant<br />Used in full concentration or half concentration 5.25% or 2.625%<br />Excellent tissue solvent<br />Can be combined with H2O2<br />Best results alternating with EDTA<br />Irrigation (Preparation for Root Canal Enlargement)<br />
  21. 21. Types of Irrigants<br />Ethylene Diaminetetracetice Acid (EDTA)<br />Strong chelating agent<br />Strong antibacterial agent<br />Not a tissue solvent<br />Types: RC prep & Glyde<br />Available in gel form<br />Irrigation (Preparation for Root Canal Enlargement)<br />
  22. 22. Types of Irrigants<br />Hydrogen Peroxide 3% (H2O2)<br />Nascent oxygen (Antibacterial)<br />Effervescence or Bubbling action<br />Irrigation (Preparation for Root Canal Enlargement)<br />
  23. 23. Types of Irrigants<br />ChlorohexidineGluconate 0.2%<br />Comparable to NaOCl but without tissue solvent capability<br />Quaternary Ammonium Compounds<br />Antiseptic, not a tissue solvent, low toxicity<br />Irrigation (Preparation for Root Canal Enlargement)<br />
  24. 24. Preparation for Root Canal Enlargement<br />Method<br />Of<br />Irrigation<br />
  25. 25. Steps of Root Canal Enlargement<br />
  26. 26. Root Canal Enlargement(Hand Instruments)<br />
  27. 27. Root Canal Enlargement(Instrument Motions)<br />Push & Pull<br />Reaming <br />Turn & Pull<br />Watch<br />Winding<br />Balanced<br />Force<br />
  28. 28. Root Canal Enlargement(Techniques: Direction & Sequence)<br />Step Back Technique<br />
  29. 29. Why do we clean & shape?<br />Mechanical Objectives<br />Biological Objectives<br />The Myth of the Geometric Canal<br />Preparation for root canal enlargement<br />Proper access<br />Tooth length determination<br />Irrigation <br />Functions of an irrigant<br />Ideal properties of an irrigant<br />Types of irrigants<br />Components of a preparation technique<br />Step-Back Technique<br />Mid Lecture Revision<br />
  30. 30. Root Canal Enlargement(Techniques: Direction & Sequence)<br />Crown Down Technique<br />
  31. 31. Root Canal Enlargement(Engine Driven Instruments)<br /><ul><li>Rotary instruments had a tendency:
  32. 32. For canal packing with dentin debris
  33. 33. For ledges and perforations
  34. 34. For canal straightening
  35. 35. For instrument breakage
  36. 36. For loss of operator tactile sense</li></ul>Historically they were not widely accepted<br />
  37. 37. Root Canal Enlargement(Engine Driven Instruments)<br />With the introduction of NiTi instruments attitudes changed<br />
  38. 38. Root Canal Enlargement(Engine Driven Instruments)<br /><ul><li>Vibratory instruments</li></ul>How were they used?<br />
  39. 39. Considerations when Preparing Curved Canals<br /><ul><li>Be aware of the curves in the canal
  40. 40. Always use an Irrigant
  41. 41. Never skip files
  42. 42. Never force files
  43. 43. Precurve your files
  44. 44. Anticurvature filing
  45. 45. Use hybrid techniques (Enlarge coronally first)
  46. 46. Use NiTi Files</li></li></ul><li>Considerations when Preparing Curved Canals<br />
  47. 47. When Should You End Your Preparation?<br /><ul><li>When the walls feel smooth and the dentin chips appear yellow white
  48. 48. When there is sufficient resistance form (3 sizes above the initial file)
  49. 49. Adequate taper (To accommodate for a spreader 1-2 to the apex)</li></li></ul><li>Procedural Errors During Cleaning & Shaping<br />
  50. 50. Procedural Errors During Cleaning & Shaping<br />
  51. 51. When Should You End Your Preparation?<br /><ul><li>When the walls feel smooth and the dentin chips appear yellow white
  52. 52. When there is sufficient resistance form (3 sizes above the initial file)
  53. 53. Adequate taper (To accommodate for a spreader 1-2 to the apex)</li></li></ul><li>Procedural Errors During Cleaning & Shaping<br /><ul><li>Canal Blockage
  54. 54. Clinical Appearance: Can’t reach working length
  55. 55. Etiology:
  56. 56. Insufficient irrigation
  57. 57. Lack of recapitulation
  58. 58. Management:
  59. 59. Irrigation & recapitulation with small sized files</li></li></ul><li>Procedural Errors During Cleaning & Shaping<br /><ul><li>Ledge Formation
  60. 60. Clinical Appearance:
  61. 61. Loss of working Length
  62. 62. Solid blockage
  63. 63. File out of path radiographically
  64. 64. Etiology:
  65. 65. Insufficient irrigation
  66. 66. Lack of recapitulation
  67. 67. Using large size instrument in narrow canals
  68. 68. Skipping files
  69. 69. Narrow access</li></li></ul><li>Management of Ledge Formation<br />
  70. 70. Procedural Errors During Cleaning & Shaping<br /><ul><li>Perforation
  71. 71. Clinical Appearance:
  72. 72. Sudden pain
  73. 73. Bleeding into the canal
  74. 74. File appears out of the canal (Radiographically)</li></li></ul><li>Procedural Errors During Cleaning & Shaping<br /><ul><li>Perforation
  75. 75. Etiology:
  76. 76. Coronal Perforation: Over-Enlargement of the canals
  77. 77. Furcation Perforation:Failure of locating the canals
  78. 78. Mid-root Perforation: Over-Enlargement & lack of precurving
  79. 79. Apical Perforation: Improper estimation of the working length</li></li></ul><li>Perforations<br />
  80. 80. Procedural Errors During Cleaning & Shaping<br /><ul><li>Perforation
  81. 81. Treatment:
  82. 82. Coronal Perforation: Filling of the perforation
  83. 83. Furcation Perforation:Repair
  84. 84. Mid-root Perforation: Renegotiation of the canal and the obturation & follow up
  85. 85. Apical Perforation: Reestablishment of the working length</li></li></ul><li>Procedural Errors During Cleaning & Shaping<br /><ul><li>Instrument Separation
  86. 86. Clinical Appearance:
  87. 87. Loss of working length
  88. 88. Missing piece of the instrument
  89. 89. Fractured portion appears on the radiography</li></li></ul><li>Procedural Errors During Cleaning & Shaping<br /><ul><li>Instrument Separation
  90. 90. Etiology:
  91. 91. Using Excessive force
  92. 92. Failure to inspect instrument
  93. 93. Skipping files</li></li></ul><li>Procedural Errors During Cleaning & Shaping<br /><ul><li>Instrument Separation
  94. 94. Treatment:
  95. 95. Removal of the fragment with ultrasonics
  96. 96. Bypass the instruments
  97. 97. Obturate to the instrument fragment and follow up</li></li></ul><li>Why do we clean & shape?<br />Mechanical Objectives<br />Biological Objectives<br />The Myth of the Geometric Canal<br />Preparation for root canal enlargement<br />Proper access<br />Tooth length determination<br />Irrigation <br />Irrigant types, functions and ideal requirements<br />Step-Back Technique<br />Crown-Down Technique<br />Rotary & Vibratory instrumentation<br />Considerations when preparing curved canals<br />When should we end our preparation<br />Errors during preparation<br />Lecture Revision<br />

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