The document discusses root canal preparation techniques. It describes cleaning and shaping objectives to remove debris and bacteria while creating a tapered canal for filling. Irrigation solutions like sodium hypochlorite and EDTA are discussed for cleaning. Instrumentation with nickel titanium or stainless steel files of varying tapers, tips, lengths, and sizes is described. The crown-down technique is outlined, starting with larger files coronally and progressing apically with smaller files. Estimating canal size and determining working length is also summarized.
Endodontic surgery is performed to address issues like failed root canal treatments, procedural errors, anatomical variations, and biopsies. It involves raising a surgical flap, resecting the root tip, preparing and filling the root end cavity. Potential complications include swelling, pain, nerve damage and infection. A variety of materials can be used for the root end filling including zinc oxide eugenol cements, MTA, composites and glass ionomer cements. The goal is to provide an apical seal to prevent reinfection from microbes remaining in the root canal system.
The document discusses strategies for managing teeth with irreversible pulpitis, known as "hot teeth", including supplemental injections like intra-ligamentary (PDL), intra-osseous, articaine buccal infiltration, and intra-pulpal when conventional injections fail to provide anesthesia. It provides details on techniques for different supplemental injections using devices like the Wand or Stabident system and recommends strategies based on tooth location, such as inferior alveolar nerve block plus lingual and intra-osseous for mandibular posterior teeth.
This document discusses techniques for mandibular anesthesia. It focuses on the inferior alveolar nerve block, which anesthetizes the inferior alveolar nerve, mental nerve, and incisive nerve. The technique involves locating anatomical landmarks like the coronoid notch and pterygomandibular raphe, then inserting the needle 1 cm above the occlusal plane of the mandibular posteriors and advancing it to the bone near the mandibular foramen to deposit the solution within 1 mm of the inferior alveolar nerve. Precautions are taken to avoid forceful bone contact. Failure can occur if the injection is too low or anterior, or due to accessory innervation. Complications include hematoma, tr
Gow gates & vazirani akinosi technique of nervePOOJAKUMARI277
The document summarizes two techniques for mandibular nerve blocks - the Gow-Gates technique and the Vazirani-Akinosi closed mouth technique.
The Gow-Gates technique involves injecting the anesthetic at the neck of the condyle using intraoral and extraoral landmarks to block the mandibular nerve. It provides anesthesia of the mandibular teeth and surrounding soft tissues with a single injection. The Vazirani-Akinosi technique is done with the patient's mouth closed by inserting the needle through the mucosa at the level of the maxillary molar junction to block the mandibular nerve. Both techniques effectively anesthetize the mandibular region for dental
This document discusses various methods for gaining space in orthodontic treatment, including proximal stripping, arch expansion, extraction, distalization of molars, uprighting tilted molars, derotation of posterior teeth, and proclination/flaring of anterior teeth. It provides details on techniques such as rapid maxillary expansion using devices like Hyrax or bonded expanders, extraction of first premolars, and distalization of molars using appliances like pendulum or Jones Jig. The document also covers indications, advantages, and disadvantages of different space gaining methods.
This document discusses apexification and indirect pulp capping procedures. Apexification is used to induce calcification at the open apex of an immature tooth to allow for root canal treatment. Materials used include calcium hydroxide, tricalcium phosphate, and MTA. Calcium hydroxide is placed in the canal and replaced every 3 months until radiographic evidence of apical barrier formation. MTA can also be used by placing it at the apex. Indirect pulp capping covers the deepest carious dentin with a biocompatible material like calcium hydroxide to prevent pulpal exposure while removing infected dentin, allowing for pulp preservation.
The document discusses working length determination in endodontics. It defines working length as the distance from a coronal reference point to the point where canal preparation and obturation should terminate. This is usually 1mm short of the apical foramen. Several methods of determining working length are discussed, including radiographic methods and the use of electronic apex locators, which provide objective measurements with high accuracy. Consequences of working length that is too long or too short are also outlined.
This document discusses the various instruments used for tooth preparation for dental crowns and restorations. It outlines 12 different instruments including flat end and round end tapered diamonds, torpedo diamonds and burs, short and long needle burs, small wheel diamonds, radial fissure burs, and flame diamond burs. For each instrument, it provides the specific uses in tooth preparation for different types of dental crowns like PFM, cast metal, and full porcelain crowns. The objectives are to use the correct instruments for each tooth preparation step to obtain the best results and prosthesis for the patient.
Endodontic surgery is performed to address issues like failed root canal treatments, procedural errors, anatomical variations, and biopsies. It involves raising a surgical flap, resecting the root tip, preparing and filling the root end cavity. Potential complications include swelling, pain, nerve damage and infection. A variety of materials can be used for the root end filling including zinc oxide eugenol cements, MTA, composites and glass ionomer cements. The goal is to provide an apical seal to prevent reinfection from microbes remaining in the root canal system.
The document discusses strategies for managing teeth with irreversible pulpitis, known as "hot teeth", including supplemental injections like intra-ligamentary (PDL), intra-osseous, articaine buccal infiltration, and intra-pulpal when conventional injections fail to provide anesthesia. It provides details on techniques for different supplemental injections using devices like the Wand or Stabident system and recommends strategies based on tooth location, such as inferior alveolar nerve block plus lingual and intra-osseous for mandibular posterior teeth.
This document discusses techniques for mandibular anesthesia. It focuses on the inferior alveolar nerve block, which anesthetizes the inferior alveolar nerve, mental nerve, and incisive nerve. The technique involves locating anatomical landmarks like the coronoid notch and pterygomandibular raphe, then inserting the needle 1 cm above the occlusal plane of the mandibular posteriors and advancing it to the bone near the mandibular foramen to deposit the solution within 1 mm of the inferior alveolar nerve. Precautions are taken to avoid forceful bone contact. Failure can occur if the injection is too low or anterior, or due to accessory innervation. Complications include hematoma, tr
Gow gates & vazirani akinosi technique of nervePOOJAKUMARI277
The document summarizes two techniques for mandibular nerve blocks - the Gow-Gates technique and the Vazirani-Akinosi closed mouth technique.
The Gow-Gates technique involves injecting the anesthetic at the neck of the condyle using intraoral and extraoral landmarks to block the mandibular nerve. It provides anesthesia of the mandibular teeth and surrounding soft tissues with a single injection. The Vazirani-Akinosi technique is done with the patient's mouth closed by inserting the needle through the mucosa at the level of the maxillary molar junction to block the mandibular nerve. Both techniques effectively anesthetize the mandibular region for dental
This document discusses various methods for gaining space in orthodontic treatment, including proximal stripping, arch expansion, extraction, distalization of molars, uprighting tilted molars, derotation of posterior teeth, and proclination/flaring of anterior teeth. It provides details on techniques such as rapid maxillary expansion using devices like Hyrax or bonded expanders, extraction of first premolars, and distalization of molars using appliances like pendulum or Jones Jig. The document also covers indications, advantages, and disadvantages of different space gaining methods.
This document discusses apexification and indirect pulp capping procedures. Apexification is used to induce calcification at the open apex of an immature tooth to allow for root canal treatment. Materials used include calcium hydroxide, tricalcium phosphate, and MTA. Calcium hydroxide is placed in the canal and replaced every 3 months until radiographic evidence of apical barrier formation. MTA can also be used by placing it at the apex. Indirect pulp capping covers the deepest carious dentin with a biocompatible material like calcium hydroxide to prevent pulpal exposure while removing infected dentin, allowing for pulp preservation.
The document discusses working length determination in endodontics. It defines working length as the distance from a coronal reference point to the point where canal preparation and obturation should terminate. This is usually 1mm short of the apical foramen. Several methods of determining working length are discussed, including radiographic methods and the use of electronic apex locators, which provide objective measurements with high accuracy. Consequences of working length that is too long or too short are also outlined.
This document discusses the various instruments used for tooth preparation for dental crowns and restorations. It outlines 12 different instruments including flat end and round end tapered diamonds, torpedo diamonds and burs, short and long needle burs, small wheel diamonds, radial fissure burs, and flame diamond burs. For each instrument, it provides the specific uses in tooth preparation for different types of dental crowns like PFM, cast metal, and full porcelain crowns. The objectives are to use the correct instruments for each tooth preparation step to obtain the best results and prosthesis for the patient.
This document discusses various root canal preparation techniques including step-back, crown-down, and balanced force techniques. It provides details on each technique's procedures, advantages, and limitations. The step-back technique involves initial apical preparation followed by step-wise coronal preparation to create tapers. Crown-down starts with coronal flaring before apical instrumentation to minimize debris extrusion. Hybrid and balanced force techniques combine aspects of different methods.
Provisional restoration in fixed partial denturebhuvanesh4668
This document discusses various techniques for fabricating provisional restorations. It begins by defining provisional restorations and outlining their key requirements and purposes. It then describes common provisional luting materials and different types of provisional restorations that can be used. The remainder of the document focuses on detailing specific techniques for fabricating provisional restorations, including direct fabrication techniques, indirect techniques using impressions or templates, and the use of prefabricated crowns. Key steps are outlined for a variety of techniques.
This document discusses impacted teeth, including causes, frequency, complications, and surgical removal procedures. It begins by defining an impacted tooth and listing common causes such as irregular tooth positioning or premature tooth loss. Mandibular third molars are most frequently impacted. Complications include caries, infection, neurological issues, cysts, and fractures. Surgical procedures for removing impacted lower third molars and upper third molars involve gaining access, removing bone, and luxating the tooth. Classification systems describe impacted tooth positions and relationships.
This document discusses root perforations, including their causes, classification, diagnosis, and treatment using mineral trioxide aggregate (MTA). It begins by defining a root perforation and listing potential causes. It then discusses factors that affect prognosis and classifications of perforations. Detection methods like radiographs and apex locators are presented. The document outlines a case study of successful repair of a strip perforation using MTA and concludes that MTA is a suitable material for perforation repair.
This document compares and contrasts microabrasion and macroabrasion techniques for treating tooth discoloration. Microabrasion involves using a paste of hydrochloric acid and pumice or silicon carbide to dissolve and abrade the enamel surface. It is a conservative treatment that removes only superficial stains. Macroabrasion uses diamond or carbide burs to remove defects at a faster rate but with less control than microabrasion. Both techniques can improve the appearance of teeth affected by conditions like fluorosis but microabrasion allows for better control and more conservative removal of tooth structure.
This document discusses different types of periodontal instruments and their uses. It describes five main classifications of instruments: periodontal probes, explorers, scaling/root planing/curettage instruments, periodontal endoscopes, and cleansing/polishing instruments. Specific instruments are discussed in detail within each classification, including their parts, designs, uses, and benefits. Gracey curettes, sickle scalers, hoe scalers, files, and ultrasonic instruments are some of the instruments explained in the document.
This document discusses the cleaning and shaping of root canals. It defines cleaning as the removal of pathogenic contents from the root canal and shaping as creating a 3D tapered shape that is widest coronally and narrowest apically. The objectives of shaping are outlined as both mechanical and biological to remove debris without forcing it periapically and create sufficient space for obturation. Various techniques are described such as step-back, crown-down, and hybrid techniques. Considerations like instrument movements, irrigation methods, and the goals of apical enlargement are also covered.
This document discusses various obturation techniques for filling root canals including:
1. Cold lateral compaction, the most widely used technique, involves inserting a master cone coated with sealer followed by lateral compaction of accessory cones.
2. Warm vertical compaction uses heated pluggers to vertically compact gutta percha that has been softened with heat.
3. Carrier-based techniques like Thermafil involve heating and inserting a gutta percha coated metal core carrier into the canal.
The document provides details on how to perform each technique and their advantages and disadvantages. A variety of materials can be used for obturation including gutta percha, resins, and single cone techniques.
BIOMECHANICAL PRINCIPLES OF TOOTH PREPARATIONAamir Godil
The document discusses the principles of tooth preparation for dental restorations. It is divided into three categories: biologic considerations which focus on tissue health, mechanical considerations related to restoration integrity and durability, and esthetic considerations affecting patient appearance. Key points include the importance of conserving tooth structure, placing margins for easy finishing and hygiene, designing taper and contours for adequate retention and resistance, and selecting materials and techniques to meet esthetic needs. Proper tooth preparation is essential for successful long-term restoration outcomes.
Tooth mobility refers to loose teeth that can move within their sockets. It is classified on a scale of 0 to 3 based on the degree of horizontal and vertical movement. Physiologic mobility of about 0.25mm is normal, while pathologic mobility over 1mm indicates loose teeth from periodontal disease or trauma. Periodontal disease is a primary cause as it leads to loss of attachment and bone supporting the teeth. Treatment involves splinting loose teeth together, replacing missing teeth, and correcting occlusal surfaces to reduce excessive forces. For advanced periodontal cases, extraction may be necessary.
This document provides information on bilateral sagittal split osteotomy (BSSO), a common surgical procedure for the mandible. Some key points:
- BSSO involves making sagittal cuts along the ramus and body of the mandible to allow advancement or setback of the mandible. It was first described in the 1950s and has undergone several modifications.
- Indications for BSSO include mandibular deficiencies, prognathism, asymmetries, open bites, and cross bites. Contraindications include decreased posterior body height and ramus hypoplasia.
- The surgical procedure involves incisions, osteotomy cuts, splitting the segments, mobilization, positioning, and
Principles of tooth preparation in Fixed Partial DenturesVinay Kadavakolanu
The document discusses principles of tooth preparation for dental restorations. It summarizes that the all-ceramic crown preparation design requires the highest percentage of tooth structure reduction at 65.26%, while ceramic veneers require the lowest at 30.28%. Proper tooth preparation aims to preserve tooth structure, provide retention and resistance, maintain structural durability and marginal integrity, and preserve the periodontium. The amount and location of tooth reduction impacts these factors.
This document discusses curved and dilacerated root canals. It defines these terms and lists their causes, prevalence, locations, and methods of detection. Curved and dilacerated canals present challenges for instrumentation like ledges, perforations, and blocked canals. The document describes types of curves and dilacerations based on morphology and location. It outlines techniques for managing these canals, including precurving files, using smaller files, modifying file edges, and crown-down instrumentation. Managing restoring forces and active cutting lengths helps navigate curves safely and minimize iatrogenic damage.
This document discusses direct and indirect pulp capping procedures. Indirect pulp capping involves covering the deepest layer of remaining carious dentin with a biocompatible material to prevent pulp exposure and stimulate tertiary dentin formation. Direct pulp capping places a protective dressing directly over an exposed pulp to preserve its vitality. Various materials used for both procedures are discussed, along with their advantages and disadvantages. The document provides details on performing indirect and direct pulp capping clinically and factors affecting their success.
The document discusses guidelines for preparing access cavities for root canal treatment. It outlines principles such as removing all caries and defective restorations, conserving tooth structure, and providing straight-line access to canal orifices. Specific guidelines covered include visualizing internal anatomy, evaluating anatomical landmarks, preparing cavities through lingual/occlusal surfaces, and locating all root canals before placing a dental dam. The goal is to efficiently locate and treat all canals following principles of access cavity design.
Apexogenesis & apexification in pediatric dentistryDr. Harsh Shah
SDDCH Parbhani
Presented by : Vipul GIratkar
Dept. of Pediatric dentitstry
Guided by . Dr. Rehan Khan
DIscussion regarding apexification and apexogenesis
Dr. MM House classified patients' psychology into four types for house classification in 1950:
1. Philosophical - Easygoing and confident in dentists with excellent prognosis.
2. Exacting - Intelligent and methodical but demanding with good prognosis.
3. Hysterical - Emotionally unstable and never satisfied with good to poor prognosis.
4. Indifferent - Unconcerned about dental treatment and difficult to motivate with good prognosis.
House also categorized patients as cooperative or uncooperative. Cooperative patients accept treatment readily while uncooperative patients are difficult to treat due to their negative attitudes. Understanding patients' expectations and psychological profiles is important for achieving patient satisfaction and successful dental treatments
This document discusses various minimal invasive dentistry techniques including:
- Atraumatic Restorative Treatment (ART) which uses hand instruments and glass ionomer cement to arrest caries lesions.
- Cavity modifications using high and low speed burs that aim to preserve tooth structure by only removing infected dentin.
- SonicSys Micro which uses an oscillating handpiece for proximal cavities.
- Chemomechanical caries removal using solutions like Carisolv or Caridex to selectively degrade carious dentin.
- Air abrasion using aluminum oxide particles to remove hard dental tissue with minimal invasiveness.
- Bonded restorations using adhesive materials like composites, glass ionomers and
Treatment of pulpitis with biological, vital amputational and extirpation met...Linda Jenhani
This document discusses various methods for treating pulpitis, including biological, vital amputation, and extirpation methods. It examines the stages of treatment, efficacy of different methods, and ways to prevent complications. Specific focus is given to biological and vital amputation methods for treating reversible pulpitis by removing irritants if present and using calcium hydroxide or initiating root canal treatment depending on the exposure and size of exposure.
Vital pulp therapy aims to preserve healthy pulp tissue and includes procedures like indirect/direct pulp capping, pulpotomy, and apexification. The goal is to stimulate reparative dentin formation and maintain the tooth as a functional unit. Success depends on factors like the patient's age, pulp chamber size, bacterial contamination, and quality of the restoration. Indirect pulp capping involves stepwise caries removal and capping the remaining dentin layer, while direct capping places a material directly over an exposed pulp. Pulpotomy and apexification procedures are used to treat immature teeth and maintain root development.
This document discusses various root canal preparation techniques including step-back, crown-down, and balanced force techniques. It provides details on each technique's procedures, advantages, and limitations. The step-back technique involves initial apical preparation followed by step-wise coronal preparation to create tapers. Crown-down starts with coronal flaring before apical instrumentation to minimize debris extrusion. Hybrid and balanced force techniques combine aspects of different methods.
Provisional restoration in fixed partial denturebhuvanesh4668
This document discusses various techniques for fabricating provisional restorations. It begins by defining provisional restorations and outlining their key requirements and purposes. It then describes common provisional luting materials and different types of provisional restorations that can be used. The remainder of the document focuses on detailing specific techniques for fabricating provisional restorations, including direct fabrication techniques, indirect techniques using impressions or templates, and the use of prefabricated crowns. Key steps are outlined for a variety of techniques.
This document discusses impacted teeth, including causes, frequency, complications, and surgical removal procedures. It begins by defining an impacted tooth and listing common causes such as irregular tooth positioning or premature tooth loss. Mandibular third molars are most frequently impacted. Complications include caries, infection, neurological issues, cysts, and fractures. Surgical procedures for removing impacted lower third molars and upper third molars involve gaining access, removing bone, and luxating the tooth. Classification systems describe impacted tooth positions and relationships.
This document discusses root perforations, including their causes, classification, diagnosis, and treatment using mineral trioxide aggregate (MTA). It begins by defining a root perforation and listing potential causes. It then discusses factors that affect prognosis and classifications of perforations. Detection methods like radiographs and apex locators are presented. The document outlines a case study of successful repair of a strip perforation using MTA and concludes that MTA is a suitable material for perforation repair.
This document compares and contrasts microabrasion and macroabrasion techniques for treating tooth discoloration. Microabrasion involves using a paste of hydrochloric acid and pumice or silicon carbide to dissolve and abrade the enamel surface. It is a conservative treatment that removes only superficial stains. Macroabrasion uses diamond or carbide burs to remove defects at a faster rate but with less control than microabrasion. Both techniques can improve the appearance of teeth affected by conditions like fluorosis but microabrasion allows for better control and more conservative removal of tooth structure.
This document discusses different types of periodontal instruments and their uses. It describes five main classifications of instruments: periodontal probes, explorers, scaling/root planing/curettage instruments, periodontal endoscopes, and cleansing/polishing instruments. Specific instruments are discussed in detail within each classification, including their parts, designs, uses, and benefits. Gracey curettes, sickle scalers, hoe scalers, files, and ultrasonic instruments are some of the instruments explained in the document.
This document discusses the cleaning and shaping of root canals. It defines cleaning as the removal of pathogenic contents from the root canal and shaping as creating a 3D tapered shape that is widest coronally and narrowest apically. The objectives of shaping are outlined as both mechanical and biological to remove debris without forcing it periapically and create sufficient space for obturation. Various techniques are described such as step-back, crown-down, and hybrid techniques. Considerations like instrument movements, irrigation methods, and the goals of apical enlargement are also covered.
This document discusses various obturation techniques for filling root canals including:
1. Cold lateral compaction, the most widely used technique, involves inserting a master cone coated with sealer followed by lateral compaction of accessory cones.
2. Warm vertical compaction uses heated pluggers to vertically compact gutta percha that has been softened with heat.
3. Carrier-based techniques like Thermafil involve heating and inserting a gutta percha coated metal core carrier into the canal.
The document provides details on how to perform each technique and their advantages and disadvantages. A variety of materials can be used for obturation including gutta percha, resins, and single cone techniques.
BIOMECHANICAL PRINCIPLES OF TOOTH PREPARATIONAamir Godil
The document discusses the principles of tooth preparation for dental restorations. It is divided into three categories: biologic considerations which focus on tissue health, mechanical considerations related to restoration integrity and durability, and esthetic considerations affecting patient appearance. Key points include the importance of conserving tooth structure, placing margins for easy finishing and hygiene, designing taper and contours for adequate retention and resistance, and selecting materials and techniques to meet esthetic needs. Proper tooth preparation is essential for successful long-term restoration outcomes.
Tooth mobility refers to loose teeth that can move within their sockets. It is classified on a scale of 0 to 3 based on the degree of horizontal and vertical movement. Physiologic mobility of about 0.25mm is normal, while pathologic mobility over 1mm indicates loose teeth from periodontal disease or trauma. Periodontal disease is a primary cause as it leads to loss of attachment and bone supporting the teeth. Treatment involves splinting loose teeth together, replacing missing teeth, and correcting occlusal surfaces to reduce excessive forces. For advanced periodontal cases, extraction may be necessary.
This document provides information on bilateral sagittal split osteotomy (BSSO), a common surgical procedure for the mandible. Some key points:
- BSSO involves making sagittal cuts along the ramus and body of the mandible to allow advancement or setback of the mandible. It was first described in the 1950s and has undergone several modifications.
- Indications for BSSO include mandibular deficiencies, prognathism, asymmetries, open bites, and cross bites. Contraindications include decreased posterior body height and ramus hypoplasia.
- The surgical procedure involves incisions, osteotomy cuts, splitting the segments, mobilization, positioning, and
Principles of tooth preparation in Fixed Partial DenturesVinay Kadavakolanu
The document discusses principles of tooth preparation for dental restorations. It summarizes that the all-ceramic crown preparation design requires the highest percentage of tooth structure reduction at 65.26%, while ceramic veneers require the lowest at 30.28%. Proper tooth preparation aims to preserve tooth structure, provide retention and resistance, maintain structural durability and marginal integrity, and preserve the periodontium. The amount and location of tooth reduction impacts these factors.
This document discusses curved and dilacerated root canals. It defines these terms and lists their causes, prevalence, locations, and methods of detection. Curved and dilacerated canals present challenges for instrumentation like ledges, perforations, and blocked canals. The document describes types of curves and dilacerations based on morphology and location. It outlines techniques for managing these canals, including precurving files, using smaller files, modifying file edges, and crown-down instrumentation. Managing restoring forces and active cutting lengths helps navigate curves safely and minimize iatrogenic damage.
This document discusses direct and indirect pulp capping procedures. Indirect pulp capping involves covering the deepest layer of remaining carious dentin with a biocompatible material to prevent pulp exposure and stimulate tertiary dentin formation. Direct pulp capping places a protective dressing directly over an exposed pulp to preserve its vitality. Various materials used for both procedures are discussed, along with their advantages and disadvantages. The document provides details on performing indirect and direct pulp capping clinically and factors affecting their success.
The document discusses guidelines for preparing access cavities for root canal treatment. It outlines principles such as removing all caries and defective restorations, conserving tooth structure, and providing straight-line access to canal orifices. Specific guidelines covered include visualizing internal anatomy, evaluating anatomical landmarks, preparing cavities through lingual/occlusal surfaces, and locating all root canals before placing a dental dam. The goal is to efficiently locate and treat all canals following principles of access cavity design.
Apexogenesis & apexification in pediatric dentistryDr. Harsh Shah
SDDCH Parbhani
Presented by : Vipul GIratkar
Dept. of Pediatric dentitstry
Guided by . Dr. Rehan Khan
DIscussion regarding apexification and apexogenesis
Dr. MM House classified patients' psychology into four types for house classification in 1950:
1. Philosophical - Easygoing and confident in dentists with excellent prognosis.
2. Exacting - Intelligent and methodical but demanding with good prognosis.
3. Hysterical - Emotionally unstable and never satisfied with good to poor prognosis.
4. Indifferent - Unconcerned about dental treatment and difficult to motivate with good prognosis.
House also categorized patients as cooperative or uncooperative. Cooperative patients accept treatment readily while uncooperative patients are difficult to treat due to their negative attitudes. Understanding patients' expectations and psychological profiles is important for achieving patient satisfaction and successful dental treatments
This document discusses various minimal invasive dentistry techniques including:
- Atraumatic Restorative Treatment (ART) which uses hand instruments and glass ionomer cement to arrest caries lesions.
- Cavity modifications using high and low speed burs that aim to preserve tooth structure by only removing infected dentin.
- SonicSys Micro which uses an oscillating handpiece for proximal cavities.
- Chemomechanical caries removal using solutions like Carisolv or Caridex to selectively degrade carious dentin.
- Air abrasion using aluminum oxide particles to remove hard dental tissue with minimal invasiveness.
- Bonded restorations using adhesive materials like composites, glass ionomers and
Treatment of pulpitis with biological, vital amputational and extirpation met...Linda Jenhani
This document discusses various methods for treating pulpitis, including biological, vital amputation, and extirpation methods. It examines the stages of treatment, efficacy of different methods, and ways to prevent complications. Specific focus is given to biological and vital amputation methods for treating reversible pulpitis by removing irritants if present and using calcium hydroxide or initiating root canal treatment depending on the exposure and size of exposure.
Vital pulp therapy aims to preserve healthy pulp tissue and includes procedures like indirect/direct pulp capping, pulpotomy, and apexification. The goal is to stimulate reparative dentin formation and maintain the tooth as a functional unit. Success depends on factors like the patient's age, pulp chamber size, bacterial contamination, and quality of the restoration. Indirect pulp capping involves stepwise caries removal and capping the remaining dentin layer, while direct capping places a material directly over an exposed pulp. Pulpotomy and apexification procedures are used to treat immature teeth and maintain root development.
Cleaning and shaping the root canal systemParth Thakkar
The document discusses various techniques for cleaning and shaping the root canal during endodontic treatment. The objectives are to remove infected tissue, provide access for irrigants and medicaments, create space for obturation, and maintain tooth integrity. Key steps discussed include determining working length, instrumentation using techniques like step-back preparation, and irrigation. Factors that can affect working length determination and techniques to enhance cleaning and shaping are also outlined.
This document discusses diseases of the pulp, including types of pulpitis such as reversible, irreversible, acute, and chronic pulpitis. It outlines causes of pulp inflammation including mechanical, thermal, chemical and bacterial causes. Symptoms and classifications of different types of pulpitis are described. Histological features and management approaches for various pulp diseases like necrosis and hyperplastic pulpitis are also summarized.
1) There are several techniques for cleaning and shaping root canals during endodontic procedures, including step-back, crown-down, and hybrid techniques.
2) The step-back technique involves first enlarging the apical third of the canal with small files, then using larger files to step back and flare the middle and coronal thirds.
3) The crown-down technique starts with flaring the coronal third, then preparing the middle and apical thirds with progressively smaller files moving from the crown toward the apex.
This document describes the crown-down pressureless technique for cleaning and shaping root canals. It involves initially using larger Gates-Glidden drills and files in the coronal 2/3 of the root canal and progressively using smaller files until reaching the desired working length. This prevents debris from being extruded apically, as was a disadvantage of previous step-back techniques. The crown-down technique provides a coronal escapeway for debris and reduces the risk of extrusion.
Endodontic instruments /certified fixed orthodontic courses by Indian dental...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
CLEANING AND SHAPING USING ROTARY ENDODONTIC INSTRUMENTS /certified fixed or...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
La técnica telescópica o Step-back permite la conformación de conductos curvos respetando la anatomía mediante una reducción gradual de la longitud de trabajo y aumento del calibre de los instrumentos. Consiste en dos fases, la primera para conformar la porción apical y la segunda para modelar los tercios medio y cervical. Aunque existe controversia sobre la extensión apical ideal, esta técnica permite obtener paredes lisas con menor desgaste en comparación con otras, pero también puede causar transporte apical o perforaciones.
Direct pulp capping involves placing a protective material directly over an exposed dental pulp to encourage healing and formation of reparative dentin. It is a conservative treatment alternative to root canal therapy to save a tooth's vitality when the exposure is small. Success rates range widely from 13-98% depending on factors like the type of exposure, quality of the restoration, and operator skill. Calcium hydroxide and mineral trioxide aggregate are commonly used capping materials that induce healing, but newer options like Biodentine show promise as well. Future trends may involve techniques like lasers, gene therapy, or stem cells to further improve pulp capping outcomes.
This document discusses irrigation in endodontics. It provides an introduction to irrigation solutions and devices used, challenges of irrigation, and recent advances. It describes the ideal characteristics of endodontic irrigants and commonly used solutions such as sodium hypochlorite. Sodium hypochlorite is the current irrigant of choice and its properties, concentrations, effects on dentin, and safety considerations are discussed in detail. The document concludes by emphasizing the importance of irrigation in endodontic treatment.
Preparacion biomecanica de los conductosguest5cd9df
El documento describe los principios básicos de la preparación biomecánica (PBM) de conductos radiculares. La PBM consiste en limpiar y dar forma al conducto para permitir la desinfección y obturación mientras se respeta la anatomía original. Se usan instrumentos mecánicos, sustancias químicas e irrigación/aspiración para lograr una forma cónica, paredes lisas y mantener el diámetro apical original.
Este manual provee guías para estudiantes en procedimientos de endodoncia clínica. Incluye cómo elaborar un diagnóstico clínico y endodóntico completando una historia clínica y exámenes como radiografías. También cubre procedimientos como lograr anestesia adecuada, apertura coronaria, aislamiento del campo operatorio, determinación de longitud de trabajo, preparación del conducto radicular, uso de irrigantes, eliminación de barro dentinario, medicación intraconducto y obturación. El objetivo es que los estudiant
The document discusses diseases of the dental pulp, including pulpitis and necrosis. It defines the pulp as the formative organ of the tooth that builds dentin. Pulpitis is the most common cause of dental pain and can be reversible or irreversible depending on the severity of inflammation. Untreated pulpitis can lead to necrosis or death of the pulp. Causes include mechanical, thermal, chemical, and bacterial factors. Management involves removal of irritants and root canal treatment if needed.
The document discusses recent advances in rotary endodontic instrumentation. It describes several new rotary file systems including Revo-S, which uses only 3 nickel-titanium instruments to simplify treatment while optimizing cleaning. It also discusses the GTX M-Wire system, which features files made of a new nickel titanium wire that has greatly enhanced resistance to cyclic fatigue. The Self-Adjusting File is also summarized, which has a hollow design that allows for continuous irrigation and lacks a rigid metal core to help avoid canal transportation in curved canals.
The document discusses the definitions, objectives, and techniques for cleaning and shaping the root canal system, including the use of various hand files, rotary instruments, and ultrasonic devices. It covers the phases of negotiation, coronal pre-enlargement, working length determination, and root canal shaping techniques. The goals are to remove debris and shape the canal to receive obturation while preserving the canal anatomy and preventing errors.
This document discusses methods for determining the working length in root canals. It defines key terms like working length, cementodentinal junction, and apical constriction. It describes the significance of accurately determining working length and consequences of being over or under extended. Both radiographic and non-radiographic methods are outlined, including their advantages and limitations. The document concludes that no single method is entirely satisfactory and that a combination of methods should be used to accurately determine working length.
Endodontics. anatomy of root canals. instrumentsLinda Jenhani
This document discusses endodontics, including the anatomy of tooth cavities and root canals. It describes endodontic instruments such as files, reamers, broaches and rotary instruments. Common endodontic procedures like tooth cavity disclosure, amputation, and extirpation of the pulp are also outlined. Methods for root canal treatment including step-back, crown-down, and balanced force techniques are explained. Considerations for adequate root canal preparation and potential errors are summarized.
The document discusses the preparation of the root canal system through cleaning and shaping. It defines cleaning as the removal of contents from the root canal to eliminate bacteria, and shaping as the mechanical process of establishing a continuous taper to the canal to allow for better instrumentation, irrigation, and obturation. The objectives of preparation are to remove all irritants from the canal biologically and to develop a tapered conical form that maintains the original canal anatomy mechanically. Principles of preparation include outlining the canal shape, removing debris, and developing retention and resistance forms through appropriate tapers and diameters.
The document discusses a new paradigm in nickel-titanium (NiTi) instrumentation called the Self-Adjusting File (SAF) system. The SAF represents an improvement over traditional rotary NiTi files by adapting to the three-dimensional anatomy of the root canal, continuously irrigating during instrumentation, and requiring only a single file per canal. Studies have shown the SAF more effectively cleans and shapes canals while preventing issues like canal transportation compared to traditional rotary files. The simple SAF procedure and ability to respect root canal anatomy may provide more effective and higher quality root canal treatments.
Cleaning and shaping of the root canal system has both mechanical and biological objectives. It aims to create a continuously tapered shape from the coronal to apical ends while maintaining the natural curvature and apical foramen. Proper cleaning and shaping requires adequate access preparation, working length determination, irrigation, and the use of step-back or crown-down techniques. Potential errors include ledge formation, perforation, canal blockage, and separated instruments.
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Myanmar Society of Oral Implantology collaborates with Dental Implant system using in Myanmar and celebrates Two days seminar. At this event, as the President of MSOI, I present this topic on Dentium Dental Implant System. It was sponsored by Zizawa Company.
This document discusses cleaning and shaping of root canals. It begins by defining cleaning and shaping and outlining their objectives. It then describes various phases and techniques for cleaning and shaping, including patency filing, working length measurement, coronal pre-enlargement, and root canal shaping techniques like step-back, crown-down, and hybrid techniques. It provides guidelines for instrumentation and discusses functional motions. The document provides details on each phase and compares advantages and disadvantages of different techniques.
This document discusses pulp therapy procedures for primary teeth. It begins by outlining the lifespan of primary pulp organs. It then discusses diagnostic considerations, definitions, objectives and goals of various pulp therapy techniques. It provides details on the armamentarium, instrumentation methods, irrigation, and limitations of endodontic treatment in primary teeth. Overall, the document provides an overview of pulp therapy procedures for maintaining cariously involved primary teeth.
Comparison of root microcrack formation after root canal preparation using tw...iosrjce
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Biomechanical preparation1/ rotary endodontic courses by indian dental academyIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This document provides information on biomechanical preparation for root canal treatment. It discusses various techniques for cleaning, shaping, and preparing the root canal including step-back technique, step-down technique, crown-down pressureless technique, balanced force technique, and rotary instrumentation techniques. It also covers objectives of root canal preparation, rules for cleaning and shaping, potential procedural accidents and their prevention, and the importance of avoiding over-instrumentation.
This lecture explain the basic of root canal preparation in endodontic treatment. It is not meant to be a comprehensive lecture, rather an preliminary one
- Determining the accurate working length is critical for successful endodontic treatment. The working length is defined as the distance from a coronal reference point to the point where canal preparation and filling should terminate, usually 1mm short of the anatomical apex. Several radiographic and non-radiographic methods can be used to estimate the working length, with the goal of terminating instrumentation at the apical constriction. Common radiographic techniques include using pre-operative measurements, grids, or mathematical formulas based on relative instrument and tooth lengths on radiographs.
This study compared the effects of 6 nickel-titanium rotary file systems (OneShape, ProTaper Universal, ProTaper Next, Reciproc, Twisted File Adaptive, and WaveOne) on root canal geometry changes in severely curved mesial root canals of mandibular molars. The root canals were scanned using cone-beam computed tomography before and after instrumentation to assess changes. The Reciproc system removed significantly more dentin than the OneShape, ProTaper Universal, and Twisted File Adaptive systems. However, there were no significant differences among the groups regarding transportation, curvature changes, surface area changes, or centering ability. All 6 file systems similarly straightened root canal curvature and produced similar canal transportation
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Purpose, rationale, and importance of obturation.pdfTomJMDienya
The document discusses the purpose, rationale, and importance of obturation after root canal treatment. Obturation functions to prevent reinfection by acting as a barrier and sealing any surviving bacterial cells. Failure to eliminate etiological factors and prevent further contamination can lead to treatment failure. At least 5mm of gutta percha retained in the root provides an adequate apical seal and reduces leakage. Coronal leakage through the restoration is also a significant cause of treatment failure if the access cavity is left unfilled and exposed to fluids over time.
The document summarizes research on the self-adjusting file (SAF) system for root canal preparation.
[1] The SAF is a hollow file made of compressible nickel titanium that adapts to the cross-sectional shape of the canal. It removes dentin through a grinding motion with irrigation flowing continuously through it.
[2] Studies show the SAF prepares flat and oval canals more effectively than rotary files, removing up to 75 micrometers of dentin from the entire canal wall. It also induces less stress on root dentin than rotary files.
[3] The continuous flow of irrigant through the SAF improves disinfection by suspending more bacteria into the
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Devitalized extirpation, amputation and combined method
1. Devitalized extirpation,Devitalized extirpation,
amputation and combinedamputation and combined
method of pulpitismethod of pulpitis
treatment. Mummification:treatment. Mummification:
stages, complications.stages, complications.
Comparative characteristicsComparative characteristics
of different methods ofof different methods of
pulpitis treatment.pulpitis treatment.
2. Cleaning and Shaping ofCleaning and Shaping of
the Root Canal Systemthe Root Canal System
3. Objectives of Canal PreparationObjectives of Canal Preparation
Start with the end in mindStart with the end in mind
4. Objectives of root canal preparationObjectives of root canal preparation
The root canal system must be:The root canal system must be:
CleanedCleaned of its organic remnantsof its organic remnants
ShapedShaped to receive a threeto receive a three
dimensional filling of the entiredimensional filling of the entire
root canal spaceroot canal space
5. Objectives of root canal preparationObjectives of root canal preparation
The canal isThe canal is
First cleansed by irrigationFirst cleansed by irrigation
Then shaped by instrumentationThen shaped by instrumentation
6.
7. Cleansing of the root canalCleansing of the root canal
ObjectivesObjectives
Removal of organic debrisRemoval of organic debris
Elimination of bacteriaElimination of bacteria
8. IrrigationIrrigation
An ideal irrigant:An ideal irrigant:
Is nontoxicIs nontoxic
Dissolves vital and necrotic tissueDissolves vital and necrotic tissue
Is bactericidalIs bactericidal
Lubricates the canalLubricates the canal
Removes the smear layerRemoves the smear layer
9. Sodium hypochloriteSodium hypochlorite
Dissolves vital and necroticDissolves vital and necrotic
tissuetissue
Is bactericidalIs bactericidal
Lubricates the canalLubricates the canal
11. ProlubeProlube
Facilitates placement of fileFacilitates placement of file
Entraps debrisEntraps debris
Helps in removal of the smearHelps in removal of the smear
layerlayer
13. Shaping of the root canalShaping of the root canal
Canal shape – produced byCanal shape – produced by
instrumentationinstrumentation
Objective is a smooth taperedObjective is a smooth tapered
preparationpreparation
22. Tip DesignTip Design
Non-cutting tipNon-cutting tip
Bullet nose (60 degree) tipBullet nose (60 degree) tip
Smooth transition angle whereSmooth transition angle where
tip meets flat radial landstip meets flat radial lands
23. Tip DesignTip Design
Designed to follow a pilot holeDesigned to follow a pilot hole
Guides instrument through canalGuides instrument through canal
during preparationduring preparation
28. Cross sectional geometryCross sectional geometry
Radial lands separated by three u-Radial lands separated by three u-
shaped flutesshaped flutes
Provide space for accumulation ofProvide space for accumulation of
debrisdebris
Moves debris out of canalMoves debris out of canal
29. Length of cutting bladeLength of cutting blade
Traditionally 16 mmTraditionally 16 mm
Orifice shapers – 10 mmOrifice shapers – 10 mm
30. Sizing of instrumentsSizing of instruments
ISO sizesISO sizes
Number refers to tip diameter inNumber refers to tip diameter in
tenths of mmtenths of mm
The tip diameter increases byThe tip diameter increases by
0.05 mm from sizes 10 to 60,0.05 mm from sizes 10 to 60,
then by 0.10 mmthen by 0.10 mm
31. Sizing of instrumentsSizing of instruments
% increase in diameter from #10% increase in diameter from #10
to #15 file is 50%to #15 file is 50%
Difference between #55 and #60Difference between #55 and #60
is only 9%is only 9%
32. Sizing of instrumentsSizing of instruments
Series 29Series 29
Progressive 29% increase in tipProgressive 29% increase in tip
diameterdiameter
Instruments are better spacedInstruments are better spaced
More instruments in smaller sizesMore instruments in smaller sizes
and fewer large instrumentsand fewer large instruments
33. Crown Down TechniqueCrown Down Technique
The coronal portion is preparedThe coronal portion is prepared
before the apical portionbefore the apical portion
Follows medical principle ofFollows medical principle of
cleansing before probing a woundcleansing before probing a wound
35. Crown Down TechniqueCrown Down Technique
Eliminates constrictions in theEliminates constrictions in the
coronal regioncoronal region
Reduces effect of canal curvatureReduces effect of canal curvature
Improves tactile awareness duringImproves tactile awareness during
apical preparationapical preparation
36. Crown Down TechniqueCrown Down Technique
Allows more effective irrigationAllows more effective irrigation
Removes majority of tissue andRemoves majority of tissue and
microbes before apical third ismicrobes before apical third is
approachedapproached
Reduces change in working lengthReduces change in working length
during apical preparationduring apical preparation
37. Crown Down TechniqueCrown Down Technique
Coronal thirdCoronal third Orifice shapersOrifice shapers
Middle thirdMiddle third 0.06 taper rotary Profiles0.06 taper rotary Profiles
Apical thirdApical third 0.04 taper hand Profiles0.04 taper hand Profiles
38. Clinical ProcedureClinical Procedure
Estimate working lengthEstimate working length
Parallel radiographParallel radiograph
Estimated working length is the distanceEstimated working length is the distance
from the reference point to thefrom the reference point to the
radiographic apexradiographic apex
41. Clinical ProcedureClinical Procedure
Explore the canalExplore the canal
Ensure that canal corresponds toEnsure that canal corresponds to
radiographic apexradiographic apex
Small file – #10 K-fileSmall file – #10 K-file
May need to precurve these SS filesMay need to precurve these SS files
42. Clinical ProcedureClinical Procedure
Files used in a push/pull orFiles used in a push/pull or
quarter turn pull motionquarter turn pull motion
Never rotate these filesNever rotate these files
through 360 degreesthrough 360 degrees
48. Clinical ProcedureClinical Procedure
Actual Working LengthActual Working Length
determinationdetermination
Preparation should terminate atPreparation should terminate at
Apical constrictionApical constriction
1 mm short of radiographic apex1 mm short of radiographic apex
54. Clinical ProcedureClinical Procedure
This technique applies only to teethThis technique applies only to teeth
ranging from 18 – 23 mm in lengthranging from 18 – 23 mm in length
Coronal third measurement is WL minus 8Coronal third measurement is WL minus 8
mmmm
Middle third measurement is WL minus 4Middle third measurement is WL minus 4
mmmm
Apical third measurement is WLApical third measurement is WL
55. Preparation of the coronal thirdPreparation of the coronal third
Coronal third measurement is working lengthCoronal third measurement is working length
minus 8 mmminus 8 mm
Prepared using Profile orifice shapersPrepared using Profile orifice shapers
56. Preparation of the coronal thirdPreparation of the coronal third
Profile orifice shapersProfile orifice shapers
In sequence larger to smallerIn sequence larger to smaller
57. Preparation of coronal thirdPreparation of coronal third
Measure WL minus 8 mm on theMeasure WL minus 8 mm on the
largest Orifice Shaperlargest Orifice Shaper
Lubricate the canal with ProlubeLubricate the canal with Prolube
58. Preparation of coronal thirdPreparation of coronal third
Rotate OS at 300 rpmRotate OS at 300 rpm
Note: Orifice shaper should be rotating atNote: Orifice shaper should be rotating at
300 rpm before it is placed in the canal300 rpm before it is placed in the canal
Advance the OS in 1 mm incrementsAdvance the OS in 1 mm increments
When resistance occurs, retract OSWhen resistance occurs, retract OS
while still rotatingwhile still rotating
Never force any instrument apicallyNever force any instrument apically
59. Preparation of the coronal thirdPreparation of the coronal third
This OS will not extend to WL minusThis OS will not extend to WL minus
8 mm8 mm
Irrigate copiouslyIrrigate copiously
61. Preparation of coronal thirdPreparation of coronal third
Move to next smallest OSMove to next smallest OS
This will extend further than previous instrumentThis will extend further than previous instrument
Repeat the steps described for largest OSRepeat the steps described for largest OS
Move to next smallest OSMove to next smallest OS
Continue this sequence until working lengthContinue this sequence until working length
minus 8 mm is reachedminus 8 mm is reached
62. Preparation of coronal thirdPreparation of coronal third
Return to largest OSReturn to largest OS
This will now extend further intoThis will now extend further into
the canal than it did previouslythe canal than it did previously
Repeat this sequence until thisRepeat this sequence until this
(the largest) OS reaches WL(the largest) OS reaches WL
minus 8 mmminus 8 mm
63. Preparation of the coronal thirdPreparation of the coronal third
Never force any instrumentNever force any instrument
apicallyapically
Irrigate after every instrumentIrrigate after every instrument
Use copious amounts of ProlubeUse copious amounts of Prolube
65. Preparation of middle thirdPreparation of middle third
Middle third measurement is WLMiddle third measurement is WL
minus 4 mmminus 4 mm
Prepared using 0.06 taper SeriesPrepared using 0.06 taper Series
29 rotary Profiles in sequence29 rotary Profiles in sequence
larger to smallerlarger to smaller
66. Preparation of middle thirdPreparation of middle third
Prepared with 0.06 Series 29 NiTi rotary Profiles
67. Preparation of middle thirdPreparation of middle third
Measure working length minus 4 mmMeasure working length minus 4 mm
on the largest 0.06 taper series 29on the largest 0.06 taper series 29
rotary filerotary file
Set green rubber stop at that lengthSet green rubber stop at that length
Lubricate the canal with ProlubeLubricate the canal with Prolube
68. Preparation of middle thirdPreparation of middle third
Rotate at 300 rpmRotate at 300 rpm
File must be rotating at 300 rpm before itFile must be rotating at 300 rpm before it
is placed in canalis placed in canal
Advance file in 1 mm incrementsAdvance file in 1 mm increments
When resistance occurs, retract fileWhen resistance occurs, retract file
while still rotatingwhile still rotating
Copious irrigation with NaOClCopious irrigation with NaOCl
70. Preparation of the apical thirdPreparation of the apical third
Prepare to actual working lengthPrepare to actual working length
Use 0.04 taper NiTi hand files inUse 0.04 taper NiTi hand files in
sequence smaller to largersequence smaller to larger
72. Preparation of apical thirdPreparation of apical third
Measure working length on #15 fileMeasure working length on #15 file
Set rubber stop at that lengthSet rubber stop at that length
Lubricate the canal with ProlubeLubricate the canal with Prolube
73. Preparation of apical thirdPreparation of apical third
Advance size 15 file to workingAdvance size 15 file to working
lengthlength
Rotate file through 360 degreesRotate file through 360 degrees
Irrigate copiously with NaOClIrrigate copiously with NaOCl
after each fileafter each file
74. Preparation of the apical thirdPreparation of the apical third
Advance size 20 file to workingAdvance size 20 file to working
lengthlength
Continue through sequence,Continue through sequence,
seating each file to working lengthseating each file to working length
75. Preparation of apical thirdPreparation of apical third
The largest file that extends to workingThe largest file that extends to working
length is the Master Apical file (MAF)length is the Master Apical file (MAF)
For large canals – minimum MAF #40 - 50For large canals – minimum MAF #40 - 50
For small canals – minimum MAF #35 - 40For small canals – minimum MAF #35 - 40
76. Master Apical FileMaster Apical File
Take a radiograph with MAF in place.Take a radiograph with MAF in place.
This confirms:This confirms:
• LengthLength
• PlacementPlacement