The document discusses the history of endodontics from ancient times to modern day. It describes some key events and advances, such as: - Ancient Chinese believed dental caries were caused by "toothworms" as early as the 14th century BC. - The Chinese used arsenicals to treat pulpitis in 200 AD and amalgam fillings in 659 AD, preceding similar techniques in Europe by over 1000 years. - In the 18th-19th centuries techniques improved with rubber dam, gutta percha points, and standardized instruments, but arsenicals and primitive methods persisted. - The field of endodontics was established in the 20th century with the first endodontic

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KHARTOUM
SUDAN
Dr. Abdalazim Badraldin
Sudanese Dental Center
November 2017

4. Who said
that????
‫القال‬ ‫منو‬
‫ليك‬

7. .
Radiograph of skeletal remains showing
maxillary right lateral incisor with bronze
wire (2.5 mm) implanted in the root canal
of a Nabatean warrior buried in the Negev
desert
2,200 years ago (200 BC). Reproduced
with permission from Dr.
Joseph Zias, State of Israel
Department of Antiquities, and J Am
Dent Assoc 1987;114:665….Ingle 5th edition

8. --- The first mention of the “toothworm”
theory is found in the Anastasia Papyrus
of the thirteenth century BC
---- The ancient Chinese subscribed to the
“toothworm” theory of dental caries
(fourteenth century BC
---- Chinese language character for “caries”
was composed of a worm on top of a tooth.

9. -- Fifteen hundred years later, by the year 200 AD, the
Chinese were using arsenicals to treat pulpitis,
preceding Spooner, who was the first to do so in
Europe, by 1600 years.
-- The Chinese also used amalgam to fill cavities
in the teeth as early as 659 AD.
--Dr. Harry B. Johnston, of Atlanta, a well-known lecturer
and clinician in the early twentieth century coined the
term endodontics from the Greek word ‘‘en,’’ meaning in or
within, and ‘‘odous,’’ meaning tooth: the process of working
within the tooth. In 1928, his practice was identified as the
first practice to be ‘‘limited to endodontics.

10. -- American Association of Endodontics - Chicago -1943
-- The first issue of the Journal of Endodontia in 1946
-- American Dental Association recognized ‘‘endodontists’’
as a special area of dentistry in 1963. The first examination
and certification of diplomates occurred 2 years later in 1965
Louis I. Grossman
Dr. Grossman divided the 200 years between
1776 and 1976 into four 50-year periods.
The first period, 1776 to 1826, abscessed
teeth were treated with leeches or toasted ,
and pulps were cauterized with red-hot
wires. Root canals were being filled from
apex to crown with gold foil.
EndodonticInstrumentations

11. The second half-century, 1826 to 1876, the founding of
the first dental journal and the first dental school, the
introduction of general anesthesia, rubber dam, gutta-
percha root canal points, and the barbed broach, as well
as three- and four-sided tapering broaches for cleaning
and enlarging canals, intracanal antiseptics, and
oxyphosphate of zinc cement. At the same time, however,
pulps were still being removed by driving wooden pegs
into the canal, and crowns of the teeth were also being
“snipped” off at the gingival level to cure toothache.
Arsenicals were still being used to devitalize pulps.

12. The third half-century, 1876 to 1926, discover and
development of the x-ray
The final 50-year period, 1926 to 1976, improvements
in radiographs, anesthetics, and procedures as
well as the introduction of new methods and agents.
Calcium hydroxide , ethylenediaminetetraacetic
acid (EDTA) for chelation. Many root canal medications
appeared, and arsenic finally disappeared from the dental
pharmacopeia. This same period saw the publication of the
first major text devoted to endodontics, Dr. Grossman’s Root
Canal Therapy, as well as the introduction of standardized
instruments and cavity preparation. The period also
witnessed the rise and decline of the silver root canal
Ingle endodontic 5th edition

20. Location of canal Orifice

29. Standardization of Endodontic Instrument
International Standardization Organization ISO

30. Standardization of Endodontic Instrument
International Organization for Standardization
ISO

31. Standardization of Endodontic Instrument
International Designation Organization
ISO

32. 06 08 10 15
90
20
100
50
25
55
110
30
120
60
35
70
130
40
80
140
45
150
Standardization of Endodontic Instrument
International Designation Organization
ISO Color Size (Tip Diameter)

33. Standardization of Endodontic Instrument
Taper Size
It is expressed as the amount of file diameter
increases each millimeter along its working surface
from the tip towards the file handle.
4% Taper 0.64 mm increase in diameter

34. K- file K -reamer

35. K-reamer
instruments can be manufactured by
twisting a triangular blank
by machine . Reamers cut and enlarge
canals with rotational motions.
K Reamers have a rake angle which
makes them most efficient in rotary
motion, hence reaming is prefered
reamer used in shaping the canal
less flute than file

36. Reaming motion involving
clockwise rotation of instrument

39. K-type instruments are produced using one of two techniques.
It is the more traditional way of production . In which graduated
sizes of round “piano”wire are ground into various shapes
such as square, triangular, or rhomboid.
A second grinding operation properly tapers these pieces.
To give instruments the spirals that provide the cutting edges,
the square or triangular stock is then grasped by a machine
that twists it counterclockwise a programmed number of
times—tight spirals for files, loose spirals for reamers.

40. The second and newer
manufacturing method is to grind
the spirals into the tapered wire
rather than twist the wire to produce
the cutting blades.
Grinding is totally necessary for
nickel-titanium instruments.
Because of their superelasticity,
they cannot be twisted.

44. Ultra flex files
a milled K-type NiTi
file. The flutes are
less sharp than in a
steel counterpart
Sure flex
a milled, K-type NiTi
file has a greater
helix angle than the
Ultra Flex

46. -- Used for difficult and calcified canals
-- High flexible
Available in size 8, 10, 15 of length 18, 21 and 25 mm.

47. Were described by Weine.
Comes under intermediate files
provided with half sizes between
conventional instruments.
Available in sizes from 12-37
-- 12, 17, 22, 27, 32, 37.
Used for narrow canals.
They are formed by cutting 1 mm
from tip of instrument.

48. --- machined from a tapered
cylindrical block or from
round steel wire by griding
--- A series of intersecting
cones in cross serction.
--- highly efficient at removing
dentine on the outstroke
when used in a filing motion,
but have poor fracture
resistance in rotation

49. --- H- files is effective only
when using a filing motion
(up down movement).
--- Better cutting action
than K-file (more positive rake angle)
--- Come in size 08-140 ,All with taper 0.02
--- Identified by the circle symbol on the handle
Action -- withdrawal stroke .

50. - S-shaped in cross section-modified
from Hedstrom file .
- designed with two spirals
for cutting blades,
a double-helix design.
-- perfect blend of flexibility,
durability and cutting ability.
filling and reaming motion
-- Marketed as Unifile and Dyantrak

51. A- file
Variant of H- file
More flexible
Flutes/ cutting edges are at acute angle to
the long axis of the file.
When used in curved canals,
Flutes on the inner edge collapse and hence
no dentine is removed,
On the outer edge it opens, filling the
dentine on the outer curvature (simulates
anticurvature filling

52. Heath 1988
Cross- section: Six corners,
two 90˚ cutting edges at
each of the three points
of the blade.
Radial land
Adapt well to curved canals
Non cutting tip
E.g. Profile, GT files, Light speed,
Ultra-flex files

53. Buchanan has further modified
the Hedstroem file, the Safety
Hedstrom file (Sybron
Endo/Kerr), which has a
noncutting side to prevent
ledging in curved canals.
.“Safety”Hedstroem with flattened
non-cutting side to prevent
“stripping

56. Small flame-shaped non-cutting tip instrument
used in the conventional hand piece
Different sizes – coded by rings or
colored bands on shank
Are slightly flexible and will follow
the canal shape but can perforate the
canal if used too deeply
functions :
Preparing the coronal two thirds of molars canals.
Removing the lingual shoulder.
Widen the canal when an instrument
has fractured within it

57. used in conventional hand piece
Most often used in preparing
coronal portion of the root canal
for recieving a post core .
Peeso reamers are not flexible
or adaptable, if not used with
care can perforate canal
Safe-ended tip
Tip – Diameter: 0.7 – 1.7
Used in a brushing motion
EndodonticInstruments

61. These instruments all deliver an irrigant which is usually
sodium hypochlorite into canal space while cleaning and
shaping are carried out by a vibrating K-file

64. Remove bur
from the head
Wash the head under warm water
and clean softly with a toothbrush.
After the proper F-Type nozzle for the
head is connected, insert into the back
end of the head and spray for 2 - 3
seconds or until lubrication is expelled
from the head of the handpiece.
Open the door
and properly
connect the
head to the
F-type adapter
And make
certain the bur
hole is facing
The door. Close
the door securely

65. Place the head upright to help
Drain the handpiece of excess
lubricant. 15 minutes is sufficient.
Or place head on the motor and
with the head down run for 10 seconds
Select “EL” Mode for the extra
long cleaning cycle. Press the
START button and wait until
Care3 Plus completes cleaning
, lubrication and purging cycle.
Bag and place head in the
autoclave.(Remember: Do not
autoclave with bur in the chuck)
It is not necessary to spray the handpiece
after the autoclave cycle is complete

66. GENERATIONS OF MOTORS
a) First generation motor without torque control.
b) Second generation motor with torque limiter.
c) Third generation motor with simple torque control.
d) Forth generation motor with apex locator and torque
control
Role of Motors
Torque control motors allow the
setting of torque generated by the
motor. In low torque control motors,
torque values set on the motor are
supposed to be less than the value of
torque at deformation and at separation
of the rotary instruments

67. First-generation motor
without torque control
second-generation motor
with sensitive torque limiter.
Third-generation simple
torque-controlled motor
Forth-generation motor with
built-in apex locator and torque control

69. Speed reverse
Torque Gear
Program Memorize
auto reverse Power

70. Speed reverse
Torque Gear
Program Memorize
auto reverse Power

71. An electronic apex locator is an electronic
device used in endodontics determine the
position of the apical constriction and thus
determine the length of the root

74. Sodium hypochlorite (NaOCl) is the irrigant of choice
for all endodontic procedures.
Antibacterial and tissues dessolvant Properties
What concentration?
Based on current available evidence there is no
rationale for using NaOCl at concentration over 1% .
1%NaOCl is to be used in copious irrigation (10-
20ml per canal). Increase the temperature improve
the efficacy of sodiun Hypochlorite.
Storage and Shelf – life?
5.25% solution can stay stable for 10 weeks. Diluted
solutions stay stable for up to 1 week.
Store at room temperature away from light .
( endodontic solution protocol—
E Alkarim & Malisa Good
June 08 )

75. Disadvatages :-
- toxicity and tissues irritation
- bad odor
Treatment of Sodium Hydroxide accident
--- Re assure the patient and inform him/her about
the cause and nature of the complication
--- Immediately irrigate with normal saline to
decrease the soft tissues irritation
by diluting NaOCl
--- Let the bleeding response continue as it
helps to flush the irritant out of the tissues

76. Has no tissue dissolving ability and
cannot remove the smear layer
Good antimicrobial properties against
gram positive bacteria
Can be use in 0.2 or 2% concentration
2% is the concentration recommended
in endodontic literature (Zamany et al
2003, Ercan et al 2004)
( endodontic solution protocol—
E Alkarim & Malisa Good
June 08 )

77. 5% IPI is effective against E-faecalis
Can be used to infiltrate the canal ,
5-10 ml for 5-10 min for retreatment
cases
Caution, iodine allergy
( endodontic solution protocol—
E Alkarim & Malisa Good
June 08 )

78. Disposable irrigating Syringe
and
Disposable needle
• Used with an irrigant to clean and
disinfect the canal during endodontic
treatment
Syringes
Plastic syringes of different sizes
(1–20 mL) are most commonly used
for irrigation
All syringes for endodontic irrigation
must have a Luer-Lock design

80. 1--Beveled needle:
Needle with bevel if get lodged into canal
there is a risk of forcing irrigant beyond the
apex.
2– Monoject Irrigating Needle
The most efficient delivery system in which
longer needles of a blunted ,open-end system
were inserted to the full length of the canal to
enure optimum cleaning .
A larger volume of solution can be delivered by
this method
3-- Max-i-Probe irrigating needle :
It has closed-end and side window.
This design allow for upward flushing
action for better canal irrigation and
also eliminates possibilities of irrigant
to be pushed beyond the apical foramen

81. 1—Sonic & Ultrasonic Files
- For activation for Sodium
hypochlorites.
- Removal of Smear layer

82. Despite limitation calcium
hydroxide is the best available
medicament to be used as inter-
appointment dressing.
Preparation containing calcium
hydroxide and iodoform e.g.
(vitapex, metapex) are mainly for
paediatric endodontics
Ledermix for cases of hypermic
irreversible pulpitis

83. The functions of Rubber dam are:
1. To prevent contamination by saliva.
2. To prevent slipping of instrument into the
throat (ingestion of instruments).
3. Prevent contamination between the patient
and dentist.
4. It prevents the strong irrigating solutions
and medicaments contacting oral mucosa

84. The components of rubber dam :
1. Rubber dam frame
2. Rubber dam sheets
3. Rubber dam punch
4. Rubber dam clamp holder
5. Rubber dam clamps for
posterior and anterior teeth
6. Rubber dam template

85. The components of rubber dam :
1. Rubber dam frame
2. Rubber dam sheets
3. Rubber dam punch
4. Rubber dam clamp holder
5. Rubber dam clamps for
posterior and anterior teeth
6. Rubber dam template

87. Functions
• To absorb any moisture in the canal
(i.e. blood, pus and saliva)
• To carry medicaments into the canal

88. • Non-soluble, non-irritant points that
are condensed into the pulp chamber
during obturation
• Standardized type: follows same ISO
classification as endodontic files
• Non-standardized: have a greater
taper than the standard ISO type

89. • Finger instrument with
a smooth, pointed,
tapered working end
• Used to condense
gutta percha laterally
into the canal during
obturation

90. Working end is flat to facilitate plugging or
condensing the gutta percha vertically after
the excess has been removed by melting off
with a heated instrument

91. Small flexible instrument used to place
materials into the canal
• Fits into the conventional hand piece
• Use with caution as it can be easily broken

97. The ProTaper system
(Dentsply/Maillefer) represents a
new generation of NiTi instruments.
This instrument was designed by
Prof. Pierre Machtou, Dr. Clifford
Ruddle and Prof. John West in
coperation with Dentsply/Maillefer.
Can be used at 200 to 300 rpm.

98. Progressive taper
Modified guiding tip
Varying tip diameters
Modified cross-section
Varying helical angel
and pitches
Shorter handle of the
file

99. Progressive taper - The unique design factor is
the varying tapers along the instruments' long
axes. This progressively tapered design
serves to significantly improve flexibility,
cutting efficiency and safety.

100. Cross section- Modified K file type
with sharp cutting edges and no
radial lands .This convex triangular
cross section enhances the cutting
action while decreasing the
rotational friction between blade of
the file and dentin. The cross
section of F3 finishing file is slightly
relieved for increased flexibility.
Protaper have modified non cutting
guiding tip that helps in making the
file centred in the canal while
rotation.
convex, triangular
cross-section
cross-section of F3
with a reduced core
Modified tip

101. The ProTaper system originally comprised of just six
instruments: three shaping files for the crown-down
procedure and three finishing files for apical shaping
and creating a smooth transition from the middle one
third of the canal.