Ignorance or Apathy
The answer came I dont know and I dont care
This presentation is not for them. This is about developing Expertise Through the rays of knowledge for those that aspire to become The Best.......
......Dentists!
Diagnosis
Essential analysis
Instruments/ Armamentarium
Access Opening
Locating canals
BMP/ CMP Irrigation & intracanal medicaments Obturation
Diagnosis
Past medical history (Diabetes, Valv Hrt Disease ) Past dental history Attempted RC, Old RCT done,
Separated instrument, swelling extent & recurrence
Objective Symptoms
Objective Symptoms
Thermal test
Test cavity
Visual Inspection
Multiple angles
Extent of caries and relation to pulp
Radix entomolaris
Cracked tooth
Radicular cyst
Periodontal status
Steps in RCT
Access opening
Locating and negotiating canals Working length determination
Pre-endodontic Buildup
Pre-endodontic buildup
Access Cavity
Goals
Access prep
Bur angulation
Complete Deroofing
Deroofing
Locating Canals
Dentinal Map
Locating canals
Cleaning is debridement / removal of vital or necrotic tissue, bacteria with their byproducts & dentinal debrisfrom canal system
C& S IMP
Very important for safe rotary instrumentation since most rotary Niti are designed to follow a path not create one
Path Files
Working Length Determination Prep should end at the Physiologic terminus / apical constriction/ cemento-dentinal junction
Manual Rotary
Step-Back Preparation
Reamers
K file
Flexoreamer
Flexofile H file Niti flexfile Protaper Hand files
Cutting tip. In curved canals ledging easily occurs with even small reamer sizes if instruments are not pre-curved. Reamers are excellent instruments in straight canals but poorly adaptable to curved canals.
The K-file
for the preparation of straight canals. It prepares dentin effectively both in filing motion (up and down) and when rotated. In slightly curved canals : Small resistance : Continuous rotation Greater resistance : Balanced force Curved canals : pre-curve The use of filing motion in curved canals can cause transportation and ledging, and is not recommended.
Hedstroem File
Prepared from round steel wire by grinding. Cutting edge close to right angle. H file = Ledge file Only Up- down motion. Must fit loosely in the canal. Used 1-2 mm shorter than apical prep. Above 25 no. 3-4 mm shorter. Pre-curved in curved canals.
Files must be inspected for possible earlier damage to the instrument and discarded immediately if an asymmetry in the cutting area is found.
Nitiflex file
Rotary Instruments
Protaper
Greater Taper
Profile Race Endo sequence K3 files Light Speed (LSX)
1. Work instruments to light resistance and never force them. 2. Only use instruments in a well irrigated and lubricated canal. 3.The appropriate finishing file passively follows the canal to the desired length then is immediately withdrawn. 4. Use in constant rotation at a speed of 250-350 rpm. 5. Clean flutes frequently and check for signs of distortion or wear.
A progressively tapered file engages a smaller zone of dentine which reduces torsional loads, file fatigue and the potential for breakage. Improve flexibility, cutting efficiency and typically reduces the number of recapitulations needed to achieve length, especially, in tight or more curved canals. ProTaper instruments are prepared from round nickel-titan wire by grinding. Cross-section of the instruments shows a triangular structure with three cutting points and no radial lands. ProTaper instruments have a non-cutting tip to guide the instrument in the canal and reduces the risk for ledge formation. The convex triangular cross-section reduces the contact area between the file and dentine. This greater cutting efficiency has been safely incorporated through balancing the pitch and helical angles.
Hand Protaper
The cross-section of the RaCe instruments is a convex triangle, with the exeption of the two smallest instruments, #15/02 and #20/02 (taper 02), which both have a square cross-section. special attention has been focused on achieving a smooth metal (NiTi) surface Each RaCe instruments has a constant taper ranging from 02 taper to 10 .
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Ledging
Zipping
The standardized preparation technique resulted in procedural errors when used in a curved canal.
Irrigation
Lubricate canal to avoid instrument separation Dissolve the pulp remnants Washing out debris created by instrumentation Kill or remove the micro-organisms in root canal and biofilm Clean the smear layer Canal should be wide enough for irrigant to reach apex,
Saline
Distilled water
Side venting irrigating tips
Intracanal Medicaments
Ca(OH)2
Chlorhexidine gel 2%
Antibiotics Phenolic compounds
Obturation
The success of endodontic treatment depends on meticulous root canal preparation.
What you take out is more important than what you put in This does not mean that root canal obturation is less important.
Hermetic Seal
The purpose of obturation is to seal and prevent:
Tissue fluids from percolating back & providing a culture medium for residual microbes
Obturatation
Patient asymptomatic
Should be easily introduced in canal Should not shrink Should seal laterally as well as apically Impervious to moisture
Techniques
LATERAL CONDENSATION
1.MASTER CONE GP WHOSE SIZE CORRESPOND TO THE LAST LARGEST NO. FILE USED TO SHAPE THE CANAL TILL WL IS CHOSEN.
DISADVANTAGES:
Lateral Condensation
Thermoplasticised GP
System B, Obtura
ADVANTAGES :
ALL ACCESSARY CANAL ARE FILLED. NO SPACE LEFT UNFILLED IN THE CANAL.
DISADVANTAGES: CAN LEAD TO THE OVER-OBTURATION OR FILLING BEYOND THE APICAL FOREMEN. EXCESSIVE VERTICAL FORCE CAN LEAD TO ROOT FRACTURE.
Desirable Obturation!