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Cleaning and Shaping of the Root Canal System Edit by Hou Tiezhou 02988088507.

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Presentation on theme: "Cleaning and Shaping of the Root Canal System Edit by Hou Tiezhou 02988088507."— Presentation transcript:

1 Cleaning and Shaping of the Root Canal System Edit by Hou Tiezhou

2 Objectives of Canal Preparation Start with the end in mind

3 Objectives of root canal preparation The root canal system must be: Cleaned of its organic remnants Cleaned of its organic remnants Shaped to receive a three dimensional filling of the entire root canal space Shaped to receive a three dimensional filling of the entire root canal space

4 Objectives of root canal preparation The canal is Cleansed primarily by irrigation Cleansed primarily by irrigation Shaped primarily by instrumentation Shaped primarily by instrumentation

5

6 Cleansing of the root canal Objectives Removal of organic debris Removal of organic debris Elimination of bacteria Elimination of bacteria

7 Irrigation An ideal irrigant: Is nontoxic Is nontoxic Dissolves vital and necrotic tissue Dissolves vital and necrotic tissue Is bactericidal Is bactericidal Lubricates the canal Lubricates the canal Removes the smear layer Removes the smear layer

8 Sodium hypochlorite Dissolves vital and necrotic tissue Dissolves vital and necrotic tissue Is bactericidal Is bactericidal Lubricates the canal Lubricates the canal

9 Sodium Hypochlorite Cannot be considered non-toxic!!!

10 Prolube EDTA and carbamide peroxide in a water soluble base

11 Prolube Facilitates placement of file Facilitates placement of file Entraps debris Entraps debris Aids in removal of the smear layer Aids in removal of the smear layer

12 EDTA Chelating agent Chelating agent Effectively removes smear layer Effectively removes smear layer

13 Shaping of the root canal Canal shape – produced by instrumentation Canal shape – produced by instrumentation Objective is a smooth tapered preparation Objective is a smooth tapered preparation

14 Shaping of the root canal

15 Instruments Instruments differ according to: Metal Metal Taper Taper Tip design Tip design Cross sectional geometry Cross sectional geometry Length of cutting blades Length of cutting blades Sizing Sizing

16 Metals Nickel titaniumStainless steel Excellen flexibilityLess flexible Conforms to canal Straightens and curvature transports canal Plastic deformationPermanent deformation

17 Metals Stainless steel files demonstrate permanent deformation

18 Metals Nickel titanium files demonstrate plastic deformation

19 Taper Definition Increase in diameter per unit length

20 What is Taper? 0.32 mm diameter increase D16D mm diameter increase D16 D1

21 What is taper?

22 Taper Taper of instruments in U of M file kit Stainless steel files – 0.02 taper Stainless steel files – 0.02 taper OS – variable tapers ranging from 0.05 to 0.08 OS – variable tapers ranging from 0.05 to 0.08 Series 29 rotary Profiles – 0.06 taper Series 29 rotary Profiles – 0.06 taper NiTi hand files – 0.04 taper NiTi hand files – 0.04 taper

23 Tip Design Non-cutting tip Non-cutting tip Bullet nose (60 degree) tip Bullet nose (60 degree) tip Smooth transition angle where tip meets flat radial lands Smooth transition angle where tip meets flat radial lands

24 Tip Design Designed to follow a pilot hole Designed to follow a pilot hole Guides instrument through canal during preparation Guides instrument through canal during preparation

25 Tip Design

26 Cross-sectional geometry Three radial lands Three radial lands Each contains bidirectional cutting edges Each contains bidirectional cutting edges Keep instrument centered in the canal Keep instrument centered in the canal Cutting edges scrape dentin Cutting edges scrape dentin

27 Cross sectional geometry

28

29 Radial lands separated by three u- shaped flutes Radial lands separated by three u- shaped flutes Provide space for accumulation of debris Provide space for accumulation of debris Moves debris out of canal Moves debris out of canal

30 Length of cutting blade Traditionally 16 mm Traditionally 16 mm Orifice shapers – 10 mm Orifice shapers – 10 mm

31 Sizing of instruments ISO sizes Number refers to tip diameter in tenths of mm Number refers to tip diameter in tenths of mm The tip diameter increases by 0.05 mm from sizes 10 to 60, then by 0.10 mm The tip diameter increases by 0.05 mm from sizes 10 to 60, then by 0.10 mm

32 Sizing of instruments % increase in diameter from #10 to #15 file is 50% % increase in diameter from #10 to #15 file is 50% Difference between #55 and #60 is only 9% Difference between #55 and #60 is only 9%

33 Sizing of instruments Series 29 Progressive 29% increase in tip diameter Progressive 29% increase in tip diameter Instruments are better spaced Instruments are better spaced More instruments in smaller sizes and fewer large instruments More instruments in smaller sizes and fewer large instruments

34 Crown Down Technique The coronal portion is prepared before the apical portion The coronal portion is prepared before the apical portion Follows medical principle of cleansing before probing a wound Follows medical principle of cleansing before probing a wound

35 Crown Down Technique

36 Eliminates constrictions in the coronal region Eliminates constrictions in the coronal region Reduces effect of canal curvature Reduces effect of canal curvature Improves tactile awareness during apical preparation Improves tactile awareness during apical preparation

37 Crown Down Technique Allows more effective irrigation Allows more effective irrigation Removes majority of tissue and microbes before apical third is approached Removes majority of tissue and microbes before apical third is approached Reduces change in working length during apical preparation Reduces change in working length during apical preparation

38 Crown Down Technique Coronal thirdOrifice shapers Coronal thirdOrifice shapers Middle third0.06 taper rotary Profiles Middle third0.06 taper rotary Profiles Apical third0.04 taper hand Profiles Apical third0.04 taper hand Profiles

39 Clinical Procedure Estimate working length Estimate working length Parallel radiograph Parallel radiograph Estimated working length is the distance from the reference point to the radiographic apex Estimated working length is the distance from the reference point to the radiographic apex

40 Parallel Radiograph

41 Clinical Procedure Establish straight line access to apical third Establish straight line access to apical third

42 Clinical Procedure Explore canal patency Ensure that canal is negotiable to radiographic apex Ensure that canal is negotiable to radiographic apex Small file – #10 K-file Small file – #10 K-file May need to precurve these SS files May need to precurve these SS files

43 Clinical Procedure Files used in a push/pull or quarter turn pull motion Files used in a push/pull or quarter turn pull motion Never rotate these files through 360 degrees Never rotate these files through 360 degrees

44 Clinical Procedure

45

46 Estimate canal size Radiographic appearance Radiographic appearance Crown/root morphology Crown/root morphology Standardized tables Standardized tables

47 Estimation of canal size

48 See Table in manual

49 Clinical Procedure Actual WL determination Preparation should terminate at Apical constriction Apical constriction 1 mm short of radiographic apex 1 mm short of radiographic apex

50 Clinical Technique Actual WL determination Radiograph Radiograph Apex locator Apex locator

51 Clinical Procedure Actual Working Length Determination

52 Clinical Procedure

53 Apex Locator

54 Clinical Procedure Crown down cleaning and shaping of canals

55 Clinical Procedure This technique applies only to teeth ranging from 18 – 23 mm in length Coronal third measurement is WL minus 8 mm Coronal third measurement is WL minus 8 mm Middle third measurement is WL minus 4 mm Middle third measurement is WL minus 4 mm Apical third measurement is WL Apical third measurement is WL

56 Preparation of the coronal third Coronal third measurement is working length minus 8 mm Coronal third measurement is working length minus 8 mm Prepared using Profile orifice shapers Prepared using Profile orifice shapers

57 Preparation of the coronal third Profile orifice shapers Profile orifice shapers In sequence larger to smaller In sequence larger to smaller

58 Preparation of coronal third Measure WL minus 8 mm on largest OS Measure WL minus 8 mm on largest OS Lubricate the canal with Prolube Lubricate the canal with Prolube

59 Preparation of coronal third Preparation of coronal third Rotate OS at 300 rpm Rotate OS at 300 rpm Note: Orifice shaper should be rotating at 300 rpm before it is placed in the canal Advance the OS in 1 mm increments Advance the OS in 1 mm increments When resistance is encountered retract OS while still rotating When resistance is encountered retract OS while still rotating Never force any instrument apically Never force any instrument apically

60 Preparation of the coronal third This OS will not extend to WL minus 8 mm This OS will not extend to WL minus 8 mm Irrigate copiously Irrigate copiously

61 Irrigation

62 Preparation of coronal third Move to next smallest OS Move to next smallest OS This will extend further than previous instrument Repeat the steps described for largest OS Repeat the steps described for largest OS Move to next smallest OS Move to next smallest OS Continue this sequence until working length minus 8 mm is reached Continue this sequence until working length minus 8 mm is reached

63 Preparation of coronal third Return to largest OS Return to largest OS This will now extend further into the canal than it did previously This will now extend further into the canal than it did previously Repeat this sequence until this (the largest) OS reaches WL minus 8 mm Repeat this sequence until this (the largest) OS reaches WL minus 8 mm

64 Preparation of the coronal third Never force any instrument apically Never force any instrument apically Irrigate after every instrument Irrigate after every instrument Use copious amounts of Prolube Use copious amounts of Prolube

65 Preparation of coronal third

66 Preparation of middle third Middle third measurement is WL minus 4 mm Middle third measurement is WL minus 4 mm Prepared using 0.06 taper Series 29 rotary Profiles in sequence larger to smaller Prepared using 0.06 taper Series 29 rotary Profiles in sequence larger to smaller

67 Preparation of middle third Prepared with 0.06 Series 29 NiTi rotary Profiles

68 Preparation of middle third Measure working length minus 4 mm on the largest 0.06 taper series 29 rotary file Measure working length minus 4 mm on the largest 0.06 taper series 29 rotary file Set green rubber stop at that length Set green rubber stop at that length Lubricate the canal with Prolube Lubricate the canal with Prolube

69 Preparation of middle third Rotate at 300 rpm Rotate at 300 rpm File must be rotating at 300 rpm before it is placed in canal Advance file in 1 mm increments Advance file in 1 mm increments When resistance is encountered retract file while still rotating When resistance is encountered retract file while still rotating Copious irrigation with NaOCl Copious irrigation with NaOCl

70 Preparation of middle third

71 Preparation of the apical third Prepare to actual working length Prepare to actual working length Use 0.04 taper NiTi hand files in sequence smaller to larger Use 0.04 taper NiTi hand files in sequence smaller to larger

72 Preparation of apical third

73 Measure working length on #15 file Measure working length on #15 file Set rubber stop at that length Set rubber stop at that length Lubricate the canal with Prolube Lubricate the canal with Prolube

74 Preparation of apical third Advance size 15 file to working length Advance size 15 file to working length Rotate file through 360 degrees Rotate file through 360 degrees Irrigate copiously with NaOCl after each file Irrigate copiously with NaOCl after each file

75 Preparation of the apical third Advance size 20 file to working length Advance size 20 file to working length Continue through sequence, seating each file to working length Continue through sequence, seating each file to working length

76 Preparation of apical third The largest file that extends to working length is the Master Apical file (MAF) The largest file that extends to working length is the Master Apical file (MAF) For large canals – minimum MAF # For large canals – minimum MAF # For small canals – minimum MAF # For small canals – minimum MAF #

77 Master Apical File Take a radiograph with MAF in place. This confirms: Take a radiograph with MAF in place. This confirms: LengthLength PlacementPlacement

78 Mission accomplished Smooth tapered preparation


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