2 ENDO basis Treat pulp and periapical diseases Endo treatment (root canal) should be performed in case of: - Pulp necrosis or irreversible pulpitis - Vital pulp (but poor prognosis of pulp vitality, high risk of pulp exposure during the coronal restoration, root amputation or hemisection)Contra-indications:Patient with high risk of infective endocarditisTooth with no functional future (wisdom teeth)Tooth with inadequate periodontal support
3 Techniques comparison Endo BasisTechniques comparisonManual technique+: Tactile sense+: less risk of perforation (NiTi)-: Numerous files are needed-: Time consuming-: Access difficulties (posterior areas)Rotating technique+: Fast canal preparation+: Auto-reverse- : Fatigue of the filesReciprocity technique+: Few files needed (1hand file + 1 mechanical file)+: Same movement as manual (F+R)+: Secure (less breakage, less apical pressure, etc)
4 Endo basis To fit all canals, files present different shapes: Canal morphology variesCurved / straightLarge / SmallLong / shortThe canals’ common feature is their taperPrepared canals: Taper 10 % in coronal area, 2 to 4% in the apical zoneTo fit all canals, files presentdifferent shapes:Different lengthMost popular length:21mm, 25mm, 29mmOther: 15mm, 19mm, 23mmDifferent diameters (ISO)Different tapers4%, 6%, 8%, 12%Ø15Ø20Ø25Ø30Ø35Ø40Radial-landed (Smooth) ex. ProFile (Dentsply), HERO (Micro-Méga)Straight edges (Cut) Ex. ProTaper (Dentsply),RaCe (FKG), Sequence (Brasseler)Ex. EndoEZE AET (Ultradent)Other shapesDifferent files shape+ Clockwise and counterclockwise cutting edgesBibliography:A la recherche des limes endodontiques idéales, Dr. Mc Spadden, Dental Tribune, 2009
5 Files codes FKG I-Race Mani Taper Ø ISO Number of uses Yellow= 2% Red= 4%Blue= 6%FKG I-RaceManiØ ISORed= 25Number of uses
6 ENDO treatment protocol DiagnosisSensitivity tests,palpation (etc)+ pre-operativeX-raysPreparationAccessPreparation of the access cavity (pulp chamber roof removal, access to the root canal orifices, ...) + Determination of the working length Intra-operative X-rays (beware of deformations)Apex locators, ...Anesthesia (if necessary) + Tooth/access preparation (removal ofcaries, bone ...) + Rubber damPierre RollandPrimacaineTMSOPIX²PSP !XXMind
7 Removal of all pulp tissues and bacteria, toxins (etc) ENDO treatment protocolCanal shapingRemoval of all pulp tissues and bacteria, toxins (etc)=Prior Irrigation(Sodium Hypochlorite 2,5%)+Initial manual explorationMechanical shaping (rotating/reciprocating) with irrigation (after each instrument uses)- Crown Down principle with decreasing taper files (from the crown to the apex)- Step-Back (from the apex to the crown)Final irrigation: EDTA + Hypochlorite + dryingObturationAdjust the sterile master cone to the working length(X-Ray + drying)Place the biocompatible cementGutta-percha compaction + X-rayCoronal obturationCoronal restoration ASAPSO4Lateral Gutta perchacondensationPierre RollandEDETATSalvizol EDTAirrisafePierre RollandSealite - Cortisomol
8 1 2 3 4 8 5 6 7 9 Diagnosis (decay + abscess) (CAP2 – dome removal)PreparationPreparation (rotary bur)Access (Decalcification ET18D)12Shaping (manual)Shaping (mechanical)34Shaping (irrigation)(Canal finding - ETBD)Access8567Obturation - Performed on dry canal.Lateral condensation (use of spreaders)Lateral warm condensation (SO4 ultrasonic tip with no irrigation)Vertical warm compaction (manually or mechanically), etc.Coronal obturation + Prosthetics9
9 ENDO retreatmentAny failure of canal treatment will lead to a root canal retreatment
10 SATELEC® in ENDO Excellent reputation in endodontics The convergence of years of technicalendo experienceWide range of specialized tips
14 - Encoder technology included - E-type (ISO 3964) connection micromotor - 6 contra-angle ratios pre-set: (1:1 ; 6:1 ; 8:1 ; 16:1 ; 20:1 ; 32:1) - Speed without contra-angle: 1,000 to 10,000Rpm Speed with a 16:1 100 to 600Rpm - Torque with a 16:1 0.5 to 7.5Ncm + MAX (10Ncm) - Many new Rpm settings to respond to all file systems
15 Speed Angle SATELEC Exclusivity Very high precision The ENDODUAL is the first unit having an encoder coupled with an accurate micromotor.This patented encoder calculates an algorithm ensuring:In rotating mode high speed accuracy.- In reciprocating (F+R) mode an exact angle measurement for:- Evaluating the angular position,- Getting the best performances for each file system.SpeedVery highprecisionAngle
17 Precision and rapidity Versatile, complete, light and compact, the ENDO micromotor offersa new vision of endodontics.EncoderThe encoder calculates an algorithm for greater precision,Integrated calibration systemThe integrated calibration system checks the contra-angle’s mechanical inertia for a perfect micro-motor/contra-angle adjustment.MicroprocessorAdvanced microprocessor for an extremely short response time.
18 Torque is not needed in Reciprocating mode (Max) Freedom of settingsReduction rateRPM1:16:18:116:120:132:110001501251001500200120200025017525003001803000350350040028040004504500500500055055006006000650650070070007507500800800085085009009000950950010000110012001300140012501600Torque is not needed in Reciprocating mode (Max)Ncm with a 16:10.511.522.533.544.555.566.577.5MAX
20 Open System TAKE CONTROL OF THE WAY YOU PRACTICE An open system compatible with all rotating and reciprocating files providing access to future endodontic instrument innovations via its:- 2 modes available (Rotating and Reciprocating),- Wide choice of contra-angle ratios ISO 3964 connections,- Independent torque, speed and angle settings.
21 Files compatible with the ENDODUAL ISO contra-angle chuckRotating files:All rotating files are compatible with the ENDODUALFollow the manufacturer settingsReciprocating files:Wave one/Reciproc (30°FWD – 150°REV) Grip sensation and cutting differencesWave One Ø25 Taper 8%, Ø21 Taper 6%, Ø40 Taper 8% - Reciproc Ø25 Taper 8%, Ø40 Taper 6%, Ø50 Taper 5%,In the near future, other file manufacturers will most probably launch their own reciprocating filesRotating files tested in reciprocating motion:S2 and F2 from Denstply Maillefer (150° FWD – 30° REV)Reciproc® file WaveOne® fileProtaper ® file
25 CalibrationControls the contra-angle’s mechanical inertia for a perfect micromotor/contra-angle match.Repetitive sterilizations and contra-angle wear can lead to a lack of precision.This function accurately measures the properties of the micromotor and contra-angle handpiece prior to use for exact values.
26 10 customizable automatically saved programs Rotating10 customizable automatically saved programsavailable in each mode.Switching from Rotating to reciprocatingFor micromotor/ contra-angle matchSelect the contra-angle ratio (1:1 ; 6:1 ; 8:1 ;16:1 ; 20:1 ; 32:1)Select the speed rotation 100 to 600Rpm (16:1)Select the torque 0.5 to 7.5Ncm + MAX (10Ncm) (16:1)Clockwise/counterclockwise rotationSelect the AutoreverseSTOP, AR, SARParameters selection
27 Rotating STP - “STOP” Autoreverse AR – “Standard” Autoreverse Beeping sound notifies user when 75% of the preset torque has been reached and when preset torque limit has been exceeded.STP - “STOP” AutoreverseStops without reverse rotation.AR – “Standard” AutoreverseWhen file reaches the set torque value, the motor runs reverse until the motor has been stopped. Next start will be in Forward.SAR – “Special” AutoreverseWhen file reaches the set torque value, the motor runs reverse until the file is freed andAutomatically returns to Forward.
28 Rotating movement QUALITY OF THE AUTO-REVERSE Microprocessor analysis Between X and Y, the torque is increasing progressively until MAX valueMicroprocessor analysisThe time from « x » to « y » must be as short as possible(less than 1/1000 sec. )
30 ProTaperS1: Enlargement of the coronal and middle third S2: Enlargement of the middle third and apical third SX: Relocate the coronaries entries (can replace S1 and S2 files for short canals) F: Files dedicated to the finishing on the apical zone (different tip diameter and taper) Basic protocol (3 to 4 Protapers): 1. K10/K15 files for canal exploration 2. S1 to the manual file insertion length 3. Manual file to the apical third 4. S1 to the working length (WL) 5. S2 to the WL 6. F1 to the WL
32 FKG Back Most cases 600 rpm et 1,5 Ncm 1. K10 manual file Most cases 600 rpm et 1,5 Ncm1. K10 manual file2. R1 to working length (WL).3. R2 to WL4. R3 to WLDifficult case 600 rpm et 1,5 Ncm2. R1 to 2/3 of working length (WL)3. R1a to reach WL4. Continue shaping with R1b to WL5. Carry on shaping with R2 to WL6. Finish shaping with R3 to WL500600 RpmI-Race 600 Rpm et 1,5 NcmBack
34 MICRO-MEGA1. Initial penetration of the canal using the K n°10 file2. Revo-S™ instruments shoud be used with a rotation speed ranging between 250 to 400 Rpm.SC1 (Shaping and cleaning 1): perform a slow and unique downward motion in a free progression without pressure.SC2: use SC2 with a progressive 3 wave movement (3 back-and-forth motions) to reach a minima the working length.SU (Shaping Universal) : use SU with a slow and unique downward motion in a free progression and without pressure. Then check apical patency and if necessary, perform an upward circumferential filing motion.3. Apical Shaping. Finishing of the last 5mm. AS30, AS35, AS40Back
37 10 customizable automatically saved programs Reciprocating10 customizable automatically saved programsavailable in each mode.Switching from Rotating to reciprocatingFor micromotor/ contra-angle matchSelect the contra-angle ratio (1:1 ; 6:1 ; 8:1 ;16:1 ; 20:1 ; 32:1)Select the speed rotation 100 to 600Rpm (16:1)Dedicated to reciprocating (F+R) mode. Adjustment from 10° to 360° in forward and in reverse motion by step of 5°Parameters selection
38 Reciprocating movement Whatever the file used, the angle should be higher in cutting direction than in non cutting edges direction. Ex : Wave One (150° REV – 30° FWD), Protaper (150°FWD – 30° REV)Major AdvantagesSafe: very light apical pressureIncrease instrument life: Less cyclic fatigue (tension/compression) Less torsional fatigue
39 Fractures Cyclic fatigue Torsion File is deformed due to tension and compression motion performed in curved canals Can be reduced:- Following the file manufacturer settings (speed)Torsion File’s tip is blocked in the canal but the contra-angle continues its rotation.- Using system for limiting the torque- Following the suggested settings of the manufacturer
40 Reciprocating movement Whatever the file used, the angle should be higher in cutting direction than in non cutting edges direction. Ex : Wave One (150° REV – 30° FWD), Protaper (150°FWD – 30° REV)Major AdvantagesSafe: very light apical pressureIncrease instrument life: Less cyclic fatigue (tension/compression) Less torsional fatigueSimplicity (very easy protocol)Efficiency (decrease the global shaping time up to 40%)Respect root canal anatomy: creation of a more centered canalDecrease the screwing effect of the fileMovement facilitating the removal of smear layer on the file
41 Files - Reciprocating2 files brands dedicated to reciprocating motions are today existing:- Wave one® from Dentsply MailleferReciproc® from VDW:more aggressive but also more fragileWave one /Reciproc®: Reverse helixFixed angulations:150° REV - 30° FWDSingle use
42 Files - ReciprocatingMailleferVDWStandard protocol:K10 file: Canal explorationWaveOne until penetration length of the manual file(back-and-forth motion, debris removal on the file, irrigation)Manual file to pre-enlarge until the apical thirdWaveOne until the working length + irrigationExtract from the article: Mise en forme canalaire mino-instrumentale en mouvement réciproque WaveOne® et reciproc®, W Pertot, J. Webber, P. Machtou, S. Kuttler
43 Files - Reciprocating Irrigation: 2.5% sodium hypochlorite, Initial canal negotiation with a manual file (size 08 or size 10 or 15 for severely curved canals),Canal preparation with the ENDODUAL motor in F+R mode (F2 Protaper instrument for instance) and a slow pecking motion. Remove debris from the file and repeat this motion until the file reaches the working length.Canal preparation using only one Ni-Ti rotary instrument: preliminary observations. G. YARED, International Endodontic journal, 2007.Since 2002 many clinical studiespresented cases performed with ATRTecnika™ reciprocating motion withtraditional rotating files.
44 Files prices Rotating files: Reciprocating files: Hero Shaper Micro-Mega 26,42€ without tax for 3 files (8,80€/file)ProTaper 39€ without tax for 6 files 6,5€/fileAccording to studies, a file life cycle in continuous rotating motion variesbetween 4 to 10 uses (depending on the shape of the canal treated).Reciprocating files:WaveOne 38,98€ without tax for 3 single use files WaveOne (Small, primary, large) Reciproc R25, 40, 50 (length 21, 25, 31) Files dedicated to the reciprocating motion (reverse helix) Fixed angulations: 150° - 30°Price analysis:Max 10€ without tax/file – Uses: max x10 - min x4 = [1€-2,5€]WaveOne 13€ without tax/fileWaveOne/Reciproc files are 5 to 13 times more expensive than traditional rotating files
45 SUM UP New design, Larger display, New PCB, 6 ratios available (8:1 added),New Ncm and Rpm settings added,Simplified interface,Improvements in micromotor manufacturing process and cord resistance,Metallic micromotor connectorNew micromotor assemblingControlling equipment:Special investment in an angle and torque controlling machine.Soft changes in reciprocating mode : 1st focusing on the angles then on the speed. Giving the priority to the angle will enable to have a better angular accuracy with and without load.
46 Freedom in endodontics (mains cord equipped with 4 international plugs)Equipped with:Endo motor and cordSingle footswitch1 micromotor adhesive support
47 ENDODUAL benefits Ergonomics: Thinner and lighter micro-motor Direct access to all parametersFree system:Angles settings from 10° to 360° (FW and REV)Numerous contra-angles ratios available with ISO connectionCompatible with all files on the marketEconomical aspects:Unit available with or without contra-angleLarge choice of files available (different price range)