1. Endodontic Instruments
Mr. caputo
Unit #2 Lesson #5

2. Today’s Class
Driving Question: What are the instruments used during an endodontic treatment?
Learning Intentions: We will be able to describe endodontic instruments, accessory instruments, and medicaments necessary for endodontic treatment.
Anchor: Why is the shaping an cleaning of a root canal extremely important?

3. Pulpotomy
Removal of entire coronal pulp in pulp chamber, leaving only vital pulp within roots
Root canal’s pulp is retained and treated with medication to preserve its vitality and function
Usually done on primary teeth
Contraindicated: fistula or an abscess, tooth crown is nonrestorable, profuse hemorrhage, extreme tenderness to percussion, mobility, necrotic pulp, or pulp stones

4. Pulpotomy Procedure

5. Pulpectomy Most common endodontic procedure
Involves removal of the entire pulp from pulp chamber and from root canals of a nonvital tooth
Indications:
cooperative patient
teeth with poor chance of vital pulp treatment
for space maintenance
absence of surrounding bone loss from infection
expectation of ability to restore tooth in the future

6. Procedure for Pulpectomy
Initial x-ray is taken
Anesthetic is administered
Dental dam is placed
Dentist cuts through enamel and dentin with a high-speed handpiece bur
Slow-speed handpiece round bur and possibly spoon excavator is used to remove all decayed tooth structure

7. Procedure for Pulpectomy
Tooth opening is deepened and widened to allow access into pulp chamber(s)
Location of each root canal is determined
Infected pulpal tissue is removed (extirpation)
File(s) are placed into canal of tooth prior to second x-ray
Second radiograph is exposed
Files are measured

8. Root Canal Procedure

9. Shaping and Cleaning Each root canal is prepared and shaped
Debridement on root canal is acheived
Smaller file or reamer is used first, then next larger size, to increase canal’s width
Tapered files are used either by hand or rotary instrument in a slow-speed handpiece
Filing is within 2 to 3 mm inside of tooth apex
Irrigation is done with bactericidal liquids
Absorbent paper points are used

10. Obturation
Necessary to ensure a good seal at apex of root and for root canals to have no voids
Common material used to obturate is gutta percha, a thermoplastic rubber-like material
Gutta percha points are tapered so they ideally fit the canal after it is shaped
Endodontic sealing cements are used to hold gutta percha filling material in place
Thermafil or injection techniques can be used

11. Obturating a Root Canal
Image courtesy Instructional Materials for the Dental Team, Lex. KY

12. Final Restoration
Temporary restorative materials may be used to fill tooth and seal it from moisture contamination after root canal therapy
Dentist can either continue to prepare tooth for a permanent restoration or refer patient to another dentist for permanent restoration procedure
Endodontist will refer patient back to general dentist for post and core procedure and crown preparation
Permanent filling must be done in order to protect the tooth against fracture and recurrent decay

13. Post and Core Buildup
Endodontically treated teeth are usually already broken down and will become brittle with time because they no longer have a moisture supply
Post and core may be needed
All endodontically treated teeth will require a crown as a final restoration to prevent future problems

14. Post Placed within one or two root canals
Serves to supply extra support for a core when sufficient tooth structure does not exist
Two main categories of posts:
custom fabricated
prefabricated

15. Core Buildup
Required when there is extensive loss of natural tooth structure
Placement of pins for additional retention will also be evaluated
Most common core buildup materials are gold, amalgam, and composite
Goal of the core buildup is to establish the greatest stability and longevity of the restoration

16. Post and Core Buildup

17. Instruments and Accessories
Prepared in sterile packs or kits
Small hand-operated endodontic instruments and supplies are generally placed on disposable sponge or in compartmentalized box that can be sterilized and maintained in an orderly fashion
Several accessory items, such as instruments, filling materials, medications, irrigating solutions, and cements, must be readily available for use during endodontic procedures

18. Dental Dam Essential during all endodontic procedures
Isolates the tooth and maintains sterile field
Prevents contamination of saliva to root canals
Prevents small endodontic instruments from going down patient’s throat
Keeps infected tissues, debris, medicaments, and irrigating solutions from entering patient’s mouth
Improves visibility

19. Rubber Dam
Image courtesy Instructional Materials for the Dental Team, Lex. KY

20. Endodontic Explorer Has two long, narrow, pointed working ends
Angled from shank in order to provide access to pulp canal inside tooth
Used to locate canal openings and explore pulp chambers and canals
Courtesy Hu-Friedy

21. Endodontic Spoon Excavator
Long, double-ended
Similar in shape to a regular spoon excavator but has longer shank
Allows for detection of caries, coronal pulp tissue, or removal of cotton pellets that may be deep inside the crown of tooth
Courtesy Hu-Friedy

22. Broaches
Used to remove infected pulp tissue from within tooth’s pulp canal
Thin, flexible, tapered, and pointed, with a series of sharply pointed barbed projections that curve backward
Fragile and used with care
Disposed of in biohazard sharps container

23. Reamers Used to enlarge pulp canal after broaches
Used with reaming action or filing action
Tapered and pointed with spiral cutting edges
Cutting edges of reamers are farther apart than those found on endodontic files
Available in many sizes, beginning with size 10 and continuing in intervals of 5 up to size 60 or intervals of 10 through size 140
A step-up process

24. Endodontic Hand Reamer
Courtesy DENTSPLY/Maillefer

25. Files Look like reamers K-type, H-type (Hedstrom), and S-type
Standard numerical size designation
Standard color coding
Sizes begin with size 8 and continue through size 140
Files lengths are 21 mm, 25 mm, and 27 mm

26. Files
Available in carbon steel, stainless steel, or nickel-titanium alloy
Newer titanium files have strength and flexibility
Sterilized through dry heat, autoclave, bead sterilizer
Disposed of in biohazard sharps container

27. K-type Files Made of carbon steel
Tapered and pointed with tight spiral cutting edges arranged so that cutting occurs with rotating stroke
When dentist pulls instrument out of tooth, cutting edges scrape against walls, removing necrotic tissue

28. Hedstrom Files
Shaped like series of cones that become larger from tip toward the handle
Sharp blades of these files cut aggressively
Used in push-pull motion and not rotated as the K-type files

29. S-type Files Made of stainless steel as opposed to carbon steel
Stainless steel bends more easily, is not as brittle, is less likely to break compared with carbon steel, and can be autoclaved without becoming dull
Have S-fluted design

30. Barbed Broach, K-Type File, and a Hedstrom

31. Endodontic Stops Small round pieces of rubber, plastic, or silicone
Placed on reamers, files, or even broaches
Mark measurement of root canal
Prevent injury or perforation of apex
Courtesy DENTSPLY/Maillefer

32. Endodontic Measuring Gauges
Determine working length
Many designs for endodontic rulers
All endodontic rulers measure files, reamers, and broaches in millimeter increments in various designs