Endodontic Instruments Mr. caputo Unit #2 Lesson #5

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?

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

Pulpotomy Procedure

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

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

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

Root Canal Procedure

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

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

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

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

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

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

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

Post and Core Buildup

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

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

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

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

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

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

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

Endodontic Hand Reamer Courtesy DENTSPLY/Maillefer

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

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

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

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

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

Barbed Broach, K-Type File, and a Hedstrom

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

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