1. Endodontic Instruments

2. INTRODUCTION

3. Diagnostic instruments Instruments used during access preparation
Classification of instruments and devices according to sequence of use:
BASED ON FUNCTION
Diagnostic instruments
Instruments used during access preparation
Exploring instruments
Extirpating instruments
Root canal enlarging instruments
Obturation materials, instruments and devices
Miscellaneous

4. MODE OF USE
A) HAND
B) ROTARY

5. Diagnostic instruments
2- Specialized devices
1-Basic instruments
(examination)
Mirror
Explorer
Tweezer
Periodontal probe

6. Front surface mouth mirror
Diagnostic instruments
Front surface mouth mirror
Explorer
Periodontal probe

7. Long, narrow working ends. Angle away from shank – easy access.
DG 16
DG 16/23
Endodontic explorers
Long, narrow working ends.
Angle away from shank – easy access.
Cotton forceps

8. 2- Specialized devices A- Visual aids: 1-Magnifying loups(2-6X)
3-Transilliumination
2-Surgical microscope(2-20X)

9. A- laser Doppler flowmetry B-pulp oximetry
B- Pulp testing
I- Sensitivity tests:
1- thermal test
A- cold test
B-hot test
2-electric pulp tester
II- vitality test:
A- laser Doppler flowmetry
B-pulp oximetry

10. C- Radiographs: 1- Plain radiograph 2- Digital radiograph
3-Cone beam computed tomography CBCT)

11. II- Instruments used during access preparation
Burs
Several types of burs are used to accomplish good access preparation
Fissure burs are used in the initial stage of access preparation to establish the correct outline form ,Round burs are used to lift the roof of the pulp chamber and eliminate overhanging dentine ,Tapered Non end-cutting bur is used to 'lift lid' of pulp chamber and refine cavity.

12. Regular and surgical length round bur
Tapered bur with round end
Endo Z bur (safe tip)

13. Endo excavator:
"larger than conventional excavator" its shape allows curettage of the pulp chamber when conventional one will not reach the floor of the chamber, and used as surgical aid to excavate periapical lesion.

14. III- Exploring instruments
Endodontic Explorers : These instruments are very stiff and should not be inserted into canals. Explorers should never be heated. This double ended instrument with long tapered tines is designed to facilitates the location of canal orifice.

15. IV- Extirpating instruments
Barbed broach
Machined from steel conical blank
and have numerous hooks as part of the blade
It should fit loosely inside the canal
The B.B must only be used in the straight part of the canal
Functions
• Used to remove the intact pulp
• ‘Barbs’ on the broach snag the pulp to facilitate removal
.Retrieve a paper point or cotton pellet trapped in the canal
. Loosen debris in necrotic canal..

16. BARBED BROACH

17. V- Root canal enlarging instruments
Hand driven instruments
Modified instruments design
Engine driven enlarging instruments

18. Hand driven instruments
Kerr manufacturing company was the first to produce files in the early 1990s, hence the name K-type file and K-type reamer.
At first, root canal instruments were manufactured from Carbon steel- contain less than 2.1% of carbon . However chlorine and steam sterilization caused significant corrosion. They are used only in initial penetration of narrow canals.
The use of Stainless steel instruments (contain 18% chromium, 8-10% nickel, 0.12% carbon) improved the quality of the instruments as they where Corrosion resistant and Stiff in nature, but unfortunately they were prone to fracture and distortion.
They are precurved to the desired form to facilitate insertion in curved canals and used in anti curvature filling technique.

19. Recently. Nickel titanium – (contain 55% Ni and 45% Ti) was used to aid maintaining canal shape. They are Super elastic, Corrosion resistant, Softer, good resilience, biocompatible and have the Shape memory property.
However , they don’t show signs of fatigue before they fracture , Poor cutting efficiency and Poor resistance to fracture
NiTi
Stainless steel
Softer
Harder
Have low modulus of elasticity (Flexible)
• High modulus of elasticity( Not flexible)
Show shape memory
Don't show shape memory
Show super elasticity
• Don't show elasticity
Less cutting efficiency
• More cutting efficiency
Fractures without any indication
• Gives indication of fracture

20. Manufacturing of Hand Instruments
These are manufactured by two techniques:
By first grinding graduated sizes of round “piano” wire into various shapes and then twisting counterclockwise to produce cutting edges.
2. By grinding spirals into tapered wire rather than twisting, e.g. H-file and NiTi instruments are machined

21. Standardization of Instruments
In 1957.Ingle established a logical nomenclature for the standardization of root canal instruments, so all manufacturers could conform to length ,width, and taper in specific standards. The international standard organization (ISO) further developed the system.
Landmarks of standard instruments
Length of the instrument
Numbering of the instruments
Incremental increase in size
Color coding
Instrument taper
Tip angle

22. Length of the instrument
The first standard in length is the full extent of the shaft up to the handle and this comes in 3 lengths :25 mm(most common), 21 mm(used for posteriors and it affords better operator control), or 31 mm (commonly used for long roots as canines.
Second standard in length is the length of instrument blade
(is to be 16 mm starting from D0 till D16 )
The rest of the blade has no flutes

23. ii- Numbering of the instruments
The instruments are available in sizes 6 to 140 .Each number represent diameter of instrument in 100th of millimeter at the tip.
For example, instrument No. 25 has a diameter at D0 =25/100 = 0.25 mm.
iii- Color coding
Instrument handles should be color coded for their easier recognition ( white, yellow, red, blue, green, black) and repeated up to instrument no 140.
In addition, no 6 is Pink, no 8 is gray, and no10 is purple

24. Iv- Incremental increase in size
In small files up to size 60 ,there is
Increment each 5/100 or 0.05 mm increment at D.
In large files60 up to140 ,there is
Increment each 10/100 or 0.1mm increment at D.
While from size 6 up to10 , the increment is 2/100 or 0.02mm.
V _Instrument taper
The file diameter increases at a standard rate 0.02mm/mm Starting at D0 ,this means that the difference in diameter between D0 and D16 regardless the instrument size is always 32mm
( 0.02 X 16= 0.32 ).
E.g. instrument no 15 with 0.02 taper, would have 0.17mm diameter after 1mm from tip and 0.47mm at D16

25. Tip angle of an instrument should be 75° ± 15°.
Greater taper instruments (0.04, 0.06, 0.08, 0.10, 0.12) have also been made available.

26. FLUTE
It Is a groove in the working surface used to collect soft tissue and removed dentin chips from the wall of the canal.
The effectiveness of the flute depends on its depth , width, configuration, and surface finish.

27. Reamer
• Reamer is K-type instrument (manufactured by Kerr company), which is used to ream the canals. It cuts by inserting into the canal, twisting clockwise one quarter to
half turn and then withdrawing, i.e. penetration, rotation and retraction.
instruments can be manufactured by twisting a square or triangular blank by machine . reamer used in shaping the canal

28. • Reamer has triangular blank and lesser number of flutes
than file
• Number of flutes in reamer are 1/2 to 1/mm, while in file,
the flutes are 11/2 to 21/2/mm
• Though reamer has fewer numbers of flutes than file, cutting efficiency is same as that of files because more space
between flutes causes better removal of debris

29. K- file
instruments can be manufactured by twisting a square or triangular blank by machine the blank is twisted into a tighter series of spiral than reamer also K- file are more flexible than reamer .
K -Files with a triangular cross-section tend to have superior cutting characteristics and are more flexible, and hence less likely to transport the canal during preparation. .
Action
o'clock wise half –turn twist
K- file
Its manufactured by twisting a square or triangular blank by machine the blank is twisted into a tighter series of spiral than reamer also K- file are more flexible than reamer .

30. K -Files with a triangular cross-section tend to have superior cutting characteristics and are more flexible, and hence less likely to transport the canal during preparation. .
Mode of Action : filing (push and pull )
Watch-winding motion

32. Hedstroem File (H-file)
Hedstroem file has flutes which resemble successively triangles set one on another
Manufactured by grinding a conical steel wire.
Cut in one direction – retraction (Cutting while pulling)
Cross-section – single helix teardrop
Very aggressive

33. Hedstrom File: Recommended use
can be used both in straight canals and curved canals.
H-files must always fit loosely in the canal to avoid risk for fracture.
Small sizes up to #25 can be used down into full preparation length while bigger sizes are often used mm short.
Useful for removal of Gutta-percha in re-treatment cases
To remove /retrieve broken instruments

34. Modified instruments design

35. FLEXOREAMER
The helix angle is small, and therefore effective only in rotatory motion.
The tip of the instrument is non-cutting (bat-tip/inactive tip) making flexoreamer well suited for the preparation of evenly curved canals without risk of ledging.

36. K-FLEX:
Hybrid – strength and versatility of K- type + aggressive cutting of H-type.
K-flex file is rhombus in cross section having two acute angles and two obtuse angles . The two acute angles increase sharpness and cutting efficiency. While the two obtuse angles provide more space for debris removal.
Also the decrease in contact of instrument with canal walls provide more space for irrigation.
It is used with filing and rasping motion.
Increase flexibility.

37. The tip is noncutting type.
Flexo File
• It is similar to the K-flex file except that it has triangular cross section. This feature provides more flexibility and thus ability to resist fracture.
The tip is noncutting type.
• Flexo files has more flexibility but lesser cutting efficiency.
Triple Flex File
• It is made up of stainless steel and are triangular in crosssection.
• It has more flutes then reamer but lesser than K-file.
• Triangular cross-section provides better flexibility and
cutting efficiency

38. Flex-R-file/Roane File
• Flex-R file is made by removing the sharp cutting edges from the tip of instrument .The
noncutting tip enables the instrument to traverse along the canal rather than gouge into it.
• This design reduces procedural accidents
• Triangular cross section which provides it flexibility to be used in curved
canals.
• It is made up of NiTi

39. Modifications in H-files
Safety Hedstroem File
• This file has noncutting safety side along the length of the blade which reduces the chances of perforations.
S-File
• It is called ‘S’ file because of its cross-sectional shape.
• S-file has good cutting efficiency in either filling or reaming Action
S-File
Safety Hedstroem File
C+ File
• it is used for calcified canals.
• It is made up of stainless steel and has square crosssection.

40. Engine – Driven instruments

41. Engine Driven Instruments: 1- Reciprocating Handpiece
Commonly used reciprocating hand piece is Giromatic handpiece. It rotates with quarter turn motion at 3000 rpm Eg ..Endo-EZE , Wave one.
Wave One system

42. Note
While using engine driven reciprocating instruments, accessibility
to the apical foramen must be made first with hand instruments.

43. 2- low Speed Rotary Instruments
1-Gates – Glidden Drills
Safe tip (side cutting )
It has flame shaped cutting point mounted on long thin shaft attached to a latch type shank
Gates-Gliddens are available in a set from 1 to 6 with the diameters from 0.5 to 1.5 mm.
Due to their design, Gates-Glidden drills are side cutting instruments with safety tips.

44. TO BE NOTED • It should not be used with pressure.
• The instrument is designed to break high in the shank to facilitate its removal upon breakage as the broken part will protrudes outside the canal..

45. Uses of Gates-Glidden drills
• Enlarge root canal orifices
• For coronal flaring during root canal preparation
• For removal of lingual shoulder during access preparation of
anterior teeth
• During retreatment cases or post-space preparation
• During instrument removal,

46. 2- Flexogates
• Safe noncutting guiding tip
• Safety design, i.e its breakage point is 16 mm from the tip, so
once fractured, it cab be easily retrieved.
• Flexible so used in curved canals.

47. 3. Peeso Reamers They are rotary instruments used mainly for postspace
preparations.
• They have safe ended noncutting tip.
• Their tip diameter varies from 0.7 to 1.7 mm.
• They should be used in brushing motion.
Disadvantages
Are aggressive and might rapidly over prepare the
canal or cause perforations if used incorrectly..

48. 3- Sonic & Ultrasonic Instruments :
Ultrasonic and sonic devices activate an oscillating sinus wave-like fashion in the file with frequency of 25-30KHZ and 2-3 KHZ respectively.
Ultrasonic devices use regular type of instruments(k-file)whereas sonic devices use special instruments.

49. Advantages of sonic and ultrasonic instruments
• Due to constant irrigation, lesser chances of debris extrusion beyond the apex
• Produces clean canals free of smear layer and debris.
Enhanced action of NaOCl because of increased temperature and ultrasonic energy
Disadvantages
• Walls of prepared canals are rough.
• Chances of transportation are more in curved canals

50. Uses of Endosonics
Access enhancement
Orifice location (Locating and opening of calcified root canals)
Irrigation
Sealer placement
Gutta-percha obturation
MTA placement
Endodontic retreatment(Elimination of root obturation material and Removal of broken instruments)
Pulp stone removal.

51. 3- Nickel-Titanium Rotary Instruments

52. NiTi Rotary Instruments
NiTi was developed by Buchler since NiTi is also known as the NiTinol.
Generations of rotary instruments
• First generation : Profiles, Quantec
• Second generation : Profile GT
• Third generation : K3, RACE Protaper
• Fourth generation : V-tape

53. gear Reduction handpiece with torque control
Electric endo motor

54. VI- Obturation materials, instruments and devices

55. Obturation materials:)
Gutta Percha as CORE MATERIAL and Root canal sealers:
Non-soluble, non-irritant points that are condensed into the pulp chamber during obturation
• Standardized type: follows same ISO classification as endodontic files
• Non-standardized: have a greater taper than the standard ISO type
Zinc oxide eugenol
Calcium hydroxide
Resin sealers

56. Resilone/Epiphany obturation material

57. Instruments for root canal Filling
Root canal spreaders:
Hand spreader
Finger spreader

58. Root canal spreaders:
Used for lateral condensation [pointed end]
• Hand spreaders ( stiff )
• Finger spreaders (Flexible )
• Standardized.

59. 2- Root canal Pluggers:
Hand Plugger
Finger Plugger

60. Endodontic Pluggers Used for vertical condensation of the gutta percha
(Flat end)

61. 3- Lentulo spirals (paste carriers)
Small flexible instrument used to place materials into the canal
Fits into the conventional hand piece
Use with caution as it can be easily broken

62. Obturation devices

63. VII- Miscellaneous

64. Endodontic ruler
Instrument organizer (endodontic kit)

65. Endodontic block or Transfer sponge
ABSORBENT PAPER POINTS:
Slender cones made of paper or other absorbent material.
Uses – drying the canal
Conveying medicaments
Obtaining canal cultures
Available in standardized sizes

66. Endodontic syringe (Irrigation needles)

67. Electronic Apex Locators
An electronic instrument used to determine the distance to the apical foramen

68. Mode of Use
A lip clip is attached to the patient’s lip and another electrode is attached to the file.
When the apex is reached, a beep is heard and
a light illuminates in the device indicating the apex.

69. Electric pulp tester
Used to test the vitality of a tooth using electric stimulus
• Electric stimulus is increased in small increments until the patient can feel the stimulus
• Toothpaste or prophy paste is used to conduct the current from the pulp tester to the tooth