CREATING ENDODONTIC EXCELLENCE
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1 I. RATIONALE FOR TREATMENT (List of Abbreviations on Page 16) A. Factors Influencing Success 1. Disease Flow 2. Portal of Exit (POE) 3. Lesion of Endodontic Origin (LEO) 4. Shaping Facilitates Cleaning 5. Shaping Facilitates Packing C. MX Teeth Anatomy D. MND Teeth Anatomy 1
2 II. ACCESS PREPARATION A. Objectives B. Armamentarium C. Access Techniques (Clinical Ops) 1. Maxillary Anterior 2. Maxillary Molar 3. Mandibular Bicuspid 4. Mandibular Molar Metalift used to remove crown 2
3 III. GLIDE PATH MANAGEMENT A. Mechanical Objectives 1. Continuous Tapering Preparation (CTP) 2. Original Anatomy Maintained 3. Position of Foramen Maintained 4. Foramen as Small as Practical B. Preparation Sequence 1. Scout Coronal Two-Thirds a. Viscous chelator (RC Prep / Glyde / ProLube) b. Small-sized hand files 6 cycles feed-it-in-pull c. Explore & discover d. Secure glide path 3
4 2. Shape Coronal Two-Thirds a. NaOCl / EDTA b. Rotary NiTi files c. Pre-enlargement d. Advantages 1. Better removal of dentinal mud 2. More effective irrigation/cleaning 3. Improve preparation safety 4. Enhance deep access 5. More accurate diagnostics 6. Less post-op flare-ups 7. Encourages one-visit endodontics 4
5 3. Scout Apical One-Third a. Viscous chelator b. Small-sized hand files c. Working Length i. 15 K-file ii. Radiograph or Apex Locator d. Patency 10 K-File e. Glide Path Manual vs. Rotary 4. Shape Apical One-Third a. NaOCl / EDTA b. Manual vs. Rotary files c. Finishing criteria d. Final rinse solution(s) 5
6 C. PathFiles D. Irregular Glide Path 1. Anatomical 2. Pathological 3. Iatrogenic E. Clinical Cases 6
7 IV. CANAL PREPARATION A. ProTaper NEXT System 1. Variable Tapers on a Single File 2. Metallurgy - M-Wire Technology 3. Offset Cross-Section 4. Design Feature Advantages g.cm B. Treatment Sequence 1. Prepare straightline access to canal orifice 2. Explore the canal using small-sized hand files, determine working length, verify patency and confirm a smooth, reproducible glide path 3. Expand the glide path using a size 15 hand file or with dedicated mechanical glide path files 7
8 4. In the presence of NaOCl, Float, Brush, and Follow, along the glide path, with the X1 (17/04) file, in one or more passes, until the working length is reached 5. Use X2 (25/06), exactly as described for X1, until the working length is reached 6. Inspect the apical flutes of the X2 file; if they are loaded with dentin, then the shape is cut, the correspondingly sized gutta percha master cone or size verifier may be fitted, and the canal is ready for disinfection 7. Alternatively, gauge the foramen with a size 25 hand file and, if this file is snug at length, the canal is shaped and ready for disinfection 8
9 8. If the size 25 hand file is loose at length, then continue shaping with the X3 (30/07) and, when necessary, the X4 (40/06) or X5 (50/06), gauging after each instrument with the 30, 40 or 50 hand files, respectively 9. After removing every mechanical shaping file from a canal, irrigate, recapitulate with a small size hand file, then re-irrigate. C. Finishing Criteria - Gauge & Tune (Gauging) D. Apical Diameter versus Apical Taper 9
10 E. WaveOne 1. Single-File Technique a. Advanced design b. Special metal c. Unique movement 2. Single-File Selection a. Anatomy b. Radiographs c. Glide Path 3. Establish Straightline Radicular Access 4. Estimate Working Length 5. WaveOne Treatment Sequence 6. Finishing Criteria 10
11 V. 3-D DISINFECTION A. Endodontic Disinfection 1. Debridement 2. Smear Layer Management 3. Biofilm Disruption B. Factors Influencing Disinfection 1. Anatomy 2. Access 3. Preparation Sequence 4. Glide Path 5. Shaping Files 6. Canal Preparation 7. Irrigants 8. Irrigation Devices 9. Passive vs. Active 10. Sonics vs. Ultrasonics 11
12 C. Disinfection Methods D. EndoActivator System 1. Clinical Applications a. Debridement Smear Layer Biofilm b. Adapt and Remove Calcium Hydroxide c. Adapt Mineral Trioxide Aggregate d. Remove Residual Obturation Materials 2. Clinical Protocol a. Shape in the presence of NaOCl b. EndoActivator tip selection c. Activate 17% EDTA for 1 minute d. Activate 6% NaOCl for 30 seconds 3. Clinical Research 12
13 VI. 3-D OBTURATION A. Concepts & Objectives B. Armamentarium 1. Gutta Percha 2. Pluggers 3. Paper Points 4. Kerr Pulp Canal Sealer EWT a. Excellent flow b. Variable viscosity c. Non-cytotoxic d. Non-resorbable e. Heat activated f. Blocks pain g. Sets fast (2 hours in mouth) 5. Heat Source (Calamus) 6. Obturation Delivery System (Calamus) 13
14 C. Popular Techniques 1. Single Cone 2. Lateral Condensation 3. Vertical Compaction 4. Carrier-Based 5. Extrusion D. Clinical Operatory - Vertical Compaction Technique 1. Cone Fit 2. Plugger Fit 3. Dry w/paper points 4. Mix Sealer 5. Butter cone and place into canal 14
15 6. Downpack a. Heat Wave 3-4 mm bites b. Waves of Condensation (WOC) press 5 seconds c. Sealer Hydraulics 7. Backpack Calamus Flow a. Inject Thermo-Softened Gutta Percha 3-4 mm squirt b. Reverse Waves of Condensation press 5 seconds c. Sealer Hydraulics 8. Pulp Chamber Management E. Clinical Operatory Carrier-Based Obturation F. Clinical Cases 15
16 Abbreviations: 3-D Three-Dimensional CTP EDTA EDTA EWT GP IRR LEO MX MND NaOCl POE WL WOC Continuous Tapering Preparation EthyleneDinitriloTetraAcetate 17% (Aqueous) EthyleneDiamineTetraaceticAcid 17% (Viscous) Extended Working Time Gutta Percha Irrigate Recapitulate - Reirrigate Lesion of Endodontic Origin Maxillary Mandibular Sodium Hypochlorite Portal Of Exit Working Length Waves Of Condensation For more information please contact: ADVANCED ENDODONTICS 122 S. Patterson Ave, Ste. 206 Santa Barbara, CA Toll Free (800) Phone (805) Fax (805) info@endoruddle.com 16
17 SANTA BARBARA HANDS-ON SEMINARS PRODUCT LISTING ITEM DESCRIPTION BRAND / COMPANY Edge-Ease X-ray Comfort Cushions Strong Dental / Schein Rubber Dam Handidam (one size) Aseptico / Dentsply Tulsa Dental Rubber Dam Frame Ostby Type - Part no Hygenic / Schein Rubber Dam Clamps Molars (26, 8A), Anteriors (9), Bi s (9) Ivory or Hu-Friedy / Schein Hot Pulp Test Tip For thermal testing SybronEndo or Schein Mirror Handle w/ruler Item # Schein Stropko Irrigator Tri-plex syringe adapter Dr. John Stropko Metalift Crown & Bridge Remover Classic Practice Resources Endo Access Kit Assorted Burs & X-Gates Dentsply Tulsa Dental Tapered Diamond Burs Round End (6856L-014) / Needle ( ) Brasseler IRRIGANTS / DEVICES: Irrigating Syringes 3cc, 23 gauge (notched tip) Monoject / Schein Navi-Tip 29 gauge (notched tip), 21 mm Ultradent NaOCl Warmer Sm. hotplate for warm water bath Mr. Coffee Water Beaker 2651A (3x3) -- For NaOCl syringes Profex Medical Products RC Prep or Glyde Viscous chelator Schein Syringe for RC Prep / Glyde 1cc Plastic #0124 Ultradent Tip for syringe White Mac #0661 Ultradent 17% EDTA Aqueous chelator Roth International XylołChloroform Clean excess sealer off walls Schein HAND INSTRUMENTATION: Files / 10, 15 K-Files Dentsply Maillefer Files / 20, 25, 30, 35, 40, 50, 60 Flexofiles (20, 25, 30); SureFlex (35, 40, 50, 60) Dentsply Maillefer ProTaper Hand Files Snap-on handles (SX, S1, S2, F1, F2, F3) Dentsply Tulsa Dental Bird Beak Plier For precurving NiTi hand files Hu-Friedy / Schein Endo Ring Blue Ring w/foam Inserts Jordco / Schein ROTARY INSTRUMENTATION: PathFile Rotary Files Glide path files (13/02, 16/02, 19/02) Dentsply Tulsa Dental ProTaper Rotary Files SX, S1, S2, F1, F2, F3, F4, F5 Dentsply Tulsa Dental ProTaper NEXT Rotary Files X1, X2, X3, X4, X5 Dentsply Tulsa Dental WaveOne Reciprocation Files Small 21/06, Primary 25/08, Large 40/08 Dentsply Tulsa Dental X-Gates Single Instrument (Gates Gliddens 1-4) Dentsply Tulsa Dental Gates Glidden Drills Stainless Steel Sizes 1-6 Dentsply Maillefer Slowspeed Electric H.P. Gear Reduction / ProMark Motor Dentsply Tulsa Dental Slowspeed Electric or Air Gear Reduction KaVo America ADVANCED ENDODONTICS CLIFFORD J. RUDDLE DDS 122 S. Patterson Avenue, Ste. 206, Santa Barbara, CA (800)
18 SANTA BARBARA HANDS-ON SEMINARS PRODUCT LISTING ITEM DESCRIPTION BRAND / COMPANY OBTURATION: Gutta Percha Fine-Medium / Medium or ProTaper Matching Dentsply Tulsa Dental Pulp Canal Sealer - EWT Powder & Liquid Kerr / Schein Calamus Pack Heat Source with 40/03 Electric Heat Plugger Dentsply Tulsa Dental Calamus Manual Pluggers Sizes 8.5, 9.5, 10.5, 11.5 Dentsply Tulsa Dental Calamus Flow Gutta Percha Delivery System for backpacking Dentsply Tulsa Dental Calamus Dual System Combines Calamus Pack & Flow in a single unit Dentsply Tulsa Dental Calcium Hydroxide Interappointment dressing Pulpdent Corp / Schein EQUIPMENT: EndoActivator System Sonic Handpiece Driver & Activator Tips Dentsply Tulsa Dental Ultrasonic Unit (Piezoelectric) P5 Ultrasonic Generator Dentsply Tulsa Dental Ultrasonic Instruments ProUltra ENDO 1-5, SINE 1-6 Dentsply Tulsa Dental Electronic Apex Locator Root ZX J. Morita Microscope A variety of choices Zeiss Dental Mobile Cart Customized Endodontic Cart ASI Medical Digital Xray System Digital Radiography Practice Works / Kodak Dental Anatomy Website Patient Education Tool ToothAtlas.com ADVANCED ENDODONTICS CLIFFORD J. RUDDLE DDS 122 S. Patterson Avenue, Ste. 206, Santa Barbara, CA (800)
19 SANTA BARBARA HANDS-ON SEMINARS SUPPLIER LISTING COMPANY TOLL FREE FAX PHONE WEBSITE Advanced Endodontics endoruddle.com ACE Surgical Supply acesurgical.com Aseptico aseptico.com ASI Medical asimedical.net Bisco bisco.com Brasseler brasselerusa.com C. K. Dental Specialties ckdental.net CareCredit carecredit.com Classic Practice Resources metalift.com Dentco dentcorp.com Dentsply Maillefer maillefer.com Dentsply Tulsa Dental Spec tulsadental.com Designs for Vision designsforvision.com Ellman International ellman.com Endoco endoco.com Global Dental Products gdpdental.com Global Surgical globalsurgical.com Hu-Friedy hu-friedy.com J. Morita USA jmoritausa.com KaVo America kavo.com Link Ergonomics linkdental.com Marquis Dental perio-aid.net Moyco Precision Abrasives moycotech.com Mr. Coffee mrcoffee.com Practice Works / Kodak kodakdental.com Profex Medical Products profexmed.com Quality Aspirators qualityaspirators.com Roth International Ltd rothendo.com Schein henryschein.com SmartPractice smartpractice.com Stropko, Dr. John stropko.com SybronEndo sybronendo.com ToothAtlas.com ehuman.com Ultradent ultradent.com Zeiss zeiss.com Zimmer Dental zimmerdental.com ADVANCED ENDODONTICS CLIFFORD J. RUDDLE DDS 122 S. Patterson Avenue, Ste. 206, Santa Barbara, CA (800)
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