Instruments used in Endodontics

Transcription

1 ﺑﺳم ﷲ اﻟرﺣﻣن اﻟرﺣﯾم Instruments used in Endodontics presented by: Dr. Maram Ezzat 1

2 Classification according to sequence of use I. Diagnostic instruments II. Instruments for access preparation III. Exploring instruments IV. Root canal enlarging instruments V. Obturating instruments VI. Miscellaneous instruments I. Diagnostic instruments 1. Visual aids 2. Pulp sensitivity and vitality test 3. Equipment for radiographs 4. Supplemental diagnostic tests 2

3 1. Diagnostic instruments Basic exam. Inst. 1. Visual aids 3

4 2-Pulp Sensitivity & Vitality tests a. Sensitivity tests Thermal pulp testers Electric pulp testers Thermal Pulp testers Hot Gutta-percha stopper Rubber Wheel Hot instrument 4

5 Cold Ice rods CO2 Snow Endo Ice b-electrometric evaluation Electric pulp tester (EPT) 5

6 2-Pulp Vitality tests: a. Laser Doppler flowmetery b. Pulse Oximetry 3. Equipment for radiograph A-Plain Radiography: 1-Parallel 2-Bisecting 6

7 B-Digital Imaging system: (80% less radiation) Direct : Radiovisiography (RVG) Indirect (cordless): Digora C- Cone Beam Computed Tomography 7

8 Supplemental diagnostic tools: A. Tooth slooth : B- Methylene blue (staining test) 8

9 II-Instruments for Access preparation Endo Z Diamendo Endo Acess III- Isolating instruments: Rubber dam 9

10 IV- Instruments for tooth length determination A. X-ray B. Electronic Apex Locator 10

11 V- Intraradicular instruments These are instruments used for preparation of root canal (cleaning and shaping) Classification according to use A. Exploring instruments B. Extirpating instruments C. Enlarging instruments 11

12 A. Exploring instruments: B. Extirpating instruments Extirpation : is the removal of vital inflamed pulp. barbed broach 12

13 C. Enlarging instruments: Classification according to: Material of construction:stainless Steel, Nickel Titanium, Carbon Steel, Diamond. Power source:hand driven, engine driven (rotary or vibratory) Technique of manufacture: Counter clockwise twisting, machine grinding ISO Classification Group I: I: Hand operated e.g. broaches, Files, Reamer Group II: II: Engine driven same as group I (handle is replaced by latch type). Group III: III: Engine driven (formed of one piece of metal e.g. gates glidden, glidden, pesso drills, NiTi rotary instruments). instruments). Group IV: IV: Root canal points: points: GuttaGutta-percha., spreaders, paper points. 13

14 V- Root canal Enlarging Instruments 1:Hand driven Basic Instruments Hybrid Instruments 2- Engine driven Rotary Instruments Vibratory Instruments Hand Driven K-Reamer: K-file: 14

15 K-file H-files: 15

16 Basic Instruments K Reamer K File H File Rat-tail file 16

17 Instrument standardization Iso standardization 1. Formula for the degree of diameter and tapering: D16-D = = Length of the working part 16 mm 0.02 mm diameter/ mm length 17

18 2. Instrument numbering system: OR No. of instrument = D0 100 No. of Ins. = Do x D0 = = 0.35 mm Formula for the graduated incremental increase in the size from one instrument to another #6#6-10: 0.02 mm #10#10-60: 0.05 mm #60#60-140: 0.1mm 18

19 4. Standrdization of tip angle 5. Standardization of color coding 19

20 Recent instrument standardization Profile series 29.17% In ISO % % Golden medium: Intermediate sizes: 12,17,22,27. 20

21 What are the components of a file? The taper is usually expressed as the amount the file diameter increases each millimeter along its working surface from the tip toward the file handle 21

22 What are the components of a file? The flute of the file is the groove in the working surface used to collect soft tissue and dentine chips removed from the wall of the canal What are the components of a file? The land is a surface that projects axially from the central axis as far as the cutting edge, between flutes. 22

23 What are the components of a file? The Cutting edge (Blade) the surface of the greatest diameter that follows the groove What are the components of a file? The helix angle is the angle that the cutting edge makes with the long axis of the file. Less steep Helical angle Steeper Helical angle 23

24 What is the core of a file? The core is the cylindrical center part of the file having its circumference outlined and bordered by the depth of the flutes What is the rake angle? The rake angle is the angle formed by the leading edge and the radius of the file If the file is sectioned perpendicular to its long axis 24

25 The leading edge of the blade is ahead of the perpendicular. The leading edge of the blade is behind the perpendicular, the angle is by definition, positive. Rake angle Negative rake angle Cut by compression K file, K flex, K Reamer Positive rake angle Cut by creating a chip H file, dental burs Most NiTi 25

26 (1) Hand driven Hybrid Instruments: 1-Cross section: Square, triangle, diamond, U 2-Depth and angle of the blade: S, unifile, unifile, safety H, A file 3-Material of construction: Ni Ti, C steel 4-Method of construction: Twisting, milling 5-Taper: 4%, 6%..12% (Rotary Ni Ti) 6%..12% 6- Tip design: Non cutting 7-length of the cutting blade 8-Numbering system: Profil Series 29 1-Cross section: K flex file S File 26

27 Hybrid Instruments: 2-Depth and angle of the blade: A file Inner curve 1. Steep depth of fute 2. non cutting tip Safety H-File 27

28 Hybrid Instruments: 3-Material of construction: NiTi Super elasticity: Hyflex Hybrid Instruments: 4-Method of construction: 1- Grinding and twisting : K file,k Reamer, K flex file 2- Milling: H file, Safety H, Flex R, all Ni Ti files 28

29 Hybrid Instruments: 5-Taper: 4%, 6%..12% (Rotary Ni Ti) Greater taper files Inc. cutting efficiency More flared preparation Hybrid Instruments: 6- Tip design: Non cutting Flex-R-file K flex Cutting tip design (negotiation) but can cause transportation 29

30 Hybrid Instruments: 7-length of the cutting blade Canal master Lightspeed (Rotary) Gates Glidden Hybrid Instruments: 8-Numbering system: Golden Mediums 30

31 Enlarging instruments Endodontic instruments instruments physical properties: 1-Flexibility: Flexibility: increased by length of instrument. diameter Using NiTi. NiTi. C.s. C.s. triangle > Square 2- Cutting efficiency: efficiency: increased by using carbon steel > st.st. st.st. more acute cutting angle of blade. Triangle > square 3- Corrosion resistance: resistance: increased by - st.st. st.st. >carbon steel. Hand Instrumentation " Regardless of the instrument type, none was able to reproduce ideal results; however, clinically acceptable results could be obtained with all of them." 31

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33 Advantages: Quicker preparation. Less canal transportation Use of the crown down technique. Disadvantages: 1. Greater chance of canal ledging 2. Greater chance of canal perforation 3. Greater chance of instrument breakage 4. Loss of tactile sensation 33

34 1. Engine files and Reamers 2. Gates Glidden 34

35 3. Pessodrill 4. Automated Hand Pieces 35

36 A. Conventional bur speed Uses To develop coronal access Prepare post space channels Widen the coronal two thirds of canal With SS instruments used in straight canals only B. Reciprocating handpiece E.g. M4 safety and Endo-Express 36

37 Vertical stroke handpiece E.g. Racer: vertical strokes of mm D. Combination Canal finder : reciprocating and vertical strokes. 37

38 Gear Reduction Handpieces Endo mate TRI AUTO ZX 1. AUTO START/STOP. 2. AUTO TORQUE REVERSE. 3. AUTO APICAL REVERSE. 38

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40 NiTi instruments Properties: Show shape memory and superelasticity Softer than stainless steel Not heat treatable Lower cutting efficiency Disadvantages: Possibility of fracture Limited no. of use on instruments. Expensive. 40

41 First generation Profile Second generation Quantec Hero 642 Third generation Protaper LightSpeed K3 Heroshaper Taper is 0.04 & 0.06 U shaped C.S Used with gear reduction and high torque hand piece Non cutting tip 41

42 NiTi version of canal master Long shaft & short flame blade With special contra rpm Gear reduction hand piece at 300 RPM 3 shaping, 3 finishing Progressive changing taper efficiency & cutting area between dentin& file. Convex triangular C.S. cutting efficiency 42

43 RPM asymmetric flutes separated by lands +rake angle cutting efficiency Wide radial land & peripheral blade relief friction & torsional stress Taper is 0.04 & 0.06 U shaped C.S Used with gear reduction and high torque hand piece Non cutting tip 43

44 NiTi version of canal master Long shaft & short flame blade With special contra rpm Gear reduction hand piece at 300 RPM 3 shaping, 3 finishing Progressive changing taper efficiency & cutting area between dentin& file. Convex triangular C.S. cutting efficiency 44

45 RPM asymmetric flutes separated by lands +rake angle cutting efficiency Wide radial land & peripheral blade relief friction & torsional stress Triangular c.s. Manufactured by twisting +ve rake angle. No special motor is required. No torque control required. Single use instrument. 45

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47 Sonic Handpieces 2-3 khz SONIC AIR OSCILLATIONS 47

48 Sonic instruments RispiSonic ShaperSonic TrioSonic Ultrasonic Handpieces khz PIEZOELECTRIC 48

49 Acoustic Streaming Cavitation Ultrasonic tips 49

50 Classification of Endodontic Instruments VII- Root canal Obturation Absorbent paper points Gutta percha cones 50

51 Classification of Endodontic Instruments VII- Root canal Obturation Non-softened technique: Spreaders (Lateral compaction) Pointed tip Classification of Endodontic Instruments VII- Root canal Obturation Warmed Softened technique: a) Plugger (Vertical compaction) Flat tip Heat Carrier 51

52 Classification of Endodontic Instruments VII- Root canal Obturation Warmed Softened technique: b)thermal applicators: System B System B Classification of Endodontic Instruments VII- Root canal Obturation Thermomechanical compactor:mc Spadden Compactor, Quick fill. Quick Fill Multiphase 52

53 Classification of Endodontic Instruments VII- Root canal Obturation Thermoplasticised injectable a) Syringe injection systems:obtura II, Ultrafil Ultrafil (70 º C) 1 B-SOLIDSOLID-CORE CARRIER ThermaFil Flexible plastic core uniformly coated with a layer of guttagutta-percha the plastic core carriers are heated in an oven called the ThermaPrep Plus heating system 53

54 VII Miscellaneous 1. Apex locator 2. Endometer 3. Irrigation instruments 4. Rubber dam set 54

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