5/8/2012. Endodontics. Root Canal Preparation Root Canal Filling. Coronal Access. Isolation. Follow-up. Diagnosis

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1 Endodontics Isolation Coronal Access Root Canal Preparation Root Canal Filling Diagnosis Follow-up 1

2 Root Canal Preparation CLEANING & SHAPING Oscillatory Hand Files Stainless Steel NiTi 2

3 Hand Files Active Portion K File # 25 D16 = 0.57 mm D0 = 0.25 mm D0 D16 D0 Diameter Increases 0.02 mm each milimeter from D0 D16 = D mm 3

4 Causes of the Fractures Torsional Deformation Torsional Fracture Leonardo R.T. et al. J. Endod Jan;35(1):113-6 Suffridge CB, et al A common problem encountered with NiTi rotary instruments is the increased risk of file breakage when a file binds in the canal. JOE May

5 Causes of the Fracture It is easier to consider the risks than remove a fracture file. Carlos Garcia Puente in: Endodontics Biological Concepts and Technological Resources Artes Médicas 2009 Buchanan, L.S. Rotary NiTi files can create a nightmare of broken instruments and other complications. Placing a file in a rotary device requires different skills Compendium, August 2002, pg 744 5

6 Musikant B.L. Manufacturers have built a set of rules that must be employed to use NiTi rotary instruments more safely. The limitations and requirements of NiTi rotary instruments safe usage have been imposed upon the dentist as their responsibility. If fracture ensues, it is invariably something that the dentist has not done correctly. This may in fact, be true, but what is missing is greater reality that states all these limitations and requirements to prevent separation. One good system beats two bad. Indian Dentist Research and Review. June 2009, p Bahia M.G. and Buono V.T.L. Decrease in the fatigue resistance of nickeltitanium rotary instruments after clinical use in curved root canals OOOO and Endodontics 2005;100:

7 More frequent and important than the anatomical considerations and incomplete cleaning another factor of great concern, with regard to rotary instrumentation with NiTi files are fractures of the instrument. Over the years, it has become increasingly clear that rotary NiTi instruments are vulnerable to separation. Renato de Toledo Leonardo Renato Miotto Palo Richard D. Tuttle Tilos System Chapter XXVI in: Endodontics Biological Concepts and Technological Resources Artes Médicas 2009 The continued need for K-files associated to rotary NiTi instrumentation confirms the inability of these files to create a safe preparation. Unfortunately there is no reliable evidence, concrete or circulated, to predict and prevent such accidents. Renato de Toledo Leonardo Renato Miotto Palo Richard D. Tuttle Tilos System Chapter XXVI in: Endodontics Biological Concepts and Technological Resources Artes Médicas

8 Even with the industry s commitment to offer the widest range of instruments of NiTi, with the most diverse designs, they have not yet managed to avoid more of the same frequent fractures. Renato de Toledo Leonardo Renato Miotto Palo Richard D. Tuttle Tilos System Chapter XXVI in: Endodontics Biological Concepts and Technological Resources Artes Médicas 2009 The Heartache of Separation Richard Mounce, DDS Fracture of rotary NiTi files is the single greatest problem with their use. Dentistry Today, April

9 McSpadden J, Mounce R, Despite the advantages of rotary systems, file separation remains frustrating and all too frequent Dentistry Today, July 2004 Break down to Break through Chaos to Concept 9

10 Facing these Brutal Facts with Innovation Clinical, radiographic, microscopic and statistic evaluation data under analysis, debates and discussion Interactive process of : - Looping back and forth - Developing ideas - Testing Tilos against other systems - Revising the ideas - Seeing them break under evidence - Building a framework Tilos System Concept 10

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12 Tilos system represents a technique of cleaning and shaping, technologically possible and biologically appropriate, which exemplifies effectively the best scenario for preparing the root canals, easy to apply, safe, reliable, profitable and predictable in most cases and clinical situations, regardless of anatomical variations and pathological conditions, while promoting the achievement of better results with fewer risks and costs. This concept of hybridizing metal alloys, combines the best of each, in terms of cleaning and shaping with less likelihood of errors during the biomechanical preparation. 12

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18 Anatomical considerations Critical V Zone 18

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21 Kinematic Considerations 21

22 Tilos Handpiece Clinical Sequence 22

23 Root canal access Pulp chamber access Endo-Eze Access Burs 23

24 Root canal entrance is enlarged and interferences removed with rectifer/straight line burs Biomechanical Preparation Cleaning and Shaping 24

25 Quill Ultradent Initial Steps -Negotiation -Apical Instrument Determination -Working Length Determination T.L.- 6 mm T.L..- 3 mm (2 to 4 mm) Tooth Length (T.L.) 25

26 NiTi Apical Preparation Tooth Length (T.L.) Irrigation Protocol Pulp Chamber Medium Third Apical Third Final Steps EDTA 5ml with D.S. NaOCl NaOCl NaOCl Water 5ml with NaviTip after the use of each File 5ml with NaviTip after the 5ml with D.S. after the use use of each File of each File 5ml with D.S. CHX 5ml with D.S. Water 5ml with D.S. 26

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29 NAVITIP FX 29 GA Zmener O. et al. JOE Volume 35, Number 9, September 2009 Navi Tips 31 ga Double Sideport 29

30 Tilos Oscillatory Instrumentation Shaping File # 1(0.10mm Taper) 2 to 4 mm short of T.L. T.L..- 3 mm (2 to 4 mm) Tooth Length (T.L.) 30

31 Tilos Oscillatory Instrumentation Shaping File # 2 (0.13mm Taper) 2 to 4 mm short of T.L. T.L..- 3 mm (2 to 4 mm) Tooth Length (T.L.) Tilos Oscillatory Instrumentation Shaping File # 3 (0.13mm Taper), 6 mm short of T.L. T.L.- 6 mm Tooth Length (T.L.) 31

32 Hand instrumentation with K-File # 20 or 25,30 at Tooth Length to ensure Glide Path Tooth Length (T.L.) Oscillatory instrumentation with Shaping File # 2 (0.13mm Taper) to the Tooth Length Tooth Length (T.L.) 32

33 25.08 Oscillatory instrumentation with NiTi Transitional File Crown-Down towards the Tooth Length Tooth Length (T.L.) Oscillatory instrumentation with NiTi Transitional File Crown-Down towards the Tooth Length Tooth Length (T.L.) 33

34 Oscillatory instrumentation with NiTi Transitional File Crown-Down to the Tooth Length Tooth Length (T.L.) Apical Preparation with NiTi Hand File # 30 or 35,40 at the Tooth Length Tooth Length (T.L.) 34

35 Breaking it into Procedure Patency and Apical Instrume Glide nt Determin Path ation 35

36 Breaking it into Procedure Flare 36

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48 Requirements for an Ideal Root Canal Filling Material: Biocompatible Low Cytotoxicity Adhesion Radiopaque Extended Working Time Fluid 3D Sealing etc Root Canal Filling Material EndoREZ 48

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50 EndoREZ Uretan Dimetacrilate Matrix Bariun Sulfate Zinc Oxide Iniciators Pigments Inhibitor Root Canal Filling Technique 50

51 Myth You can three-dimensionally condense warm gutta-percha or a synthetic thermoplastic resin into every fin, web, isthmus, and lateral or accessory canal,in seconds (through remarkably conservative coronal shapes) if they have been properly cleaned and disinfected during the irrigation phase of treatment. Ahead of the curve: Future Directions in Endodontics L.Stephen Buchanan,DDS Dentistry Today Volume 28 # 4 April 2009 De-Deus G. et al. Limited Ability of Three Commonly Used Thermoplasticized Gutta- Percha Techniques in Filling Oval-shaped Canals. JOE. Vol. 34, N. 11,

52 System B System B Thermafil McSpadden System B Thermafil McSpadden McSpadden 52

53 Choice of the Coated Gutta Percha cone that fits at the apical preparation length with tug back EndoREZ 53

54 EndoREZ EndoREZ 54

55 Inject EndoREZ into the Canal Master Gutta Percha Cone in Place 55

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58 PermaFlo Purple 58

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