Dr. Gilberto Debelian

Transcription

1 Live Section - Endodontics Scandefa 2010 Dr. Gilberto Debelian Oslo, Norway

2 Endodontic Treatment of a tooth with Apical Periodontitis

3 Tooth 16 Asymptomatic apical periodontitis Chronic apical periodontitis TX: non vital pulp

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5 High Speed Low Speed

6 Ultrasounic Units Endo Success ET 18D ET 20 ET 25 K-25/21mm ET BD ET PR Ultrasonics - 20 to 40 khz frequency Remove hard tissue by Cavitation 6

7 Access Cavity Endodontic File Forceps

8 THE APICAL CONSTRICTION

9 Obturation Levels Vital Pulp Infected Pulp Success: /- 0.14mm short Failure: /- 0.20mm Chungal et al mm: Success 94% >2mm: Success 68% Long: Success 76% Sjögren et al, 1990

10 Manual Instruments

11 Preliminar reading w/ EAL mm 8 mm mm 13 mm 11

12 21 mm mm mm 13 mm Manual Instrumentation 12

13 Preliminar reading w/ EAL mm 8 mm 60 o mm 13 mm Reciprocating Hand-pieces 13

14 Scout Files to negotiate obliterated canals 10/ / /0.06 RaCe-FKG

15 21 mm mm 8 mm rpm 600 rpm 10/ / / mm Reading w/ EAL 15 Scout Files Protocol NiTi Seque nces

16 Bio RaCe - Basic Set BR0 25/0.08 BR1 15/0.05 BR2 25/0.04 BR3 25/0.06 BR4 35/0.04 BR5 40/0.04 BR6 50/0.04 BR7 60/0.02

17 17 Bio RaCe - Basic Set 21 mm 8 mm 13 mm mm BR BR BR BR3 BR BR5 Zones of Contact > < / / / / / /0.04 BR BR3 BR BR BR5

18 Intracanal Irrigation Needle penetration and diameter Needles ga. FlexiGlide Tips Vista Dental Navi Tips Ultradent

19 Irrigation Protocol - Non vital Pulps Canal Preparation w NiTi (BioRaCe) - Consult Anatomic Table 1%-2,5%NaOCl - start w 25g, finish w 30g needle Fill the canal w NaOCl Ultrasonication10-20s 17% EDTA or Citric Acid w 30g needle Fill the canal w EDTA Ultrasonication10-20s Dry with paper points Soak the canal with 2% Clorhexidine Dry with paper points IC Medication Non-Vital Pulps 1-4 weeks Fill the canal w NaOCl + EDTA Ultrasonication10-20s Dry with paper points Obturation

20 UPPER JAW ISO 50 or 60 ISO 50 ISO (if curved) ISO 50 or 60 B: ISO 35 or 40 P: ISO 40 1 canal: ISO 50 or 60 B: ISO 35 or 40 P: ISO 40 1 canal: ISO 50 or 60 MBs: ISO 35 or 40 DB: ISO 35 or 40 P: ISO 50 or 60 MBs: ISO 35 or 40 DB: ISO 35 or 40 P: ISO 50 or 60 B: ISO 40 L: ISO 40 B: ISO 40 L: ISO 40 B: ISO 40 P: ISO 40 B: ISO 40 P: ISO 40 MB: ISO 35 or 40 ML: ISO 35 or 40 MB: ISO 35 or 40 ML: ISO 35 or 40 1 canal: ISO 50 1 canal: ISO 50 1 canal: ISO 50 or 60 1 canal: ISO 50 or 60 D: ISO 50 or 60 2 Ds: ISO 40 or 50 D: ISO 50 or 60 2 Ds: ISO 40 or 50 LOWER JAW

21 Irrigation Protocol - V/NV Pulps Canal Preparation w NiTi - Minimal apical size #35 1%-2,5%NaOCl - start w 25G, finish w 30G needle Fill the canal w NaOCl Ultrasonication 10-20s After the preparation

22 22 Bio RaCe - Basic Set 21 mm 8 mm 13 mm mm BR BR BR BR3 BR BR5 Zones of Contact > < / / / / / /0.04 BR BR3 BR BR BR5

23 Irrigation Protocol - V/NV Pulps Canal Preparation w NiTi - Minimal apical size #35 1%-2,5%NaOCl - start w 25G, finish w 30G needle Fill the canal w NaOCl Ultrasonication10-20s 17% EDTA or 10%Citric Acid w 30G needle After NaOCl Fill the canal w EDTA Ultrasonication10-20s

24 Ultrasonic Units Irri-Safe 24

25 Irrigation + Ultrasonication K-25 Satelec IrriSafe Satelec

26 Irrigation Protocol - Vital Pulps Canal Preparation w NiTi - Minimal apical size #35 1%-2,5%NaOCl - start w 25g, finish w 30g needle Fill the canal w NaOCl Ultrasonication10-20s 17% EDTA or Citric Acid w 30g needle Fill the canal w EDTA Ultrasonication10-20s Obturation Vital Pulps Dry with paper points

27 Irrigation Protocol - Non vital Pulps Canal Preparation w NiTi - Minimal apical size #35 1%-2,5%NaOCl - start w 25g, finish w 30g needle Soak the canal with 2% Clorhexidine Dry with paper points Fill the canal w NaOCl Ultrasonication10-20s 17% EDTA or Citric Acid w 30g needle Fill the canal w EDTA Ultrasonication10-20s Dry with paper points

28 Obligate Anaerobes Facultatives Anaerobes

29 Irrigation Protocol - Non vital Pulps Canal Preparation w NiTi (BioRaCe) - Consult Anatomic Table 1%-2,5%NaOCl - start w 25g, finish w 30g needle Fill the canal w NaOCl Ultrasonication10-20s 17% EDTA or Citric Acid w 30g needle Soak the canal with 2% Clorhexidine Dry with paper points Ca(OH)2 Fill the canal w EDTA Ultrasonication10-20s Dry with paper points

30 Bacterial Reduction With Progressive Filing 6 Saline (Dalton 1998) Control NaOCl 1,25% (Shupping 2000) NaOCl 5,25% Ca(OH)2 (Shupping 2000) Log 10 CFU means % neg. culture 20% neg. culture 40% neg. culture 61,8% neg. culture 92,5% 0 #20 #25 #35 S1 S2 S3 S4 samples Ca(OH)2 S5

31 Irrigation Protocol - Non vital Pulps Canal Preparation w NiTi - Minimal apical size #35 1%-2,5%NaOCl - start w 25g, finish w 30g needle Fill the canal w NaOCl Ultrasonication10-20s 17% EDTA or Citric Acid w 30g needle Fill the canal w EDTA Ultrasonication10-20s Dry with paper points Soak the canal with 2% Clorhexidine Dry with paper points IC Medication Non-Vital Pulps 1-4 weeks Fill the canal w NaOCl and EDTA - Ultrasonication10-20s Dry with paper points Obturation

32 Obturation

33 Resilon TM Products

34 RaCe Fill Ref: Root Canal Sealer Auto-MIx Tips Fill RaCe CH-2304 La Chaux-de-Fonds Switzerland Ref: Points BR4 #35/ points Fill RaCe CH-2304 La Chaux-de-Fonds Switzerland Ref: Points BR4C #35/0.02 BR5C #40/0.02 BR6 #50/0.04 BR7 #60/ points Fill RaCe CH-2304 La Chaux-de-Fonds Switzerland Ref: Points BR5 #40/ points Fill RaCe CH-2304 La Chaux-de-Fonds Switzerland Ref: Accessory Points FM 120 points Inside

35 Resilon point sealer tags Resilon sealer Resilon sealer tags

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38 Final rinse: No NaOCl! NaOCl EDTA 17% CHX 2%

39 Obturation Technique Cold Lateral Condensation

40 Lateral Cold Condensation Technique Master point w/ sealer Lateral cond. w/ finger spreader Accessory point FM w/ sealer Sear off w/ a hot hand plugger and condense Light curing 40s

41 Lateral Condensation 41

42 Obturation Technique Warm Vertical Condensation

43 Warm Vertical Condensation Technique Apply the heat plugger to the pre-fitted length for 4s at 160oC Cooled for 4s Heat the plugger for 1 s and removed it cold Condense the apical plug with a cold hand plugger Place a new layer of selaer in the canal w a paper point Backfill the canal with a warm filing material

44 Obturation Technique Warm Vertical Condensation Hand pluggers #40 NiTi #80 SS #50 #100 #60 #120 44

45 Plugger selection Maillefer Dovgan

46 System B Obturation Technique Warm Vertical Condensation Obtura Extruder BR4 BR4 BR5 BR6 BR7 BR7 ML: 50/.12 taper M: 50/.10 taper FM: 50/.08 taper F: 50/.06 taper EF: 30/.04 taper 46

47 Alpha Beta HotShot - Smart Endo 47

48 Alpha HotShot - Smart Endo 48

49 Pre-op 4 weeks 6 months 49

50 Pre-op 3 wks CH 6 m 50

51 Pre-op 1 yr. 51

52 Check-up - Non-Vital Pulp AAP PAI mnd with Ca(OH)2 Resilon with LCT 12 months PAI months PAI 1-2 Working length 24mm Instrumentation # 60 Gilberto Debelian