Lec 2 - Endodontic Instruments

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Presentation Transcript


ENDODONTIC INSTRUMENTS Dr. Saurabh Chandra Dept of Conservative and Endodontics




HISTORY: 2200 years old Nabatean warrior skull oldest root canal filling 1750 – Fauchard recommended removal of pulp 1850 _ wooden pegs for debriding pulp Early 1900 – Introduction of files, reamers, pathfinder, lentulospiral 1915 - Kerr manufacturing company obtained patent for all instruments later known as k_type instruments 1957 - Richman introduced first ultrasonic system 1958 – Ingle & Levine 1st proposed standardization. 1959 – New line of standardized instruments & filling materials.

Slide 4: 

1962 – Working committee on standardization . 1964 _ Introduction of giromatic handpiece. 1975 _ 1st report on potential application of NiTi alloys 1976 – 1st approved specification for root canal instruments. 1976 to 1984_ Martin and Cunningham provided instruments that were set for vibration at 25 to 40KHz 1984 - introduction of canalfinder system 1988 -1st use of NiTi in endodontic instruments 1989 – ANSI approval of “ADA specification number 28 for endodontic files & reamers.”


CLASSIFICATION OF ENDODONTIC INSRUMENTS BASED ON FUNCTION A)EXPLORING _to locate canal orifice and to assist in obtaining patency of root canal B) DEBRIDING _to extirpate pulp and remove debris C) CLEANING AND SHAPING _ clean and shape root canals laterally and apically D) OBTURATING _To pack filling material into root canal MODE OF USE A) HAND B) ROTARY

Slide 6: 

ISO GROUPING A) GROUP I - hand use only B) GROUP II - engine driven latch type C) GROUP III - engine driven latch type drills or reamers D) GROUP IV - root canal points


EXAMINING INSTRUMENTS Instruments used in examination are 1)front surface mouth mirror _ overcomes the problem of associated with double image 2)periodontalprobe 3)explorer 4)cotton forceps


EXPLORING INSTRUMENTSENDODONTIC EXPLORERS: Long, narrow working ends --- DG-16 & D-5 Angle away from shank – easy access. Locate canal openings. Explore pulp chambers.


DEBRIDING INSTRUMENTSENDODONTIC EXCAVATOR Longer offset – better reach Excise pulp tissue from pulp chamber


BARBED BROACH, RASP AND APPLICATORS: (ANSI sp. No :63) The length of working portion of shaft is 10mm. Taper – 0.007mm/mm (Broach). 0.015mm/mm (rasp). Difference between broach and rasp _ depth and angle of cut. Barb height – half of core diameter (Broach). Barb height – one third of core diameter (rasp). Made from soft iron wire.

Slide 12: 

Barbed broach – Thin, flexible, tapered and pointed removal of intact pulp tissue, paper points and cotton dressings. Identification symbol – 8 pointed star Rasps – rough walled canal preparation. Previously rattail file


ISO GROUP I INSTRUMENTS MANUFACTURE: First made from carbon steel Now made universally of Ni-Ti and stainless steels. Produced by two techniques. 1st technique Grinding graduated sizes of round “piano” wire into various shapes and second grinding for taper. Then, twisted in counter clockwise direction for programmed number of times. 2nd technique Grind spirals into tapered wire rather than twisting. Ni-Ti instruments are produced by this technique.

Slide 14: 

1955 – first attempt to standardize instruments by Ingle & Levine Last revised in 2002 Numbers from 6 to 140 - based on the diameter of the instruments in hundredths of a millimetre at the beginning of the tip of the blades (D1) Extends up the blade to the most coronal part of the cutting edge at D2 - 16 mm in length Instrument Standardization

Slide 15: 

The full extent of the shaft, up to the handle, comes in three lengths: Short - 21 mm Standard - 25 mm Long - 31 mm

Slide 16: 

The instruments enlarge by 0.02 mm/mm from D0 to D16 The tip angle of an instrument should be 75 ±15° Color coding of instruments _ easier identification of instruments

Slide 17: 

Instruments have a taper of 0.02 mm per mm Presently, instruments with a taper greater than the ISO 0.02 mm/mm have become popular: 0.04 0.06 0.08

Parts of a file : 

Parts of a file

K Files & Reamers : 

K Files & Reamers Designed in 1904 by Kerr Manufacturing Co. Are the most widely copied and extensively manufactured endodontic instruments worldwide Previously made of Carbon Steel Presently made of Stainless Steel

Slide 22: 

K File and Reamer are the oldest instruments used to machine dentin These instruments work by the Compression – and – Release destruction of dentin surrounding a canal Reaming motion causes less transportation of the apical dentin than a Filing motion

Slide 24: 

Produced by grinding graduated sizes of round Piano wire into either a square or triangular configuration Second grinding operation properly tapers these instruments To give the instruments the spirals that provide the cutting edges, the square or triangular stock are then grasped by a machine that twists it counter clockwise a programmed number of times - tight spirals for files, loose spirals for reamers

Slide 25: 

The cutting blades that are produced are the sharp edges of either the square or the triangle In any instrument, these edges are known as the “Rake” of the blade The more acute the angle of the rake, the sharper the blade There are approximately twice the number of spirals on a file than on a reamer of a corresponding size

Slide 26: 

New 30 K file with consistently sharp blades and point 35 K file exhibiting dull blades

Slide 27: 

Cross-sectional profile of triangular No. 20 file showing consistency in angles Cross-section of competing No. 20 File with dull, rounded angles of cutting blades

Slide 28: 

The clinician should understand the importance of differentiating endodontic files and reamers from drills Drills are used for boring holes in solid materials such as gold and enamel Files, by definition, are used by a Rasping motion

Reamers : 

Reamers Reamers, are instruments that ream - specifically, a sharp-edged tool for enlarging or tapering holes They cut by being tightly inserted into the canal, twisted clockwise ¼ to ½ turns to engage their blades into dentin & then withdrawn Penetration → Rotation → Retraction Cut is made during Retraction

Slide 30: 

Reaming is the only method that produces a round tapered preparation (In straight canals) In a curved canal, the reamer should be rotated only ¼ turn, as more stress can cause breakage Heavier reamers (Size 50 and above), can be turned without breakage Newer Ni Ti reamers are flexible and resist breakage in smaller sizes

K Flex Files : 

K Flex Files The Kerr Manufacturing Company in 1982 introduced a new instrument design that they termed the K-Flex File (Sybron Endo/Kerr; Orange California) The cross-section of the K-Flex is Rhomboidal or Diamond shaped The spirals or flutes are produced by the same twisting procedure used to produce the cutting edge of the standard K-type files

Slide 32: 

This new cross-section presents significant changes in instrument flexibility and cutting characteristics The cutting edges of the high flutes are formed by the two acute angles of the rhombus and present increased sharpness and cutting efficiency The alternating low flutes formed by the obtuse angles of the rhombus are meant to act as an auger, providing more area for increased debris removal


CLEANING AND SHAPINGINSTRUMENTSK FILES Instruments with tighter spirals. 1.97 to 0.88 cutting flutes per mm of operating head. Produced mainly from square blank. Cutting action – either filing (rasping) or reaming (drilling) motion. Filing – rake of flutes rasp the walls as the instrument is withdrawn without turning. Reaming – penetration, rotation and retraction

Slide 34: 

More work hardened – stiffer than reamers. Identification symbol – square


K REAMERS Instruments with lesser number of flutes. 0.80 to 0.28 cutting flutes per mm of operating head. Produced mainly from triangular blanks. Cutting action penetration, rotation and retraction. Identification symbol – equilateral triangle


K-STYLE MODIFICATION K-FLEX: Forerunner of hybrid instruments. Hybrid – strength and versatility of K-type + aggressive cutting of H-type. Cross-section – rhombus or diamond. Cutting edge – Two acute angles. Alternating low flutes – obtuse angle – increase debri removal. Space reservoir – reduced compacting dentinal filing. Increase flexible.


HEDSTROEM FILES Cutting spiraling flutes into shaft of round, tapered stainless steel wire. Very positive rake of flute design. Impossible to ream or drill. Cut in one direction – retraction. Cross-section – single helix teardrop


FLEXOFILES: Flexible file_ triangular cross section stainless steel blank Non cutting tip(1.81 flutes per mm) Golden medium _similar in design


INTERMEDIATE FILES Produced trimming 1mm from tip of file and rounding off sharp edges on a diamond file Files changed from 10 to 12 15 to 17 20 to 22 25 to 27 Advantage -smooth progress through files Disadvantage - disposable , edges difficult to smooth may cause ledging


OBTURATING INSTRUMENTSENDODONTIC CONDENSERS AND SPREADERS: Smooth tapered metal instruments – compress and compact gutta-percha Pluggers or condensers – blunt or flat-ended tips Spreaders – more tapered and pointed tips Long handled – chrome plated or stainless steel

Slide 42: 

M series plugger-spreaders – double-ended long-handled instruments Handles colour coded Corresponds to standard sizing and taper of K-type files Finger held spreaders and condensers – similar to K-type files with plastic or metal handles.


ENDODONTIC PLIERS AND FORCEPS: Handling and placement of silver point and gutta-percha cones. Pliers – tapered groove in beak for grasping silver cone. Forceps – grooved or serrated beaks for holding gp cones. Have latch mechanism for locking in closed position.

NiTi spreaders : 

NiTi spreaders NiTi finger spreaders Used in curved canals for good obturation


ISO GROUPS II AND III Engine – driven instrument use – 3 types of contra angle handpiece. A full rotary handpiece – Latch or friction grip. Reciprocating/Quarterturn handpiece. Special handpiece – vertical stroke with reciprocating quarterturn. ISO GROUP II – Instruments with shaft and operating head as separate pieces ISO GROUP III – Instruments with shaft and operating head as one piece.


ROTARY CONTRA ANGLE HANDPIECE Instrumentation – Straight line drilling or side cutting. With round or tapered burs – coronal access to canal orifice. With special reamers – Funnel out orifices. With Nickel titanium reamer type instruments – Clean and shape canals, Misdirected or forced behind limits – Perforations.

Slide 47: 

Solution – Use of slower handpiece. Ex: 1) Medidenta/ Micro Mega MM 324 reduction gear Handpiece. 2) Aseptico Electric Motor handpiece. 3) The Quantec ETM. 4) The Moycol union broach sprint EDM. Speeds – 300 rpm for NiTi profiles. 2000 rpm for Light Speed instruments. Newer electric handpieces – Both speed and torque control. New rotary handpiece – Morita Tri Auto ZX. Tri Auto ZX – Battery – powered slow-speed (280 rpm) handpiece with a built in apex locator. NiTiMatic _ 16:1 gear reduction handpiece 300 rpm


RECIPROCATING HANDPIECE: Giromatic handpiece – Accepts latch type instruments. Canal insruments available for use with GIROMATIC giro pointer _ 16mm long orifice opener giro broach or cleanser giro file,a hedstroem configuration giro reamer heli girofile_3 cutting blades in c.s Quarter-turn motion – 3,000 times per minute.

Slide 49: 

M4 safety handpiece – 30 degree reciprocating motion. Regular hand files by their handles. Endo-Gripper – 10:1 gear ratio, 45 degree turning motion. Endo Cursor _ press button chuck Take hand instruments


RANDOM HANDPIECE Excalibur _ lateral vibrational movement 20000 to 25000 r.p.m. Use modified K files


ISO GROUP II Instruments with shaft and operating head as separate pieces: Ex: B-2 reamer – cylindrical working head 2 cutting edges – spiral c.s – rectrangle working head and shaft – similar to K-type. Used with contraangle or straight handpiece Lentulospiral – power-operated, spiral. Used with contraangle or straight handpiece

Slide 52: 

Quarter-turn reamer – power-operated, tapered and pointed used with giromatic or racer handpiece enlarge/widen root canal similar to blank of K-type. McSpadden compactor – specially designed Apically directed spirals. frictional heat softens guttapercha Other group II – K-reamer, H file, R-type rasp, barbed broach Used with giromatic or racer handpiece


ISO GROUP III Shaft and operating head as 1 piece. G-type reamer – GG drill stainless steel or NiTi Short, flame-shaped head with side cutting blades Short, non-cutting guide at tip Long-thin neck connects working head and shaft. Number 1 to 6 Used with gear reduction, slow speed, high torque handpiece Speed – 750 to 1000 RPM B-1 reamer – similar to G-type. Twice long working head.

Slide 54: 

O-type reamer – long, tapered head 3 spiralling blades – plane angle short neck. P-type reamer – Paeso drill Long, narrow, tapering head Side cutting, spiral blades Tip – cutting /non-cutting. Thick neck Number 1 to 6

BURS: : 

BURS: Burs with extended shank – preparation in pulp space with low speed handpiece. Surgical length – 26mm. Extra long shank – 34mm Ex: Brasseler, shank 25 Good visibility and control Friction grip tapered fissure burs (557 or 701) – correct outline form. Round burs – normal and extra long Size 2, 4, 6 Deroofing Longer and smaller round burs – fine calcified canals. Safe ended diamond / tungsten carbide bur / endo2 bur – taper, smooth access cavity.


ULTRASONIC INSTRUMENTS: System in which sound as an energy source activates an endodontic file resulting in a three dimensional activation of the file. File – Vibrates in a sinus wave like fashion. Antinodes _ maximal displacement (tip). Nodes – no displacement. Fracture – at the nodes. Debriding action – Cavitation and acoustic streaming. Cavitation – positive pressure followed by a negative pressure in the fluid. Cavity formed in the negative phase implodes with great force during next positive pressure phase. Acoustic streaming – small, intense, circular, fluid movement. occurs closer to the tip.

Slide 57: 

Various ultrasonics used Cavitron endodontic system. Enac unit. Piezon master 400. 20 to 25 KHZ – used. Piezoelectrical design – Decreased heat Increased energy Magnetostrictive – Increased heat decreased energy. Endosonic ultrasonic synergistic system – instrumentation + irrigation.

Slide 58: 

Cavi-Endo ultrasonic unit – 1st Use either inert sterile or chemically active irrigant. Modifications of K-type or R-type. Endosonic diamond file – cutting of dentin by abrasion. Coronal enlargement. Ultrasonic tips – used in detection of canal orifices. removal of posts, fractured instruments, coating canals with sealer


SONIC INSTRUMENTS: Sonic systems – vibration in audible frequency range Frequency – 2 to 3 KHZ. Micro Mega 1500 sonic Air endo system – Airline pressure of 0.4 MPA. Sonic file – large elliptical motion at the tip. Loaded – longitudinal motion, up and down. Oscillatory range – 1500-3000 cycles per second. Three sonic files used – Rispisonic, shaper sonic, Trio sonic.

Slide 60: 

Rispisonic – old rat tail file (8 cutting blades) coronal third Shaper sonic – husky barbed broach. (16 cutting blades). apical one third Triosonic – tripled helix H file. Sizes – 15 to 40. Length – 17 to 29mm. Rougher canal surface. Endosonic 3000- sonic handpiece similar to sonic air driven scalers. Irrigation – filtered water. Dis advantange –perforations, transportation.


ISO GROUP IV: Not strictly endodontic instrument but have been considered part of armamentarium under developing international standards. ABSORBENT POINTS: Slender cones made of paper or other absorbent material. Uses – drying the canal Conveying medicaments Obtaining canal cultures Available in standardized sizes


ROOT CANAL FILLING POINTS Smaller, slender cones of solid material. Used for canal obturation. Ex: silver points, gutta-percha points. Available in standardized sizes and taper


NON-ISO INSTRUMENTS Advent of NiTi _ newer instrument system Instruments with greater taper Tapers _ 4% ,6% ,8% ,10% ,12% Better shaping Faster treatment TERMINOLOGIES: RADIAL LAND – “The surface that projects axially from the central axis between the flutes” PITCH – “Number of flutes per unit length”

Slide 64: 

ProTaper “For Hand Use” features exactly the same instruments and clinical sequence as the rotary version It is for the all hand file users wishing to benefit from NiTi and crown-down technique.

Slide 65: 


Motion of File : 

Motion of File Lightly engage dentin by gently rotating the file clockwise until the file is snug Disengage the file by rotating handle counter clockwise 45-90 degrees Cut dentin by rotating the handle clockwise while withdrawing the file Repeat until length is reached


PROTAPER: Multiple tapering – fewer files required to create a tapered shape. Used – curved canals, restricted canals Both rotary and hand instruments Increased efficiency, effectiveness. Length – 19, 21, 25mm. Protaper SX, S1, S2, F1, F2, F3, Developed by Drs.Clifford Ruddle, John West, Pierre Mactar and Ben Johnson Designed by Francois Aeby and Gilbert Rota

Slide 68: 

Shaping files SX shaper – canals of teeth with shorter roots expand the coronal aspect of preparation increased rate of taper Do – 0.19mm, D9 – 1.1mm,D14_ 1.2mm rate of taper drops from D9 to D14 S1 shaper – D0 – 0.17mm,D14 _ 1.2mm prepare coronal third of canals S2 shaper – D0 – 0.20mm ,D14 _ 1.1mm prepare middle third along with coronal region of apical third

Slide 69: 

Finishing files To plane away variation in canal diameter in apical one third F1 – size 20, taper 0.07mm/mm (D0 to D3) F2 – size 25, taper 0.08mm/mm (D0 to D3) F3 – size 30, taper 0.09mm/mm (D0 to D3) Speed – 200 to 300 RPM Used in torque and speed control electric motor handpiece

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