Endodontic Armamentarium PDF

Endodon%c Armamentarium • Goal: chemo-mechanically debride, disinfect, and shape the root and obturate the root by sealing all portals of entry and outlet, while preserving adequate structure so the tooth is restored to func9on • Examina9on and Diagnos9cs o Exam tools normally used for decay and per...

Endodon%c Armamentarium • Goal: chemo-mechanically debride, disinfect, and shape the root and obturate the root by sealing all portals of entry and outlet, while preserving adequate structure so the tooth is restored to func9on • Examina9on and Diagnos9cs o Exam tools normally used for decay and periodontal issues (and DG16- Endo explorer) o Visual aids, loupes, microscope (op9onal): fiberop%c light o X-ray: BW, FMX, PA, Cone beam tomography CBT* o Tooth Slooth, methylene blue dye*, coLon roll o EPT, Endo Ice, ice s9cks pulse oximeter,* laser doppler flowmeter* • Isola9on: control envt we are working in to protect pt o Clamps o Clamp forceps o Frame o Rubber dam (vinyl or nitryl) o Dam punch o Floss, Wedgets* • Access o Includes entry into the pulp chamber AND loca%ng/uncovering the root canals (DG 16 Endo explorer) o Type and size of access instrument (bur, diamond, etc) depends on which tooth and type of material being penetrated. o Specialized long shank burs used to remove pulp stones and dystrophic calcifica%on (ter9ary den9n) § Ex of long shank burs: Munce, Mueller, Swiss LN • Canal loca9on and measurement o Most important: Electronic apex locator o PA x-ray with file in place at es9mated apical constric9on o Digital radiography measuring systems * o CBT o Endodon9c ruler o File stops • Canal instrumenta9on o Barbed broach o Hand files: K-files Hedstrom files, Reamers (made from stainless steel) o Rotary files (made from nickel-%tanium, more flexible) o Gates-glidden drills o Peeso reamer o Ultrasonic instruments • Irriga9on: MUST remove debris and smear layer DO NOT mix NaOCL and Chx: o Normal saline -a brown precipitate forms o Sodium hypochlorate -NaOCL will dissolve 9ssue -MUST remove one completely before placing o Chx- will not dissolve 9ssue the other in a canal. o EDTA- ethylenediaminetetraace9c acid o Citric acid o MTAD (EDTA + detergent)- adding this will help clean out smear layer o Methods of irriga9on § Syringe irriga9on with manual agita9on (file) § Rotary agita9on § Endo Vac system (Nega9ve pressure delivery and high speed suc9on combo) • Obtura9on: MUST clean pulp chamber floor o Sealer- Bioceramic*, AH plus o Lentulo spiral o GuLa percha cones o Spreaders o Pluggers o Heat source o Ultrasonic vibrator • Coronal Seal o Residual sealer/filling material removed from chamber (coLon pellet with isopropyl alcohol) o Dry coLon pellet and non-eugenol sealing material § Cavit § GI cement o If not bleaching, or a crown is the final restora9on, then a permanent restora9on can be placed in access opening • Incision and drainage armementarium o Mirror o Scapel handle (#11, #15 blades) o Periosteal elevator o Needle holder (curved needle/3-0 silk) o Suc9on 9p o Irriga9on syringe (18ga needle) o Sterile rubber dam drain o Anesthesia apparatus • Apicoectomy armementarium o Scalpal: ini9al incision into gum o Periosteal elevator: to raise the flap of gum o Straight handpiece and bur: cut into bone to expose and excise the infected apex o Mithcells Trimmer: to scrape out the infected 9ssue o Then, check if more root canal filling ma9ral is needed (ex. GIC or Bioceramic): § retrograde root filling carriers, pluggers, carvers o Suture Needle and silk o Needle Holder or Spenser Wells forceps