Week 4 Endodontic Instruments PDF

Endodontic Instruments Assistant Professor Duygu BİLGİLİ Content Introduction 1- Use of hand tools used in dental treatment practise 2- Use of special tools in endodontic treatments A. Instruments used to open the pulp cavity B. Instruments used in root canal shaping a.Ha...

Endodontic Instruments Assistant Professor Duygu BİLGİLİ Content Introduction 1- Use of hand tools used in dental treatment practise 2- Use of special tools in endodontic treatments A. Instruments used to open the pulp cavity B. Instruments used in root canal shaping a.Hand-operated instruments b.Engine-driven instruments c.Rotary instruments d.Ultrasonic and sonic instruments C.Instruments used in root canal filling (Obturation of root canal) References Introduction In general, endodontic treatment; 1- Use of hand tools used in dental treatment practise 2- Use of special instruments in endodontic treatments.  1- Use of Hand Tools Used in Dental Treatment Practise As in all dental treatments; mirror, tweezer, explorer and other hand instruments (periodontal probe…) are also used for root canal treatment. 2- Use of Special Tools in Endodontic Treatments A. Instruments used to open the pulp cavity B. Instruments used in root canal shaping C. Instruments used in root canal filling (Obturation of root canal) Specialized endodontic instruments. A, D16 explorer. B, 31 L spoon excavator. C, Glick No. 1. The plugger end (bottom) is for heating and removal of gutta-percha; the paddle (top) is for placing temporary materials. 2- Use of Special Tools in Endodontic Treatments (Continuation) A. Instruments Used to Open the Pulp Cavity The endodontic tray setup should contain an assortment of round and fissure burs, tapered and round diamonds, and (for advanced cases) mueller burs and ultrasonics. A sharp endodontic explorer is essential. Although they are often helpful in locating canals, hand files are generally not used during the access preparation. 2- Use of Special Tools in Endodontic Treatments (Continuation) A. Instruments Used to Open the Pulp Cavity (Continuation) Explorers are double-ended instruments. Their design facilitates the location of canal orifices. The spoon excavator is another long-shank instrument. The excavator is used to remove caries, deep temporary cement, or coronal pulp tissue. Specialized endodontic instruments. The endodontic excavator has a right or left A, D16 explorer. B, 31 L spoon excavator. C, Glick No. 1. The orientation similar to that of operative hand plugger end (bottom) is excavators. for heating and removal of gutta- percha; the paddle (top) is for placing temporary materials. 2- Use of Special Tools in Endodontic Treatments (Continuation) A. Instruments Used to Open the Pulp Cavity (Continuation) Round diamond burs in #4 and #6 sizes work predictably and quickly to cut through both enamel, porcelain fused-to- metal (PFM) and all-porcelain crowns. The dentist should use relatively new diamonds with abundant water and intermittent light pressure to avoid generating excessive heat. If dull diamonds are used, especially without water coolant, the dentist may be tempted to apply excessive pressure to accelerate the cutting process and thereby overheat the crown. From left to right, round diamonds in sizes #4, #6, #8, and #10. Used with copious After removing the porcelain layer of the PFM, the dentist water and a very light touch, they can can then use a carbide fissure bur or specially designed predictably and effortlessly cut through metal cutting bur to perforate the metal substructure and PFM and all-porcelain crowns without fracture underlying foundation. 2- Use of Special Tools in Endodontic Treatments (Continuation) A. Instruments Used to Open the Pulp Cavity (Continuation) Tapered diamond burs: Flame-shaped and round- ended tapered crown-preparation style diamonds can use for endodontic access. After the initial penetration into the pulp chamber has been accomplished, many dentists advise using a round carbide to finish unroofing the chamber. Coarse grit flame-shaped diamonds An option is to use an appropriately sized tapered and a few sizes of tapered round-ended diamonds can work wonders for diamond to flare the access. refining access outlines and blending The long cutting surface of the diamond can canal orifices. These diamonds can safely cut natural and decayed tooth simultaneously open the cavosurface (The wall of a structure, precious and nonprecious cavity prepared on the tooth) of the access and crowns, PFM crowns, and all-porcelain crowns. smooth irregularities in the access walls. 2- Use of Special Tools in Endodontic Treatments (Continuation) A. Instruments Used to Open the Pulp Cavity (Continuation) Steel burs: There is a notched structure at the body termination point that provides a latch connection. Made of stainless steel material. It is used when cleaning the soft dentin parts of the caries cavities close to the pulp. It provides safe operation at low speed in risky areas of the tooth close to the pulp tissue. Steel burs should be preferred instead of diamond burs in the pulp chamber to avoid the risk of perforation. 2- Use of Special Tools in Endodontic Treatments (Continuation) A. Instruments Used to Open the Pulp Cavity (Continuation) Carbide burs: In an uncrowned tooth exhibiting a patent canal, initial access is best accomplished by round or fissure carbide burs. Fissure carbide burs such as the #558 produce less "chatter" when penetrating intact enamel or dentin compared with round carbide burs. In contrast, round carbide burs such as the #6 or #8 seem to be more controllable during the From left to right, a #558 surgical length fissure carbide bur followed by #1, #2, #4, removal of carious dentin. #6, and #8 surgical length carbides.These are primarily used for cutting through natural tooth structure. 2- Use of Special Tools in Endodontic Treatments (Continuation) A. Instruments Used to Open the Pulp Cavity (Continuation) Penetrators and metal cutters: Metal cutting burs are highly practical adjuncts for use to cut the metal part of the crown. A, Metal cutting burs are useful for both precious and nonprecious crowns. Pictured from left to right are the Great White, the Beaver bur, the Transmetal, and the Brassler H34L.They feature a round-ended, crosscut design that minimizes chatter. B, Other burs advocated for endodontic access preparation include the 269GK, the Multipurpose bur, the Endo Z bur, and the Endo access bur. C, A surgical length #558 bur compared with a regular #558 bur.The surgical length bur enhances visibility by moving the head of the handpiece away from the tooth. The clinician must exercise care when using extended burs to prevent perforation. 2- Use of Special Tools in Endodontic Treatments (Continuation) A. Instruments Used to Open the Pulp Cavity (Continuation) Length burs(Surgical) length burs permit displacement of the handpiece away from the incisal or occlusal surface of the tooth, greatly increasing visibility of the cutting tip of the instrument. With technical skill, practice, and patience, the dentist can use surgical length burs to gain access in the majority of teeth, including maxillary second molars. 2- Use of Special Tools in Endodontic Treatments (Continuation) A. Instruments Used to Open the Pulp Cavity (Continuation) Mueller burs Mueller burs: Dentists who are considering dealing with difficult or exhibit a long risky cases usually prefer mueller burs. shank and are They are long-shaft, carbide-tipped burs used in a low-speed latch used in a slow- handpiece. speed, latch- They appear similar to gates glidden burs, but have a round carbide tip type handpiece instead of the noncutting tip of the gates glidden bur. The long shaft is useful for working deep in the radicular portion of the tooth. In addition, it displaces the handpiece away from the occlusal surface, allowing the dentist to see the cutting tip in action. An added benefit of mueller burs is that unlike ultrasonics that leave a ragged, rough, dusty, debris-filled cut, mueller burs leave a clean, shiny surface when used on intact dentin. Water is not used during the process because color differences in the dentin that indicate canal location are more evident in dry dentin. Because these burs are carbide, they do not endure sterilization cycles Mueller burs. The smallest 0.9 mm well and become dull quickly. bur compared with a #70 file. 2- Use of Special Tools in Endodontic Treatments (Continuation) A. Instruments Used to Open the Pulp Cavity (Continuation) Additional information The burs are stored in various boxes called bur boxes. These boxes have a cover to prevent contamination. They should be sterilized with the open cover. Diamond, steel, tungsten carbide burs are shown in order in the  2- Use of Special Tools in Endodontic Treatments (Continuation) A. Instruments Used to Open the Pulp Cavity (Continuation) Vision, magnification, and illumination: Although ultrasonic and mueller bur techniques can be used without magnification, they are faster, more predictable, and safer with magnification. Dental loop or dental microscope can be used for magnification. The operating microscope is an indispensable tool for state-of-the-art endodontic treatment. This instrument is useful in all phases of endodontic treatment from diagnosis to placement of the final restoration. REMEMBER! 2- Use of Special Tools in Endodontic Treatments A. Instruments used to open the pulp cavity B. Instruments used in root canal shaping C. Instruments used in root canal filling (Obturation of root canal) 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping In considering endodontic instruments, those that are hand-operated (such as files and reamers) are the most important. The nomenclature follows the recommendations of the International Organization for Standardization (ISO): a.Hand-operated include K-type reamers and files, Hedstrom-type file… b.Engine-driven are hand types that have a latch that inserts into a slow-speed handpiece. These are gates-glidden, peeso reamer, engine-driven reamers and files. c.Nickel titanium has been adapted rotary applications. Both hand- and engine-driven instruments have various configurations. The cross section of the instruments takes many shapes. d.Ultrasonic and sonic are diverse in design. Some resemble barbed broaches, some resemble files, and others are diamondcoated wires. All insert into a dedicated vibratory handpiece that energizes the instrument. In addition to canal preparation, other hand operated instruments are adapted for other aspects of root canal treatment, for example, canal identification and obturation. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments They are usually used manually (sometimes used with special contra-angle handpiece for hand file/ endodontics), have a thin cross-section, 2 tapered angles, expand towards the holding area, and are made of stainless steel or nickel titanium. Stainless steel instruments are relatively inflexible, which renders them not particularly adaptable to canal curvatures. Nickel-titanium instruments are more flexible and adapt more readily to fine, curved canals but have no advantage over stainless steel files in irregular canal spaces. Several cross-sectional shapes of files are commercially available. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) Hand files are generally used to determine the length of the canal and to open the first path in the canal for the endomotor files. The length of the canal is determined with hand files by attaching an apex locator (a portable electronic device used to determine the length of root canals) or by taking X-rays. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) Radiographs and apex locators are used to determine canal length, as well as various instruments. All of them must be sterilized before each treatment. Endoblock (It is a ruler used to measure the length of the canal millimetrically with canal files. It also allows marking of the canal washing needle/Irrigation needle used to wash the gutta-percha and the canal to the desired extent. It can be in many different shapes and colors.) Endometer Ring (Instead of the endoblock, these are the instruments that the dentist wears on the finger and are used for measurement purposes.) Endobox (These are capped boxes in which canal files can be arranged in order and stored sterile. Files can be placed in these boxes. If necessary, they can also be used for measurement. It can be in different shapes. It should be sterilized with the cap open after the treatment.) File stands (Rarely used, autoclavable) 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) Properties of Hand-operated Instruments Flexibility, sharpness, and corrosion resistance are properties related to metal and design. Traditional metals have included stainless or carbon steel. Compared to stainless steel, many carbon steel instruments have been shown to cut somewhat more efficiently; they are similar in other respects. However, carbon steel is little used because it is more susceptible to corrosion by autoclaving and irrigating solutions. By changing the cross-sectional design from square to triangular or rhomboid and decreasing the number of flutes per millimeter, greater flexibility is gained. Nickel-titanium wire is even more flexible. A disadvantage of the increased flexibility is that cutting efficiency of nickel-titanium files may be reduced with clinical usage compared with stainless steel because of the greater elasticity. Therefore to best utilize the properties offered with nickel-titanium files, engine-driven configurations have been developed. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) Properties of Hand-operated Instruments (Continuation) Despite specific size and shape requirements, hand-operated instruments do not demonstrate reliable and consistent dimensional standardization. Files and reamers are available in three shaft lengths: 21, 25, and 31 mm. Shorter instruments afford improved operator control and easier access to posterior teeth, to which limited opening impairs access. The 25- and 31-mm instruments are used for longer roots. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) Properties of Hand-operated Instruments (Continuation) Tip Design: Originally the tip angle of K-type files and reamers was approximately 75 degrees plus or minus 15 degrees. This design was intended to provide cutting efficiency without an excessively sharp transition angle. Newer designs have different tip angles and designs in an attempt to minimize canal alterations. The diameter at the tip of the point is known as D0. The spiral cutting edge of the instrument must be at least 16 mm long, and the diameter at this point is D16 (Diameter at end of cutting blade). https://criticalpathtechnology.com/wp/articles/exponential-distribution-of-diameters/ The specifications for standardization of files and reamers. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) Properties of Hand-operated Instruments (Continuation) Color Coding: Canal files are standardized with a thickening number system and color coding. Color coding of file handles designates size. Color coding of the newer nontraditional instruments varies according to the manufacturer. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) Properties of Hand-operated Instruments (Continuation) Sizing: Dimensions of K-type files and reamers are designated according to the diameters of the instrument at specified positions along its length (as stated in ADA specification No. 289). File tip diameters increase in 0.05 mm increments up to the size 60 file (0.60 mm at the tip), and then by 0.10 mm increments up to size 140. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) Properties of Hand-operated Instruments (Continuation) With the repetition of the same colors (like 15-40), the thicknesses continue as 45, 50, 55, 60, 70, 80. Packages with these colors together are called 'Asorti' (15-40 asorti or 45-80 asorti). Files can be packaged in the form of an assortment or numbered singularly and offered for sale. They are sold in blisters of 3, 4, 6 or in boxes. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) ***Illustration of the diameter a.Hand-Operated Instruments (Continuation) change from the tip to the shaft Properties of Hand-operated Instruments (Continuation) of a No. 25 file with 2% taper Since hand files have a taper angle of 0.02, the file diameter increases by 0.02 mm per millimeter of length. 2% taper means that for every 1 mm of the file there is a 0.02 mm increase in diameter. If there was a 4% or 6% taper, like the files used in engine systems, there would be an increase of 0.04 or 0.06mm for every 1mm of the file ***Illustration of the diameter change from the tip to the shaft of a No. 10 file with 2% taper DO: 0.10 mm D1: 0.10+0.02 =0.12 (for a file with an angle of 0.02, tapering to 0.02) D2: 0.10+(0.02x2)=0.14 Dimensional formula for H-type (Hedstrom) instruments according to ANSI specification. D16: 0.10+(0.02x16)=0.42 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) Properties of Hand-operated Instruments (Continuation) Example question 1: If the 6 mm tip of a number 8 file with a 2% taper is deformed and the dentist wants to cut it off and use the file, what number of files has it turned into? Illustration of the diameter change of a No. 8 file with 2% taper DO: 0.08 mm (for number 8 file) D1: 0.08+0.02=0.10 (for a file with an angle of 0.02, tapering to 0.02) If 1 mm had been deformed and cut, the file would have become number 10 file D6: 0.08+(0.02x6)=0.20, the file has turned into a number 20 file with a 2% taper Example question 2: A #30 file with a 4% taper was broken 5mm from the tip, what size file did it become? Illustration of the diameter change of a No. 30 file with 4% taper DO: 0.30 mm (for number 30 file) D1: 0.30+0.04 (for a file with an angle of 0.04, tapering to 0.04) D5: 0.30+(0.04x5)=0.50, the file has become a number 50 file with a 4% taper 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) Properties of Hand-operated Instruments (Continuation) Helical angle of K- and H-type instruments. Greater cutting efficiency is achieved in filing motion as the helical angle approaches 90 degrees to the dentin surface. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) Properties of Hand-operated Instruments (Continuation) Dimensions and colour coding of canal instruments. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) Longitudinal and cross-sectional shapes a.Hand-Operated Instruments (Continuation) Properties of Hand-operated Instruments (Continuation) of various hand-operated instruments. Basic cross-sectional design of instruments. (Those marked with an asterisk are brand A, Square. names.) B, Triangular. Note that small sizes of K-reamers, K- C, S-shaped. files, and K-Flex* have a different shape D, Rhomboid. Differences in cross-sectional design affect the than the larger sizes flexibility and other physical properties. 2- Use of Special Tools in Endodontic Treatments (Continuation) Hedstrom file, machined B. Instruments Used in Root Canal Shaping (Continuation) by rotating a wire on a a.Hand-Operated Instruments (Continuation) lathe. Note the spiral shape. These are efficient Properties of Hand-operated Instruments (Continuation) cutters (on the pull stroke) Two techniques, but are more susceptible to separation when locked Machined and twisted. Ground-Twisted, have been developed to manufacture hand- operated instruments. I. Machined This technique involves machining (grinding) the instrument directly A and B, A machined K- type file. Note that the on a lathe; an example is the Hedstrom-type file. transition angle at the All nickel-titanium instruments are machined. Some manufacturers leading cutting edge of produce K-type files(having different physical and working properties the tip is rounded, from the original K-type file.) rendering it noncutting. Because the machined file has less rotational resistance to breakage than a ground-twisted file of the same size. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) Properties of Hand-operated Instruments (Continuation) II. Ground-Twisted Another technique consists of first grinding, then twisting. Raw wire is ground into tapered geometric blanks; (square, triangular, and rhomboid). The blanks are then twisted counter clockwise to produce helical cutting edges. Ground-twisted instruments. A, A square file blank ground from wire. After twisting These are K-type files and reamers. K-type files counterclockwise, the appearance of a file have more twists per millimeter of length than the (more flutes) (B) and reamer (fewer flutes) (C). corresponding size of K-type reamer. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) Properties of Hand-operated Instruments (Continuation) II. Ground-Twisted (Continuation) Besides their configuration, the difference between files and reamers is their intended use. Files are manipulated with a rasping, or push-pull planing, motion. Reamers are twisted and withdrawn; therefore, cutting takes place during rotation. Because they are less versatile, reamers are seldom used. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) Types of hand instruments I. Root canal files II. Broaches/Tirnerf 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) I. Root Canal Files Root canal files and reamers are instruments used in shaping root canals. There are different types of hand files. The most commonly used ones are; K file (It has a 'Square' sign on it.) H file (Hedstroem) (It has a 'Round' symbol on it) Reamer (It has a 'Triangle' shaped symbol on it) They can be also used with contra-angle handpiece for handfile 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) *** Contra-angle handpiece for handfile /Hand file contra-angle handpiece: Attaches to the micromotor and causes the hand file to move left and right. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) I. Root Canal Files (Continuation) Types of hand files used in special cases... (Especially for calcified and narrow canals) (D finders... are also this type of file); C pilot (C files) (They have a 'C' shaped symbol on them.) C plus (C +) (There is no symbol on them, the file number is written next to them. ***Like other hand files, they can be also used with contra-angle handpiece for handfile. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) I. Root Canal Files (Continuation) ALL root canal instruments must be sterilized before the first use (unless the package states that they are 'sterilized') and after each procedure (a sterilized product is shown in the picture). Since debris particles may remain between the grooves of the files after treatment, the cleaning stage of the files before sterilization should be done well. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) I. Root Canal Files (Continuation) Two types of motion are common in root canal preparation, reaming and filing. Reaming consists of rotating the instrument clockwise and scribing an arc from one cutting edge to the next. For example, a triangular reamer has three 60- degree cutting edges and therefore requires 120 degrees of rotation (one-third of a turn), whereas Filing and reaming motions. Tooth structure is removed primarily on a file with a 90-degree angle necessitates only a the pull stroke with filing and on quarter turn before withdrawal. rotation with reaming. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) I. Root Canal Files (Continuation) Filing requires a series of repetitive motions. First, the instrument is advanced to its full length into the canal space using a passive "twiddling" motion (without debris removal). Next, the file is rotated (a quarter turn or more) and then withdrawn from the canal space while the tip is pushed against a canal wall, much as a paintbrush is applied to a wall when painting. The twiddling, reaming, and withdrawal motions are repeated with the file tip pushed against a different portion of the canal wall on each outstroke until all walls have been planed (circumferential filing). Filing and reaming motions. Tooth Hedstrom and similar design (S or U) files are used only with structure is removed primarily on a filing motion because they have less torsional resistance to the pull stroke with filing and on breakage. rotation with reaming. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) I. Root Canal Files (Continuation) K-type canal files have a 'Square' marking on them (Because they are obtained by bending square shaped stainless steel or nickel titanium). They are the most commonly used files for determining the length of the canal [The most commonly used are number 8 (gray), number 10 (purple) and number 15 (white)]. Like other hand files, they can be of very different thicknesses. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) I. Root Canal Files (Continuation) Type H files have a 'Round' symbol on them (Because they are obtained by bending round shaped stainless steel or nickel titanium). They are hand files with a strong force used to remove the canal walls. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) I. Root Canal Files (Continuation) Reamer has a 'Triangle' shaped symbol on it (because it is obtained from triangular shaped wire). Like other files, they are numbered from fine to coarse. It is used more rarely than K and H files. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) I. Root Canal Files (Continuation) From top to bottom, K file, Reamer H file respectively. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) I. Root Canal Files (Continuation) C-Pilot (C Files) has a 'C' shaped symbol on it. These files are used to reach the working length in curved and/or blocked canals. These files have high bending power (because they are produced with a special thermal hardening process). They are available in different lengths (such as 19,21,25mm) (Figure VDW trademark) 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) I. Root Canal Files (Continuation) C Plus (C +) Files: There are no symbols on them. The number of the file is written on the side. They have pyramid shaped tips. These files are especially used for opening calcified and difficult canals. Available in different lengths (21, 25mm etc.) 2- Use of Special Tools in Endodontic Treatments (Continuation) Additional Information In addition to hand files used to open calcified canals, 'Edta gel/cream' can also be used. A very small piece of this gel/cream should be put on the glove or in a suitable place. The file used to open the calcified canal is used by lightly touching this gel/cream. Since 'Edta gel/cream' is an inorganic tissue solvent, it should not remain in the canal for more than 1 minute to avoid perforation. For this reason, the canal should be washed with sodium hypochlorite between procedures. After the treatment, the syringe containing the product should be disinfected and removed. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) I. Root Canal Files (Continuation) Avoidance of Instrument Separation: Separation of hand files in the canal is prevented by regularly inspecting the instrument for defects such as Unwinding of the flutes (twisting clockwise and opening of the flutes); Roll-up of the flutes (excessive continued clockwise twisting after unwinding); Tip distortion (the tip has been bent excessively); Defects created during instrumentation. Corrosion. Each file shown must be discarded because of possible breakage. ***If an instrument exhibits anysigns of wear, it should A, Unwinding of the flutes. be discarded immediately. Prevention is the key to B, "Roll-up" of the flutes. avoiding untimely instrument separation. C, Unwound and bent instrument 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) a.Hand-Operated Instruments (Continuation) II. Broaches/Tirnerf Barbed broaches are stainless steel instruments with plastic handles. The tapered wire broach is barbed by scoring and prying a tag of metal away from the long axis of the wire. There is no symbol on it. The difference from other files is that it has no 'Taper' and the handle is thinner. (Unlike hand files, these tools do not have a taper of 2%). Barbs entangle and remove canal contents. This instrument should be neither bound in the canal nor aggressively forced around a canal curvature. Either action may cause fracturing. Barbed broaches should not be reused. Single barbed broaches are available in presterilized bubble packaging. While it was previously used to remove the pulp (no longer recommended, as it causes rupture Barbed broach showing the of the apical pulp), it can now be preferred to remove residual pieces (such as cotton fibers) barbs pulled away from the remaining in the canal. instrument shaft REMEMBER! 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping In considering endodontic instruments, those that are hand-operated (such as files and reamers) are the most important. The nomenclature follows the recommendations of the International Organization for Standardization (ISO): a. Hand-operated include K-type reamers and files, Hedstrom-type file… b. Engine-driven are hand types that have a latch that inserts into a slow-speed handpiece. These are gates-glidde, peeso, engine-driven reamers and files c. Nickel titanium has been adapted rotary applications. Both hand- and engine- driven instruments have various configurations. The cross section of the instruments takes many shapes. d. Ultrasonic and sonic are diverse in design. Some resemble barbed broaches, some resemble files, and others are diamondcoated wires. All insert into a dedicated vibratory handpiece that energizes the instrument. In addition to canal preparation, other hand operated instruments are adapted for other aspects of root canal treatment, for example, canal identification and obturation 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) b. Engine-Driven Instruments Canal Orifice Flaring Instruments An especially important step in preparation for instrumentation (with hand file or rotary instrument) is flaring of the canal orifice. This GT rotary file has a #35 tip, 1.25 mm maximum flute diameter, and a.12 taper. It can Several instruments are available to aid in orifice flaring. These be used at up to 700 RPM for orifice flaring. It can be used as a single instrument. include: Gates glidden drills (preferable if rotary files will not be used), Peeso reamers (is not preferred nowadays), GT rotary files (is not preferred nowadays. Dentsply Tulsa Dental, Tulsa, OK), Orifice shapers (is not preferred nowadays) ***These instruments should also be sterilized before first use and after each treatment. Orifice shapers are 19 mm long and proceed from a #20/.05 taper to #80/.08. They are used in sequence from left to right to create a funnel within the canal. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) b. Engine-Driven Instruments(Continuation) Gates-Glidden Drills: These drills are elliptically (flame) shaped burs with a latch attachment. They are numbered according to the number of lines on the handle. Gates Glidden Gates-glidden drills are used to open the orifice. drills. They also achieve straight-line access by removing the dentin shelf and rapidly flaring the coronal third of the canal. Importantly, these drills must be continuously rotated. If they stop, the head may lock in the canal, with torsional failure and fracture. Gates-glidden drills are available in 15-and 19-mm lengths. The shorter instruments are helpful in posterior teeth, where access to the canal orifice is limited. They were especially preferred before the introduction of rotary files. There are also those who do not recommend its use due to the risk of perforation. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) b. Engine-Driven Instruments(Continuation) Peeso Reamers: These reamers are also used as adjunctive devices in canal preparation. They are numbered according to the number of lines on the handle. They are basically similar to gates-glidden drills but have parallel cutting sides rather than an elliptical shape. These instruments are available with or without safe tips. Peeso reamers have been suggested as a means of improving straight-line access, although they are less well controlled than gates-glidden drills. They were especially preferred before the introduction of rotary files. There are also those who do not recommend its use due to the risk of perforation. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) b. Engine-Driven Instruments(Continuation) Gates-glidden drills and peeso reamers are made from stainless steel. Table shows the comparative ISO sizes of both gates-glidden drills and peeso reamers. REMEMBER! 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping In considering endodontic instruments, those that are hand-operated (such as files and reamers) are the most important. The nomenclature follows the recommendations of the International Organization for Standardization (ISO): a. Hand-operated include K-type reamers and files, Hedstrom-type file… b. Engine-driven are hand types that have a latch that inserts into a slow-speed handpiece. These are gates-glidde, peeso, engine-driven reamers and files c. Nickel titanium has been adapted rotary applications. Both hand- and engine- driven instruments have various configurations. The cross section of the instruments takes many shapes. d. Ultrasonic and sonic are diverse in design. Some resemble barbed broaches, some resemble files, and others are diamondcoated wires. All insert into a dedicated vibratory handpiece that energizes the instrument. In addition to canal preparation, other hand operated instruments are adapted for other aspects of root canal treatment, for example, canal identification and obturation 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) c. Rotary Instruments The engine-driven nickel-titanium files are used by performing reaming or reciprocating action via an endo motor. This makes the filing process easier for the dentist and speeds up the preparation phase. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) c. Rotary Instruments Additional Information Endomotors are devices where the speed, torque and movement type options specific to the brand of the canal files used can be adjusted. The features of the file system used can be recorded on the device to provide easy operation. There are wired, wireless, apex compatible cable or with an apex locator system in itself. The device should be regularly charged and kept ready for use during the day. ***https://www.youtube.com/watch? v=_YZnWmLBTg0 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) c. Rotary Instruments(Continuation) The nickel titanium rotary instruments have other variable tapers of 0.02, 0.04, 0.05, 0.06 0.07, 0.08.. For every millimeter of length, the diameter can increase by 0.02, 0.04... mm. These greater tapers make these more aggressive in creating marked flaring preparation. Another "standard" introduced by one of the Nickel-titanium rotary files of nickel-titanium rotary series (Profile)is a varying design. 29% constant increase in tip diameters A-B 0.04 and greater taper (GT) between sizes. titanium files (Profile). 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) c. Rotary Instruments(Continuation) There are different systems for motorized canal files. For example; there are systems such as Protaper universal, resiproc blue, edge endo X7, wave one gold, Protaper retreatment D1, D2, D3... While hand files are standardized with various color codes; endomotor canal files can be coded according to the standard of the system they belong to. ALL root canal files must be sterilized before first use (unless the package states 'sterile') and after each procedure. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) c. Rotary Instruments(Continuation) Additional Information When using retreatment files, various solutions are also used to facilitate the removal of old pieces of gutta-percha that need to be removed from the canal. These are gutta-percha and sealer solvents of various brands. These are Guttasolv (for gutta), Endosolv (for Sealer), Endosolv R (for resin-containing sealer), Endosolv E (for Ojenol-containing sealer...etc), Orange oil Chloroform (very irritating), Eucalyptol.... 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) c. Rotary Instruments (Continuation) Torsional limit is the amount of rotational torque that can be applied to a "locked" instrument to the point of breakage (separation). Smaller instruments (less than size 20) can withstand more rotations without breaking than larger (greater than size 40) instruments. There is no difference in torsional strength between ground-twisted and machined files. However, machined files are weaker, demonstrating less plastic deformation before failure occurs. Therefore, this tendency toward less visible deformation before separation requires more caution with the use of machined files to avoid instrument failure. Under test conditions, the nickel-titanium files (all are machined) have increased resistance to fracture compared with stainless steel files. 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) c. Rotary Instruments (Continuation) Avoidance of Instrument Separation: The manufacturer of the nickel-titanium rotary files suggest using them in high-torque slow-speed handpieces that rotate at 150 to 700 rpm. The number of canals that can be prepared with a nickel-titanium instrument varies from 4 to 16, depending on the size and curvature of the canals and pressure used with the files. Overused rotary nickel-titanium files exhibiting Some manufacturers recommend the use of 1 file on only 1 tooth. "roll-up" (small arrow), and "unwinding" (large The smaller and more curved the canal, the more wear and tear on arrow). the instrument. All manufacturers suggest discarding the files if any deformation occurs. Figure shows instrument fatigue and "roll-up" and breakage of nickel-titanium instruments after use in canals. REMEMBER! 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping In considering endodontic instruments, those that are hand-operated (such as files and reamers) are the most important. The nomenclature follows the recommendations of the International Organization for Standardization (ISO): a. Hand-operated include K-type reamers and files, Hedstrom-type file… b. Engine-driven are hand types that have a latch that inserts into a slow-speed handpiece. These are gates-glidde, peeso, engine-driven reamers and files c. Nickel titanium has been adapted rotary applications. Both hand- and engine- driven instruments have various configurations. The cross section of the instruments takes many shapes. d. Ultrasonic and sonic are diverse in design. Some resemble barbed broaches, some resemble files, and others are diamondcoated wires. All insert into a dedicated vibratory handpiece that energizes the instrument. In addition to canal preparation, other hand operated instruments are adapted for other aspects of root canal treatment, for example, canal identification and obturation 2- Use of Special Tools in Endodontic Treatments (Continuation) B. Instruments Used in Root Canal Shaping (Continuation) d. Ultrasonic and Sonic Instruments (Continuation) Usually, ultrasonic/sonic instruments are used by attaching ultrasonic tips to them. Ultrasonic/sonic tips can be used to remove pulp stones and to cut dentin when locating additional canals. They are also used to open the access cavity, to increase the activation of the irrigation solution in the canal, to help remove the broken file. REMEMBER! 2- Use of Special Tools in Endodontic Treatments A. Instruments used to open the pulp cavity B. Instruments used in root canal shaping C. Instruments used in root canal filling (Obturation of root canal) 2- Use of Special Tools in Endodontic Treatments (Continuation) C. Instruments Used in Root Canal Filling (Obturation of root canal) Several filling techniques are available. The most commonly used filling technique is the lateral condensation and vertical condensation technique. 2- Use of Special Tools in Endodontic Treatments (Continuation) C. Instruments Used in Root Canal Filling (Obturation of root canal) Fine finger spreader (Continuation) (left) and fine finger plugger (right). Both a. Spreaders and Pluggers are used similarly for Usually the dentist uses a spreader (with a stopper) (Usually a 25 lateral condensation. Spreaders are spreader) for lateral condensation of gutta-percha and a plugger for pointed and pluggers are vertical condensation (not as common as a spreader but should be used). flat at the tip. Spreaders are used for condensing and adapting gutta-percha and creating space for accessory cones. Spreaders and pluggers are either handled, having a shank attached to a metal handle, or finger-type, having only a small plastic handle. Handled instruments do not negotiate curved canals. D11 handled spreader (left) and a Finger spreaders and pluggers are best suited for obturating curved fine finger spreader (right). canals. Both are designed for lateral Finger spreaders and pluggers have different tips. condensation. The finger Pluggers are flat, whereas spreaders are pointed. spreader (or plugger) is more versatile and safer. 2- Use of Special Tools in Endodontic Treatments (Continuation) C. Instruments Used in Root Canal Filling (Obturation of root canal) (Continuation) a. Spreaders and Pluggers (Continuation) There is no special symbol on the spreader, the number of the spreader is written on the head. The color coding of the files also applies to the spreader and plugger. ***These instruments should also be sterilized before first use and after each procedure. 2- Use of Special Tools in Endodontic Treatments (Continuation) C. Instruments Used in Root Canal Filling (Obturation of root canal) (Continuation) Spreaders and Pluggers (Continuation) The taper of spreaders varies among instruments. Highly tapered spreaders increase in diameter at a greater rate than do standardized instruments, which increase 0.02 mm per mm of length. The greater the taper, the more the canal space must be enlarged or flared to facilitate spreader penetration. Both stainless steel and nickel-titanium spreaders are available. The obvious advantage of nickel-titanium spreaders over stainless steel spreaders is greater spreader penetration in highly curved canals. The disadvantage of nickel-titanium spreader is the inability to precurve it for patients with limited interocclusal space. 2- Use of Special Tools in Endodontic Treatments (Continuation) C. Instruments Used in Root Canal Filling (Obturation of root canal) (Continuation) Lentulo Lentulo spiral drills are twisted wire instruments used in the contra-angle handpiece/slow- speed handpiece. It has different diameters and these are in standard asorti colors. They have been used to calcium hydroxide or sealer into the canal. They must be used with care to avoid "throwing" quantities of unset material out of the apex. In fact, there is no reason to use lentulo drills other than to place calcium hydroxide paste. The drill must be rotated so that it will not "screw" itself into the canal; otherwise they may lock and separate. These instruments should also be sterilized before first use and after each treatment. Lentulo spiral drill is used to spin calcium hydroxide into canals 2- Use of Special Tools in Endodontic Treatments (Continuation) C. Instruments Used in Root Canal Filling (Obturation of root canal) (Continuation) Additional Information The Glick No. 1 instrument is used for placement of temporary restorations with the paddle end and removal (and then condensation) of excess gutta- percha with the heated plugger end. The rod-shaped plugger is graduated in 5-mm increments. Specialized endodontic instruments. A, D16 explorer. B, 31 L spoon excavator. C, Glick No. 1. The plugger end (bottom) is for heating and removal of gutta- percha; the paddle (top) is for placing temporary materials. References William T. Johnson MD DDS MS. Color atlas of endodontics. Mahmoud Torabinejad, Richard E. Walton. Principles and practice of endodontics https://www.slideshare.net/slideshow/45857311231022467029pdf/255 125720#49 Kenneth M. Hargreaves , Louis H. Berman. Cohen's Pathways of the Pulp https://acikders.ankara.edu.tr/pluginfile.php/109859/mod_resource/ content/0/6-%20ENDODONT%C4%B0DE%20KULLANILAN %20ALETLER.pdf https:// www.slideshare.net/slideshow/45857311231022467029pdf/25512572 0#49