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Endodontics. Definition. Clinical and anatomical structure of teeth

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Title: Endodontics. Definition. Clinical and anatomical structure of teeth


1
Endodontics. Definition. Clinical and anatomical
structure of teeth cavities and root canals of
teeth. Endodontic instruments. Basic endodontic
procedures tooth cavity disclosure, amputation,
extirpation of the pulp. Methods of medicament
and instrumental treatment of root canals
("Step-Back", "Crown-down" techniques).
Medications. Mistakes and complications in root
canal treatment.
Lecturer Levkiv Mariana Department of
Therapeutic Dentistry TSMU
2
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3
Anatomy of tooth cavity
Parts of a pulp cavity. The pulp cavity of this
mandibular second molar is made up of a coronal
pulp chamber with pulp horns and two root (pulp)
canals.
4
  • Anatomy of root canal

5
  • Anatomy of apical part of the root
  • anatomical apical hole (apical foramen) - a place
    of transition the dentin into cement
  • physiological hole (apical constriction) - the
    border between pulp and periodontium, placed 1 mm
    away from the X-ray hole
  • X-ray hole.

6
Topographical and anatomical features of teeth
cavities of different group of teeth.
Access preparations into pulp chambers showing
orifices to canals. Ideally shaped openings
provide access into the pulp chamber for
endodontic treatment. Pulp canal orifices on the
floor of each pulp chamber correspond with the
number and location of pulp canals in each tooth.
7
Anterior - Triangular
8
Canines - ovoid
9
Premolar - Round
10
Molar - Rhomboid
11
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12
Endodontic instruments
  • According to ISO endodontic instruments are
    classified

Hand instruments files(K and H), barbed
broaches, spreader and plugger (vertical and
lateral gutta percha condensors ).
Rotary instruments H-files and K-reamers for
slow handpiece, lentulo spiral ?ller/rotary paste
?ller.
Pins gutta percha pins, silver
Rotary instruments Gates Glidden drills, Peeso
reamer drills.
13
  • But its more convenient to use classification by
    Curson(1996) that is based on clinical usage of
    endodontic instruments.
  • Cursons classification is as follows
  • - diagnostic instruments root needles(Miller
    needles)
  • - instruments for removing the soft teeth
    tissues barbed broaches
  • - instruments for passing, enlargement and
    shaping the root canals (K-reamers, K- files,
    H-files)

14
  • The main endodontic instruments and their use
  • Barbed broaches
  • Functions and precautions
  • Finger instruments
  • Disposed of in the sharps container
  • Used to remove the intact pulp
  • Barbs on the broach snag the pulp
  • to facilitate removal
  • They need to be used cautiously as
  • they can bind and break in the canal
  • Varieties
  • Available in different sizes and widths

15
  • Gates Glidden drills
  • Function, features and precautions
  • To enlarge the coronal third of the canal during
    endodontic treatment
  • Small ?ame-shaped cutting instrument used in
    the
  • conventional handpiece
  • Different sizes coded by rings or coloured
  • bands on shank
  • Are slightly ?exible and will follow the canal
  • shape but can perforate the canal if used too
    deeply
  • Dispose of in sharps container
  • Should be used only in the straight sections of
  • the canal

16
  • Peeso reamer drills
  • Function, features and precautions
  • To remove gutta percha during post preparation
  • Small ?ame-shaped cutting instrument used in
    the conventional handpiece
  • Different sizes coded by rings or coloured
  • bands on shank
  • Peeso reamers are not ?exible or adaptable,
  • if not used with care can perforate canal
  • Dispose of in sharps container

17
  • NiTi (Nickel titanium) rotary instruments
  • Function, features and directions for use
  • Used to clean and shape the canals
  • Used with endodontic handpiece and motor
  • NiTi is ?exible and instruments follow the
  • canal outline very well
  • Several varieties of systems with different
  • sequences of instruments are used
  • Important to follow the manufacturers
  • recommended speeds and instructions for use
  • Varieties
  • Different lengths 21mm and 25mm

18
  • Reamers Rarely used or indicated. Disadvantages
    of reamers include their inflexibility with ?
    size, which can result in a wider canal being cut
    apically. Have now been replaced by files.
  • Files These are used either with a longitudinal
    rasping or a rotary action (e.g. clockwise
    direction).
  • The main types of file available are
  • K-type-file. Made by twisting a square metal
    blank.
  • K-flex file. Similar to K-file but made by
    twisting a rhomboid shape blank alternating
    blades with acute and obtuse angles. More
    flexible than K-file but becomes blunt more
    quickly.
  • Hedstroem file.

A. K - style file.
B. K - style reamer.
C. K - flex file.
19
Hedstroem file. Made by machining a continuous
groove into a metal blank. More aggressive than
K-file. Must never be used with a rotary action
as liable to fracture.
20
  • Endodontic K ?les. Also called Root canal hand
    ?les
  • Function, features and precaution
  • Finger instrument
  • Colour coded by size. The 6 colours used most
    often are size 15 (white) 20 (yellow) 25
    (red) 30 (blue) 35 (green) 40 (black). Also
    available in size 6 (pink), 8 (grey) and 10
    (purple)
  • Operator gradually increases the size of the
  • ?le to smooth, shape and enlarge canal
  • The larger the number of the ?le, the larger
  • the diameter of the working end
  • Disposed of in the sharps container
  • Varieties
  • Different lengths 21mm, 25mm and 30mm

21
  • Lentulo spiral ?ller/rotary paste ?ller
  • Function and features
  • Small ?exible instrument used to place
    materials into the canal
  • Fits into the conventional handpiece
  • Use with caution as it can be easily broken
  • Different sizes available

22
Geometric symbols of endodontic instruments
23
Common terms and expressions used in endodontics
Tooth cavity disclosure
Pulpotomy (amputation)
Pulpectomy (extirpation)
24
  • The main purpose of root canal treatment is
  • removal of pulp
  • removal of infected dentine from the inner wall
    of the root canal
  • enlargement and shaping a root canal for its
    adequate filling.
  • The procedure of root canal treatment has such
    stages
  • - disclosure of the tooth cavity
  • - disclosure of the root canal orifices
  • - the root canal passing
  • - the root canal enlargement
  • - the root canal shaping.

25
  • Manipulations of root canal treatment (RCT) are
    carried out manually or with the help of rotary
    instruments by several treatment methods, the
    most widespread among them are
  • apical-crown - envisage treatment from the apical
    hole to canal orifices with gradually increasing
    of instrument diameter( e.g. from ?10 -? 40)
  • crown-apical - envisage root canal
  • treatment that starts from canal orifices
  • to apical hole with a gradual decrease
  • in instrument diameter(e.g. from ?40
  • ? 10)
  • hybrid method of treatment - have been
  • developed out of the two methods.

26
  • Step-back technique The apical part of the root
    canal is prepared first and the canal is then
    flared from apex to crown. Blockage of canals may
    occur using this technique, and irrigation can be
    difficult.

27
  • Crown-down technique This (along with several
    others) prepares the coronal part of the canal
    before the apical part. This has advantages and
    is the preferred technique.

28
  • Balanced force technique This involves using
    blunt-tipped files with an anticlockwise rotation
    whilst applying an apically directed force. It
    requires practise to master but is particularly
    useful when preparing the apical part of severely
    curved canals.

(A) In the balanced force technique the file is placed to working length and rotated clockwise 90 degree with light pressure to engage dentin.
(B) The file is then rotated counterclockwise 120 degree while apical pressure is maintained to cut and enlarge the canal. Debris is removed with a final clockwise rotation that loads the flutes with loosened debris.
29
  • Anticurvature filing

30
  • Advantages of orifice enlargement
  • Effectively, ? the curvature in the coronal
    part of the root canal, allowing straighter
    access for files to the apical region. It
    therefore reduces the likelihood of apical
    transportation (zipping).
  • It allows improved access for the flow
  • of irrigant solution within the canal.
  • It reduces the likelihood of apical extrusion
  • of infected material as most of the canal
  • debris is removed before apical instrumentation
  • takes place. This is particularly important
  • because the majority of bacteria in an infected
  • root canal are located in the coronal region.

31
  • Drugs for chemical enlargement of root canals

Type of active ingredient The product, the manufacturing company
A solution of EDTA Largal ultra (Septodont) Edetat solution (Pierre Roland) Endofree (Dencare)
A solution of citric acid and propionic acid Verifix (Spad)
Gels based on EDTA Canal (Septodont) HPU15 (Spad) RC-prep (Premier) ????? ????? (??????-?)
32
  • Root canal treatment should include thorough
    mechanical debridement and medicatment treatment
    as well (antiseptic solutions), these two
    procedures should go together.
  • Irrigants. Dilute sodium hypochlorite is
    generally considered to be the best irrigant as
    it is bacteriocidal and dissolves organic debris.

33
Prepared root canal for sealing, regardless of
the method of instrumental treatment, must
fulfill the following criteria as follows
  • To be sufficiently enlarged
  • To have a conical shape (tapered)
  • To have formed apical ledge
  • Do not contain a necrotic dentine
  • Do not have typical smell
  • To be clean and dry
  • Do not have a painful reaction to percussion.

34
  • Common errors in canal preparation

Lateral perforation
Incomplete debridement
Ledge formation
Apical transportation
Apical perforation
Elbow formation
Strip perforation
35
The stiff instrument tends to straighten within
the curved root canal (1), causing ledge
formation (2), zipping (3) or perforation (4).
36
Thank you for attention!
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