owner and inventor of kids-e-crowns … instruments in...concerns in paediatric dentistry loss of...

Dr Mukul Jain, M.D.S

(Paediatric And Preventive Dentistry) India

Private Practitioner

Owner and inventor of Kids-e-crowns

Namaste………..Jambo…..Salaam

“A New Smile for Africa”

Rotary Instruments in paediatric dentistry

Challenges in paediatric dentistry

Behaviour management Complex root canal system

Ahmed, H., 2013. Anatomical challenges, electronic working length determination and current developments in root canal preparation of primary molar teeth. Int. Endod. J. 46, 1011–1022.

Concerns In Paediatric Dentistry

Loss of necrotic primary molars leading to space loss

Schafer, E., Erler, M., Dammaschke, T., 2006a. Comparative study on the shaping ability and cleaning efficiency of rotary

MTWO instruments. Part a. Shaping ability in simulated curved canals. Int. Endod. J. 39, 196–202.

Objectives of cleaning and shaping

Provide irrigation

path

Dis-infection-Remove bacteria

Creating space for

subsequent instruments

Cohen, S., Hargreaves, K.M., 2006. Pathways of the Pulp, 9th ed. Mosby Publishers, St. Louis, pp. 301–311, 842.

Ideal Pulpectomy Technique

Kuo, C.I., Wang, Y.L., Chang, H.H., Huang, G.F., Lin, C.P., Guo, M.K., et al, 2006. Application of Ni-Ti rotary files

for pulpectomy in primary molars. J. Dent. Sci. 1, 10–15

• Fast procedure

• Effective debridement

• No weakening the tooth structure

• Endangering the underlining permanent teeth.

• Minimal procedural complications.

• Maintaining tooth function until it is naturally exfoliated.

Yang, S.F., Rivera, E.M., Walton, R.E., Baumgardner, K.R., 1996. Canal debridement: effectiveness of sodium hypochlorite

and calcium hydroxide as medicaments. J. Endod. 22, 521–525

Success of pulpectomy

Elimination of bacteria

By creating irrigation pathways

Through cleaning and shaping

Why Rotary Endodontics in Pediatric dentistry?????

Tissue and debris are quickly removed

Shashikiran, N.D., 2006. In vitro comparison of Ni Ti rotary instruments and stainless steel hand instruments in root

canal preparation of primary and permanent molars. J. Indian Soc. Pedod. Prev. Dent. 24, 186–191

Why Rotary Endodontics in Pediatric dentistry ?????

Funnel shaped Preparation Follow and preserve canal anatomy

Silva, L.A., Leonardo, M.R., Nelson-Filho, P., Tanomaru, J.M., 2004. Comparison of rotary and manual instrumentation techniques on cleaning capacity and instrumentation time indeciduous molars. J. Dent. Child 71, 45–47

40 no file 30 no file 20 no file

Taper of Rotary files

Cohen, S., Hargreaves, K.M., 2006. Pathways of the Pulp, 9th ed. Mosby Publishers, St. Louis, pp. 301–311, 842

• Shorter than 19 mm

• Extripate pulp completely, not push beyond apex

• Single file system

• Avoid excessive cutting of soft primary dentin

• Cost effective, easily available

• High fatigue & torsional resistance

Ideal rotary file for primary teeth

• World’s first rotary file for primary teeth• Kids endodontic shaper KEDO-S• 3 published articles – G. Jeevanandan (2018)

15-Nov-18Pediatric Rotary Endo @ PEDOCON 2018

Dr S Rupesh

• D1 – Narrow canals in primary molars (15K snug fit), 0.025 tip dia• E1 – Wider canals in primary molars (15K loose fit), 0.030 tip dia, mandibular distal, maxillary

palatal• U1 – Incisors, 0.040 tip dia• To be used 1- 2 times and not more than 3 -4 seconds in each canal

• Heat treated Niti files• M wire technology• Greater resistance to cyclic fatigue than Kedo-S

15-Nov-18Pediatric Rotary Endo @ PEDOCON 2018

Dr S Rupesh

• 42% higher peak torque strength

• 100% cutting efficiency for first 12 cases

• 90% reduction in efficiency after that due to TiO2 and cutting edge wear

KEDO-SG BLUE

• Short 17 mm files

• Heat treated NiTi files,

Controlled memory wire

• Reduced separation

• Constant taper files – 4%, 6%

• Conservative canal preparation

Guidelines

• Gentle, do not force

• Passive brushing---push pull

• Only 4-5 seconds per file

• Speed and torque controlled motor

250-300 RPM, 2-2.5 N

Guidelines• Use lubricant

• Irrigation– don’t keep canal dry

Musale, P.K., 2013. Rotary instruments in primary teeth. J. Int. Oral Health 5, 140.

Straight lines acess

Glide pathCoronal

flaring- rotary opener

Canal shaping-Rotary file

H- file hand

Rotary Endodontics protocol

Irrigation Irrigation Irrigation Irrigation Irrigation

Straight Line access

Patency Filing- Glide path

• 10 or 15 K File

• Ensure file reaches

radiographic apex

• Pre curve if require

Coronal Flaring

• Reservoir for irrigants

• Straight line access

• Removes infected tissue

Sx

Narrow Canal- 4% 20 Medium Canal- 4% 25 Large Canal- 4% 30

Pulp extirpation - Barbed broaches

10K – 15K – Rotary - 30/35H

ANY ROTARY SYSTEM

Adult rotary system in primary teeth

• Length is big

• Cut more dentine

• Stiff

10 K-hand file

SX 25- H hand file

S2

Chang et al. Applocation of Ni-Ti rotary files for pulpectomy in primary molars. J Dent Sci, 2006.

Pro Taper Protocol in Primary

Molar

15K - 20K - (+/-SX) -S2Kuo et al 2006

- 30/35H

• Tip size 20, apical taper 4%• Approximates root canal size of

primary molars

OPTIONAL

• Greatest range of taper• Simplifies instrumentation procedures• Replaces GG

15K - 20K – (– +/-SX) – S2– F1- F2

With teeth undergoing physiologic root resorption (Pinheiro et al 2012) • Apical size of root canal larger• F2 (apical size 25) suggested as appropriate file than S2 • F3 appropriate for lower distal and upper palatal canals

Neolix in paediatric dentistry

Disadvantages of rotary instruments in primary teeth

• Primary dentin is softer and less dense

• Roots are shorter, thinner, and more curved

• Root tip resorption is often undetectable

• Rotary instruments are centered in root canals during rotation and leave unclean areas and potentially infected tissue in fins and isthmuses…H file

• Training and cost

Kim, H.C., Kim, H.J., Lee, C.J., Kim, B.M., Park, J.K., Versluis, A., 2009. Mechanical response of nickel-titanium instruments with different cross-sectional designs during shaping of simulated curved canals. Int. Endod. J. 42, 593–602.

Un-winding Discard files

10K – 15K – Rotary - 30/35H

ANY ROTARY SYSTEM

Thank you

“A New Smile for Africa”