mr. caputo unit #2 lesson #5 endodontic instruments
TRANSCRIPT
MR. CAPUTOUNIT #2 LESSON #5
Endodontic Instruments
Today’s Class
Driving Question: What are the instruments used during an endodontic treatment?
Learning Intentions: We will be able to describe endodontic instruments, accessory instruments, and medicaments necessary for endodontic treatment.
Anchor: Why is the shaping an cleaning of a root canal extremely important?
Pulpotomy
Removal of entire coronal pulp in pulp chamber, leaving only vital pulp within roots
Root canal’s pulp is retained and treated with medication to preserve its vitality and function
Usually done on primary teethContraindicated: fistula or an abscess, tooth
crown is nonrestorable, profuse hemorrhage, extreme tenderness to percussion, mobility, necrotic pulp, or pulp stones
Pulpotomy Procedure
Pulpectomy
Most common endodontic procedureInvolves removal of the entire pulp from
pulp chamber and from root canals of a nonvital tooth
Indications: cooperative patient teeth with poor chance of vital pulp treatment for space maintenance absence of surrounding bone loss from infection expectation of ability to restore tooth in the
future
Procedure for Pulpectomy
Initial x-ray is takenAnesthetic is administeredDental dam is placedDentist cuts through enamel and dentin with
a high-speed handpiece burSlow-speed handpiece round bur and possibly
spoon excavator is used to remove all decayed tooth structure
Procedure for Pulpectomy
Tooth opening is deepened and widened to allow access into pulp chamber(s)
Location of each root canal is determinedInfected pulpal tissue is removed
(extirpation)File(s) are placed into canal of tooth prior
to second x-raySecond radiograph is exposedFiles are measured
Root Canal Procedure
Shaping and Cleaning
Each root canal is prepared and shapedDebridement on root canal is acheivedSmaller file or reamer is used first, then
next larger size, to increase canal’s widthTapered files are used either by hand or
rotary instrument in a slow-speed handpiece
Filing is within 2 to 3 mm inside of tooth apex
Irrigation is done with bactericidal liquidsAbsorbent paper points are used
Obturation
Necessary to ensure a good seal at apex of root and for root canals to have no voids
Common material used to obturate is gutta percha, a thermoplastic rubber-like material
Gutta percha points are tapered so they ideally fit the canal after it is shaped
Endodontic sealing cements are used to hold gutta percha filling material in place
Thermafil or injection techniques can be used
Obturating a Root Canal
Image courtesy Instructional Materials for the Dental Team, Lex. KY
Final Restoration
Temporary restorative materials may be used to fill tooth and seal it from moisture contamination after root canal therapy
Dentist can either continue to prepare tooth for a permanent restoration or refer patient to another dentist for permanent restoration procedure
Endodontist will refer patient back to general dentist for post and core procedure and crown preparation
Permanent filling must be done in order to protect the tooth against fracture and recurrent decay
Post and Core Buildup
Endodontically treated teeth are usually already broken down and will become brittle with time because they no longer have a moisture supply
Post and core may be neededAll endodontically treated teeth will require a
crown as a final restoration to prevent future problems
Post
Placed within one or two root canalsServes to supply extra support for a core
when sufficient tooth structure does not existTwo main categories of posts:
custom fabricated prefabricated
Core Buildup
Required when there is extensive loss of natural tooth structure
Placement of pins for additional retention will also be evaluated
Most common core buildup materials are gold, amalgam, and composite
Goal of the core buildup is to establish the greatest stability and longevity of the restoration
Post and Core Buildup
Instruments and Accessories
Prepared in sterile packs or kitsSmall hand-operated endodontic
instruments and supplies are generally placed on disposable sponge or in compartmentalized box that can be sterilized and maintained in an orderly fashion
Several accessory items, such as instruments, filling materials, medications, irrigating solutions, and cements, must be readily available for use during endodontic procedures
Dental Dam
Essential during all endodontic proceduresIsolates the tooth and maintains sterile fieldPrevents contamination of saliva to root
canalsPrevents small endodontic instruments from
going down patient’s throatKeeps infected tissues, debris,
medicaments, and irrigating solutions from entering patient’s mouth
Improves visibility
Rubber Dam
Image courtesy Instructional Materials for the Dental Team, Lex. KY
Endodontic Explorer
Has two long, narrow, pointed working ends
Angled from shank in order to provide access to pulp canal inside tooth
Used to locate canal openings and explore pulp chambers and canals
Courtesy Hu-Friedy
Endodontic Spoon Excavator
Long, double-endedSimilar in shape to a
regular spoon excavator but has longer shank
Allows for detection of caries, coronal pulp tissue, or removal of cotton pellets that may be deep inside the crown of tooth
Courtesy Hu-Friedy
Broaches
Used to remove infected pulp tissue from within tooth’s pulp canal
Thin, flexible, tapered, and pointed, with a series of sharply pointed barbed projections that curve backward
Fragile and used with careDisposed of in biohazard sharps container
Reamers
Used to enlarge pulp canal after broaches Used with reaming action or filing actionTapered and pointed with spiral cutting
edgesCutting edges of reamers are farther apart
than those found on endodontic filesAvailable in many sizes, beginning with size
10 and continuing in intervals of 5 up to size 60 or intervals of 10 through size 140
A step-up process
Endodontic Hand Reamer
Courtesy DENTSPLY/Maillefer
Files
Look like reamersK-type, H-type (Hedstrom), and S-typeStandard numerical size designationStandard color codingSizes begin with size 8 and continue through
size 140Files lengths are 21 mm, 25 mm, and 27 mm
Files
Available in carbon steel, stainless steel, or nickel-titanium alloy
Newer titanium files have strength and flexibility
Sterilized through dry heat, autoclave, bead sterilizer
Disposed of in biohazard sharps container
K-type Files
Made of carbon steelTapered and pointed with tight spiral cutting
edges arranged so that cutting occurs with rotating stroke
When dentist pulls instrument out of tooth, cutting edges scrape against walls, removing necrotic tissue
Hedstrom Files
Shaped like series of cones that become larger from tip toward the handle
Sharp blades of these files cut aggressivelyUsed in push-pull motion and not rotated as
the K-type files
S-type Files
Made of stainless steel as opposed to carbon steel
Stainless steel bends more easily, is not as brittle, is less likely to break compared with carbon steel, and can be autoclaved without becoming dull
Have S-fluted design
Barbed Broach, K-Type File, and a Hedstrom
Endodontic Stops
Small round pieces of rubber, plastic, or silicone
Placed on reamers, files, or even broaches
Mark measurement of root canal
Prevent injury or perforation of apex
Courtesy DENTSPLY/Maillefer
Endodontic Measuring Gauges
Determine working length
Many designs for endodontic rulers
All endodontic rulers measure files, reamers, and broaches in millimeter increments in various designs