Case Presentation

A Rinsing cannulae should screw securely onto the disposable syringe. B The thin cannulae must be evenly bent and must not be kinked. The device for bending files (Endobent) can also be used for cannulae. C The canal should be thoroughly rinsed between each change of files. Every root canal should be rinsed with at least 20mL of NaOCl. D For an effective antibacterial and tissue dissolving effect, it is important that the rinsing cannula penetrate deeply into the canal. This is virtually...

Root Canal Instrumentation 1GG

Optical Aids for Instrumentation 102 Determining the Working Length 104 Electronic Determination of Working Length 108 Instrumentation Using the Step-back Technique 118 Instrumentation Using the Step-down Technique 120 Instrumentation Using the Double-Flare Technique 122 Instrumentation Using the Crown-Down Technique 124 Problem-solving during Instrumentation 126 Instrumentation of an Obliterated Root Canal 128 Power-driven Root Canal Instrumentation 130 Cleansing the Root Canal Surfaces 148...

Rwj

Silver points have been used in endodontics for over 100 years. The underlying premise during the development of silver point root canal fillings was the antibacterial effect of silver. Even small amounts of silver or mercury completely kill bacteria in vitro. This led to the term oligodynamic effect (Greek oligos, little dynamos, force). The assumption was that bacteria release soluble metal salts from the surface of the silver point, and that these have a toxic effect. As early as 1921, a...

Ybx

The American Association of Endodontists defines a flare up as an acute exacerbation of a periapical inflammation following initiation of or during endodontic treatment. The incidence of such postoperative pain varies according to various studies between 1.4 and 45 , and in most patients necessitates an additional appointment. The etiology of post-instrumental pain is usually multifactorial. There is no doubt that pain will persist as a result of incomplete instrumentation, e.g., incomplete...

Info

The instrumentarium consists of a nine-piece plugger set. The instruments of sizes 8-12 begin with a diameter of 0.4 mm, and the diameter increases by 0.1 mm per instrument. The pluggers are graduated at 5 mm intervals. This permits checking the length, even when the instrument is within the root canal. Three pluggers are used that are slightly smaller than the diameter of the root canal at corresponding depths. The smallest plugger should extend to 45 mm coronal to the apical foramen. In the...

Yqz

Overlooked primary root canals or apical ramifications are usually the cause of endodontic failure. About 40 of mandibular incisors exhibit two root canals, but only in 1 does one observe two separate apical foramina. During endodontic retreatment, orthoradial and ex-centric radiograph projections must be made in order to depict the anatomic variations. Approximately 84 of maxillary first premolars and ca. 58 of second premolars exhibit an additional root canal. In addition, 8 of first...

C O

During treatment planning, only teeth with a favorable prognosis should be included, those that are amendable to prosthetic reconstruction. After removal of old restorations, it is necessary to fabricate a temporary that will provide a coronally reproducible reference point for determining endodontic working length, and to protect the tooth between appointments from overloading or fracture. In addition, an impervious closure against the oral milieu is necessary to prevent salivary ingress and...

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Scalpel, microsurgical 206 Screw, root fracture 50 Sealer 176, 184 Secondary dentin - caries, superficial, chronic 8 - pulp capping, direct 52 Secondary infection, failure, Selenomonas sputigena 12 Sensitivity test - thermal 34 Sensitivity testing 34 - results, false 42 Shape memory 132 Shaper 114 Shaping 116 Shaping file 146 Silver point, removal of 198 Smear layer 148 Sodium hypochlorite 154, 168 Soft-Core 184 Soft tissue swelling 190 Solution, physiologic saline 154 Sonic-Air attachments 114...

Ck

Once the osseous resection cavity has been tamponated and the bleeding stopped, the root surface is carefully examined using a mi-cromirror CX-1 at 15-25 x magnification. Staining the surface with methylene blue (Canal Blue, VDW) brings anatomic structures into better visual prominence. Following removal of excess stain using sterile NaCl solution, it is easier to inspect the periodontal ligament and other apical structures such as canal orifices, isthmus, C-shaped canals, fracture lines and...

Anatomy and Types of Endodontic Pathology

Normal Endodontium 2 Dental Caries 4 Caries Detector 6 Reversible Pulpitis 8 Irreversible Pulpitis 10 Bacterial Infection of Pulpal Tissues 12 Pulpal Necrosis 14 Clinical Pulp Exposure 18 c Internal Mineralization 20 (3 Acute Apical Periodontitis 24 -Si Chronic Apical Periodontitis 26 ((3

Bwc

Perforations represent the second most common reason for endodontic failure. The most favorable chance for success resides with immediate closure of the perforation, and the chances increase with increasing distance from the apex perforations in the coronal third can be treated and closed using an orthograde approach in the middle third, surgical exposure of the perforation is usually indicated in the apical third, apicoectomy or root amputation or tooth hemisection must be performed. Diagnosis...

Thieme

Library of Congress Cataloging-in-Publication Data Taschenatlas der Endodontie. English Pocket atlas of endodontology Rudolf Beer, Michael A. Baumann, Andrej M. Kielbassa translated by Thomas M. Hassell. p. cm. ISBN 3-13-139781-0 (GTV alk. paper) -ISBN 1-58890-347-8 (TNY alk. paper) 2. Endodontics-Handbooks, manuals, etc. DNLM 1. Dental Pulp Diseases-Handbooks. 2. Root Canal Therapy-Handbooks. WU 49 B414t 2006a RK351.B445 2006 This book is an authorized and revised translation of the German...

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The extraoral examination involves consideration of normal findings as well as pathological changes, and it is enhanced by the patient's own statements. External facial form and features are recorded as symmetrical or exhibiting asymmetric defects. The facial skin may exhibit abnormalities such as fistulae, erythema, or pallor, which may necessitate further clarification because they may indicate possible intraoral pathology. The neurologic examination includes testing of motor function,...

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The original Greater-Taper or GT Rotary instrument set derives from Buchanan (1996), and is available commercially from the Tulsa Dental Company, mainly for the American market. It consists of six instruments (GT Rotary files 06 20, 08 20, 10 20 as well as GT accessory files 12 35, 12 50, and 12 70). In Europe, these instruments are manufactured by the Swiss firm Maillefer, and have been expanded by four additional instruments of the ProFile systems 04 04 20, 04 25, 04 30, and 04 35. The GT...

Funnel Formation

An apical funnel will form as the result of improper instrumentation and straightening of the apical segment of a dilacerated root canal. To prevent such funnel formation, the apical end of the instrument must be bent more severely than the canal dilaceration that is visible on the radiograph. Only the use of sufficiently long, thin, and flexible files will prevent any apical widening. When using the balanced-force technique, the instrument must be removed from the canal and carefully cleaned...

Root Canal Filling with Limited Mouth Opening

In order to avoid ledge creation or blockage in the region of the apical 4 mm, the root canal instruments must be prebent Space problems can occur when using instruments 25 and more mm long in a patient with inhibited jaw opening. Therefore, during initial instrumentation, the instrument is inserted into the mesial root canals of molars. The stopper notch will then provide orientation, first in the mesial canal and subsequently distally. Apically, the instruments are more severely prebent than...

Illustrations

A The maxillary first premolar usually presents canal types 4-7, e.g., with two canals that are either completely separate, or which course more or less together. In mandibular premolars, 70 exhibit type 1 with a single root canal. Only with first premolars does one encounter configurations 4 or 5 in 25 of cases. B The mandibular first molar has two roots The mesial root has two canals that in 4045 of cases terminate at a common apical foramen. In the diagram, the distal root is sectioned in...

Abb

The indication for apexification is pulpal necrosis and incomplete root development. Further root development in the face of pulpal necrosis is highly unlikely the root canal walls diverge apically making preparation of an apical stop impossible. Treatment is therefore targeted toward inducing the formation of an apical buttress of hard tissue, and avoiding any overfilling of the canal. The working length is established somewhat shorter in order to avoid overinstrumentation. Because of the thin...

Fyz

For use in endodontics, two titanium alloys have been used to date titanium-aluminum and nickel-titanium alloys. Both of these alloys take advantage of the special characteristics of titanium titanium combined with the primary nickel component has become the basic material for the fabrication of root canal instruments. In addition to the titanium-aluminum alloy, presently there are four nickel-titanium alloys available for use as dental raw materials. These alloys are produced by numerous...

Sug

For more than a century, articles have been published regarding power-driven root canal instrumentation. The Giromatic from Micro-Mega was the accepted product after an extensive phase of development. Nevertheless, it had several disadvantages The hoped for time saving was only slight, the fine tactility of hand instruments was lost, dilacerated root canals were often straightened and the walls were inadequately smoothed. Errors of instrumentation in dilacerated canals led to funnel formation...

Gnf

Chelators have the capacity to limit the formation of smear layer on the canal wall surfaces during root canal instrumentation. The effectiveness is related more to the duration of application than upon the choice of any particular preparation, and decreases significantly from coronal toward apical. Only five minutes after application there exists a 30- m thick demoralization zone, which achieves 40 m after 30 minutes and up to 50 m after 48 hours. The interface between this layer and the...

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According to the international Association for the Study of Pain (1ASP), pain is defined as an unpleasant sensation and a disturbing sensation that is attended by actual or potential tissue damage. Acute pain is always associated with some sudden or acute circumstance. On the other hand, according to established definitions, chronic pain is uninterrupted pain of three to six months' duration, which negatively influences cognitive emotional status through disturbance of personal awareness, mood,...

Ss

Emergency treatment in the deciduous dentition, including treatment for pulp exposure, is different from treatment for permanent teeth because direct pulp capping has a less favorable prognosis, and therefore pulpal amputation is the treatment of choice. However, if the pulp exposure is very small and there is no indication of pulpitic changes, an attempt at direct pulp capping may be justified. Nevertheless, if the pulp exposure occurs in carious dentin or if pulpal damage has already...

Is

Many considerations go into each rubber dam application informing the patient about materials and procedures, consideration of the clinical situation (e.g., remaining tooth crown), selection of rubber dam material and clamps, as well as the location and size of the perforations in the rubber dam material. Applying the rubber dam can be done in four different ways. For endodontics, the most reasonable approach is simultaneous application of the clamp and the rubber dam. In this so-called wing...

Cvr

The radiographic apex is the only point that can be measured on a radiograph. In some cases, the difference between the apex and the apical constriction cannot be accurately determined. As demonstrated by Van de Voorde and Bjorndahl, the apical constriction is on average 1.1 mm distant from the anatomical apex and the apical foramen is 0.3 mm removed. Thus, the endodontic working length is only correctly determined in about 75 of cases. Forty-five percent of endodontic instruments that appear...

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The indication for pulpotomy on a symptomfree permanent tooth exhibiting incomplete root development is a broad pulp exposure with or without inflammation limited to the coronal pulp. The time between pulp exposure (e.g., trauma) to treatment should not exceed 48 hours. A differentiation is made between a partial pulpotomy with removal of only some of the coronal pulp and leaving behind segments of the coronal pulp with healing potential, and a complete pulpotomy with removal of the entire...

Uvd

Perforations at or near the bifurcation occur in 3-10 of cases. The prognosis is dependent upon prevention and the treatment of a possible bacterial infection. With aseptic technique and immediate closure, the success rate is very high. Root perforations at the height of the alveolar crest may communicate with periodontal pockets, and therefore have a low success rate. Orthograde canal fillings are unsatisfactory surgical intervention is recommended. Perforations often occur in the coronal root...

Figures

B K files D Flexicut (A), Flexofile (B), Fexoreamer (C), K-Flex (D) with rhomboid cross-section. G Power-driver NiTi files (Profile) with different ISO standardization and 4 conicity. H NiTi-GT in 06, 08, 10, and 12 conicities. I NiTi Flexogate with a 2-mm long working section, similar to Gates-Glidden.

Bwp

The success of retreatment of a canal previously treated with gutta percha depends on the quality of condensation, the length of the filling and the severity of dilaceration of the canal. Coronal portions of the gutta percha are softened with a heated instrument and removed. Then, Gates-Glidden drills are used to remove 3-5 mm of gutta percha from the canal, creating space for the application of a dissolving solution. Dissolving the gutta percha is indicated if the filling is well sealed and...

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These two terms, cleaning and shaping, encompass and characterize clearly the most basic requirements for canal instrumentation, which were established by the old master of endodontics, Professor Schilder, more than 30 years ago cleansing and giving the canal a proper form to receive the filling. Cleaning signifies the removal of all materials from the root canal, including infiltrated tissues, antigenic material, all organic components, bacteria and their products, but also caries, tissue...

Canal Projection Technique

Natural Alternative Root Canal

In addition to the clinical findings, radiographs have special significance for the determination of therapy. For example, in the posterior segments, 30-70 more dental caries will be diagnosed compared with clinical examination alone. It is astounding to note the differences in diagnosis by different examiners of the same radiograph Interexaminer agreement is often less than 50 . When the same films were examined eight months later, only 88 of examiners agreed with their initial diagnosis...

Anesthesia in Various Intraoral Areas

A The target for the inferior alveolar nerve is within the pterygomandibular space immediately before its entrance into the mandibular canal. The foramen is at the height of the molar occlusal surfaces. The needle is inserted parallel to the occlusal surface until contact with bone, somewhat superior to the lingula. At least 1.5 ml of anaesthetic solution is then slowly injected. B In the maxillary posterior region, the anaesthetic solution is deposited posterior to the maxillary alveolar...

Advanced Endodontics Alliance

Radiographic Images Pulpitis

The endodontium consists of mineralized (dentin) and nonmineralized (pulp) portions, and encompasses the functional-anatomic relationships of the dentin-pulp system. odontoblasts and their processes The odontoblasts are densely aligned along the inner surface of the dentin. Their processes extend through the entire dentin layer to the dentinoenamel junction, and are up to 5 mm long depending on the dentin thickness. The odontoblasts are interconnected through gap junctions as well as tight...

Epithelialized Pulp Polyp

Root Vasculature Expression

If the carious process progresses so far that the pulp chamber is actually opened clinically, pus can escape and the inflammatory reaction process will be quite different vis- -vis closed pulpitis. Differentiation is made between chronic open ulcerative pulpitis and chronic open hyperplastic pulpitis. In contrast to closed pulpitis, these two forms of pulpitis are easily diagnosed clinically. As soon as the progression of caries leads to broad opening of the pulp chamber, any exudate can escape...

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In order to relieve the dentist from some of the very laborious and time-consuming root canal instrumentation, Rollins 1899 described a needle-shaped root canal bur that was driven by a dental motor. Speed limitation to 100rpm was intended to avoid instrument breakage. However, it was not until the introduction of the Racer file head in 1958 and the Giromatic handpiece in 1964 that the epoch of power-driven root canal instrumentation began. The Giromatic handpiece produced reciprocating quarter...

Tiq

Following trepanation and extirpation of the pulpal tissues, the working length is determined radiographically. The double-flare technique involves three procedures 3. flaring of the entire root canal. The canal orifice is an anatomically determined narrowing, the coronal constriction. Early elimination of this constriction simplifies the subsequent instrumentation steps. Coronal widening is performed via reverse flaring. To accomplish this, the hand instruments files destined for later apical...