Instrument s for access cavity preparation

Basic Endodontic InstrumentsPrepared by

Dr . JOY DUTTA

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CONTENT

INTRODUCTION

INSTRUMENTS FOR ACCESS OPPENING

INSTRUMENTS FOR CANAL PREPARATION

ROOT CANAL FILLING INSTRUMENTS

REFERENCE

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INTRODUCTION

In considering the endodontic instruments those that are hand operated are the most important.

However other specialised instruments such as explorers & excavators have been designed to adapt to the root canal treatment requirement.

Originally instrument for root canal treatment were few in number and crude in design.

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The earliest hand operative devices had long handles that were best suited for anterior teeth.

As RCT diversified, small finger instruments were developed for posterior teeth.

New designs in endodontics instruments have been introduced and will continue to evolve.

Instrument s for access cavity preparation

ENDO ACCESS BURS

ENDO Z BURS

Instrument s for access cavity preparation NameBurs Functionseveral types of burs are be used to accomplish good access preparation Fissure burs are used in the initial stage of access preparation to establish the correct outline form ,Round burs are used to lift the roof of the pulp chamber and eliminate overhanging dentine ,Tapered Non end-cutting bur is used to 'lift lid' of pulp chamber and refine cavity.

Instrument s for access cavity preparationFront surface mirror

Instrument s for access cavity preparation NameFront surface mirrorFunctionis best suited for visibility deep within the pulp chamber.

Instrument s for access cavity preparationroot canal explorer

Instrument s for access cavity preparation Nameprobe/root canal explorerFunctionUsed to probe and detect canal openings within the pulp chamber

Extirpation Instrumentendodontic spoon excavator

Instrument s for access cavity preparation NameEndo excavator Function"larger than conventional excavator" its shape allows curettage of the pulp chamber when conventional one will not reach the floor of the chamber, and used as surgical aid to excavate periapical lesion.

PERIODONTAL PROBE

COTTON HOLDING FORCEPS

ENDODONTIC RULER

INSTRUMENT ORGANIZER

TRANSFER SPONGE

International Standards Organization (ISO)(based on use) Group I: hand use only: K-type files H type file R-Type rasps Barbed broaches spreaders condenser

Group II: engine driven latch type Same design as in group I but made to attach to hand piece.Niti Rotary instruments like Profile, Lightspeed.

Group III: engine driven latch typeEndodontic engine driven instruments fabricated from a single metal latch and shaft and operative head.Gates Glidden drills and Peeso reamers.

Group IV: root canal points. Gutta percha, silver points and paper points.

According to Cohen

Hand instruments: those specific to endodonticsInstruments for pulp space preparationGroup IGroup IIGroup III Devices for root canal length measurements Instruments for root canal obturationDevices for removal of root canal obstructions

Extirpation InstrumentBarbed broach

Extirpation InstrumentBarbed broach

Extirpation InstrumentBarbed broach

Extirpation Instrument NameBarbed broachesFunctions Used to remove the intact pulp Barbs on the broach snag the pulp to facilitate removal .Retrieve a paper point or cotton pellet trapped in the canal . Loosen debris in necrotic canal..

Extirpation InstrumentThe braded broach comes in different sizes, and the selection of suitable size is very important, it should fit loosely inside the canal, when braded broach size is larger than the canal size, the hooks of broaches engaged in the dentinal wall of the canal and stick there "Jammed broach" and with drawing it becomes difficult and might fracture inside the canal.

if the dentist faced by Jammed broach, the broach should be removed vertically without twisting. The bared broaches must only be used in the straight part of the canal, and insertion of the broach (not exceed 2\3) of the canal length of the ideal way to use it is

Rasps They have ADA specification No. 63.

Rasps have similar design to barbed broach except in taper and barb size. Barb size is larger in broach then rasp(Fig. 12.5).

They are used to extirpate pulp tissue.

ISO standardization

ISO standardization Before a standardized configuration was adopted, endodontic instrument varied greatly from one manufacturer to another. The configuration adopted is that set by the International Organization for Standardization (ISO), All ISO hand instruments, along with paper points, silver points and standardized gutta-percha points, conform to this system. of 0.50 mm.

. ISO standardized files have a cutting length of 16 mm, have a specified diameter at the tip (termed D1) and increase in diameter by 0.02 mm for each millimeter along the file, so that at the end of the cutting part (16 mm along the file) the diameter (termed D2) is 0.32 mm greater than at D1. This is called an .02 taper

Files may vary in length, any extra length is provided by a blank portion. The nominal size of the instrument is based on the diameter of its tip (the diameter at D1) expressed in hundredths of a millimeter. Thus an ISO size 50 file will have a tip diameter of 0.50 mm

ISO standardization also uses a color for each size, as shown below:ColorNominal SizePink06Grey08Purple10White15 45 90Yellow20 50 100Red25 55 110Blue30 60 120Green35 70 130Black40 80 140

The amount of increase in diameter from one inst. to the next is 0.05 mm in inst. from size 10 60, and 0.1 mm in inst. from size 60 140.

Alloys Used for ManufacturingEndodontic Instrumentsa. Carbon steelb. Stainless steelc. Nickle-titanium .

Carbon steel: carbon contain less- than 2.1 percent

Advantage: They have high hardness than stainless steel instruments.Disadvantages Prone to corrosion, so cannot be resterilized Prone to rust.Example: Barbed broach

Stainless steel instrumentsThese are corrosion resistant instruments. They contain 18 percent chromium, 8-10 percent nickel and 0.12 percent carbon.Advantage: Corrosion resistantDisadvantages Stiff in nature Prone to fracture Prone to distortionExample: K-file, H-file, reamer

Disadvantages of NiTi files Poor cutting efficiency.

NiTi files do not show signs of fatigue before they fracture

Instruments for root canal preparation K- reamer

Instruments for root canal preparation K- reamer

Instruments for root canal preparation K-reamer instruments can be manufactured by twisting a square or triangular blank by machine . reamer used in shaping the canal Action o'clock wise quarter turn twist .

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Made from triangular blanks.

More flexible.

The helix angle is small, therefore effective only in rotating motion

Has cutting tip

0.5-1 flute/mm.

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comes in sizes 06 - 140,

all with a taper of 0.02.

design is identified by the triangle symbol on the handle.

It is used by continuous rotation when the resistance is small or moderate

and by balanced force when the resistance is greater.

In curved canals ledging easily occurs with even small reamer sizes if instruments are not pre-curved.

RECCOMMENDED USES

Reamers can be rotated only using moderate pressure.

Use of force, particularly with smaller sized instruments, may result in distortion of the helical structure and ultimately in fracture.

Each instrument should be checked for symmetry by rotating it against an even background before introducing it into the canal

SAFETY TIPS

Instruments for root canal preparation K- file

Instruments for root canal preparation K- file

K -Files with a triangular cross-section tend to have superior cutting characteristics and are more flexible, and hence less likely to transport the canal during preparation. .

Action o'clock wise half turn twist .

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Made from rectangular blanks

Helix angle is greater than in a reamer, and therefore preparation by a K-file is effective both in rotary and filing motion.

The tip of the instrument is cutting

less flexible than reamers but are more effective in cutting.

1.5-2.25 flute/mm

K-files are produced in sizes 06 - 140,

all with a taper of 0.02.

K-file design is identified by the square symbol on the handle.

It prepares both in filing motion (up and down) and when rotated.

In slightly curved canals -continuous rotation when the resistance is small and balanced force against greater resistance.

Compared to reamers, the use of continuous rotation is limited because of the screwing effect typical of K-file

RECOMMENDED USE

K-files can be rotated only using moderate pressure.

Use of force, particularly with smaller sized instruments may result in distortion of the helical structure and ultimately in fracture.

Balanced force technique and filing instead of continuous rotation should be used with sizes 06 - 15 to minimize fracture risk.

Each instrument should be checked for symmetry by rotating it against an even background before introducing it into the canal

SAFETY TIPS

Instruments for root canal preparation Hedstom file

Instruments for root canal preparation Hedstom file

Instruments for root canal preparation

Hedstom file are machined from a tapered cylindrical block. In cross-section they have the appearance of a series of intersecting cones. Hedstroem files are highly efficient at removing dentine on the outstroke when used in a filing motion, but have poor fracture resistance in rotation

Action withdrawal stroke .

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Manufactured from round steel wire by grinding.

The helix angle is close to right angle, which is therefore preparation by H files is effective only when using a filing motion (up and down movement).

More positive rake angle.

blade with a cutting rather than a scraping angle

come in sizes 08 140.

all with a taper of 0.02.

H-file design is identified by the circle symbol on the handle.

can be used both in straight canals and curved canals.

Cut only in retraction.

In curved canals, files (sizes 20/25 and bigger) must be pre-curved to correspond to the shape of the curve.

H-files must always fit loosely in the canal to avoid risk for fracture.

Small sizes up to #25 can be used down into full preparation length while bigger sizes are often used 1 - 3 mm short.

RECOMMENDED USES

Hedstrom files show a greater risk for fracture than reamers and K-files if used in a wrong way.

Hedstrom must always fit loosely in the canal and they must never be rotated.

In curved canals Hedstrom-files are pre-curved to correspond to the shape of the canal.

Before introducing them into the canal, all Hedstrom files must be inspected for possible earlier damage to the instrument and discarded immediately if an asymmetry in the cutting area is found

SAFETY TIPS

FLEXO FILES

manufactured from a triangular steel wire that is twisted to give the typical shape of a file.

The helix angle is small, and therefore effective only in rotatory motion.

The tip of the instrument is non-cutting (bat-tip/inactive tip) making flexofiles well suited for the preparation of evenly curved canals without risk of ledging.

FLEXOFILES

Flexofile is suited for both straight canals and slightly curved canals.

Effective both in filing motion(up and down) and when rotated.

In slightly curved canals the recommended techniques are continuous rotation when the resistance is small and balanced force against greater resistance.

Use of continuous rotation is limited as compared to reamers because of the screwing effect typical of K-files

USES

Rhomboidal or Diamond shaped

This new cross-section presents significant changes in instrument flexibility and cutting characteristics

The cutting edges of the high flutes are formed by the two acute angles of the rhombus and present increased sharpness and cutting efficiency

The alternating low flutes formed by the obtuse angles of the rhombus are meant to act as an auger, providing more area for increased debris removal

K FLEX FILES

Made by removing the sharp cutting edges from the tip of instrument.

Have non cutting tip, so less chances of ledge formation, canal transportation when used with balance force technique.

Triangular cross section which provides it flexibility

Made up of NiTi and cut during anticlockwise rotary motion

FLEX R FILES

It is called S because of its cross-sectional shape.

Produced by grinding, whichmakes it stiffer than H file.

The file is designed with 2 spirals for cutting blades, forming double helix design.

It has good cutting efficiency in either filing or reaming action, thus file can also be classified as hybrid design.

S FILES

Used for difficult and calcified canals.

Have better buckling resistance than k files.

Available in size 8, 10, 15 of length 18, 21 and 25 mm.

C + FILES

Were described by Weine.

Comes under intermediate files provided with half sizes between conventional instruments.

Available in sizes from 12-37 like 12, 17, 22, 27, 32, 37.

Used for narrow canals.

They are formed by cutting 1 mm from tip of instrument.

GOLDEN MEDIUM FILES

NiTi (Nickel titanium) rotary instruments

NiTi (Nickel titanium) rotary instrumentsThese files are used to flare the coronal aspect of the root canal. Although they are manufactured from nickel-titanium the files are relatively inflexible, as the cross-sectional diameter is larger than that of a standard file (ISO). The use of these instruments is therefore best restricted to the relatively straight parts of the root canal to avoid strip perforation. It is recommended that they are used in a hand piece driven by an electric motor at 150-300 rpm

Gates-Glidden drills

Gates-Glidden drills

Gates Glidden Drills:It is the main rotary instrument used for the pre-enlargement of the coronal 2/3rd.It has a flame shaped cutting headThey are used in speeds from 750 1000 rpmThey should be used in a brushing motion like a painters brush to carve away restricted dentin from the orifice.

Mechanical steel instruments

They comes in a box of 6 instruments

Identified by the number of rings on the handle

They have tip diameters from 0.5 1.5 mm

Has a safe ended tip

Fracture of the instrument usually occurs at the base oshan as it is most stressed and weakest point

Flexogates

Advantages of Flexogates

Gates-Glidden drillsSmall flame-shaped cutting instrument used in the conventional hand piece Different sizes coded by rings or colored bands on shank Are slightly flexible and will follow the canal shape but can perforate the canal if used too deeply

functions :Preparing the coronal two thirds of molars canals.Removing the lingual shoulder.Widen the canal when an instrument has fractured within it.

Peeso Reamer

Peeso ReamersMost often used in preparing coronal portion of the root canal for recieving a post coreSafeendedTip Diameter: 0.7 1.7Used in a brushing motion

Peeso reamers drillsSmall flame-shaped cutting instrument used in the conventional hand piece Different sizes coded by rings or colored bands on shank, Peeso reamers are not flexible or adaptable, if not used with care can perforate canal functions :Removing gutta-percha from the canal during post space preparation or during retreatment.

Instruments for root canal preparation Disposable irrigating syringe and disposable needle

Plastic syringes of different sizes (120 mL) are most commonly used for irrigation .

All syringes for endodontic irrigation must have a Luer-Lock design

Instruments for root canal preparation NameDisposable irrigating syringe and disposable needleFunction, features and precaution Used with an irrigant to clean and disinfect the canal during endodontic treatment A blunt needle with side exiting delivery will reduce the risk of the needle bindingwithin the canal

Beveled needle:Needle with bevel if get lodged into canal there is a risk of forcing irrigant beyond the apex.

Monoject irrigating needle:Monoject endodontic needles to be the most efficient delivery system in which longer needles of a blunted, open-end system were inserted to the full length of the canal to ensure optimum cleaning.A larger volume of solution can be delivered by this method

Max-i-Probe irrigating needle : It has closed-end and side window. This design allow for upward flushing action for better canal irrigation and also eliminates possibilities of irrigant to be pushed beyond the apical foramen

Instruments for root canal preparation Absorbent paper points

Instruments for root canal preparation NameAbsorbent paper pointsFunctions To absorb any moisture in the canal (i.e. blood, pus and saliva) To carry medicaments into the canal

Instruments for root canal Filling Gutta - percha

Instruments for root canal Filling NameGutta percha pointsFunction and features Non-soluble, non-irritant points that are condensed into the pulp chamber during obturation Standardized type: follows same ISO classification as endodontic files Non-standardized: have a greater taper than the standard ISO type

Instruments for root canal Filling Hand spreader

Instruments for root canal Filling Finger spreader

Instruments for root canal Filling spreader

Instruments for root canal Filling NameFinger spreaderFunction, features and precaution Finger instrument with a smooth, pointed, tapered working end Used to condense gutta percha laterally into the canal during obturation

Instruments for root canal Filling Hand Plugger

Instruments for root canal Filling Finger Plugger

Instruments for root canal Filling Plugger

Instruments for root canal Filling NameEndodontic pluggerFunctionWorking end is flat to facilitate plugging or condensing the gutta percha vertically after the excess has been removed by melting off with a heated instrument

Instruments for root canal Filling Lentulo spiral Drill

Instruments for root canal Filling NameLentulo spiral filler/rotary paste fillerFunction and features Small flexible instrument used to place materials into the canal Fits into the conventional hand piece Use with caution as it can be easily broken

the endodontic ruler

the endodontic ruler

the endodontic rulerFunction

Special endodontic rulers are available for measuring the length of finger instruments

Endodontic block or Transfer sponge

Endodontic block or Transfer sponge

Functions An endodontic block is a study block used to organize and hold endodontic finger and rotary instruments during procedures;

Reduces the possibility of percutaneous injuries when handling endodontic finger and rotary instruments

Endo locking tweezers

Endo locking tweezersEndo locking pliers or (endo locking tweezers):

it has lock "latch" that permits materials to be held without continuous finger pressure, it has a groove at the tip, the grooved tip facilitate holding absorbent points and gutta percha cones.

Electronic Apex Locators119

Electronic Apex Locators120NameApex locator

Functions An electronic instrument used to determine the distance to the apical foramen The screen allows the operator to visualize the file movement during instrumentation

Electric pulp tester121

Electric pulp tester122NameElectric pulp tester

Function and directions for use

Used to test the vitality of a tooth using electric stimulus Electric stimulus is increased in small increments until the patient can feel the stimulus Toothpaste or prophy paste is used to conduct the current from the pulp tester to the tooth

Loupes

operating microscope

Loupes & operating microscope Illumination and magnification are vital forthe location of root canals. The endodontist would use a surgical microscope while a general dental practitioner might have loupes and a headlight that give excellent magnification and illumination .

REFERENCE

INGLES ENDODONTIC,5TH EDITION

PATHWAYS OF PULP,5TH EDITION

GROSSMANS ENDODONTIC,13TH EDITION ENDODONTIC INSTRUMENTS:BASIC AND HAND,MOHD ABBAS,2014.

MASTERING ENDODONTIC INTRUMENTATION:MACSPADDEN,2006.

REVOLTION IN ENDODONTIC INSTRUMENTS:REVATHI S RAO

ENDODONTIC INSTRUMENTS AND MATERIALS :DR SHANDRA SHOSTRAD

Thank you