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8/3/2019 Bio Mechanical Instrumentation
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Rotary CanalRotary CanalPreparationPreparationRotary CanalRotary CanalPreparationPreparation
Dr. Ebtissam Al-Madi, BDS, MSc, Cert Endo, Cert Med Informatics
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Outline Objectives of Cleaning & Shaping
Biological
Clinical
Mechanical
Instrumentation Techniques Stepback technique
Crowndown technique Rotary Instrumentation
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Biological Objectives Removal of all tissue, bacteria and bacterial
products and substrates from the rootcanal system
Mechanical Shaping of the root canal system to
facilitate placement of a root canal filling
Clinical Eliminate apical periodontitis and return
tooth to normal function3Al-Madi, 491 Den, 2008/904/Apr/09
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Cleaning
Shaping Filling
Endodontic
Triad
Shaping to facilitate cleaning and Filling
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Access
Preparation
Cleaning & Shaping
of the canal
Obturation
Restoration
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Stepback
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Stepback Technique(1960s)
The most widely used preparationtechnique
Replaced Non-tapering Preparationtechnique
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Stepback Technique Apical Preparation:
1. Establish access (straightline)
2. Establish working length
3. File Instrument (watch-winding, file, ream, etc)
4. Place next larger file,instrument, and repeat till
you reach file 3-4 sizeslarger (MAF)
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Stepback Technique
Step back:1. Place next larger file to a
length 1 mm shorter ofworking length, file, irrigateand recapitulate
2. Repeat process withsuccessively larger files at 1mm increments shorter thanpreceding file.
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Stepback Technique Variations to the classic stepback
technique Initially enlarge coronal aspect with GG
burs
Complete coronal preparation with GGburs
Use of small GG burs in mid-root level
Use of Hedstrom files to flare thepreparation
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Stepback technique Advantages
Minimizeprocedural errors(transportation,ledging, apicalperforation)
Disadvantages Significant apical
extrusion of debris(post-operativepain)
Apical blockage
Canal deviation
Alteration of
working length
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Crown down
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Crowndown Technique
More recent technique Produce similar result to step-back
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Crowndown technique Development of straight-line access Eliminate pulp chamber obstructions
and check patency GG enlargement with size 4-3-2,
irrigate Coronal to mid root enlargement with
instruments from large to small,irrigate
Establish working length, irrigate Introduce progressively smaller files
deeper into the canal until resistanceis encountered Establish apical preparation size Complete preparation 14Al-Madi, 491 Den, 2008/904/Apr/09
Crowndown technique
Variations to the classic crowndowntechnique Crown-down pressure-less technique
Roane technique
Double flare technique
Modified double flare technique
Rotary Instrumentation
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Crowndown technique Advantages
Reduce apicalextrusion (reducepain)
Elimination coronalinterferences
Improved irrigation toapical part of canal
Facilitate workinglength determination
Disadvantages Early blockage of
canal
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Instruments
HandInstruments
RotaryInstruments
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Hand instruments
Been in use for over 100years
Still integral part ofcleaning & shaping
Better tactile sensation
ISO standardization
Broaches, k-files, Flex-R files, NiTi files, H-files
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Hand engine driven Properties of NiTi Alloy
Superelasticity High resistance to cyclic fatigue
Series 29
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Rotary Files Advantages
Less transportationand ledging
Shape canaluniformly
Reduced operatorfatigue
Improvedefficiency
Disadvantages Cannot be used in
some cases Buildup of debris Cannot use beyond
apical foramen Fracture can occur
suddenly Initial cost Loss of tactile
sensation
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Rotary Instruments
Lightspeed Profile
Hero
Quantec
K3
Flexmaster
GT
Protaper Sequence
RaCe
V-taper
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Design characteristics Non-cutting vs cutting
tip
Tip size
Taper
Cross section
Rake angle
Helix angle
Pitch
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Tip could be
non-cutting,
cutting
Tip shape
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Tip Size
Can be the same as ISO hand
tips sizes- color coded accordingly
Can be half sizes (12.5, 17.5,etc) as in Light Speed.
Can skip sizes ( only 20,30, 40)as in GT rotary
Can be nonspecific sizes(according to percentages ex.18.5, 20..) as in ProTaper.
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Increased radial landincreases peripheral
strength behind the
cutting blade
Smaller radial landequals decreased
strength for bladesupport
Cross section- Radial Lands
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Rake Angle
The rake angle is the angle formed by the cuttingedge and a cross section taken perpendicular to thelong axis of the instrument
Rake angles affect thecutting efficiency andthe aggressiveness ofthe file
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Overly Positive Rake Angle
Positive Rake Angle
Neutral Rake Angle
Negative Rake Angle
Rake Angle
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As the flute angle isincreased more debriscan be carried awayfrom canal.
Helical flute angles
The helical angle is the angle that the cutting edgemakes with the long axis of the file
Constant helical fluteangles allow debris toaccumulate and are moresusceptible to the effectof screwing in forces.
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Pitch
Pitch is the number of spirals or threads perunit length.
Constant pitch andconstant helical anglesproduce a pulling orsucking down into thecanal.
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Lightspeed(Senia & Wildey 1990s)
Long, thin non-cutting shaft
U shape design
Most flexible RI
Low incidence oftransportation,preparation errors,and loss of workinglength
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Profile(Ben Johnson 1994)
Increased taper
Began as series 29#0.02 taper, then#0.04 and 0.06 tapers
Profile (maillefer-Europe) manufacturedtips similar to ISO
Negative rake angle
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Coronally pre-enlarge
Use of Orifice shapers
Alternative use of #.04and #.06 tapers as wellas alternate tip sizes
Same basic techniquefor similarly designedfiles
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Profile41Al-Madi, 491 Den, 2008/904/Apr/09
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Profile
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K3(McSpadden)
Predecessors:
Quantec
Unique crosssectional designwith +ve rakeangle, 3 wide radiallands, peripheral
blade relief
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ProTaper(Cliff Ruddle, John West, Pierre Matchou)
Only 6 instruments Modified k file
with no radial lands
Varying taper thatincrease coronallyin shaping files andopposite infinishing files
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ProTaper52Al-Madi, 491 Den, 2008/904/Apr/09
Hybrid technique Instruments can be used in a manner that
promotes their individual strengths andavoids their weaknesses
Hand instruments secure a patent glidepath
Tapered rotary instruments efficientlyenlarge coronal canal areas
Less tapered instruments allow additionalapical enlargement
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Newer RotaryInstruments?
Light Speed Hero 642
GT files
Quantec
Flexmaster
RaCe V-Taper
Endo Sequence
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More information Pathways of the Pulp 9th e-edition
Endodontics- Ingle 5th
CD editon Advanced Endodontics- Rhodes Endodontics- Stock JOE IEJ Company brochures & Videos Internet
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ObturationObturationtechnologiestechnologiesObturationObturation
technologiestechnologies
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The ideal obturatingmaterial
Easily manipulated and provides ample working time Dimensionally stable with no shrinkage once inserted
into the canal Seals the canal laterally and apically, conforming toits complex internal anatomy
Nonirritating to the periapical tissues Impervious to moisture and nonporous Unaffected by tissue fluids-no corrosion or
oxidization Inhibits bacterial growth Radiopaque and easily discernible on radiographs Does not discolor tooth structure Sterile Easily removed from the canal if necessary 61Al-Madi, 491 Den, 2008/904/Apr/09
Obturating materials Core Materials
Silver cones
Gutta percha
Resilon
Sealers
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Resilon
Resin-basedobturation material Polyurethane Similar to GP:
Method of placement
Remove smear layer Use a self-etch primer Light cure coronal
surface
Advantages: Less coronal leakage Reduced PA
inflammation More resistant to
fracture
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Methods of obturation Lateral compaction Warm vertical Compaction
Continuous Wave compaction Warm Lateral Compaction Thermoplastic Injection Techniques Carrier based Gutta-Percha Thermo-mechanical Compaction Solvent Techniques Pastes
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Continuous WaveCompaction technique
Electric Heat Carrier (System B-Elements system)
Tapered Stainless steel pluggers(#.06, .08, .10, .12) with #50 tip(.5mm)
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System B
Fit master cone (Fine-medium-large) Prefit plugger to 5-7 mm of canallength
Set heat to 200c Sear off coronal GP Compact with heat to within 3 mm of
binding point Maintain non-heat position with firm
pressure for 5-10 sec Remove plugger with a 1 sec burst of
heat. Back fill with thermoplastic injection
technique or warm verticalcompaction 66Al-Madi, 491 Den, 2008/904/Apr/09
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Elements Obturation
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How & Where to learn? Read & understand the brochure-
Don't be fooled! Read the literature in textbooks andjournals- Be an informed consumer.
Try on extracted teeth till youmaster the technique- try before youbuy.
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