Cleanliness is next to Godliness....

Cleanliness is next to Godliness....
How apt this old adage to the science of endodontics, as the very goal of root canal treatment is the complete debridement of all tissue and debris from the root canal system followed by perfect obturation. Although this may not always be attainable, striving for this ideal should be the goal of every endodontic professional. The cleaning and shaping of root canal depends on various factors: Techniques Operator skill Materials Type of instrument used Instruments play a very important role and to understand these, today's seminar is on endodontic instruments. ENDODONTIC INSTRUMENTS

ENDODONTIC INSTRUMENTS
Although general guidelines exist for root canal preparation, due to the complex and varied canal anatomy each case presents unique characteristics requiring the clinician to vary the armamentarium and technique to adequately clean and shape the canals. A variety of instruments are thus available for this purpose. ENDODONTIC INSTRUMENTS

CONTENTS MATERIALS STANDARDIZATION CLASSIFICATION FILE DESIGN HAND INSTRUMENTS HANDPIECES INSTRUMENTS CONCLUSION CONTENTS Materials Standardization Classification Access cavity instruments File design Hand instruments Handpieces Ni-Ti rotary instruments Conclusion References ENDODONTIC INSTRUMENTS

MATERIALS USED ENDODONTIC INSTRUMENTS

MATERIALS Carbon steel Stainless steel Titanium Nickel titanium MATERIALS The material from which the root canal instruments are made is important. The material must be hard enough to hold a sharp edge but flexible enough to follow curves and resist breakage. CARBON STEEL: Traditionally (until 1960) endodontic instruments were made with carbon steel/ these instruments were produced by grinding graduated sizes of round piano wire into square or rectangular configuration. Disadvantages: brittle rigid –likely to fracture susceptible to corrosion (sterilization with iodine, chlorine, steam sterilization, or NaOCl solution) STAINLESS STEEL :Stainless steel instruments have replaced carbon steel today. A stainless steel wire is ground along the long axis into a 4 sided (square) or 3 sided (triangular) tapered shaft and twisted into flutes. Advantages: more resilient and ductile than carbon steel Less likely to fracture (compared to carbon steel) less susceptible to corrosion. Distortion Stiffness of the material Tendency to fracture Need to precurve the file in curved canals To overcome these disadvantages there was a search for an alternative material for endodontic instruments. The most promising alloy at this time is NITINOL or Nickel Titanium alloy and more resilient Ti-Al alloy. TITANIUM – it is flexible NICKEL TITANIUM- it is the most flexible (will be discussed in detail under Ni-Ti rotary instruments) ENDODONTIC INSTRUMENTS

Materials used: a) In 19th century carbon steel was used for manufacturing of instruments. Disadvantages fracture tendency due to the brittleness of metal. corrosion along with NaOCl irrigant and during steam sterilisation. b) In 20th century stainless steel was used by Kerr manufacturing company . Advantages : It is flexible ,hence less likely to fracture when strained. less susceptible to corrosion. Disadvantage: when canal curvature is > 450 it may fracture

c) Nickel titanium (nitinol) NiTi__most flexible
Advantages – low elastic modulus and thus provides very good elastic flexibility to instrument ,hence used in curved canal shape memory alloy ---it has the ability to recover from plastic strain when unloaded. Dis advantage –expensive difficult to manufacture and mill. d) Titanium and aluminium alloy.

Standardisation Historically, the search for the perfect instruments for removing “worms” from the root canal space has been an ongoing quest. Thistles for this purpose were largely abandoned by the early 1800’s. The first “modern” broaches were made from untempered steel of watch springs. Historically, very little was done to improve the quality of standardization of instruments until the1950’s. Before 1958 endodontic instruments were manufactured without any established criteria. There was no uniformity in quality control, manufacture or progression from one size to another and there was no correlation of instruments and filling materials in terms of size and shape. These were arbitrarily numbered from 1 to 6.beginning in 1955, a serious attempt was made to correct these abuses, and in 1959 a new line of standardized instruments and filling materials were introduced. In 1958, Ingle and Levine proposed standardization of these instruments: 1) Instruments shall be numbered from 10 to 100, the numbers to advance by 5 units to size 60, then by 10 units to size 100. 2) Each number shall be representative of the diameter of the instrument in hundredths of a mm at the tip. 3) The working blade (flutes) shall begin at the tip, designated site D1, and shall extend exactly 16 mm up the shaft, terminating at designated site D2. The diameter of D2 shall be 32/100 or 0.32mm greater than that of D1. This sizing ensures a constant increase in taper of 0.02 mm per mm for every instrument regardless of the size. Add table from ingle 5th pg 475 By 1962, a working committee on standardization was formed which included: Manufacturers American Association of Endodontists (AAE) American Dental Association (ADA) This group evolved to the present day International Standards Organization (ISO) which consisted of : Federation Dentaire International WHO ADA instrumentation committee In 1976 the first approved specification for root canal instruments was published, i.e. ADA Spec. No. 28. Formulation of product specifications is through the joint effort of the ANSI (American National Standards Institute) and the CDMIE (Council on Dental Materials, Instruments and Equipment) of the ADA. Working independently, both FDI/ISO and ANSI groups continue to make progress in the development of international and national standards for endodontic instruments and materials. In 1989, the ANSI granted approval of the ADA Spec No 28 for endodontic files and reamers. Other specifications were later added: 1) The tip angle of the instrument should be 75±15º. 2) Instrument sizes should increase by 0.05 mm at D1 between nos 10 and 60, and they should increase by 0.1 mm from nos 60 to 150. 3) The full extent of the shaft, upto the handle is available in 3 lengths: Standard : 25 mm Long : 31mm (canines) Short : 21 mm (2nd, 3rd molars) 40 mm: for endodontic implants Special lengths: 19 mm instruments 4) Other changes were: Universal use of stainless steel than carbon steel. In addition instrument handles have been color coded for easier recognition. Re-emergence of power driven instruments. 5) The numbering system was revised in 2002. Smaller (No. 06 and 08) files and larger (No. 110 to 150) sizes were added to increase instrument selection. These nos were based on the diameters of the instruments in hundredeths of a millimeter at the beginning of the tip of the blade called D0 (diameter 1) and extending up the blades to the most coronal part of the cutting edge at D16 (diameter 2)-16 mm in length. Additional measurements of D16, 16mm from D1 , and D3, 3mm from D1 were added. D16 was added as many manufacturers were making files with cutting lengths greater than 16mm and D3 was added because of the importance of the apical 3mm of the instrument in adequate apical preparation. Newer changes includes: Addition of tapers greater than ISO 0.02 taper; i.e. 0.04, 0.06, 0.08 tapers. Half sizes in the 0.02 flare : 2.5, 17.5, 22.5, 27.5, 32.5, 37.5-for shaping fine canals. Use of different materials ENDODONTIC INSTRUMENTS

STANDARDISATION: Ingle and Levine in 1958 recommended. describes 3 features a) Diameter and width b) Length of cutting blade c) Taper ENDODONTIC INSTRUMENTS

D1---1/100th of mm D2---D1+0.32mm Taper is 0.02mm/mm of length STANDARDIZATION Ingle and Levine (1959) Instruments No Diameters- 1/100 of tip D1 and D2 ENDODONTIC INSTRUMENTS

Instrument are numbered from 10 to 100, the numbers to advance by 5 units to size 60 and then by 10 units till size 100 2) Each number shall describe the diameter of instrument in 100th of a mm at the tip eg: size 10-tip is 0.1mm 3) The working blade (flutes) shall begin at the tip designated as D1, and the flutes extends to the length of 16mm designated as D2 Taper of the instrument from D1 to D2 is in increments of 0.02mm in width/mm of length ENDODONTIC INSTRUMENTS

So, the diameter of D2 shall be 0.32mm greater than D1 ex: 20 reamer D1 is 0.2 D2 is = 0.52 Other specifications: a) Tip angle of instrument ± 15 b) Instrument sizes should increase by 0.05mm at D1 between 10 to 60 And by mm from 60 to 100 for increased instrument selection. ENDODONTIC INSTRUMENTS

Instruments are available in different lengths 21mm, 25mm,28mm, 30mm,40mm 21mm length is used for molars 25mm length is used for anteriors 28 & 30mm length is used for cuspids 40mm reamers used in preparing canals for endodontic implants ENDODONTIC INSTRUMENTS

4) Instruments are color coded White 15 45 90 Yellow 20 50 100 Red 25 55 110 Blue 30 60 120 Green 35 70 130 black 40 80 140 ENDODONTIC INSTRUMENTS

For narrow Root canals- size 06, 08 , are used pink grey purple Modifications –of k-flex files Length of flutes is 18mm from tip to extent I.e D1and D2 not signified This recommends use of D0 and D16 D D16 1mm above D0 is D1 D17 - D18 are also present ENDODONTIC INSTRUMENTS

In Jan 1976, ASI [American std institute] granted approval of ADA Specification. No.28 for endo files and reamer No.58 for H files ENDODONTIC INSTRUMENTS

ADA Specification. No.28 revision in March 1981 stated instrument sizes No.6,8,10,15 were added to original standardisation 2) D1 and D2 changed to D0 and D16 Six factors considered while analyzing endo instrument Material that is cut Anatomic configuration of r.c Material of cutting instrument Manufacturing process (grinding / twisting) Design of instrument (files – reamer) Fluid used during procedure. ENDODONTIC INSTRUMENTS

Manufacture of instrument ENDODONTIC INSTRUMENTS

Manufacture of instrument: In early 1900’s Kerr manufacturing company designed and manufactured new K type endodontic instrument. Initially the instrument were manufactured from round tapered piano wire (carbon steel), but now they are made from st. steel blanks. ENDODONTIC INSTRUMENTS

The st.steel wire is ground along its long axis into a 4 Sided (square c.s) or 3sided (triangular c.s) tapered shaft that is twisted into flutes extending 16mm from the top to the tip of blade . The number of flutes twisted into each blade determines whether instrument is a file or reamer. Files---tighter flutes Reamers---looser flutes ENDODONTIC INSTRUMENTS

Recently rhomboidal or diamond shaped blanks are twisted to produce a file---K flex to increase flexibility & cutting efficiency. H files– Manufactured from round st.steel wire machined to produce spiral flutes resembling cones or screw. Unifiles Machined from round st.steel wire by cutting 2 superficial grooves to produce flutes in a double helix design. ENDODONTIC INSTRUMENTS

The cutting edges may be generated by twisting the metal shaft along its long axis or by machining it. When twisted, square blank produces rigid instrument, the triangular shape is flexible, rhomboid shape is more flexible. When machined, the depth of cut used to produce the flutes dictates the flexibility and strength of the instrument.They tend to be more susceptible to fracture. ENDODONTIC INSTRUMENTS

CLASSIFICATION ENDODONTIC INSTRUMENTS

CLASSIFICATION According to Grossman Exploring instruments Instruments for debridement Shaping instruments Obturating instruments ENDODONTIC INSTRUMENTS

According to Grossman [based on the function] 1) Exploring : to locate the canal orifices. to determine or assist in obtaining patency of the R C Egs : Endodontic explorer & smooth broaches 2) Debridement : to extirpate the pulp to remove cotton pellets or paper points Egs : barbed broach 3) Cleaning & Shaping Egs : Reamers and file ENDODONTIC INSTRUMENTS

4) Obturating : For condensation of G.P & to create space laterally Egs : Spreaders and pluggers lentulospirals [engine driven,latch type of attachment and Working portion is spring like that is coated with RC sealer. ENDODONTIC INSTRUMENTS

International Standards Organization (ISO) has grouped root canal instruments according to their use: Group I: hand use only: Files H-type K-type reamers and files Broaches Group II: engine driven latch type Same design as in group I but made to attach to hand piece. Profile, Lightspeed ENDODONTIC INSTRUMENTS

Group III: engine driven latch type Low speed instruments where latch type attachment is in one piece with working part. Gates Glidden drills and Peeso reamers. Group IV: root canal points. Gutta percha, silver points and paper points. ENDODONTIC INSTRUMENTS

According to Stock: Twisted Machined K-files H file K- reamer Flex R K-flex file Canal master Flexo Heliapical Zipper flexicut Flexogates Mc spadden engine file ENDODONTIC INSTRUMENTS

Broaches and Rasps : oldest endo instrument : used for removal of pulp tissue : used for removal of cotton or paper points from R.c Broach Rasp Barb height is large It is small As the barb comes out of instrument,broach is a weaker instrument compared to rasp 3. Taper is to 0.01 mm/mm Taper is mm/mm ENDODONTIC INSTRUMENTS

More fragile because of depth of shallower and cut rounded barbs 5. Coronally angulated barbs perpendicular to long axis of metal Both are not used beyond middle 3rd of R.c and also entangle in R.c and get separated ENDODONTIC INSTRUMENTS

Differences in files and reamers Fracture More in counterclockwise 90° 60° ENDODONTIC INSTRUMENTS

K- File Produced by twisting a 4 sided pyramidal blank I.e Square c.s The instrument have between one quarter to ½ spiral per mm length The file has more flutes per length unit than the reamer The blade angle makes them best suited for cutting dentine using a push pull filing motion. [K type instrument works by crushing the dentin when turned into a canal smaller than the diameter of the instrument] ENDODONTIC INSTRUMENTS

K Reamer: ENDODONTIC INSTRUMENTS

K Reamer: The instrument is produced by twisting a 3 sided blank i.e triangular c.s which makes reamer more flexible than files. These instruments have less than one tenth and one quarter of a spiral per mm of length giving a rake angle which cuts more efficiently using a rotary motion ,hence reaming motion. They are used with a rotating pushing motion limited to half turn and disengage with a pulling motion ENDODONTIC INSTRUMENTS

Flutes are placed farther apart and hence more space between flutes allowing better transport of dentin debris Angle less than 90 ,cutting efficiency is more. If surface area is less , then flexibility is more. ENDODONTIC INSTRUMENTS

Reaming— place instrument till apical constriction and give ¼ to ½ turn and pull out. In narrow canal-less turn is given and in wider canal large turn is given. Files can be used in reaming motion,but reamer does not cut efficiently in filing motion. ENDODONTIC INSTRUMENTS

Files Reamer Square c.s triangular c.s Tighter flutes loose spirals Resists fracture better. Cutting efficiency is times more Maintains keen edge sharpness is lost rapidly More number of flutes less number of flutes Filing and reaming motion reaming motion ENDODONTIC INSTRUMENTS

K style modification----K flex file It was introduced in 1982 This instrument is twisted from a tapered blank with a rhombic c.s that produces alternating high and low flutes that increase flexibility and cutting efficiency of instrument and also facilitates removal of debris. a<90 improved cutting efficiency b>90 (obtuse angle) does not contact R.C,increased debris removal Used in curved and narrow canals. a b b a ENDODONTIC INSTRUMENTS

Flex O files It is very similar to K file but is made from softer more flexible steel It does not fracture easily and is very flexible. Tip is modified to non cutting ENDODONTIC INSTRUMENTS

Golden medium: Range of intermediate files described by Weine provide half sizes between traditional instruments for narrow canals (instrument should be intermediate to 12-20 Sizes from (12,17,22,27,32,37) manufactured by maillefer. ENDODONTIC INSTRUMENTS

(weine suggested trimming 1 mm from the tip of the file rounding off sharp edges on diamond nail file) In this way, file sizes 10, may be converted to 12,17,22,27. Disadvantage is files are made disposable ,and edges are difficult to smooth. ENDODONTIC INSTRUMENTS

Flex R file: designed to be used in balanced force technique. Machined from blank of triangular c.s Non cutting tip ENDODONTIC INSTRUMENTS

An instrument is rotated a quarter turn [clockwise] as gentle pressure is exerted to insert it. This action positions the cutting edges equally into the walls. Next it is rotated anticlockwise at least 1/3 of a revolution. Simultaneous apical pressure and anticlockwise rotation of file sustains a balance between tooth structure and instrument so that it is near the canal axis. ENDODONTIC INSTRUMENTS

Heliapical: This instrument resembles conventional file in the apical 4-5mm the remainder being a narrow blank shank Small sizes fracture ENDODONTIC INSTRUMENTS

HEDSTROM FILES (ANSI 58) Milled instrument- multiaxial grinding Positive rake angle Cuts in pull motion Uses ENDODONTIC INSTRUMENTS

It is machined from a blank of circular c.s. The flutes are produced by machining a single helix into the metal stock, producing a series of intersecting cones which increase in size from tip to handle . The strength and flexibility is determined by the depth of flute or residual bulk of metal in central portion of file. H- File machined instrument ENDODONTIC INSTRUMENTS

The blades are at right angles to dentine surface and so most efficient cutting motion is a pulling stroke. No dentine is removed by push stroke Rotating the instrument with a tip of file engaged in dentin is a common cause of fracture. ENDODONTIC INSTRUMENTS

They are aggressive cutters. It resembles ‘Christmas tree’ appearance. [cone over cone] used to remove loose broken instrument. Disadvantage: Fracture tendency because of depression between flutes causing narrowness between core material. ENDODONTIC INSTRUMENTS

H- Style Modification: Burns uni file: It is identical to H file but it has two cutting blades instead of single cutting blade. S-shaped c.s or double helix design cuts more efficiently ENDODONTIC INSTRUMENTS

Canal Master: The cutting portion resembles a reamer with blunted edges and is reduced to 1-2mm with a 0.75mm non cutting pilot tip. The rest of the instrument consists of a parallel sided blank of round c.s, narrower than the cutting tip. The most efficient means of cutting is using a clockwise rotary motion through 600 Fracture potential is more. ENDODONTIC INSTRUMENTS

Canal Master & Canal Master U
Wildey and Senia 1-2mm cutting head 0.75 mm non-cutting head Blank shaft Sizes available Now available in Ni Ti ENDODONTIC INSTRUMENTS

Flexogates : St. steel instrument resembles canal master It consists of a smooth, flexible shank which is circular and small in c.s Non cutting tip is followed by approximately one spiral of fluting on an expanded head carried on the shank. It is made weak at the handle to ensure access for removal of broken instrument ENDODONTIC INSTRUMENTS

Mc Spadden Engine file Used in rotary hand piece at slow speed (300r pm) Made from Ni – Ti alloy. ENDODONTIC INSTRUMENTS

- S- file: Variation of unifile A- File Modified by levy Available as hand and automated files steep depth of flutes (400 helical angle ) non cutting tip avoids ledges and perforations. ENDODONTIC INSTRUMENTS

Greater taper Hand Files Made of Niti. Each instrument is designed to be active in counter clockwise direction and has a D0 diameter 0.2 [D0 – 0.2] GT files have increasing tapers of 0.06, 0.08, 0.10, mm/mm The length of the blades varies from file to file depending on the taper. Designed to cut more toward their shank side cutting blades . ENDODONTIC INSTRUMENTS

International Standards Organization (ISO) Group I: hand use only Group II: engine-driven latch type Group III: engine-driven latch type Group IV: root canal points International Standards Organization (ISO) has grouped root canal instruments according to their use: Group I: hand use only: Files H-type K-type reamers and files R-type Rasps (rattail files) Probes (smooth broaches) applicators Broaches Pluggers, spreaders Group II: engine driven latch type Same design as in group I but whose handle has been replaced with an adapter for insertion into a slow speed contrangle handpiece. They are composed of two parts, an operative cutting head and a latch type attachment. e.g. Profile, Lightspeed, also included are Lentulo paste fillers, also included are specially designed root canal instruments : B-2 , quarter turn reamers Group III: engine driven latch type Similar to group II, in that they are Low speed instruments with latch type attachment. But they are fabricated from a single piece of metal-latch , shaft and cutting head are composed all of one piece. Eg. Gates Glidden drills and Peeso reamers. As well as a host of others, B-1 reamer, A, D, O, KO, T, M –type reamers and the Kurer Root-Facer. Group IV: root canal points. Gutta percha, silver points and paper points. These instruments will be described in detail later. ENDODONTIC INSTRUMENTS

According to Cohen Hand instruments: those specific to endodontics Instruments for pulp space preparation Group I Group II Group III Devices for root canal length measurements Instruments for root canal obturation Devices for removal of root canal obstructions According to Cohen Hand instruments: those specific to endodontics Devices for root canal length measurements Instruments for pulp space preparation (Cohen 9th) Group I: hand and finger operated such as barbed broaches, K type and H type instruments Group II; low speed instruments on which latch type of attachment is part of the working head. Eg; Gates glidden burs and Peeso reamers Group III: engine driven instreuments similar to hand and finger operated instruments. However, handles of these engine driven instruments have been replaced with attachments for latch type handpiece. In the past, few instruments were in this group as rotary files were rarely used, but with the popularity of rotary Ni-Ti instruments, although not standardized, these instruments are included in this group. Instruments for root canal obturation Devices for removal of root canal obstructions ENDODONTIC INSTRUMENTS

ADA classification Type I : Reamers Type II : Files Type III : Hedstroem files Type IV : Rasps Type V : Broaches Type VI : Probes Type VII : Applicators Type VIII : Condensers Type IX : Spreaders Classification of endodontic instruments and materials: (see write up) Classification of Endodontic files and reamers according to new ADA specification No. 28 Type-I Reamers (FDI/ISO Root Canal Reamers type-K). Type-II Files (FDI/ISO Root Canal Files type-K). Type-III Hedstroem Files (FDI/ISO Root Canal Files type-H). Type-IV Rasps (FDI/ISO Root Canal Rasps type-R). Type-V Broaches (FDI/ISO Root Canal Barbed Broach. Type-VI Probes (FDI/ISO Root Canal probes). Type-VII Applicators (FDI/ISO Root Canal Applicators). . Type-VIII Condensers (FDI/ISO Root Canal Condensers). Type-IX Spreaders (FDI/ISO Root Canal Spreaders). ENDODONTIC INSTRUMENTS

According to Harty For access cavity preparation Basic instruments Burs Rubber dam For root canal preparation Hand instruments Power assisted root canal instruments Electronic canal measuring system Measuring instruments, gauge and stands Instruments for retrieval of broken instruments and pastes Instruments for root canal filling According to Harty For access cavity preparation Basic instruments Burs Rubber dam For root canal preparation Hand instruments Power assisted root canal instruments Electronic canal measuring system Measuring instruments, gauge and stands. Instruments for retrieval of broken instruments and pastes Instruments for root canal filling ENDODONTIC INSTRUMENTS

HAND INSTRUMENTS ENDODONTIC INSTRUMENTS

INSTRUMENT PACK front surface reflecting mouth mirror Endolocking tweezers Probes Excavators Metal ruler Endoring Miscellaneous HAND INSTRUMENTS FOR ENDODONTICS (INSTRUMENT PACK) A basic pack of instruments must be available specifically for routine root canal procedures. A front surface reflecting mouth mirror is preferable to prevent the double image of the fine detail in an access cavity that occurs with a conventional mirror. Endolocking tweezers allow small items to be gripped safely and passed between nurse and operator.te tip of the beak should be blunt and containing grooves. They are important for four handed transference between operator and the assistant. The regular Perry or College Plier is also required for working inside the pulp chamber because the working ends of the “Points Pliers” are often too large. A D-5(cohen 9) explorer , No (Grossman), DG16 endodontic probe is required to detect canal orifices. The endodontic explorer has two straight very sharp ends that are angled in different directions form the long axis of the instruments. It has a right angled and a binagled end. A CK-17 explorer serves the same purpose, but its thinner stiffer tip can be used to identify calcified orifices. A #17 operative explorer can be used to detect any pulp chamber roof especially in area of pulp horn. * NEW: a new addition to the finding and enlarging orifices, is the MICRO-OPENER with K type flutes, in 0.04 and 0.06 tapers, mounted like a spreader that can be used to uncover, enlarge and flare the orifices. This is followed by the MICRO – DEBRIDER with H file type flutes, and ISO 0.02 taper to further open and flare down the canal. The excavator is long shanked, with a small blade to allow access into the pulp chamber. They have a much longer offset from long axis of the instruments(for better reach inside the constricted canal chambers) than the regular spoons. They are used to remove carious material and excise pulp tissue. , therefore they should be kept well sharpened. The pocket-measuring probe is useful, a routine CPITN probe with clearly visible gradations is ideal. A furcation probe is useful to check for the presence of furcation involvement. Miscellaneous: Other items usually included are a flat plastic, sterile cotton wool rolls, sterile cotton wool pledgets, artery forceps to grip a periapical radiograph and a metal ruler, or other measuring device that may be sterilized. A clean-stand or other device such as the endoring is required to hold the endodontic instruments. Paper points are also required, and the simplest method of storage and use is to purchase presterilized packs with five points in each pack. it is useful to have all endodontic instruments in sterilized containers, such as the clean stand or endodontic ring shown in Figure of file holders. This allows the instruments to be easily controlled, and accessed by both the operator and assistant during treatment. Other Instruments required are : Rubber dam kit Radiographic equipment ENDODONTIC INSTRUMENTS

Endo locking tweezer Mirror Long shank excavator ENDODONTIC INSTRUMENTS

Explorer: No DG 16 Explorer: CK 17 DG 16 Right angle Binangle # 17 operative explorer ENDODONTIC INSTRUMENTS

Micro opener & Debrider Micro opener 7 mm K type flutes # 10, 15, 0.04, 0.06 tapers Micro debrider Hedstrom cutting configuration .02 taper, sizes #20, 30 16mm cutting flutes For hard-to-reach, hard-to-visualize canals ENDODONTIC INSTRUMENTS

Other instruments/equipment
Selection of file holders Other instruments/equipment ENDODONTIC INSTRUMENTS

ACCESS CAVITY INSTRUMENTS
ENDODONTIC INSTRUMENTS

Round carbide burs Fissure carbide burs Tapered diamond burs ENDO ACCESS BUR HANDPIECES: High speed handpiece: for penetration of dentin Slow speed handpiece: increased tactile awareness , for removal of pulp chamber roof Ultrasonics: for constricted/receded and calcified chambers BURS: Round carbide burs (# 2, 4, 6, 8): remove caries (better control than fissure carbides), create initial external outline shape, penetrate the roof, removal of the roof. These are: (Messing) Standard bur: for removing calcified deposits at entrance of canal at pulp floor 16 mm bur for floor of pulp chamber: Shank is 3 mm longer than standard bur Long shank round bur: Overall length is 23 mm Goose neck round bur : for locating sclerosed canals, extended narrow shank does not get deflected by the wall of access cavity Fissure carbides (#558, #57) : produce less “chatter” when penetrating intact enamel or dentin as compared to round carbides. Also for extension of the axial walls. Tapered diamonds: a round carbide may result in uneven gouged walls when used to finish the unroofing of the pulp chamber. The long cutting surface of the diamond can open the cavosurface of the access and smoothen the walls. The tapered rounded end diamond is also used (Endo access bur: Is a friction grip, stainless steel bur with special diamond coated round tip that matches round burs of size No. 2, No.4 and No 6 with a diamond shaft for smoothening and shaping the access walls ,these burs are useful for initial and final access preparations . These burs combine both penetration and smoothening capabilities.) However, both the carbide and diamond fissure burs can gouge the pulp floor and the walls if used improperly. Fissure carbide and diamond with safety tips: safer choice for axial wall extensions .(ENDO Z BUR: A safe ended diamond or tungsten carbide bur, with a non cutting tip, is used to taper the access cavity preparations. The non cutting tip prevents gauging on the floor of pulp chambers and cavity walls) Round diamonds (#4, 6): to cut through PFM and all porcelain crowns. Diamond burs are less traumatic to porcelain than carbides and are more likely to penetrate it without cracking or fracturing it. After removing the porcelain, a carbide fissure bur of special metal cutting bur can be used to penetrate the metal. Metal cutting burs: includes the Great White, Beaver bur, Transmetal bur (the bur has extra fine crosscuts ), Brassler H34L. They have round ended, cross cut design, that minimizes chatter. Used to penetrate metal restorations like amalgam, all metal cast restorations and metal copings of PFM’s. Surgical length burs (round and fissure): increases the visibility of the cutting tip of the instrument by moving the head of the handpiece away from the tooth. Care should be taken when extended burs are used to prevent perforation. The regular-length bur on the left will reach 9 mm. The surgical-length bur will reach 14 mm. Brasseler also manufactures latch-type, 34-mm-long round burs with standard shafts of 2.4-mm diameters. These are 4 mm longer than standard, 30-mm, surgical length, slow-speed round burs. These burs are available in sizes from No. 8 round down to 1/2-round. As manufactured, they have little use in troughing or deep-exploration operations, because the bulky shaft tends to impinge on the walls of the access cavity Mueller Burs: long shaft , carbide tipped burs used in latch type handpiece. The 34 mm Muller bur is a right angle but similar in design and function to the LN bur. Its round bur, mounted on a long neck is available on six diameter sizes. Used for working deep in radicular part. It displaces the handpiece away and enhances visibility. They leave a clean shiny surface on the dentin unlike ultrasonics (which leave ragged, roug, debris filled , dusty areas). Used for calcified teeth. Used in brushing motion to search for white dots - Calcified canals without water and with the use of Stropko irrigator or air only syringe. Disadv: 1) However, the shaft of the smallest Mueller bur is only ~0.5 mm in diameter, and as such, these bur shafts are excessively flexible during use. 2) Additionally, at a tip diameter of 0.8 mm, the smallest Mueller bur tip is just slightly smaller than the No. 2 round bur (0.9 mm). And very often, round burs of much smaller diameter are required for these delicate, deep operations. LN burs: . It is a 1/2-round bur with a shaft diameter similar to that of the smallest Mueller burs (~0.55 mm). It is a right angled, tungsten steel half round bur mounted on along neck. The 28 mm length allows deep drilling alongside posts or broken instruments for easier removal and for locating small canal in the roots. However, because the narrowed portion of the LN bur shaft is only 8 mm long as compared to the narrowed portion of the Mueller bur, which is 15 mm long, the LN shaft is considerably stiffer. The overall length of the LN bur, however, is only 28 mm (Figure 3), and that renders it far less useful for troughing and deep exploration. Multipurpose™ bur: The Maillefer Multi-Purpose Bur is a versatile instrument made from Tungsten Carbide. The bur is excellent for a variety of procedures including: Initial endodontic access Sectioning of impacted molars Cutting of teeth at root level Root separation and amputation of broken roots Munce Discovery Bur: However, custom-modification of the shaft of the 34 mm round burs of 2.4 mm diameter at chairside (with a long carbide or diamond bur) down to ~1 mm in diameter preserves adequate shaft stiffness while providing relief from impingement on access cavity walls. They are 34mm-long narrow-shafted non-flexible tiny round carbide burs. The added length provides a functional view corridor beyond the handpiece head. Available in 4 head sizes (#1/2, #1, #2, #4) . ADV: Uncover hidden canals Provide positive control for deep troughing Avoid the heat and fine dust of ultrasonic tips Ultrasonics : ENDODONTIC INSTRUMENTS

Fissure carbide& diamond with safety tips Round diamond Surgical length bur ENDODONTIC INSTRUMENTS

Metal cutting bur Ultrasonics Mueller bur LN bur Munce Discovery Bur Multipurpose™ Bur ENDODONTIC INSTRUMENTS

FILE DESIGN ENDODONTIC INSTRUMENTS

FILE DESIGN According to Twisted or Machined Taper Tip design Types Cutting Non cutting Partially cutting Functions Problems and its management ENDODONTIC INSTRUMENTS

STERILIZATION Cleaning instruments Ultrasonic bath Chemicals Dry heat Moist heat Salt / glass bead Checking sterilization Browne’s tubes Sterilization bags LavEndo-for disinfection ENDODONTIC INSTRUMENTS

Knowledge is the antidote to fear.
- Ralph Waldo Emerson CONCLUSION

Cleanliness is next to Godliness....

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Cleanliness is next to Godliness....

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Presentation on theme: "Cleanliness is next to Godliness...."— Presentation transcript:

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