cleaning and shaping of root canal system

this presentation talks about the cleaning and shaping of root canal system, intracanal medication and the disinfection in details and pictures

this presentation talks about the cleaning and shaping of root canal system, intracanal medication and t

this presentation talks about the cleaning and shaping of root canal system, intracanal medication and the disinfection in details and pictures this presentation talks about the cleaning and shaping of root canal system, intracanal medication and the disinfection in details and pictures
he disinfection in details and pictures

1. Cleaning and Shaping of Root Canal System. 1 Dr. Morouj Adil Badawi BDS, AEGD.

2. Steps of Cleaning and Shaping

3. Steps of Cleaning and Shaping 3 rationale: Characteristics of wide and narrow apical preparation Benefits Drawbacks Narrow apical size Minimal risk of canal transportation and extrusion of irrigants or filling material Can be combined with tapered preparation to counteract some drawbacks Less compaction of hard tissue debris in canal spaces Little removal of infected dentin Questionable rinsing effect in apical areas during irrigation compaction Possibly compromised disinfection during interappointment medication Not ideal for lateral compaction Wide apical size Removal of infected dentin Access of irrigants and medications to apical third of root canal Risk of preparation errors and extrusion of irrigants and filling material Not ideal for thermoplastic obturation

4. Steps of Cleaning and Shaping 4 Techniques: Standardized Technique: It adopts the same working length for all instruments introduced into a root canal. Frequently, full length was not obtained , either because of blockage or because of coronal binding.

5. Steps of Cleaning and Shaping 5 Standardized Technique:

6. Steps of Cleaning and Shaping 6 Techniques: Step-back Technique: Shape larger than that produced with the standardized approach. Stepwise reduction of the working length for larger files, typically in 1-mm or 0.5-mm steps.

7. Steps of Cleaning and Shaping 7 Step-back Technique:

8. Steps of Cleaning and Shaping 8 Techniques: Step-down Technique: Shaping the coronal aspect of a root canal first. Minimize or eliminate the amount of necrotic debris extruded through the apical foramen. Greater control and less chance of zipping near the apical constriction.

9. Steps of Cleaning and Shaping 9 Techniques: Balanced forced Technique: Involves three principal steps. Clockwise rotation of about 90 degrees to engage dentin. Counterclockwise to break loose the engaged dentin chips from the canal wall. File is removed with a clockwise rotation to be cleaned

10. Steps of Cleaning and Shaping 10 Techniques: Balanced forced Technique:

11. Steps of Cleaning and Shaping 11 Rotary nstrumentation : (Specific Niti Istramentation Techniques): Crown Down: For Profile and several others ( ProFile Vortex, HERO 642, K3, and FlexMaster ). Working length is determined after any coronal preenlargement . Open glide path is secured with K-files up to size #15 or #20.

12. Steps of Cleaning and Shaping 12 Instrumentation techniques: Single Length: ProTaper Universal and ProTaper Next. Instruments differs from that for many other NiTi rotary files (except MTwo , WaveOne and Reciproc ) in that no traditional crown-down procedure is performed. Size #10 and #15 hand files as path-finding files

13. Steps of Cleaning and Shaping 13 Instrumentation techniques: Protaper : Shaping files S1 and S2 are then passively inserted into the scouted canal spaces. If necessary, the SX file can be used. After each shaping file is used irrigation should be used. The apical third is fully negotiated and enlarged to at least a size #15 K-file, and the working length is confirmed.

14. Steps of Cleaning and Shaping 14 Instrumentation techniques: Protaper : ProTapers S1 and S2 to the full working length, in a floating, brushing motion . ProTaper finishing files , used in a nonbrushing manner ; because of their decreasing taper, these files will reach the working length passively. Recapitulation and irrigation conclude the procedures.

15. Steps of Cleaning and Shaping 15 Instrumentation techniques:

16. Steps of Cleaning and Shaping 16 Instrumentation techniques: Hybrid techniques:

17. Steps of Cleaning and Shaping 17 Final apical enlargement IAF (Initial Apical File) : First file to bind at working length (WL). MAF (Master Apical File) : File used to shape the apical third. FF (Final File) : Last file used in apical preparation. Apical Gauging : Use K-files to verify apical size. Proper gauging shows WL reached with one file size, while the next larger stops short. If Undershaped : Additional enlargement is needed. Use a hybrid technique suited to the canal anatomy. Patency Check : Always verify that apical patency is maintained after enlargement.

18. Disinfection of the root canal system

19. Irrigation 19 The mechanical and chemical objectives : Flush the debris out. Lubricate the canal Dissolve organic and inorganic tissue Prevent the formation of a smear layer during the instrumentation or dissolve it once has formed Detach and disrupt biofilms

20. Irrigation 20 In principle. irrigants should: Have high efficacy against anaerobic and facultative microorganisms in their planktonic state and in biofilms Inactivate the endotoxin Be nontoxic when they contact the vital tissues Not cause an anaphylactic rection

21. Hydrodynamic of irrigation Irrigation dynamics refers to how irrigates flow , penetrate , and readily exchange within the root canal system. 21

22. Irrigation 22 The effectiveness of root canal irrigation in terms of debris removal and eradication of bacteria depends on several factors : The penetration depth of the needle diameter of the root canal Inner and outer diameter of the needle irrigation pressure viscosity of the irrigant , velocity of the irrigant at the needle tip type and orientation of the needle bevel

23. Irrigation 23 The penetration depth of the needle the size and length of the irrigation needle in relation to root canal dimension is of utmost important for the effectiveness of irrigation. The effectiveness of root canal irrigation in terms of debris removal and eradication of bacteria depends on several factors :

24. Irrigation 24 The diameter of root canal The apical diameter and taper of the root canal have an impact on the needle penetration depth. The effectiveness of root canal irrigation in terms of debris removal and eradication of bacteria depends on several factors :

25. Irrigation 25 Inner and outer diameter of the needle: The external needle d iameter is of relevance for the depth of introduction into the root canal and for the rigidity of the needle body. The stropko flexi-tip: (30 gauge) needle is a nickle -titanium to improve penetration into curved root canals The effectiveness of root canal irrigation in terms of debris removal and eradication of bacteria depends on several factors :

26. Irrigation 26 Irrigation pressure The internal needle diameters the pressure necessary for moving the syringe plunger. Narrow needles require more pressure onto the plunger and extrude the irrigant with higher velocity than large needle sizes. The effectiveness of root canal irrigation in terms of debris removal and eradication of bacteria depends on several factors :

27. Irrigation 27 The effectiveness of root canal irrigation in terms of debris removal and eradication of bacteria depends on several factors : Types and orientation of the bevel of the needle Lateral opening and have a closed, safe-ended tip.

28. Irrigation 28 Irrigants

29. Irrigation 29 Irrigants the properties of an ideal irrigants for root canal treatment

30. Irrigation 30 The irrigants : Most commonly used irrigating solution. Because of it’s an antibacterial capacity and the ability to dissolve necrotic tissue, vital pulp tissue, and the organic components of dentine and biofilms in fast manner . Concentrations : between 0.5% and 6% for root canal irrigation. If lower concentration it is recommended that the solution be used in higher volume and in more frequent intervals. Sodium Hypochlorite

31. Irrigation 31 The irrigants : Sodium Hypochlorite Toxicity: If inadvertently NaOCL is extrude through the apex, severe accidents may occur. Time: Hypochlorite should be used throughout the instrumentation, and for 1 to 2 minutes after completing the instrumentation.

32. Irrigation 32 The irrigants : Naocl Accident: Sodium Hypochlorite Severe pain, edema of neighboring soft tissues. Possible extension of edema over the injured half of face and upper lip. Profuse bleeding from root canal, profuse interstitial bleeding with hemorrhage of skin and mucosa (ecchymosis).

33. Irrigation 33 The irrigants : Naocl Accident: Sodium Hypochlorite Inform the patient and control pain with local anesthesia and analgesics. Cold compresses to reduce swelling. After 1 day, warm compresses and frequent warm mouth rinses. Recalled daily to monitor recovery. Antibiotics is not obligatory, only in case of high risk or evidence of secondary infection.

34. Irrigation 34 The irrigants : Binding to the negatively charged surfaces of bacteria damaging the outer layers of the cell wall. At high concentration it has bactericidal. At low concentration it is bacteriostatic. Normally used at concentration between 0.12% and 2% Unlike NaOCl , CHX is capable of remaining in the dentin because of the cationic nature of its molecule. Chlorhexidine: Substantivity:

35. Irrigation 35 The irrigants : NaOCL and CHX when in contact produce a change of color and a precipitate. The combination of CHX and EDTA produces a white precipitate. Interaction between CHX, NaOCL , and EDTA:

36. Irrigation 36 The irrigants : Chelate and remove the mineralizes portion of the smear layer . Used in a concentration of 17%. Remove the smear layer in less than 1 minute. If it is left in the canal for longer, erosion of dentine has been demonstrated. For root canal preparation, EDTA has limited value alone as an irrigation fluid In modern endodontics, EDTA is used once the cleaning and shaping are completed for around 1 minute . Ethylenediamine Tetra-Acetic Acis (EDTA):

37. Irrigation 37 The irrigants : QMiX was introduce in 2011. Used at the end of instrumentation. Contains a CHX-analog, Triclosan and EDTA as decalcifying agent. Further clinical research is needed Qmix :

38. Irrigation 38 The irrigants : Concentration ranging from 2% to 5%. Kills a wide spectrum of microorganism. IKI was able to eliminate E.faecalis from bovine root dentine used with a 15 minute Some patients are hypertensive to this compound. Iodine potassium idodie :

39. Intracanal medication

40. Intracanal medication 40 Most popular intracanal medication. Hermann introduce it in 1920. A series of articles promoted the antibacterial efficacy of Ca(OH)2 However, newer clinical studies and systematic reviews failed to show a clear benefit of C(OH)2 Calcium hydroxide:

41. 41 The main characteristic of Ca(OH)2 include: Limited solubility. High pH. Use as a broad-spectrum antimicrobial agent. Ability to sustain antimicrobial action for long periods. Calcium hydroxide: Intracanal medication

42. 42 Care must be taken not to extrude Ca(OH)2 through the apex, as this carries the risk of reaching the maxillary sinus or the mandibular canal Calcium hydroxide: Intracanal medication

43. 43 It was thought that because of their volatile properties , it could penetrate dentinal tubules and anatomical irregularities. Studies in vitro shown that phenol and phenol preparation are highly toxic to mammalian cells, and their antimicrobial effectiveness does not sufficiently balance their toxicity. Phoenolic preparation: Intracanal medication

44. 44 Used as formocresol , is highly toxic , mutagenetic and carcinogenic. However, it has been used extensively in endodontic therapy. All formaldehyde preparations are potent toxins with antimicrobial effectiveness much lower than their toxicity The alternatives are better antiseptics with significantly lower toxicity. Formaldehyde: Intracanal medication

45. 45 Chlorinated solutions have been used for many years to irrigate root canals. They are also used as intracanal dressing. Tincture of iodine (5%) for disinfecting rubber dam and tooth surfaces. Halogens: Intracanal medication

46. 46 Applied inside the root canal to reduce pain and inflammation , Inhibits bacterial protein synthesis. Developed in 1960 by Prof. André Schroeder. Steriod : Intracanal medication

47. 47 Composed of Metronidazole + Ciprofloxacin + Minocycline. Used in regenerative endodontics to disinfect root canals. Triple-Antibiotic Paste (TAP) : Intracanal medication Concerns: Risk of bacterial resistance Tooth discoloration from minocycline Toxicity to stem cells Potential for allergic reactions

48. 48 Irrigation solution serve as lubricants. Special gel-type substance as also marketed. Wax-based RC-Prep, which contains EDTA and urea peroxide, and glycol-based Glyde. Another function of lubricants is to facilitate the mechanical action of endodontic hand or rotary files. lubricants: Intracanal medication

49. Disinfection devices and techniques

50. 50 Allows exact placement , replenishing of existing fluid, rinsing out of larger debris particles. Direct contact to microorganisms in areas close to the needle tip. In passive syringe irrigation, irrigation reach 1 to 1.5 mm apical to the needle tip . Excess pressure or binding of needles irrigant should be avoided to prevent extrusion into periapical spaces Syringe delivery Disinfection devices and techniques

51. 51 Corono -apical movements of the irrigation needle. Stirring movements with small endodontic instruments. Manual push-pull movements using a fitted master gutta- percha cone have been recommended. Manually Activated Irrigation Disinfection devices and techniques

52. 52 The EndoActivator System uses safe , noncutting polymer tips. Quickly and forcefully agitate irrigant solutions during endodontic therapy. Canals significantly cleaner than manual syringe irrigation. Sonically Activated Irrigation: Disinfection devices and techniques

53. 53 One where irrigation is combined with simultaneous ultrasonic instrumentation (UI). Another without simultaneous instrumentation, called passive ultrasonic irrigation (PUI). UI will never contact the entire wall, and it may result in uncontrolled cutting of the root canal walls without effective disinfection. Introduced in the canal once that the root canal system has a final apical size and taper. Research shows better elimination of debris and better penetration of irrigant . Passive Ultrasonic Irrigation: Disinfection devices and techniques

54. 54 Irrigant is delivered into the access. Very fine needle connected to the dental unit's suction device is placed into the root canal. Such a system is commercially available (Endo Vac, Discus Dental) Negative Apical Pressure: Disinfection devices and techniques

55. 55 An irrigation/evacuation system that apically delivers the irrigant under positive pressure. Thin needle containing a lateral opening. Evacuates the solution through a large needle at the root canal orifice. Designed to limit the risk of NaOCl accidents Safety-Irrigator: Disinfection devices and techniques

56. 56 So-called multisonic cleaning technology. Gentle Wave that only requires pulp chamber access. This system is non instrumentational . Have the potential to reach inaccessible canal areas . Significantly faster dissolution rate and more cleaned surface than other systems Gentle Wave System: Disinfection devices and techniques

57. 57 Lasers are widely used in dentistry It includes diode, Nd:YAG , erbium, and CO2. Laser energy may be used to activate irrigant solutions. However, further studies are needed to standardize protocols and confirm consistent outcomes. Laser-Activated Irrigation: Disinfection devices and techniques

58. 58 Photodynamic therapy (PDT) or light-activated therapy (LAT). May have endodontic applications because of its antimicrobial effectiveness . Photoactivation Disinfection: Disinfection devices and techniques

59. 59 Nanoparticles are microscopic particles with one or more dimensions in the range of 1 to 100 nm. Have a broad spectrum of antimicrobial activity and a far lower propensity to induce microbial resistance than antibiotics. Antibacterial Nanoparticles: Disinfection devices and techniques

60. 60 Exists in gaseous or aqueous forms. In vitro : Strong antibacterial effects against bacteria, fungi, protozoa, and viruses. In vivo (clinical studies): Results are inconclusive and inconsistent. Applied cautiously in endodontic treatments because of insufficient clinical validation. H ealOzone Disinfection devices and techniques

61. 61 Called electrochemically activated water or oxidative potential water. It is effectively saline that has been electrolyzed to form superoxidized water, hypochlorous acid, and free chlorine radicals. It is commercially available as Sterilox . Limited documentation in endodontic literature. More clinical research is needed before widespread adoption. Superoxidized Water: Disinfection devices and techniques

62. Criteria to evaluate cleaning and shaping

63. 63 Criteria to evaluate cleaning and shaping Well-shaped canals: Absence of procedural errors and the achievement of disinfection. Examining radiographs and relying on clinical experience . Intact apical narrowing , and no thinned-out radicular wall sections

64. Signs of mishaps

65. 65 Signs of mishaps: Instruments fracture. Canal Transportation. Perforation. Blockage

66. 66 Signs of mishaps: Instruments fracture. Incidence: Manual files: 1%–6% Rotary instruments: 0.4%–5% Fracture Risk Factors: Torsional load + cyclic fatigue, especially in curved canals. High torque or axial pressure increases fracture risk. Crown-down technique recommended to reduce taper lock.

67. 67 Signs of mishaps: Canal transportation: Unintended removal of canal wall, shifting the canal axis due to file straightening. Up to 100–150 µm transportation may be clinically acceptable.

68. 68 Signs of mishaps: Perforation: Types: Strip perforation: In furcation area of multirooted teeth. Canal curvature perforation: Due to excessive shaping. Apical perforation: Through apical foramen. Causes: Severe canal transportation. Improper access or shaping techniques.

69. 69 Signs of mishaps: Blockage: Canal becomes impassable due to: Ledge formation (from instruments straightening into canal walls). Compacted debris, pulp remnants, fractured files, or old filling materials. Clinical Signs: Inability of flexible files to reach working length (WL).

70. Sample Protocol For Contemporary Cleaning And Shaping Procedures