Rotary system in endodontic treatment

For undergrad BDS students

1. Rotary System in Endodontic Treatment Modern technique of root canal preparation Dr K M Abdullah Al Harun Lecturer Dental Unit Sylhet MAG Osmani Medical College , Bangladesh

2. Content Introduction History of rotary endodontic instruments Components of rotary system Endomotor Stainless steel hand K-files NiTi rotary files Lubricating and irrigation solutions Procedure Isolation Access cavity preparation Canal negotiation, Working length determination and glide path preparation Cleaning and shaping of root canal/ Root canal preparation Canal obturation

3. Introducion Endodontics is the branch of dentistry concerning dental pulp and tissues surrounding the roots of a tooth . “Endo” is the Greek word for “inside” and “ odont ” is Greek for “tooth .” Endodontic treatment, or root canal treatment, treats the soft pulp tissue inside the tooth….. American Dental Association

4. Introduction Root canal treatment (RCT) at a glance

5. Introduction Why Rotary System? Rotary shaping instruments are replacing the conventional hand file systems after the introduction of NiTi files to endodontics almost two decades ago. Advantages of this system are--- Enables more complicated root canal systems to be shaped with fewer procedural errors. Enhances the shaping ability of the canal. Reduces clinical mishaps like blocks, ledges, transportation and perforation. Shortens the cleaning and shaping time.

6. History of rotary endodontic instruments

7. History of rotary endodontic instruments

8. Components of rotary system Endomotor Generations of Motors— • First generation motor without torque control. • Second generation motor with torque limiter. • Third generation motor with simple torque control. • Forth generation motor with apex locator and torque control.

9. Components of rotary system Stainless steel (SS) hand K-files are used to negotiate the root canal initially and to maintain the patency of the canal after use of every cycle of NiTi file. #06, #08, #10, #15 and #20 SS K-files are used for initial canal negotiation and preparation of glide path for rotary files. #10 SS K-file is used to maintain the patency .

10. Components of rotary system NiTi rotary files (First introduced in 1990s) The Nickel titanium rotary instrument systems have 2 main categories: Active instruments: Have active cutting blades similar to K flexo file. They have the ability to cut more efficiently, aggressively and tendency to straighten the canal curvature. Passive Instruments : These instruments have a radial land between cutting edges and flute. The radial land touches the canal wall on its entire surface, guiding the instrument – stable and balanced with in the canal. All of them having non-cutting tips to avoid transportation.

11. Components of rotary system Advantage of NiTi over SS files Nickel titanium Stainless steel Excellent flexibility Less flexible Conforms to canal curvature Straightens and transports canal Plastic deformation Permanent deformation

12. Components of rotary system NiTi rotary files

13. Components of rotary system Lubricating and irrigation solutions Objectives of irrigation: Mechanical & Chemical functions Flushing Lubrication Dissolution Smear layer removal Biological functions Antimicrobial

14. Components of rotary system Commonly used irrigating agents used in endodontics Chemically Inactive Solutions Normal saline Local anaesthetic solution Chemically active solutions Main solutions: Sodium hypochlorite (NAOCL) (0.5-5.25%) Chlorhexidine (CHX) (0.2-2%) Decalcifying solutions: 17% Ethylene diamine tetra acetic acid(EDTA) Citric acid Hydroxy ethylidene-bisphosphonate (HEBP) Qmix ( químico MECÁNICA MIX Other irrigating agents : A. Hydrogen peroxide. B. Iodine based compounds. Recent advances in irrigation: A. Carisolv . B. Ruddles solution. C. Bioactive materials like bio(active) glass D. Chitosan .. E. Cetrexidine

15. Procedure Isolation with Rubber Dam

16. Procedure Access cavity preparation Gain access in to the pulp chamber using diamond bur (Round in special endodontic bur) Diamond D Bar Endo Access bur Endo Z bur Endo two bur

17. Procedure After access cavity preparation a # 10 SS k file (#06 and #08 for very narrow canal) is introduced into the canal with watch-winding motion. If the canal was calcified, deposited a small amount of EDTA preparation in to the pulp chamber to soften the dentin in those area. Irrigate the canal with NaOCl . Use # 15 to determine working length with the help of Apex locator and x-ray. Then # 20-SS K-file. This step ensure sufficient space for accommodation of NiTi rotary file in a reproducible glide path. Canal negotiation, Working length determination and Glide path preparation

18. Procedure Cleaning and shaping of root canal/ Root canal preparation with NiTi Rotaty files The “Golden Rules” for NiTi Rotary Preparation 1. Assess case difficulty 2. Provide adequate access 3. Prepare with hand files up to size #20 prior to rotary use 4. Use light touch and low rpm 5. Proceed with crown-down sequence 6. Replace rotary instruments frequently

19. Procedure Clinical Strategies Access Preparation Straight line access is necessary prior to use NiTi Rotary file. Don’t Force File Respect Difficult Canal Anatomy Don’t Overuse Files Avoiding Breakage Takes Practice Don’t Try to Bypass Ledges Avoid Cutting With the Entire Length of File Don’t Start and Stop suddenly Length Control is Critical Check Canal Patency After Every Cycle Use NiTi Rotary Files With Copious Irrigation Solution Should be done in two phases Phase- i Coronal flaring Phase-ii Apical shaping Cleaning and shaping of root canal/ Root canal preparation with NiTi Rotaty files

20. Procedure Obturation

21. Thanks for your attention