Professional Documents
Culture Documents
Material.
Techniques.
Operators skill
Earlier, for the manufacture of root canal instruments, the
Stainless steel.
The stainless steel wire is ground along its long arms into a 4-
shaft that is twisted into flutes. The number of flutes twisted into each
blade of a similar sized-instrument determines whether that instrument
is a reamer (less flutes) or a file (more flutes).
Before 1958, endodontic instruments were manufactured without
benefit of any established criteria. There was little uniformity in quality
control or manufacture, no uniformity existed in progression from one
instrument to the next, and there was no co-relation of instruments and
filling materials in terms of size and shape.
In 1959, a new line of standardized instruments and filling
material was introduced by Ingle and Levine.
i)
ii)
iii)
ii)
Classification of Instruments
I According to Grossman
a) Exploring instruments
i.e. to locate the canal orifice and determine its
patency
Endodontic explores
Smooth broaches
b) Debriding instruments
4
Barbed broach
c) Shaping instruments
i.e. to shape the root canal laterally and apically
Reamers
Files
d) Obturating instruments
i.e. to cement and pack gutta-percha into the root
canal
Spreaders
Pluggers
Lentulo-spirals
Files
K-type (Kerr)
H-type (Hedstroem)
Reamers K-type
Broaches
Pluggers
Spreaders
Peeso
A, D, O, K, O, T
(G-type)
(P-type)
(M-type reamers)
Gutta percha
Silver
Paper
Machined
K-files
- H-file
K-reamer
- Flex-R
K-flex
- Heliapical
Flexo
- Canal Master
Zipper Flexicut
- Flexogates
- McSpadden Engine file
Reamers
Loose spirals
(1.93-0.88 mm)
(0.80-0.28mm)
Square blank
-
Resists # better
-
Triangular blank
-
(K-type) Reamers
Are used for drilling.
They cut by being tightly inserted into the canal, twisted
clockwise one to turn to engage the blades into the dentin
and then withdrawn.
Penetration rotation Retraction and the cut is made during
retraction.
Reaming is the only method that produces a round, tapered,
preparation possible only in straight canals Reamers, in such
cases they are rotated turn.
In slightly curved canals reamers should be rotated only
turn as more stress will cause breakage.
Files as well as reamers can be used for reaming but conversely,
reamers do not work well as files their flutes are too widespread
to rasp.
Files
Achieves its principal cutting action on withdrawl.
But it cuts on push motion as well.
Square Reamers
Bent instrument.
Type II
Type III :
Type IV :
Type V
Type VI :
Full fracture.
A] K-flex file
In 1982 Kerr manufacturing co introduced a new instrument
termed K-flex file.
Cross section is rhombus / diamond shaped.
It
is
viewed
as
the
fore-runner
of
the
so-called
11
Weine, suggested trimming 1mm from the tip of the file and
rounding off sharp edges on a diamond nail file. In this way, files
sizes 10, 15, 20, 25 may be converted to 12, 17, 22 and 27.
The disadvantages of this technique are that the files are made
disposable and the edges may be difficult to smooth, which
therefore creates ledges during filing. A recent innovation by
Maillefer overcomes these problems using the intermediate files
Golden Mediums.
Zipper Flexicut
Produced by twisting a triangular shank made from SCS
spacecraft steel.
It is a high vacuum-fired chrome nickel steel.
Advantages:
-
Flexibility.
Non-aggressive tip.
13
Flexo-File
This is a flexible instrument twisted from a stainless steel blank
of angular cross-section.
With 1.81 flutes/mm length.
Tip is modified to be non-cutting.
A recent addition Golden Medium is of parallel design but provides
a range of intermediate sizes (12, 17, 22, 27, and 32).
Zipper Flexicut
HEDSTROEM (H) FILES
Machined from a blank of circular cross-section.
The flutes are produced by machining a single helix into the
metal, producing a series of intersecting curves which increase in
size from the tip to the handle.
The strength and flexibility of the instrument is determined by the
depth of the flute or the residual bulk of metal in the central
portion of the file.
The blades thus formed are virtually at rt. <s to the dentin surface
(+ve rake <).
14
15
than turn.
designed
for
use
in
the
reciprocating
handpieces
(Crinomatic). This variation of the unifile had a non-cutting pilot tip and
an altered helical pitch angle to prevent the instrument from binding,
when in use.
S File
Is a variation of the unifile in its double helix configuration as
well as variations in flute depth.
16
It differs from the unifile since the angle of the flutes remains
uniform through the length of the instrument and the depth of the
flutes increases from tip to handle.
Cutting by reaming is also possible due to its flute design.
Buchanan has further modified the H-type file as the safety Hedstroem
MAC FILE
Newest version.
Produced in nickel-titanium, which gives the instrument
superelasticity.
A-FILE
Modified by levy to function better with the automated canal
finder system.
17
18
Non-cutting pilot tip ensures that the file remains in the lumen of
the canal, thus avoiding zipping and transportation at the apex.
These files are used in both a push-pull and rotary motion.
19
Hand
Engine driven
3 major feature
20
Less breakage.
21
Barbed
Smooth
22
Barbed Broaches
Taper
of
broaches
is
0.007mm/mm (less than half
that of rasps).
c.
23
Smooth Broaches
There is a smooth broach, which is sometimes used as a
Pathfinder.
K1
K2
Easy to use.
Saves time.
Reduction in fatigue
The overall strain becomes less and fatigue is decreased.
Moreover, procedural time may also be less compared to hand
instrumentation.
Limitations:
They do not simplify the entire root-canal treatment procedure as
they have no role in the early phase of the treatment. Correct diagnosis,
proper access cavity, locating the orifices, debriding the canals and
determining the root canal length, have to be done manually using ones
intelligence, knowledge and clinical experience. Moreover, most of
25
these devices can be used in the root canals only after the completion of
preparation of canals using 150 size No. 15.
Lack of tactile sensation
This is an advantage with hand instruments such registration with
instruments (apical stop) alerts the clinician to be cautious and greatly
aids in avoiding procedural mishaps. Continuous use of automated
handpiece against resistance may lead on to either # of the RC
instrument or cause mishaps. Newer models such as canal finder system
are designed to stop functioning on countering resistance in the root
canal. The problem of lack of tactile sensation can be overcome to a
great extent three proper and sequential use of automated root canal
instruments and expertise.
Classification.
A. Reciprocal (impact specially designed short reciprocal
most to the cutting instrument).
B. Rotary.
C. Ultrasonic.
D. Sonic.
A. Handpieces that work on the principle of offering alternating
movement to RC instruments are termed reciprocal handpieces.
26
Rotary
Reciprocal.
Vertical.
Random.
I] ROTARY
Instrumentation with a full rotary handpiece is by straight line
drilling or side-cutting.
Uses:
27
10RPM.
NITIMAC is a new gear reduction handpiece (NT Company,
USA).
-
28
Sensor files
-
Nitixl files
instruments
Advantages:
Flexibility.
Resistance to #
GGD has a long, thin shaft ending in a flame-shaped head with a safetip to guard against perforation.
Uses:
-
are inflexible.
29
These sizes have been now converted to the 150 instrument sizes
and colours.
Both are flame shaped
Has long sharp flutes
More efficient.
Peeso Reamer
-
Is most often used in preparing the coronal part of the root canal
for a post and core.
30
Peeso Reamer
No.
GGD
(diameter mm)
0.7
0.5
0.9
0.7
1.10
0.9
1.30
1.10
1.50
1.30
1.70
1.50
Orifice Opener
-
31
II] RECIPROCAL
This uses a special handpiece which contra-rotates the instrument,
through 90 3000 times / minute (quarter-turn motion).
-
Vertical (push-pull)
Giromatic
Kerr M4
Intra-Endo 3- LDSY
Endo-Cursor
Endo Lift
Giromatic
Introduced in 1964
A variety of canal instruments can be used with the
Giromatic.
-
Giro broach.
Giro reamer
32
According to Weine
-
Kerr M4
-
Disadvantages:
-
Developed in France
33
The files tip are rounded and negative cutting angle is given for
the first flute. This avoids procedural errors.
Disadvantages:
-
34
Uses:
-
Canal header
Is a modified speed reducing handpiece.
Has a vertical movement and of 4 8mm and a contra-rotational
movement which is restricted to 30. Three cutting instruments are
available.
-
Intra-Endo 3-LDSY
is a racer-type handpiece.
is a look-alike of the canal finder system.
apart from up and down movement, it can impart also full turn
movement; the latter occurring when axial pressure is applied.
the vertical movement is in the range of 0.4mm.
it canal also make use of conventional reamers and H-files.
Another type of look-alike of the canal finder system is the
Endo-lift (Kerr).
35
EXCALIBUR
produces a random lateral vibratory motion.
it vibrates only laterally and is devoid of any vertical movement.
the amplitude of movement is 1.5-2mm.
K-files are used at 20,000-25,000 rpm.
this devices may be classified as a subsonic instrument (oscillates at
1000-2000 frequency per sec.).
Disadvantages:
due to its effective cutting ability, it may remove dentin excessively.
tends to straighten the canals or causes strip perforation.
III] ULTRASONICS is based on a system in which sound as energy
source activates a file. This results in a 3-D activation of the file. The
main debriding action was though be bycavitation.
-
Magnetostrictive
-
Peizo-electric
More powerful.
if NaOCl is used as an
cooling.
tubing.
Disadvantages:
This
apical widening.
37
Advantages:
-
10-15 No. files should be used as there are most flexible and less
likely to cause ledges.
Uses:
a) as a root canal shaping device.
b) As a debriding device.
-
38
SONICS
The principal sonic endodontic handpiece available today is the
o Micro Mega 1500 (MM 1500)
o Sonic Air Endo System
-
Rispi Sonic.
Shaper Sonic.
Trio sonic.
Rispi
Shaper
Developed
by
Dr.
L.M.
Lawrichesse
in Italy.
France.
Resemble rat-tail
Used
Used
in
the
in
husky
broach.
blades.
cutting
16
in
the
Heliosonic
39
or
Resembles
reamer.
a
barbed
Useful
for
cutting
blades.
Also known as
Triosonic files.
Resembles
coronal 2/3rd of
Has
apical 1/3rd.
file.
By
Trio
and
placing
Ca(OH)2 pastes.
Disadvantages:
widening
Produces
undulating
rippled
Most effective in
/
canal
canal
the
triple-helix
(than
Rispisonic)
Resembles
Hedstroem file.
Least effective
walls.
LASERS
The use of laser is still to be approved by the U.S. food and Drug
Administration. Nonetheless, the method appears promising.
Wachman was the first to suggest lasers.
40
Sonics
Oscillation is transverse.
It largely elliptical.
firmly grasping the ridged silver cone, whereas the forceps may have
either grooved or serrated beaks for holding G.P. cones.
Endodontic forceps differ from
forceps in that they have a latch mechanism for locking the instrument
in the closed position. This mechanism allows easier transfer of
instrument and material from assistant to operator during treatment.
ii)
Pluggers
Have more tapered and pointed Have slunt or flat-ended tips for
tips for lateral packing of the compression
material
42
5 digit no.
The first 2 digits represent the diameter of the
hundredths of mm.
43
Increased flexibility.
Cutting efficiency is less than flex S.S. as they cut more on the
outer surface of the canals in curved canals.
44
Ni-Ti
History
In the early 1960s, a Ni-Ti alloy was developed by W.F. Buchler,
a metallurgist investigating non-magnetic, salt-resisting, water proof
alloys for the space programme at Naval Ordinance Lab, USA.
The term NITINOL, an acronym suggests the elements from
which the material is composed.
Ni-NICKEL
Ti-TITANIUM
Nol NAVAL ORDINANCE LABORATORY
In dentistry, Andersen and Hilleman (1971) were first to
introduce it in the field of orthodontics.
Walia et al in 1988 inspired its introduction in endodontics.
Advantages over S.S.
-
Ni-Ti files can retain the shape of the curved canal and do not
straighten like stainless steel.
45
Properties of Ni-Ti
The alloys contain:
54% - Ni.
44% - Ti
2% or less cobalt.
These alloys undergo superelastic deformation and undergo a
stress inducted Martenisitic phase (close packed hexagonal phaseweaker phase) transformation from a parent structure that is Austenite
(body-centred cubic lattice) stronger and stable phase.
46
Features of Ni-Ti
a) Shape memory
-
b) Super/Pseudo elasticity
-
47
Union Broach.
Onyx-R-file.
These 2 instruments have proved to be superior to other Ni-Ti
instruments.
Topic of controversy
-
If too much +ve, the blade becomes engaged into the surface
excessively and binds without forming chips.
48
b) Flute design
-
c) Radial land
-
d) Frictional Resistance
-
e) Notch
-
If the notch is too close to the cutting edge, stresses will tend to
concentrate on the notch e.g. is H-file that will lead to crack
formation to ideally it should be away from the cutting edge.
HERO 642.
Light speed.
Profile Family
I] 29 series
a) Hand instruments 0.02 taper.
b) Rotary instruments 0.04, 0.06 taper
II] ISO series
a) 0.04 and 0.06 ISO rotary instruments (also available as hand
instruments).
III] Profile Orifice shaper 0.05-0.08 taper
IV] Profile GT rotary instruments (also available as hand files)
I a) Profile 29 series with 0.02 taper
-
Advantages:
1) 8 files replace the 11 files of the traditional ISO sizes 1060.
2) These instruments are spread with more instruments at
smaller sizes and less instruments at the larger sizes.
3) Transition between sizes is enhanced due to greater and
gradual increase in diameter.
4) Come in total of 13 instruments instead of ISO 21
instruments.
b) Profile series 29 with 0.04 and 0.06 Rotary Type:
-
0.05/0.1mm of the width at the tip between each instrument e.g. the
51
Have radial land which has a U shaped flute and helps in lifting
the debris coronally.
0.06 Taper
-
Taper is 6%
52
Use:
-
Tapers --> 0.3, 0.4, 0.045, 0.05 and 0.055 all with identical tip size 25.
-
a) u-type.
b) Hedstroem with progressive radial lands.
c) 0.02 tapers with equal radial lands throughout their lengths.
d) With dissimilar helical angles to permit widening at the apex and
preferential side cutting.
0.04 Taper
-
Taper is i) 4%
No.s available 15-90 (15, 20, 25, 30, 35, 40, 45, 60, 90).
53
Use:
-
d) Profile O.S.
Use:
-
are used for preparing the coronal section of the canal and also
for removing G.P. and sealer before inserting the post.
They operate at very slow speed of 350 rpm thus assuring safe
handling.
The u-file radial landed flute design keeps the instrument centred.
Lets negotiation even in the most severely curved canals with less
risk of apical transporting, ledging or perforating.
f) GT Range
-
55
GT Rotary
GT Accessory files
Taper is 6-12%
Taper is 4%
Taper is 12%.
Length: 21 and
21, 25 and 31
21 & 25mm
diameter 35, 50
25mm
mm
i.e.
The
Used
for
of
of
preparation
to
sleepest
obtain a more
tapered
technique.
ring
on
shank.
0.08
in
smaller
most
roots
mandibular
molars.
56
the
coronal
portion.
Identified by one
curved canals.
and 70mm
preparation
20-35
sizes.
D1=0.2mm
No.s
Used
canals.
in
large
Introduced by McSpadden.
The original Quantec 2000 series had a 90-tip. This sharp tip
appears to predispose to problems like zips, elbows and
perforations. So, they were replaced.
QLX Non-cutting.
Have a +ve cutting blade angle, as a result the dentin is cut rather
than scraped.
Radial lands adds support and also prevents stress cracks in the
flutes cutting edges.
Tip Design
SC-safe cutting.
LX-non-cutting
57
SC
-
Ideal for:
-
Calcified canals.
LX
-
Ideal for:
-
Severe curvatures.
Advances in Micromotor
a) Quantec ETM (Electric Torque Control Motor)
-
58
High.
Elasticity.
Ro
Rotation.
3 tapers
6%
- Sizes 20, 25, 30
opening.
Orifice opening
the W.L.
59
An inactive tip.
Progressive pitch.
Disadvantages:
-
Resembles the GGD and are used in low speed handpieces 13002000 rpm (10:1 gear reduction).
Non-cutting pilot tip. This helps to keep the instrument within the
canal and avoid ledging.
MAR
-
Elbows
-
Ledges
-
Perforations
-
Danger zones
-
Is the area coronal to the elbow where excess dentin has been
removed from the inner aspect of the curve.
Transportation
External
Internal
62
Conclusion
-
63