ENDODONTICS :PAST ,PRESE

NT AND FUTURE

DIKSHYA PUROHIT
 What is Endodontics ?

Root Canal Treatment (RCT)

• Is removal of vital or necrotic pulp tissue from

pulp chamber and root canal by cleaning
and shaping process
• Then the chamber and canal cavities must be
blocked by suitable sealing materials to not
become a shelter of pathogens ''hermetic
seal''
.
..
•' • I•
•
•''
Periapical x-ray film showing endodontically treated upper molar
 ?•

• PuIp i nj ury ..
• Prosthetic treatment ..
 The empirical era(1687-1905)
 Charles Allen is credited with writing
the first book in English devoted
exclusively to dentistry. Although
endodontics as we know it today was
not practiced at that time, Allen
discussed procedures for
transplanting teeth in his third
edition, published in 1687. However,
he did not record the pulpal
procedure performed when "taking
out the rotten teeth or stumps and
putting in their places some sound
ones drawn immediately out of some
poor body's head.
 History
• 1687 the aim of Endodontics has been to
relieve pain, maintain exposed pulp, and
preserve teeth. Often, these attempts were
successful.
Fauchard {1678-1761), considered the founder
of modern dentistry, who in his textbook ''Le
chirurgien dentiste'' precisely described the
dental pulp and dispelled the legend of the
''tooth worm," which had been considered the
cause of caries and toothaches since the time of
the Assyrians.
• 1725, Lazare Riviere introduced the use of oil
of cloves for its sedative properties.
• 1746, Pierre Fauchard described the
removal of pulp tissue.
The Vitalistic era (1806-1878)

 In 1805, J. B. Gariot became one of the

first to recognize the problem of
vitality in connection with pulp
treatment, in Traitk des Maladies de la
Bouche, he declared that destruction of
the pulp does not destroy the vitality of
the tooth
• 1820, Leonard Koecker cauterized
exposed pulp with a heated instrument
and protected it with lead foil.

• 1836, Shearjashub Spoone

recommended arsenic trioxide for pulp
devitaIization.
1838, Edwin Maynard of Washington,
D.C. introduced the first root canal
instrument, which he created by filing
a watch spring
• In 1847, Edwin Truman introduced gutta­
percha as a filling material.
• 1860, A FINE AND RARE BEECHWOOD GUTTA-PERCHA
GOLF BALL MARKING MACHINE OWNED BY WILLIE
PARK
• In 1850, W.W. Cadman confirmed that the aim
of pulp capping, which had already been
proposed by Koecker in 1821, was to form a
dentin bridge. .

I •
I

•
• In 1864, S.C. Barnum of New York prepared a
thin rubber leaf to isolate the tooth in the
course of filling.
• Together with G.A. Bowman, he introduced
the rubber dam clamp forceps in 1873.
Recent rubber dam
clamp forceps
• In 1867, Bowman used gutta-percha cones as
the sole material for obturating root
canals.
• 1867, Magitot suggested the use of an
electric current to test pulp vitality.
• In 1885, Lepkoski
substituted
formalin for
arsenic to ''dry''
the non-vital pulp
stumps left in the
root canals after
excision of the
coronal pulp to
prevent their
decomposition.
• At the end of the 17 th century, prosthetic
restorations, including the Richmond or Davis crown,
became increasingly popular. Since they required the
use of canal posts, they created an ever greater
need for endodontic therapy.
• In 1891, the German dentist Otto Walkhoff
introduced the use of camphorated
chlorophenol as a medication to sterilize root
canals.
Intra-canal medication
• In 1895, and more precisely in
the evening of November 8
in
his laboratory in the Bavarian
city of Wurzburg, the scientist
Konrad Wilhelm van Roentgen
accidentally discovered a new
form of energy that had the
ability to penetrate solid
material. Because of their
unknown nature, he decided to
calI these rays ''X''.
• A few weeks later Otto Walkhoff, a dentist in
Brunswick, Germany, took the first dental
radiograph, making a contribution to dentistry
that almost equaled Roentgen's to
medicine.
• Roentgen's discovery of the X-ray has
been ranked in importance with the
discovery and development of anesthesia
by Horace Wells and William Morton, both
dentists, and the discovery of
microorganisms and their role in disease
by the likes of Pasteur and Lister.
• In 1900, Price described periapical
radiolucencies as ''blind abscesses'' and
advised the use of radiography for
establishing the diagnosis of pulpless teeth.
In 1908, Dr. Meyer L.
Rhein, a physician
and dentist in New
WORKIN

York, introduced a G 100TH LENGTH

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technique for \

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length and level of ---- --- -
obturation.

About the same time, G.V. Black suggested a

measurement control to determine the length of the
canal and the size of the apical foramen, so that
overfilling could be prevented.
• In 1904, Frank Billings directed the attention
of dentistry and medicine to the apparent
relationship between oral sepsis and bacterial
endocarditis.
• The focal infection era (1909-1937)
• 1909, Mayrhofer published a work linking the
nature of pulpal infection with specific
microorganisms. The results indicated that
streptococ-ci were present in about 96% of
the cases studied.
• A wrong believe that the pulpless teeth
can cause dangerous infection to the whole
body because it has a septic foci introduced
by William Hunter, an English physician and
pathologist , and there is no benefit from
treating pulpless teeth, this believe make
the dentists to extract any pulpless teeth
• This cause a stop in developing of root canal
treatment for 40 years !
• Coolidge, Johnson, Reihn, Callahan, Grove,
Prinz, and others. Mainly because of their
efforts, the principle of preserving the
pulpless tooth survived, they improve their
current procedures by using aseptic
techniques, bacteriological and histological
methods, and X-rays for diagnostic
purposes.
• It was not until the late 1940s or early 1950s
that the cumulative laboratory research and
clinical evidence was sufficient to confirm
that the devitalized tooth did not play a role
in the causation of systemic disease. Thus the
theory of focal infection failed and faith was
restored in endodontic treatment .
 In1884 John Farrar indicated that root surgery
was “a bold act, which removes the entire
cause and which will lead to a permanent cure,
may not only be the best in the end, but the
most humane”
 The historical focus of surgical attention was
too often limited to the eradication of the soft
tissue surrounding the root apex, neglecting
the removal of the intracanal irritants and
proper sealing of the apical foramen
PRESENT ENDODONTICS
 Diagnosis
• cone beam computed tomography
''CBCT''
 Endodontic testing is divided into two main components
 periapical tests. The periapical tests include percussion and
palpation.
 pulp sensibility
,ELECTRIC PULP TESTING

COLD TESTING

HEAT TESTING
 Major techniques of
anaesthesia
 Local infiltration
 Regional nerve block
 Supplementary techniques
Intraseptal or intraosseous injection
Interpulpal injection
Periodontal ligament injection
 LOCAL ANESTHESIA DELIVERY DEVIC
ES
 Vibrotactile devices VibraJect Accupal
 local anesthetic delivery (CCLAD) systems,
Wand/Compudent system
 Comfort control syringe
 Jet injectors Syrijet
 Safety dental syringes and devices for Intra-
Osseous (IO) anesthesia.
SafetyWand™RevVac™ safety syringe
 Access cavity preparation
 INSTRUMENTS FOR ACCESS CAVITY PREPARATION 
Access Opening Burs They are round burs with 16
mm bur shank (3 mm longer than standard burs).
 Access Refining Burs. These are coarse grit flame-
shaped, tapered round and diamonds for refining
the walls of access cavity preparation.
 Surgical Length Burs.
 Munce Discovery (MD) Burs
Instrumentation in root canal
 Negotiation
 Patency
 Working length determination
 Shaping techniques
 Working width
Techniques in bmp

BMP

Step Crown
hybrid
back down
The general classification of
endodontic instruments:

Non-rotary endodontic
instruments used with a
Hand operated instrument :
handpiece:engine driven
files reamers broaches
instrument and ultrasonic
and sonic instruments

Rotary
instruments
 ELECTRONIC APEX
LOCATOR
 It is used to determine the position of the apical
foramen and its location and thus determine the
length of the root canal

 Generations

 First generation :1969:These apex locators use the

resistance method for determining the WL
 Secondgeneration :1971:These apex locators use the
Impedance method for determining the WL
 Third generation:These apex locators use two
frequencies instead of a single one to measure the
impedance in order to determine the WL
 Fourth generation :These apex locators use multiple
frequencies (2-5 frequencies) to measure the impedance
in order to determine working length
Endodontic Microscope
Why enhanced visions is
necessary in dentistry
 Few procedures that demand
tolerance well beyond the 0.2 mm
limit
1. root canal location
2. caries removal
3. furcation and perforation repair
4. post placement or removal
5. bone and soft tissue grafting
http://www.slideshare.net/ulibra22/operating-microscope-
in-endodontics?from_m_app=android
• Endodontic instruments can be divided into 4 different
groups:
 
• GROUP 1. Instrumentation used for manual root
canal procedure.
• GROUP 2. Instrumentation for mechanized or rotary
duct procedure.
• GROUP 3. Trephines for mechanized use (Weight
burs, Gates glidden, etc.).
• GROUP 4.Instruments and materials for sealing the
duct (paper cones, capacitors, etc.).
 
• ISO classification. Not all files qualify for this classification. For
them to be part of it, they must have the following characteristics:
1. The calibre of the file is numbered 10 to 100, with jumps of five
units to size 60 and jumps of ten units to size 100.
2. The cutting edges will start at the tip of the instrument with the so-
called diameter 0 (D0) extending exactly 16 millimeters to the
stem, ending at diameter 16 (D16). 
3. The diameter of D16 will be 32/100 or .32 mm larger than that of
D0
4. These measurements ensure a constant increase in taper of 0.02
mm per instrument regardless of size..
5. The angle at the tip should be 75° ± 15°.
6. Numbers 6 and 8 have been added more recently for more
versatility
Type of cut and section.
1. K files. The most commonly used type for canal root procedures.
Over time, they have varied from square to triangular and
rhomboidal in cross-section, giving rise to the K-Flex and Flex-R
file
. K-Flex files (Kerr). Files feature a unique rhomboid design, which
provides a short axis for flexibility while maintaining crosssectional
strength.
. Flex-R files. Triangular cross section , non cutting tip , more cutting
efficiency

. K-Colorinox files. They are made of high quality Swedish steel,

very thin and stainless. Manufactured by torsion, it gives them a high
resistance to fracture, keeping their metal fibres intact. They enlarge
the root canal, either abrasively or sharply.
C+ files. Root canal exploration file. Available in 18mm, 21mm
and 25mm lengths and 8-15 gauges.
 . C-Pilot files: C-Pilot files are special endodontic files for
particularly sinuous and calcified ducts.
Triple Flex files. Unlike turned files, Triple-Flex is highly
resistant to breakage, even under high stress situations. Twisted
instrument.
Flexicut files. For the treatment of narrow, highly curved root
canals with a filing motion. 
. Hedströem files. Drags large amounts of fabric in its traction
cut.
. UltraFlex,
Uniflex and Unifile files. Less known and
more specific. Turned instrument. The files of the Unifile
system are manufactured by turning.
 Reamers or reamers (Reamer). It has the characteristic
of producing a passive towing system. It will have 0.80 to
0.28 cut-off marks per millimeter on its side. Of triangular
cross-sectional configuration. 
Nervous tyrants. Progressively disused because it is
very aggressive, this is only used in cases of very wide
ducts
Rotary systems

a F
Why rotary ??

Improved safety and

consistency of results
Improved efficiency
Improved procedural
simplicity
Composition

 It was back in 1988 when Dr. Harmeet D Walia

introduced the use of the wonder metal, nickel
titanium (NiTi), for the manufacture of root canal
shaping files. In the beginning, these files were
made of carbon steel or stainless steel. With the
introduction of NiTi files, the evolution of rotary files
was marked. 
 First Generation Rotary Files:

System GT LightSpeed Quantec

These rotary files, being the first of their kind, had

passive cutting radial lands and fixed tapers of 4%
and 6%. The number of files that were to be used to
achieve acceptable canal shaping was numerous.
The notable files of the first generation are Lightspeed
(Lightspeed Endodontics – 1992) Profile (Dentsply Tulsa
– 1993), Quantec (Sybron Endo – 1996) and System GT
(Dentsply Tulsa – 1998).
 Second generation rotary files

ProTaper Mtwo Hero Shaper

The next set of files made from the wonder metal was introduced into
the market during 2001. The distinctive property of the 2nd generation
files is that they had active cutting edges.
The manufacturers of these files included asymmetrical cross sections
and design inconsistencies.
Few of these include progressively changing taper, reverse taper and
alternating pitch length.
These instruments had greater cutting efficiency owing to the active
cutting edges and resulted in straightening canal curvatures while
preparation.
 Third generation rotary files

Twisted Files Profile GT Series X Hyflex CM

The third generation saw great emphasis being

laid on NiTi metallurgy. 
Manufacturers focused on using heating and cooling
methods that resulted in a reduction of the cyclic
fatigue associated with the file, which in turn would
reduce the risk of instrument fracture while working
with canals with prominent curvatures.
Fourth generation rotary files

Liberator Self Adjusting File Reciproc

The continuing research yielded yet another

significant finding. Canal preparation was found
to be more efficient with the use of
reciprocation. Reciprocation may be defined as
any repetitive up and down or back and forth
motion. The reciprocating file systems were
aimed at improving the standard of shaping
techniques in endodontics.
 Fifth generation rotary files

ProTaper Next  One Shape  Revo-S

The fifth generation of endodontic rotary files saw yet another
innovative feature that dictated efficiency of canal shaping. This was
the offsetting of the center of mass or center of rotation. Files having
an offset design were seen to produce a mechanical wave of motion
that transverses along the length of the file. A file having an offset
design allows improved cutting and removal of debris by increasing the
cross-sectional space, in comparison to a file with a centered mass of
rotation. The reduced engagement between the file and the dentin,
further reduces the chances of an undesirable taper lock or the screw
Irrigants
Uses

 Removal of intracanal obstruction

 Increased action of irrigating solution
 Ultrasonic condensation of gutta-percha
 Placement of mta
 Surgical endodontics : root end cavity
preparation
 Root canal preparation
  

Irrigants used
Irrigant name Concentrations Main Advantages Main Disadvantages

Antimicrobial and Toxic,

Sodium Hypochlorite 0.5-3% bactericidal even at low Ineffective in removing
concentrations the smear layer

Doesn’t dissolve smear or

Antibacterial substantivity
Chlorhexidine 0.12-2% organic matter,Allergic
lasting up to 12 hours
reaction

Ethylene-Diamine-Tetra- Chelating, removes smear,

17% No antibacterial effect
Acetic acid lubrication

Penetrate deep, antiviral

Potassium iodide 2.5% Allergic reaction
and antibacterial

Interacts with sodium

Citric acid 10-50% Removes smear
hypochlorite
• Irrigating
ultrasonic
device
.
 IRRIGATION
 MANUAL :
 SYRINGE IRRIGATION WITH NEEDLES/CANNULA
 BRUSHES:ENDOBRUSH , NOVITIPFX ,
 MANUAL –DYANAMIC AGITATION :HAND ACTIVATED WELL FITTING GUTTA
PERCHA
 MACHINE ASSISTED :ROTARY BRUSHES :RUDDLE BRUSH, CANAL BRUSH
 CONTINUOUS IRRIGATION IRRIGATION DURING ROTARY
INSTRUMENTATION :QUANTEC –E
 SONIC :RISPISONIC FILE , ENDOACTIVATOR
 ULTRASONIC :CONTINUOUS (NUSSTEIN’S DEVICE
 INTERMITTENT :ULTRASONIC FILE
 PRESSURE ALTERNATION DEVICES :ENDOVAC , RINSENDO
Intracanal medications
• It should be an effective antimicrobial agent
• It should be nonirritating to the periradicular tissues
• It should remain stable in solution
• It should have a prolonged antimicrobial effect
• It should be active in the presence of blood, serum, and
protein derivatives of tissues
• It should have low surface tension
• It should not interfere with the repair of periradicular tissues
• It should not stain tooth structure
• It should not induce a cell-mediated immune response.
Indications

• To dry persistently wet or the so-called

weeping canals
• To eliminate any remaining microbes in the
pulp space
• To render root canal contents inert
• To neutralize tissue debris
• To act as a barrier against leakage from an
interappointment dressing in symptomatic
cases.
CLASSIFICATION

 PHENOLIC PREPARATION
PHENOL
PARAMONOCHLOROPHENOL
THYMOL
CRESOL
 ALDEHYDE PREPARATION :
FORMOCRESOL
TRICRESOL FORMALIN
GLUTARALDEHYDE
 HALOGENS
 CALCIUM HYDROXIDE
 CHLORHEXIDINE
 ANTIBIOTICS
PBSCN
TRIPLE ANTIBIOTIC PASTE
 CORTICOSTEROID ANTIBIOTIC COMBINATION
 BIOACTIVE GLASS
Sealers

 Sealer, root canal (cement) is defined

as a radiopaque dental cement used,
usually in combination with a solid or
semi-solid core material, to fill voids
and to seal root canals during
obturation
 Root canal sealers can be classified broadly as 
 Commonly used sealers:
• Zinc-oxide–eugenol-based sealers 
• Epoxy resin-based sealers 
• Calcium silicate–based sealers (CSBS) 
 Other available sealers:
• Calcium hydroxide sealers
• Silicone sealers
• Glass ionomer–based sealers 
• Other resin-based sealers
• Medicated sealers (not recommended) 
OBTURATION
• Cold Lateral Compaction: A cold lateral compaction technique uses
spreaders, gutta-percha, and scalpels to replace missing tooth material along
the lateral or elongated sides of the root channels, entombing infection and
making sure that the tooth cannot be reinfected. 

Warm Lateral Compaction: Using the same method as cold lateral compaction,

but instead accesses the side position of the tooth and then uses irrigation acids
and gutta-percha heating devices to seal in the channels, allow any remaining
bacteria to die off, and provide a tight seal for the tooth. 
•Warm Vertical Compaction: In rarer cases, root channels can
have a vertical development inside the tooth, making accessing the
channels more difficult when attempting to remove the infection.
However, warm vertical compaction compensates for any damage
to these vertical channels by accessing it through a vertical incision
rather than a literal one, using gutta-percha heaters to seal the
tooth. 
•Continuous Wave Compaction: Warm compaction
techniques, although useful, can take longer to proceed. A
continuous-wave compaction technique uses electrical
heat for a continuous wave of heat to the affected area,
giving the gutta-percha more mobility to move through
the root channels and accelerate the drying process. 
• Carrier-based Gutta-Percha: This technique is used in specific
cases where the root channels have curves that bend alongside the
front and mid-root areas of the tooth. A carrier device aims to
improve fluid filtration for the channels and thus makes this
technique an alternative to lateral compaction. 
ThermaFill Thermoplasticized Technique: By combining the use of
carriers and thermoplasticized gutta-percha, this technique can be
used for long and curved root channels and aim to increase
accessibility and flexibility without smearing the gutta-percha
material. 

• . 
Chemically Plasticized Gutta-Percha: For channels that
have unusual curves, this method removes the need for
heating devices and carriers by hardening the gutta-percha
with chemical solutions such as xylol eucalyptol and
chloroform
•SimpliFill Sectional Obturation: Instead of performing
the technique all at once, the SimpliFill technique
removes the need for post-space preparation by
attempting to create an apical seal for the front channels
of the tooth to prevent leakage and lateral condensation. 

.
McSpadden Thermomechanical Compaction: With
techniques that require heating techniques, the McSpadden
technique uses instrument rotations of higher speeds to create
controlled thermomechanical compaction for the gutta-percha
and remove the problem of uncontrollable heat temperature.
Custom Cone Obturation: For those who have immature root
channels, all previously mentioned root canal techniques can
use custom gutta-percha cones to help accommodate this
immaturity
• Obturation
of root
canals by
hot
injectable
gutta -
percha
-
-
Bioactive material
MTA
Mineral trioxide aggregate (MTA) was
developed for use as a dental root repair
material by Mahmoud Torabinejad.
It is formulated from commercial 
Portland cement, combined with bismuth oxide
powder for radio-opacity.

MTA is used for creating apical plugs during 

apexification, repairing root perforations during 
root canal therapy, and treating internal 
root resorption.
This can be used for root-end filling material
and as pulp capping material. Originally, MTA
was dark gray in color, but white versions have
been on the market since 2002.
Biodentin sealer

BioRoot'
RCS
 Biodentine is a calcium-silicate bio active material.
• It has superior mechanical, physical and handling
properties comparable to most commonly used
restorative materials.
• It is used as a temporary enamel restoration and
permanent dentine restoration
• It is used during root perforations, apexifcation,
resorptions, retrograde fllings, pulp capping procedures,
and dentine replacement
 Endosequence Root repair
material

EndoSequence BC Sealer is a patented, revolutionary premixed

root canal sealer which utilizes new bioceramic nanotechnology.
Unlike conventional base/catalyst sealers, BC Sealer utilizes the
moisture naturally present in the dentinal tubules to initiate its
setting reaction. The canal should be dried just as you normally
would, but unlike other sealers, the set is not inhibited by moisture.
This highly radiopaque and hydrophilic sealer forms
hydroxyapatite upon setting and chemically bonds to both dentin
and to our bioceramic points
Bioaggregate
 Bioaggregate is a new bioceramic root repair and root-end
filling material composed of a powder component
consisting of tricalcium silicate, dicalcium silicate,
tantalum peroxide, calcium phosphate monobasic and
amorphous silicon dioxide and a liquid component of
deionized water.
 It is indicated in repair of root perforation, repair of root
resorption, root end filling, apexification and in pulp
capping. Studies have shown that Bio Aggregate is more
biocompatible than MTA
 Ceramicrete
A ceramicrete based dental or bone material was
introduced which had hydroxyapatite powder and cerium
oxide radioopaque fillers.This material is biocompatible and
radioopaque. The material is also known to release calcium
and phosphate ions during setting.
A comparison of the root-end seal achieved using
Ceramicrete, Bioaggregate and White MTA was done to
study the prevention of glucose penetration.
Both Bioaggregate and Ceramicrete showed similar sealing
ability to MTA, with Ceramicrete showing significantly
better results than Bioaggregate.
 ENDODONTIC SURGERY
Application of cone beam technology :CBCT is a
powerful tool that can assist in determining the exact
dimensions and location of a periapical lesion as well
as the three-dimensional relationships of roots to
neighbouring anatomical structures
Use of the surgical microscope
 Tissue anesthesia: : Procedures should be performed within a
specific time frame (usually within 60–90 mins) to prevent loss of
anesthesia in addition to loss of local hemostasis . The use of
appropriate hemostatic agents is common-place in surgical
endodontics
 Soft tissue management. The base of each tissue flap should be
as wide as the top so that the incision does not bisect tissue
fibers and blood vessels
 Hard tissue access . When the bone must be removed with a
rotating bur, it is done in a shaving manner with coolant to
 Root-end resection : Removal of 3–4 mm of the root end
is commonplace and is usually required to eliminate
anatomical irregularities and contaminated (biofilms,
bacteria, and endotoxins) radicular hard tissue
 Root-end cavity preparation : The depth of preparation
is usually 3–4 mm
 Root-end filling : amalgam , the sporadic use of dentin-
bonded modified resins , the continued use of IRM and
Super-EBA , the current advocacy of mineral trioxide
aggregrate , and the emerging use of bioceramics
 Surgical regenerative techniques : guided tissue
regenerative techniques (GTR) in conjunction with
periapical surgery
FUTURE OF ENDODONTICS
 BIOACTIVE ENDODONTICS

VITAL PULP CRYOTHERAPY

In this sterile ice is used with edta bioceramics , restorative
material that is exposed directly or indirectly because of carious
lesion.
Usually used in partial pulpectomy or pulp that is capped and
restored later
Contraindication
Acute and chronic apical abcess
Pretreatment pulpal diagonosis is necrotic
Periradicular diagonosis of asymptomatic apical periodontitis
 Regenerative Endodontics
 Regenerative endodontics has proven to be a biological approach
to endodontic treatment compared to the current clinical
methodology. This technique can be done on necrotic or vital
pulps of mature and immature teeth. In order to fill a prepared
canal, regenerative endodontics makes use of periradicular
blood. This eliminates the need for cold lateral compaction
techniques and warm vertical. It also eliminates the use of carrier-
based root-filling materials that are needed for canal obturation.
 After a regenerative endodontic procedure, the generated tissues
in the canals are bone-like, periodontal ligament-like, and
cementum-like tissues with nerves and blood vessels. However,
these tissues cannot be classified as true pulpal tissue. As opposed
to foreign obturation materials, they are the host’s vital tissue.
 Listed below are some canal preparation guidelines that
need to be considered before performing regenerative
endodontics.
• There is no need for the coronal two-thirds of the canal to be
overly enlarged.
• The apical foramen’s final canal size must be a minimum
MAF size of 0.32 mm. This is to allow the periapical
tissue’s blood cells to easily migrate into the canal space.
• If the teeth have a pretreatment pulpal diagnosis of necrosis,
it is advisable to first treat these teeth.
 Real time guided endodontics
 A guided endodontic access preparation can be approached in
two different ways: static guidance, implies the use of a
template, whilst dynamic navigation relies on markers
positioned in the patient's mouth and a camera system
  a CBCT with the smallest possible ‘field of view’ and ideally
high resolution is required to visualize the calcified root
canals. 
 For the virtual planning of the access cavity, a software is
required to overlay the data of the CBCT in DICOM format with
those of the surface scan (stl format). In the aligned 3D data
set, the true-to-scale virtual image of the drill must be placed
so that the tip reaches the visible part of the calcified root
canal
Virtual planning in implant software: a Virtual access
planning: 3D image reconstruction of cone beam
computed tomography and virtual burs with axis within
the range of conservative endodontic access
cavity. b Template with resin sleeve designed in
software. c Virtual planning in premolar. Template
(orange outline), scan surface (red outline), virtual bur
(yellow cylinder), and cone beam computed tomography
were superimposed in software
  In cases where the root canal cannot be visualized
in the CBCT, the apex of the tooth is chosen as the
apical target point
  After inserting the template with the incorporated
sleeve in the patient's mouth, the bur is moved a
few millimetres in depth at low speed and with
pumping movements.
  If the canal is successfully detected, conventional
root canal treatment can now take place.
Dynamic navigation scheme: A marker is positioned in the patient's
mouth. A stereoscopic camera is connected to a computer. The
corresponding software presents the dynamic navigation in real time.
The spatial and angular deviation as well as the depth is displayed
 New irrigation system :

 Max I probe
 Navi tip fx
 The quantic e irrigation system
 The vibringe system
 Photoactivated disinfection
 Ozone based delivery system
 The VATEA system
Recent advances in sealers
 Tricalcium Based Sankin Apatite Root Canal Sealer • Appetite
Root Canal Sealer • Composed of hydroxyapatite and tricalcium
phosphate. • 3 types.
 Type I • Powder • Tricalcium phosphate – 80%. • Hydroxy apatite
– 20%. Liquid • Polyacrylic acid – 25%. • Water – 75%. • This is
used for vital pulpectomy.
 Type II Powder: • Tricalcium phosphate – 52%. • Hydroxyapatite
– 14% • Iodoform – 30%. Liquid • Polyacrylic acid – 25% • Water –
75% • Used in infected canals
 Type III: Powder • Tricalcium phosphate – 80%. • Hydroxyapatite
– 14% • Iodoform – 5% • Bismuth subcarbonate – 1% Liquid •
Polyacrylic acid – 25% • Water – 75% • Used in cases of accidental
perforation and retrograde filling material
 Newly Developed Calcium Phosphate Type Sealers Are
•
 Tdm-S Buffer Solution Composition
Powder • Tetracalcium phosphate • Dibasic calcium
phosphate
Liquid • Citric acid • Dibasic sodium phosphate •
Condroitin sulphate • Distilled water
 A Modified Mciivain’s & Buffer Solution Composition
Powder • Tetracalcium phosphate • Dibasic calcium
phosphate
Liquid • Citric acid • Dibasic sodium phosphate •
Condroitin sulphate • Distilled water Sealer Application
After the selection of the compacting instrument
 Recent Advances in Root Canal
Disinfection
 Antibacterial nanoparticles (NPssize range of 1-100 nm These
materials present unique physicochemical properties, such as large
surface area/mass ratio, and increased chemical reactivity .
The increased number of atoms and increased surface to volume
ratio compared with micro/macro-structures are suggested to
contribute to the distinctly different properties of nanomaterials.
 Antimicrobial photodynamic therapy (APDT) APDT is a two-step
procedure that involves the application of a photosensitizer,
followed by light illumination of the sensitized tissues, which
would generate a toxic photochemistry on target cells, leading to
killing of microorganisms
 Photon-induced photoacoustic streaming (PIPS) PIPS is based on
the radial firing stripped tip with laser impulses of subablative
energies of 20 mJ at 15 Hz for an average power of 0.3W at 50 μs
impulses. These impulses induce interaction of water molecules
with peak powers of 400W. This creates successive shock waves
leading to formation of a powerful streaming of the antibacterial
fluid located inside the canal, with no temperature rising
 Gentlewave irrigationsystem aims to clean the root canal through
generation of different physiochemical mechanisms including a
broad spectrum of sound waves. Multisonic waves are initiated at
the tip of GentleWave™ handpiece, which is positioned inside the
pulp chamber . It delivers a stream of treatment solution from the
handpiece tip into the pulp chamber while excess fluid is
simultaneously removed by the built-in vented suction through the
handpiece.
 Future perspectives on
surgical endodontics
 Lasers :
cutting efficiency, root-end resection, root-end
cavity preparation, seal of the root-end cavity,
sterlization of the surgical site, permeability of the
resected dentin, pain reduction following surgery,
and healing rates, using various lasers including the
CO2, Nd:YAG, holmium:YAG, Er:YAG, Ga-AL-AS, and
ErCR:YSGG
.
Peizoelectric :
Advantages claimed for the application of
piezoelectric surgery in endodontics include : •
protection of soft tissues;
• optimal visualization of the surgical field;
• decreased blood loss;
• reduced vibration and noise;
• increased patient comfort; and
• protection of tooth structures
 Nanotechnology and
bioengineered tooth units
 With the evolution in nanotechnological principles in the science
of material manipulation , would it not be possible to perform a
root-end resection using a cool but efficient laser in a matter of
seconds in order to achieve disinfection, followed by the
nanoencapsulation of the resected root apex with nanorods,
spheres, or tubes that are HA (hydroxyapatite) based-encourage
the regeneration of a genetically engineered root structure?

 Bioengineered tooth unit replacements as mature organs for

replacement regenerative therapy are rapidly becoming a reality.
Thank you