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BIO MECHANICAL PREPARATION IN ROOT CANAL TREATMENT.pptx
- 1. BIOMECHANICAL PREPARATION PRESENTED BY: DR.ARCHANA PAI IST MDS DEPARTMENT OF PUBLIC HEALTH DENTISTRY
- 2. INTRODUCTION The successful endodontictherapy depends on correct access opening followed by thorough biomechanical cleaning and a three-dimensional obturation...
- 3. The preparation ofthe root canal space involves three separate procedures: Cleaning Shaping Apical preparation These procedures are challenging and constitute a major portion of the effort in root canal treatment. In addition to the removal of the irritants, the preparation of the canal is important to ensure adequate canal obturation. Click icon to add picture
- 4. CLEANING / DEBRIDEMENT •The cleaning refers to the removal of all contents of the root canal system before and during shaping. • Organic substances, micro flora, bacterial by-products, food, caries, denticles, pulp stones, dense collagen, previous root canal filling material and dentinal fillings resulting from root canal preparation.
- 5. SHAPING o Shaping refersto a specific cavity form with specific objectives. o The shape permits vertical pluggers to fit freely within the root canal system and to generate the hydraulics required to transform and capture a maximum cushion of the gutta percha and a micro film of sealer into all foramina. Click icon to add picture
- 6. APICAL PREPARATION o Itis critical to prepare an apical matrix or barrier at proper working length.. o This barrier has two functions: o To serve as a stop against which to condense gutta- percha. o To prevent materials, irrigants, and instruments from extruding into the periapical tissues, with resultant irritation & inflammation.
- 7. DEFINITION BIO MECHANICAL PREPARATION Itis the attainment of free access to the apical foramen, through the root canal, by mechanical means without injuring the periapical tissue.
- 8. RULES FOR ROOTCANAL CLEANING AND SHAPING o Direct access should be obtained along the straight lines o The length of the tooth should be accurately determined o Instruments should be used in a sequence of sizes with periodic recapitulation and without skipping of the sizes o Instruments should be used with a quarter to half turn and withdrawn with a full stroke o The barbed broaches should be used cautiously and only when the root canal is wide enough to permit their insertion and rotation without binding o Instruments should be fitted with stoppers
- 9. PRECAUTIONS DURING INSTRUMENTATION oA root canal instrument should not be forced if it binds o Always only controlled finger pressure should be used in manipulating an instrument in the root canal. o Always instrumentation of root canal should be done in a wet canal. o Instruments must be used extravagantly particularly in the smaller sizes o Once the working length of a tooth is determined, all instruments must be kept within the confines of the root canal.
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- 11. REAMING • In endodonticpractice, reaming is commonly done by use of reamers , though files can also be used. • It involves clockwise rotation of an instrument. The instrument may be controlled from insertion to generate a cutting effect
- 12. FILING • The termfiling indicates push-pull motion with the instrument. • But this active insertion of instrument with cutting force is a combination of both resistance to bending and apically directed hand pressure. This may lead to canal ledging, perforation and other procedural errors.
- 13. COMBINATION OF FILINGAND REAMING • In this technique file is inserted with a quarter turn clockwise and apically directed pressure (i.e. reaming) and then is subsequently withdrawn (i.e. filing). • File edges get engaged into dentin while insertion and breaks the loose dentin during its withdrawal. • By performing this combination of reaming and filing repeatedly, canal enlargement takes place. • But this technique has also shown the occurrence of frequent ledge formation, perforation and other procedural errors
- 14. WATCH WINDING MOTION •It is back and forth oscillation of the endodontic instrument (file or reamer) right and left as it is advanced into the canal. • The angle of rotation is usually 30 to 60 degrees
- 15. CIRCUMFERENTIAL FILING • Usedfor canals that are larger and are not round. • The file is placed in the canal and withdrawn in a directional manner sequentially against the mesial, distal, buccal and lingual walls
- 16. TECHNIQUES OF ROOTCANAL PREPERATION • STEP BACK PREPERATION • CROWN DOWN PRESSURE-LESS TECHNIQUE • PROFILE SYSTEM • PROTAPER SYSTEM
- 17. Click icon toadd picture STEP BACK PREPARATION
- 18. ADVANTAGES • It isless likely to cause periapical trauma • It facilitates the removal of more debris • The greater place that results from instrumentation facilitates packing of additional gutta percha cones by either the lateral or vertical condensation method • The development of apical matrix or stops, prevents over filling of the root canal.
- 19. DISADVANTAGES • The pulpaldebris and bacteria may be pushed apically. • Irrigation, critical part of debridement stage, cannot penetrate to the apex because of narrowness of the canals. • Increased chances of errors like ledge formation
- 20. Click icon toadd picture CROWN DOWN PRESSURE- LESS TECHNIQUE
- 21. ADVANTAGES • Removal ofcoronal interference • Straighter access to the apical third of the root • Removal of canal contents and micro-organisms before apical preparation • Increased space for instrumentation and irrigation of the apical third of the root • Minimal apical extrusion of the debris
- 22. DISADVANTAGES • Coronal portioncan be over prepared and under irrigated. • Could results in ledges and blockages, and with over zealous use of the files a perforation or strip may be created on the inner curve • In calcified teeth, working length has to be obtained first.
- 23. ENGINE DRIVEN PREPARATIONWITH NI-TI INSTRUMENTS • Before using these instruments, one should take care to have a straight-line access to the canal system. • Canals should be thoroughly explored and passively enlarged before using rotary instrument. • Instruments should be constantly moving and speed of rotation of each instrument should be known. All of these Ni-Ti rotary systems incorporate: • Crown down preparation. • Apical preparation as finale. • Increasing taper instruments
- 24. PROFILE SYSTEM 1. Makea straight- line access to the canal orifice. 2. Estimate the working length of the canal from preoperative radiograph. 3. Create a glide path before using orifice shapers. Establish this path with a small, flexible, stainless-steel number 15 or 20 file.
- 25. 4. Use orificesshapers sizes 4, 3, 2, and 1 in the coronal third of the canal. 5. Perform crown down technique using the profile instruments 6. Now determine the exact working length by inserting conventional number 15 K-file 7. After establishing the exact working length complete the crown down procedure up until this length. Use profile 25, 30 for apical preparation
- 26. PROTAPER FILES 1. Theforemost step is gaining straight line access to the canal orifices. 2. Establish a smooth glide path before doing any instrumentation with ProTaper system. 3. Now prepare the coronal third of the canal by inserting S1 into the canal using passive pressure. Don’t go more than third fourth of the estimated canal length. 4. Irrigate and recapitulate the canal using number 10 file.
- 27. 5. In shorterteeth, use of Sx is recommended. 6. After this S2 is worked up to the estimated canal length. 7. Now confirm the working length using small stainless steel K- files up to size 15 by electronic apex locators and/or with radiographic confirmation. 8. Use F1, F2 and F3 (if necessary) finishing files up to established working length and complete the apical preparation. Then refine the apical preparation using corresponding stainless steel file to gauge the apical foramen and to smoothen the canal walls
- 28. ULTRASONIC INSTRUMENT 1. Afteractivation, ultrasonic file is moved in the circumferential manner with push-pull stroke along the walls of canal. 2. File is activated for one minute. This procedure is repeated till the apex is prepared to at least size 25.
- 29. ERRORS WHILE CLEANINGAND SHAPING OF THE CANAL • Loss of working length • Blockage of the canal system • Ledging • Over-instrumentation • Overpreparation/under- preparation • Breakage of instruments in the canal • Zipping (elliptication) • Stripping or lateral wall perforation
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