(HAND INSTRUMENTS)

ENDODONTIC INSTRUMENTS
GUIDED BYDR. ARUNDEEP SINGH

Presented byArvinder

CONTENTS

History Classification Diagnostic instruments Basic instruments Isolating devices Instruments for access cavity prepration Standardisation of endodontic instruments Exploring instruments Debriding instruments Cleaning & shaping instruments Irrigation devices Root canal filling instruments Non ISO instruments

HISTORY
1750- Fauchard recommended removal of pulp. 1850- wooden pegs for debriding pulp. Early 1900- introduction of files,reamers,lentulospiral. 1915- Kerr manufacturing company obtained patent for all instruments later known as K type instruments. 1957- Richman introduced first ultrasonic system. 1958- Ingle & Levine first proposed standardisation. 1959- filling materials. 1964- introduction of giromatic handpiece. 1988- 1st use of NiTi in endodontics instruments.

SUCCESS OF ENDODONTICS DEPENDS UPON ENDODONTIC TRIAD

Access cavity preparation Biomechanical Preparation of the root canal.(Cleaning and shaping) Obturation For these three steps instruments are mandatory

Ingles endodontics 6th edition

MATERIALS

Carbon steel- high cutting efficiency

Stainless steel- low cutting efficiency & becomes dull rapidly Nickel titanium- Ni 54% ,Ti 44% Co & boran- improve surface hardness

At high temperatures,NiTi exsts as BCC lattice,reffered to as AUSTENTIC phase (stable & stronger) On cooling,this phase transfers to close packed hexagonal known as MARTENSITIC phase(weak phase) This transformation results NiTi austenite phase in 2 featuresstress induced 1. Shape memory 2. Super elasticity Martensitic phase stress relieved Austenite phase

DISADVANTAGE- cutting efficiency is only 60% than that of stainless steel files

CLASSIFICATION

Classification According to Function (Grossmans Classification)

FUNCTION Exploring INSTRUMENTS Smooth broaches and endodontic explorers (Used to locate canal orifice and to determine the direction and patency of root canal)

Debriding

Barbed broaches (Used to extirpate the pulp and to remove debris and other foreign materials
Reamers and Files (Used to shape the canal space laterally and apically ) Pluggers, spreaders and lentulospirals (To cement and pack guttapercha points into the canal space)
Grossmans 12th edition

Shaping Obturating

ISO AND FDI CLASSFICATION OF ENDODONTIC INSTRUMENTS

TYPES TYPES OF INSTRUMENTS HAND / ENGINE DRIVEN
Endodontic instruments for hand use only

EXAMPLES

K-type files H type file R-Type rasps Barbed broaches spreaders condenser

Ingles 5th edition

ISO AND FDI CLASSFICATION OF ENDODONTIC INSTRUMENTS

TYPES TYPES OF INSTRUMENTS HAND / ENGINE DRIVEN
Engine driven instruments Handle has been replaced by a latch type adaptor for insertion in contra angle hand piece

EXAMPLES

II

Similar to group I instruments Niti Rotary instruments like Profile Paste fillers (lentulospirals)
Ingles 5th edition

GROUP I

GROUP II

K- reamer

Greater Taper Ni-Ti instruments

Lentulospiral
GROUP III

TYPES

TYPES OF INSTRUMENTS HAND / ENGINE DRIVEN

EXAMPLE

III

Endodontic engine driven instruments latch and shaft and operative head, all made of a single piece Endodontic points

Gates glidden Peezo reamer

IV

GP points Silver points Paper points

Ingles 5th edition

ACCORDING TO COHEN
Group 1- manually operated instruments (barbed broaches & K type,H type instruments) Group 2- low speed instruments with latch type attachment (GG burs & peesoreamers) Group 3- engine driven Ni-Ti rotary instruments Group 4- engine driven instruments that adapt themselves three dimensionally to shape of root canal. (SAF,self adjusting file) Group 5- engine driven reciprocating instruments Group 6- ultrasonic instruments

Cohens 10th edition

DIAGNOSTIC DEVICES
For pulp vitality
Battery operated instrument connected to a probe. Designed to stimulate a response by electrical excitation of the neural elements within the pulp. Does not provide any information regarding the vascular supply to the tooth. Considered advantageous when compared with the thermal tests since the quantitative readings are obtained.

Cohens 10th edition

 Pulse
.

oximetry

Non invasive oxygen saturation monitoring device widely used in medical practice for recording blood oxygen saturation levels during administration of I.V. anesthesia. System consists of a probe containing a diode that emits light in two wavelengths Red 660nm Infrared 940nm Probe is placed on labial surface of tooth-ideally on middle 1/3rd & a silicon photodetector diode is placed on opposing surfaces of tooth & is connected to a microprocessor . In the red range the oxyhaemoglobin absorbs less light than deoxyhaemoglobin & vice versa in the infrared region.
Cohens 10th edition

Mechanism of the dental pulse oximeter. (a) Light-emitting diode emitting red light at 660 nm. (b) Light-emitting diode emitting infrared light at 940 nm. (c) Photodetector. (d ) Pulse oximeter monitor. (e) Pulse oximeter sensor. (f) Custommade pulse oximeter sensor holder. HbO2, oxygenated hemoglobin; HbR,deoxygenated hemoglobin; SpO2, oxygen saturation of arterial blood

 Laser

doppler flowmetry

1. Non invasive , electro optical technique 2. Can measure blood flow in microvasculature systems.

3. Incident laser beam of known wavelength is directed through crown of tooth 4. moving red blood cells cause frequency of laser beam to be dopple shifted & some light to be back scattered out of tooth
Cohens 10th edition

Cold tests (A stream of cold air,ethyl chloride spray(-41C), application of ice,Carbon-di-oxide snow (dry ice-78.5C))

Heat tests(Hot air,Hot water,A hot burnisher ,Hot gutta-percha ,Hot compound)

Cohens 10th edition

MAGNIFICATION DEVICES

Loupes

DISADVANTAGES1. Fixed magnification power that can not be increased or decreased. 2. No integerated light source 3. No way to digitally document viewed images. 4. Focus is adjusted through movements of clinicians head.

Operating microscopes
1. Wide range of magnification. 2. Coaxial illumination 3. Easy photographic documentation 4. Focus adjustments by moving the microscope. Cohens 10th edition

BASIC INSTRUMENTS

Front surface mouth mirror

Locking pliers
It has a lock that allows materials to be held without continuous finger pressure; also it has a groove which facilitates holding gutta percha and absorbing points. Cohen 10th edition

Explorer

DG-16 endodontic explorer

Cohen 10th edition

Endodontic excavator
-larger than a spoon excavator -excavation of the contents of the pulp chamber. -Also used in curettage of periapical lesions in surgical endodontics .

the endodontic ruler

Cohen 10th edition

Endodontic file organiser

:It is used for arrangement

of reamers and files according to the size and length.

The organizer provides holes for the files to be place vertically.

Cohen 10th edition

Transfer sponge: It is sponge saturated with disinfectant solution. The reamers and files can be placed in it after being used.

Cohen 10th edition

MICROINSTRUMENTS

Micromirrors

Microcondensers

Cohen 10th edition

MATERIALS FOR ISOLATION

Rubber dam provides the best possible isolation. In 1864 S.C.Barnum a New York city dentist introduced the rubber dam into dentistry 1. Rubber dam sheets 2. Rubber dam clamps 3. Rubber dam holders(frame) 4. Rubber dam retainer forceps 5. Rubber dam punch 6. Rubber dam templates or stamps 7. Dental floss 8. Wedgets
Ingles 6th edition

RUBBER DAM SHEET

It is made of latex or non-latex. Available in 2 sizes- 5*5 6*6 Available in varying thickness. Light and dark sheets are available for colour contrast. Has a shiny & dull side, dull side will be facing the occlusal side.

Ingles 6th edition

Rubber Dam Clamps

Clamps without wings

Clamps with wings

Ingles 6th edition

3. RUBBER

DAM HOLDER (FRAME)

Used to maintain the borders of the rubber dam in position. Types: a).Youngs holder-It is a U-shaped metal frame with small metal projections for securing borders of the rubber dam.

Ingles 6th edition

b). Ash pattern - most suitable for children.

C). Swenska N- frames are suitable for taking radiographs with the dam.

Ingles 6th edition

4. RUBBER

DAM RETAINER FORCEPS

Used for placement and removal of retainer from the tooth.

Ingles 6th edition

5. RUBBER

DAM PUNCH

Used for making holes in the dam Parts a). Rotating metal disc bearing 5 to 6 holes of different sizes according to size of teeth. b). A sharp pointed plunger.

Ingles 6th edition

6. RUBBER

DAM TEMPLATE

Both have positions of the teeth marked on them and are used to transfer them to the rubber dam sheet for holes to be punched.

Ingles 6th edition

7. Dental floss Tied around the retainer before carried to the oral cavity to prevent accidental aspiration of clamp.
8. Wedget

An elastic used to secure the dam around the teeth farthest away from the clamp.

Ingles 6th edition

ACCESSORIES

Rubber Dam napkin: This is a sheet of absorbent material placed between the rubber dam and skin.

Lubricant: A lubricant is applied in the area of punch holes facilitates the passing of dam septa through proximal contacts.

Ingles 6th edition

INSTRUMENTS FOR ACCESS CAVITY

PREPARATION

Hand

pieces
Vertical stroke handpiece

Reciprocating handpiece

Ingles 6th edition

BURS

Access burs:#2,#4,#6 round carbide burs

Access bur #57 fissure carbide bur

Round end cutting tapered diamond bur (endo access bur) th edition Cohen 10

safety tip tapered diamond bur(lt) Safety tip tapered carbide bur(rt)

#2, #4 round diamond burs

Transmetal bur

Cohen 10th edition

INSTRUMENTS USED IN CLEANING AND SHAPING THE PULP SPACE:

Includes: Hand Instruments Rotary Instruments

1958 Ingle and Levine first proposed standardization of endodontic instruments and suggested guidelines for the same
1) The instruments shall be numbered from 10 to 100, the numbers to advance by 5 units to size 60, and thereby by 10 units to size 100.
2) The instrument number shall be representative of the diameter of the instrument tip in hundredth of a mm (1/100). Eg. No. 20 is 0.20 mm (20/100) at the tip.

Ingles 5th edition

3) The working blades (flutes) shall begin at the tip designated site D1 and shall exactly 16 mm upto shaft terminating at designated site D2.
4) The diameter of D2 shall 0.32 mm greater than that of D1. eg: File no.20 shall have a diameter of 0.20 mm at D1 and a diameter of 0.52 (0.20 + 0.32) mm at D2 5) This sizing will ensure a constant increase in taper of 0.02 per mm of every instrument regardless of its size.

Ingles 5th edition

Ingles 5th edition

MODIFICATIONS FROM INGLES ORIGINAL

PROPOSAL BY ISO

6) An additional diameter measurement point at D3, 3 mm of from tip of cutting end of instrument at D0 7) Tip angle of an instrument should be 75o 15o

Weine 6th edition

COLOUR CODING:

The International Standards Organisation (ISO) recommended a colour coding system for easier recognition consists of 6 colours chosen in ascending order of size from light to dark Small sized instruments (06, 08,10) were also added and colour coded as pink, grey .purple respectively.

GROUP 1

Ingles 5th edition

GROUP 2

These colours are repeated in each of the three groups Change in D1

0610 1060 60160 0.02 mm 0.05 mm 0.10 mm

GROUP 3

Ingles 5th edition

Instrument length:

Measured from the instrument tip to the end of the shank (l2)

Manufactured in three lengths

Standard 25 mm

Long 31 mm (useful in canines)

Short

21 mm

the working end of the instrument (length of the cutting segment, l1 ) remains constant is 16 mm.

Broaches and rasps:

Available in 2 types- smooth & barbed

Broach doesnt cut dentin but can be used for pulp extirpation or to remove cotton or paper pts which might have lodged in canal. Manufactured from round wire,the smooth surface of which has been notched to form barbs bent at an angle from the long axis. USE- insertion through the access cavity until dentinal walls are felt,broach slightly withdrawn ,then rotated a few revolutions & removed Smooth broach is free of barbs. Used to explore the canal patency.
Weines 6th edition

Smallest size broach available has the width of a size 20 instrument. Should not used initially in narrow canals until the canal is wide enough. Both broach & rasps have similar design except in taper & barb size. Barb size is larger in broach. The broach has a taper of #.007 to #.01 taper and the rasp has a taper of #.015 to #.02 taper.

Weines 6th edition

REAMERS

Grossmans 12th edition

REAMERS:

a sharp edged tool for enlarging or tapering holes. Lesser no of flutes & have triangular blank. No of flutes are -1 per mm while in files are 11/2-2 /mm. Action:twisted clockwise to turn to engage dentin & then withdrawn-penetration, rotation and retraction. Remove intracanal debris with clockwise reaming action whereas conterclockwise turning will force debris apically.
Ingles,6th edition

Reaming is the only method that produces a round, tapered preparation, and this only in perfectly straight canals. In such a situation, reamers can be rotated turn before retracting. In a slightly curved canal, a reamer should be rotated only -turn.

FILES
Kerr manufacturing company was the first to produce it,hence the name K type file/reamer. More number of flutes than reamers, no of flutes are 11/2-2 /mm. Greater cross sectional area than reamers. Cutting action can be effected in either a filing or reaming motion.

In a filing motion,the instrument is placed into the canal at the desired length,pressure is exerted against the canal wall,and while this pressure is maintained,the instrument is withdrawn without turning.

In a reaming action,the motion is the same as for a reamer penetration,rotation,and retraction. Withdrawing the file cuts away the engaged dentin.

Ingles,5th edition

K TYPE FILES :
Square cross section. More no of flutes. Superior cutting

Grossmans 12th edition

K REAMER VS. FILE

K FLEX FILES
Rhombus/diamond

shaped cross section Cutting edges are formed by two acute angles of rhombus which leads to increase sharpness & cutting efficiency. low flutes formed by obtuse angles provide more space for debris removal & for irrigation. The major disadvantage is its rapid loss of cutting efficiency.

Ingles 6th edition

TRIPLE FLEX FILE

More recently, Kerr has introduced a hybrid instrument called as Triple-Flex File. It has more spiral flutes than a K reamer but fewer than a K file. Made from triangular stainless steel and twisted Instrument is more aggressive and flexible than the regular K-style instruments

Ingles 5th edition

FLEXOFILE:
Similar

to K FLEX but have triangular cross section. More flexibility and ability to resist #.

Ingles 5th edition

FLEX R FILES:
Made by removing sharp cutting edges from tip of instrument /tip angle is reduced Reduce ledge formation, canal transportation. Non cutting tip enables the instrument to traverse along the canal rather than gouge into it. Have triangular cross section.

Ingles 5th edition

K FILE MODIFICATIONS

K-Flex

Flex-R

HEDSTROEM FILES(H-FILE)
Flutes resemble successively smaller triangles set one on another.

Manufacture by cutting spiral flutes into the shaft of a piece of round tapered stainless steel wire.
It cuts only in one direction., during retraction

Cross section :single helix tear drop

Ingles 5th edition

USES 1. In immature teeth,where the walls are irregular & may harbour debris. 2. useful in removing silver points or loose broken instruments from canals(file is placed alongside the material to be removed,then rotated,& pulled towards the occlucal surface) 3. Widening straight canals,coronal portion of curved canals for easier placement of smaller instruments.

Ingles 5th edition

DRAWBACKS 1. It is weakened at each position during manufacture,resulting in a place for fracture if the flutes bind in dentin & the handle is rotated. If it is rotated clockwise after binding in dentin,instrument moves further apically & crack the weakened & stressed root.

Ingles 5th edition

H-FILE MODIFICATIONS

Unifile & Dynatrak

McSpadden was the first to modify the traditional Hedstroem file.Marketed as the Burns Unifile and Dynatrak These files were designed with two continous cutting edges, a double-helix design. In cross-section, the blades presented an S shape rather than the single-helix teardrop crosssectional shape of the true Hedstroem file

Ingles 5th edition

At this time, Unifiles and Dynatraks are no longer being marketed; however,the Hyflex file appears to have the same cross-sectional configuration. The S File also appears to be a variation of the Unifile in its double-helix configuration. Buchanan has further modified the Hedstroem file, the Safety Hedstrom, which has a noncutting side to prevent ledging in curved canals.

Ingles 5th edition

U FILE

A new endodontic classification of instrument, for which there is no ISO or ADA specification as yet, is the U-File. Marketed as ProFiles, GT Files, LIGHTSPEED and Ultra-Flex files. The U-Files cross-sectional configuration has two 90-degree cutting edges at each of the three points of the blade Adapts well to the curved canal, aggressively planing the external convex wall while avoiding the more dangerous internal concave wall, where perforation stripping occurs. A noncutting pilot tip ensures that the file remains in the lumen of the canal, thus avoidingtransportation and zipping at the apex. used in both a push-pull and rotary motion

Ingles 5th edition

Cross-sectional view of a U File

Ingles 5th edition

ProFiles are supplied in 0.04, 0.05, 0.06, 0.07,and 0.08 tapers and ISO tip sizes of 15 through 80.

GT ProFiles, developed by Buchanan in the U design,are unusual in that the cutting blades extend up the shaft only 6 to 8 mm rather than 16 mm, and the tapers start at 0.06 /mm (instead of 0.02), as well as 0.08 and 0.10, tapered instruments. They are made of nickel titanium and come as hand instruments and rotary files. GT instruments all start with a noncutting tip ISO size 20

Ingles 5th edition

An unusual variation of the U-shaped design is the LIGHTSPEED instrument Made only in NiTi Resembles a Gates-Glidden drill in that it has only a small cutting head mounted on a long, noncutting shaft. It is strictly a rotary instrument but comes with a handle that may be added to the latch-type instrument for hand use in cleaning and shaping abrupt apical curvatures . The instruments come in ISO sizes beginning with No. 20 up to No. 100. The heads are very shortonly 0.25 mm for the size 20 and up to 1.75 mm for the size 100

Ingles 5th edition

QUANTEC FILES.
The newly designed Quantec instrument,although called a file, is more like a reamer. used in the reamers rotary motion. Produced as both hand- and rotary-powered instruments. First designed by McSpadden. Quantec is produced in three different tapers 0.02, 0.04, and 0.06/mmas well as safe-cutting and noncutting tips. The instruments are sized at the tip and numbered according to the ISO system15, 20, 25, etc.

Ingles 5th edition

C+ FILES

C+ Files are ideal for initial instrumentation of difficult or calcified root canals. They have a cutting tip which engages the dentine and are available in three lengths, 18mm, 21mm and 25mm and three sizes 8, 10 and15 The files are stainless steel, have a square cross section and have a blunt, nonaggressive tip to allow the instrument to safely follow the canal to the apex.

HAND PROTAPER FILES

convex triangular cross-section. Six instrument set, comprised of just three Shaping and three Finishing les. Shaping File # 1 and Shaping File # 2, termed S1 and S2, have purple and white identication rings on their handles, respectively. The S1 and S2 les have D0 diameters of 0.17 mm and 0.20 mm, respectively. The Auxiliary Shaping File, termed SX, has no identication ring on its gold-colored handle and, with a shorter overall length of 19 mm, provides excellent access when space is restrictive. The SX le has a D0 diameter of 0.19 mm

NEW INSTRUMENTS WITH INTERMEDIATE

SIZES

1.

GOLDEN MEDIUMS Corresponds in size to half between standardised ISO sizes & are numbered 12,17,22,27,32,37. PROFILE SERIES-29 Hand instrument with 0.02 taper. Have constant 29% increase in tip diameter.

1. 2.

Weines 6th edition

CUSTOMISED FILES

When tha canal curvature is 30 degrees or less,removal of flutes usually is not necessary Canal curvatures> 30degrees,flute removal is mandatory.

Weines 6th edition

Three Finishing les named F1, F2 and F3 have yellow, red and blue identication rings on their handles corresponding to D0 diameters of 0.20 mm, 0.25 mm, and 0.30 mm, respectively. Additionally, F1, F2, and F3 have xed tapers between D1and D3of .07, .08, and .09, respectively

NICKEL TITANIUM

NITIFLEX K FILES MADE OF NI-TI

NICKEL-TITANIUM
1962 Buehler 55 NiTiNOL

55 wt % Ni 45 wt % Ti 2% substituted with Co

1988 Walia et al - endodontics

PROPERTIES
Show shape memory and superelasticity Softer than stainless steel Not heat treatable Have a low modulus of elasticity; but greater strength Tougher and more resilient Lower cutting efficiency

ADVANTAGES

2-3 times more elastic flexibility Superior resistance to fracture

SHAPE MEMORY PROPERTY OF Ni-Ti

DISADVANTAGES Cutting efficiency only 60% Does not give indication of wear before fracture

GREATER TAPER Ni-Ti HAND INSTRUMENTS

Made of nickel titanium Available in variable tapers

0.04
0.06 0.08

0.10
0.12
GT hand instruments

Designed to cut coronal dentin while instrument tip followed passively.

Ingles 5th edition

CANAL ORIFICE FLARING INSTRUMENTS

Instruments available are: Gates glidden drills Peeso reamers

Ingles 5th edition

GATES GLIDDEN BURS

is

one piece rotary cutting instrument bur diameter ranges from 0.5-1.5mm

and

Ingles 5th edition

There are 6 sizes each bur is marked on the latch attachment portion of the instrument with an indented strip to indicate the size .
Instrument size in mm 0.50 Equivalent K file size 50

Gates glidden drill #1

#2
#3 #4 #5 #6

0.70
0.90 1.10 1.30 1.50

70
90 110 130 150

Grossmans 12th edition

Gates glidden drills has 3 main uses: 1)Flaring of the coronal two thirds of the root canals.

2)For removal of gutta percha from a canal during post space preparation or during retreatment
3)To widen the canal for retrieval of broken instruments .

PEEZO REAMER

Similar to gates glidden but have parallel cutting sides The sizing for the peezo reamer starts at 0.70mm for a #1 peezo reamers and increases 0.20mm with every subsequent size

Peezo reamer #1 #2 #3 #4 #5

Size of the tip in mm 0.70 0.90 1.10 1.30 1.50

#6

1.70

Grossmans 12th edition

Peeso Reamers

Most often used in preparing coronal portion of the root canal for receiving a post

Safeended Tip Diameter: 0.7 1.7 mm

These reamers are available in a 32 mm length and a 28 mm length for posterior teeth

Ingles 5th edition

DEVICES FOR MEASURING ROOT CANAL LENGTH

An apex locator typically has four parts: (1) the lip clip, (2) the file clip, (3) the instrument itself, and (4) a cord connecting the other three parts. A display indicates the advancement of the file toward the apex

Root ZX apex locator with lip clip and file holder. Apex locators available in 4 generations-Resistance based;Impedance type;Frequency based) Cohens 10th edition

IRRIGATION DEVICES
Classification

JOE - June 2009

Disposable syringes for conventional irrigation

Types of irrigating needles

Commercially available 30-G needles (A-C) Open-ended needles: (A) flat , (B) beveled , and (C) notched. (D-F) Closed-ended needles: (D) side vented, (E) double side vented , and (F) multivented JOE 2010

ENDOACTIVATOR

Sonically activated instrument. A plastic file is sonically activated while in the canal. This sonic activity causes acoustic streaming of the irrigant throughout the canal enhancing the cleaning of the canal.

Cohens 10th edition

Strong, flexible, medicalgrade polymer composition Color-coded by size for identification Convenient depth gauge rings at 18, 19 and 20 mm

HOW TO USE

Prepare canal to produce a fully tapered shape Fill pulp chamber with NaOCl, EDTA, or other final rinse solution Select the Activator tip that manually fits loosely within 2 mm of working length. Attach the Activator tip over the handpiece. Place the attached Activator tip into the prepared root canal Depress the ON/OFF switch to activate. Depress the 3-speed switch to select medium speed or low speed Use a pumping action to move the handpiece/Activator in short 2-3 mm vertical strokes Agitate the intracanal solution for 30-60 seconds Repeat the above steps for each intracanal irrigant used

ENDOVAC
1.Combined irrigation/evacuation system 2.a macrocannula or microcannula is connected via tubing to a syringe of irrigant and the high-speed suction of a dental unit

Cohens 10th edition

macrocannula
The plastic macrocannula has a size 55 open end with a .02 taper

microcannula
The size 32 stainless steel microcannula has 4 sets of 3 lasercut, laterally positioned, offset holes adjacent to its closed end

attached to a titanium handle for gross, initial flushing of the coronal part of the root canal.

attached to a titanium finger-piece for irrigation of the apical part of the canal by positioning it at the working length
Cohens 10th edition

During irrigation, the delivery/evacuation tip delivers irrigant to the pulp chamber and siphons off the excess irrigant to prevent overflow. The cannula in the canal simultaneously exerts negative pressure that pulls irrigant from its fresh supply in the chamber, down the canal to the tip of the cannula, into the cannula, and out through the suction hose. Thus,a constant flow of fresh irrigant is being delivered by negative pressure to working length

Advantages 1. avoid air entrapment 2. safely deliver irrigants to workinglength without causing their undue extrusion into the periapex

SAFETY IRRIGATOR (disposable)

1. Irrigation/evacuation system that apically delivers the irrigant 2. Have a thin needle containing a lateral opening & evacuates the solution through a large needle at the root canal orifice

3. Have a large coronal evacuation tube, enabling the user to safely irrigate and evacuate simultaneously with no worry of clogging.

Cohens 10th edition

HealOzone equipment
1. Ozone is a naturally occuring compound consisting of 3 oxygen atoms. 2. Antimicrobial agent against bacteria,viruses,fungi.

Mechanism of action 1. Destruction of cell walls & cytoplasmic membranes of bacteria & fungi.

Attacks glycoproteins & glycolipids

Increased membrane permeability

Immediate functional cessation

Cohens 10th edition

The HealOzone device comprises An air filter A vacuum pump An ozone generator A handpiece fitted with a sealing silicone cup and a flexible hose.

IJCDS AUGUST, 2011 Int. Journal of Clinical Dental Science

ULTRASONIC IRRIGATION DEVICE

1. ultrasonically activated files have potential to prepare & debride root canals mechanically. 2. files oscillate at frequencies of 25-30kHz 3. operate in transverse vibration 4. 2 types

Ultrasonic irrigation

Passive ultrasonic irrigation

Cohens 10th edition

PUI 1. relies on transmission of acoustic energy from an oscillating file to an irrigant.

Small file is introduced in canal as far as apical region

Root canal filled with an irrigant solution & ultrasonically oscillating file activates the irrigant

Irrigant penetrate easily into apical part of root canal

Cohens 10th edition

INSTRUMENTS FOR FILLING ROOT CANALS:

SPREADERS used to compact gutta percha in root canal obturation.

Finger spreader

Hand spreader

Pluggers have diameter larger than spreaders & have blunt end.

Hand pluggers

NiTi finger spreader and plugger.

LENTULOSPIRAL: use for placement of the sealer, cement & Ca(OH)2 dressings.

SOTOKAWAS CLASSIFICATION OF INSTRUMENT DAMAGE

Ingles 5th edition

INSTRUMENTS FOR RETRIEVING BROKEN INSTRUMENTS AND POSTS

MASSERANN KIT - INTRODUCED BY MASSERANN

Masserann kit

Extractors

Trepan bur

REFERENCES
Ingles 5th edition Ingles 6th edition Cohens pathways of pulp 6th edition Cohens pathways of pulp 9th edition Cohens pathways of pulp 10th edition Weines endodontic therapy 6th edition Grossmans 12th edition Christos B. Evaluation of irrigant flow in the root canal using different needle types by an unsteady computational fluid dynamics model.JOE,2010 Li-sha Gu. Contemporary irrigant agitation techniques and devices.JOE 2009;35(6)