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Recent instrumentation.pptx

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Recent instrumentation.pptx

  1. 1. A Modern approach
  2. 2. Ultrasonic insrtruments Hand driven enlarging instruments Rotary instruments
  3. 3. 1)Basic enlarging insrtuments 2)Hybrid enlarging instruments
  4. 4. A- basic enlarging instruments : K – reamer k – file Triangular Square Cross section Loose Tight Twisting 0.5 – 1 f / mm 1.5 – 2.s f / mm Flutes Reaming only Rotation & push / pull Motion 60 90 Cutting angle
  5. 5. H – file Comma shape cross section Manufactured by machine grinding Used in push / pull motion only Helical angle approaches 90 Used in flaring of coronal & middle two thirds
  6. 6. * Standardization of basic instruments 1- size : Based on the diameter of the instruments in hundredth of mm at the tip of the instrument D0 Number : diameter at D0 X 100 - 0.02 mm # 6 , 8 , 10 - - 0.05 mm from # 10 – 60 - - 0.1 mm size 60 – 150
  7. 7. 2 – length : - overall length : 21 – 25 – 31 mm - length of working part : 16 mm 3- taper : Diameter increase at astandard rate of 0.02 mm / mm length
  8. 8. 4 – tip angle angle between the instrument tip 75 + or - 15
  9. 9. Color coding
  10. 10. B – hybrid enlarging instruments 1- modification in instrument design 2- modification in method of manufacturing 3- modification in instrument material
  11. 11. A- modification in instrument design : 1- MODIFICATION IN CROSS SECTION  * Flex – R file with triangular cross section That allowing increasing of : - Cutting ability - - carrier effect - - flexibility
  12. 12. K – flex file :  square cross section of k – file modified to rhomboid cross section  advantages : 1. - increasing cutting ability 2. - - increasing space for debris removal 3. - - increasing flexibility
  13. 13. S – file / uni-file The single blade of H- file was modified by adding a second blade So , increasing cutting ability
  14. 14. U - file
  15. 15. 2- modification in cutting blades : ( a ) modification of depth and angle of blades : Decreasing depth of blades leading to decreasing tendency of breakage ( b ) non cutting side of blade ( c ) flatting the edge ( radial land )
  16. 16. 3 – modification of taper : 0.02 mm to 0.04 , 0.06 , 0.08 – 0.12 mm
  17. 17. 4 – modification in tip design : -Non cutting pilot tip -- partial cutting tip
  18. 18. 5 – modification in numbering system : - golden mediums - profile series 29 : that provide constant increase in diameter & provide fewer number of instruments ( 13 )
  19. 19. B- modification in method of manufacturing : Twisting to grinding and milling That decrease surface irregularities and increase resistace to cyclic fatigue
  20. 20. C – modification in instrument material : Carbon steel Stainless steel Nickel titanium M - wire R-phase CM – wire Strength increases Flexibilty increases
  21. 21. Basic features of rotary instruments 1. Taper 2. Tip DesignS 3. Flute 4. Core 5. Pitch 6. Rake Angle 7. Helical Angle 8. Radial Land
  22. 22. 1. Taper  Def : increase in diameter per mm along file working surface(from tip to shank) Types: 1- fixed taper (standardized) 2- variable taper e.g GT 3- progressive taper e.g ProTaper
  23. 23. 2. Tip Design Types : 1. Cutting (Light speed) 2. Non cutting (K3,profile&GT) 3. Partially cutting (ProTaper)
  24. 24. 3. Flute Flutes , the grooves in working surface used to collect soft tissue and dentin chips removed from the wall of the canal.  Effectiveness of flutes depend on : 1)depth 2)width 3)configuration 4)surface finish
  25. 25. 4. Core Is the central cylindrical part of the instrument having its borders limited by flutes depth.  Types: 1. Large core diameter e.g Profile.  That increase strength and resistance to fracture but at the same time decreases flexibilty
  26. 26. 4. Core cont. 2. small core diameter e.g RaCe.  Leading to decrease in strength but increase in flexibilty
  27. 27. 5. Helical Angle Def. Angle between the cutting edge and the long axis of the instrument.  Adv. It determines which file technique to use.  Types, 1) Constant H.A 2) Variable H.A e.g GT system&K3 3) Allternating H.A e.g RaCe. 4) Non-helical angle e.g liberator.
  28. 28. 6. Rake Angle  Def. : angle formed between the leading edge and radius of the file.  Types,  1)positive..resulting in cutting action (obtuse )e.g K3 file  2)negative….resulting in scraping action(acute)e.g profile  3) neutral rake angle…..e.g light speed  N.B,  when flutes of the file are symmetrical rake angle and cutting angle are the same.
  29. 29. 7. PITCH Def.: Distance between a point on cutting edge and corresponding point on following leading edge N.B The smaller the pitch  the more the helical angles  increase cutting efficiency.
  30. 30. 7. Pitch  Types: a)constant e.g Profile & ProTaper. b)variable e.g K3.
  31. 31. 8. Radial Land Radial land is the flat surface extending between two following cutting edge
  32. 32. Landed versus non landed instruments Landed instruments Non landed instruments  Advantages: 1) Decreases screwing - in tendency (decreases ledge formation) 2) Decreases canal transportation Advantages: Cut tooth more efficiently
  33. 33. Landed versus non landed instruments cont. Landed instruments Non landed instruments 3)Decrease crack propagation at file itself. 4) Limits cutting depth (no aggressive cutting )  Disadvatages: Slow cutting. Examples: (Profile ,GT,K3……) Disadvantages: Make distortion of the canal. Examples: (Hero 642 file ,ProTaper)
  34. 34. 1.Adequate access preparation. 2.Don't force files. 3.Difficult canal anatomy. 4.Don't over use files. 5.Avoid breakage takes practice. 6.Don't try to Bypass ledges. 7.Avoid cutting with the entire length of File.
  35. 35. 8.Don't start and stop. 9.Length control is critical. 10. Proper rotational speed and torque as recommended by the manufacture. 11.It's important to use copious irrigation. 12.It's recommended to use gel based lubricant to reduce Friction.
  36. 36. Light Pressure In and Out Movement
  37. 37. The Mother-In-Law Rules Do not stay too long! Do not push too hard! When you’re done, just go away!
  38. 38. IN FACT,,,,, The creation of a glide path allows the apical end of the instrument to act as a passive pilot and thus protects the instrument from breakage even with high torque. Clifford Ruddle 2009
  39. 39. Reciprocation vs Rotaion rotation reciprocation Complete continuous rotation Clockwise and counterclockwise motion vary from quarter turn to half turn or combinations definition Cyclic fatigue Tortion fatigue
  40. 40. Reciprocation vs Rotaion rotation reciprocation file transportati- on more conservation for tooth structure and more preservation for canal anatomy centrability Shaping errors
  41. 41. Reciprocation vs Rotaion rotation reciprocation Aalmost multi file sequence almost single file endo Protaper Revo-s Reciproc Wave one example
  42. 42. GT ”Greater Taper” File: Are made of nickel titanium alloy which provides both strength and flexibility in curved canals. Cross-sectional design: Triple U shape. -Cutting part: short. -Taper: constant along the length of the file and variable in one kit provides flexibilty fo most of root canals with different anatomy -Tip design: non-cutting. Engagement to minimal amount of dentine. . Pushing the debris in a coronal direction. Decreasing the shaping errors.
  43. 43. GTX File: - Are made with M-wire is a new type of NiTi wire, has been developed by a series of thermo- cyclic processing procedures. This increases resistance to cyclic fatigue. flexibility cutting efficiency -other advantages: 1-wider flutes 2-deeper chip
  44. 44. peripheral strength behind the cutting blade friction Screwing by centering and stabilizing the instrument K3 file Asymmetrical three edges
  45. 45. resistance to cyclic fatigue and better cutting effeciency fracture resistance and flexibility Intermediate phase between austenite and martensite
  46. 46. TF cutting flutes are created by twisting the file, not grinding, eliminating micro fractures for greater strength. The advanced surface conditioning and electropolishing treatment removes the surface defects and irregularities. Twisted file Ground file Twisted file
  47. 47. Advantages: 1. Exhibits virtually no memory while traditional NiTi files are flexible, they will always try to straighten when flexed within a canal. This causes unbalanced lateral forces along the canal wall and often results in ledging as well as excess tooth structure being removed unnecessarily 2 . The vast majority of CM instruments showed multiple crack origins, whereas most instruments made from conventional NiTi wire had one crack origin. Fabricated by special thermomechanical process
  48. 48. 3. Effortless, regardless of the curvature of the canal, because adapt perfectly to the canal path for precise and conservative removal of tooth structure 4. Aggressive and safe 5. During autoclaving, the instruments can regain their shape 6. A hybrid formed of a mixture of austenite and martensite structures.
  49. 49. Examples: 1.Typhoon: Cross section triangular
  50. 50. 2.Hyflex: Cross section square 3.Neyy: Cross section square N.B An advantage of HyFlex® CM files is that they can be used with multiple techniques (crown-down, step-back) or with the single-length technique proposed by the manufacturer.
  51. 51. Protaper system Made from Ni/Ti alloy Characterize by variable taper along the entire length of the instrument. Comes in a set of 6 files: -3 shaping files , S1,s2,sx -3finishing files, F1,f2,f3
  52. 52. Made from M-wire Comes in aset of 5 files: Shaping files, X1,x2 Optional files, X3,X4,X5 Second generation Of ProTaper system.
  53. 53. Wave one single files Made from M-wire Single use ,single file system. Used in receprocating manner. Receprocating angles are:30 counter clockwise 150 clockwise. Available in length of:21,25,31.
  54. 54. Profile file system Have a non-cutting tip so has maximal security and minimizing preparation errors. tapers from 2 to 8%, enables you to treat successfully the three canal thirds using the crown-down technique Has U-shape cross section with 3 radial lands that centralize the instrument inside the canal Has high flexibility.
  55. 55. PROFILE VORTEX THE NEXT GENERATION IN THE PROFILE® INSTRUMENT SERIES Made from M-wire so there is increasing in flexibility. Available in ISO tip sizes from 15 to 50 and in .04 and .06 taper.
  56. 56. Light speed system Has non cutting tip. This instrument similar in design with gates glidden,only the tip is the working part of instrument . Can be used in hand piece of higher rpm speeds.
  57. 57. Revo-S files NICKEL-TITANIUM instruments Has asymmetrical cross section so, 1. Enter the canal in snake like movement. 2. Less stress applied on instrument. 3 file system sc1, sc2 & su
  58. 58. Mtwo system Made from super elastic Ni/Ti Its cross section is s-shaped with two cutting edges which improves its cutting efficiency “aggressive files cuts automatically while advancing apically and also laterally when using brushing file movement
  59. 59. Reciproc system made from M-Wire nickel-titanium designed for use in reciprocation Receprocating angles: 50 clockwise 170counterclockwise.
  60. 60. Let’s get to work!
  61. 61. 73 Straight « Twisted » It does NOT thread ! + FKG exclusive feature no.1 RaCe Reamer with Alternating Cutting Edges
  62. 62. 75 features:  NiTi  Triangular X-section : better penetration  Sharp edges & round tip  Excellent removal of debris  Electro-polishing surface treatment  SMD to control fatigue and uses per instrument.
  63. 63. 76 Variables tapers : .10 .08 .06 .04 .02
  64. 64. I Race 3 file sequence
  65. 65. New shank for Easy identification of instruments Depth marks to allow easy determination of the position of the instrument on Silicone Endo stop to mark working length, radio opaque  Optimal cutting efficiency  Triangular cross-section with sharp edges so Cuts better and faster, without any pressure  The smaller core grants a higher flexibility (2) and allows a better progression in curved canals  Thin core for increased flexibility  More space for debris removal
  66. 66. Ultrasonic concept  ultrasound is sound energy with a frequency above the range of human hearing, which is 20 kHz.  In dentistry the range of frequencies employed in the first ultrasonic units was between 25 and 40 kHz .Later 1 to 8 kHz ultrasonic handpieces were developed
  67. 67. Methods of producing ultrasound :- 2 basic methods :- The first is magnetostriction,. The second method is based on the piezoelectric principle
  68. 68. When used as enlarging instrument it has many disadvantages  within a tightly fitting canal , the oscillatory pattern will be reduced or even eliminated  uncontrolled filing in the apical third of the root canal .  difficulty of controlling the exact position of the tip  Improper use of Ultrasonics may cause straightening or excessive removal of the canal wall, ledging or perforation In curved canals  Ultrasonics may cause strip perforations
  69. 69. Uses  1) Access Enhancement  2) Irrigation  3) Retreatment  4) Root canal obturation  5) Endo Surgery
  70. 70. 1) Access Enhancement  Finding and Breaking Into Hidden Canals and Access Enhancement  the ultrasonic is a valuable tool to treat calcified and difficult to find canals  finding MB2 canals in more than 40% of their maxillary molar cases." Uncovering a calcified canal in a maxillary molar. (Courtesy of Dr. Helmut Walsch, Germany)
  71. 71. Two main types :  BL Tips  Start-X A newer entry to the marketplace is the BL series of tips from BL1 to BL 6 And The Start –X : From X1 to X5 BL-1 and -2 in the pulp chamber.
  72. 72. 2) Irrigation  Active irrigation & Passive Irrigation  Active irrigation
  73. 73.  Streaming improve debridement and disruption of the smear layer and biofilm.
  74. 74. Passive Ultrasonic Irrigation  Ultrasonic activation of irrigants produces at least 2 helpful effects: (1) cavitation and (2) acoustic streaming
  75. 75. Example of Irrigation : Irrisafe Irrisafe (Clinical Research Dental) tips for irrigation (ACETON North America/Clinical Research Dental). The Irrisafe tip is activated in the canal at low-to- medium power at least one mm short of working length for one minute in each canal.
  76. 76. 3) Retreatment :  removal of a metal post, a silver point, gutta-percha, obturation carriers, etc.
  77. 77. 1) Central upper incisor, where the fractured post can be clearly seen within the root canal after removal of debris and cement using the ultrasonic chisel. 2) Radiographic aspect of the same tooth 3) Ultrasonically powered chisel being used to fragment and wash away cement.
  78. 78. 4) The Masseran trepan is advanced along the cement interface. 5) Ultrasonic vibration being applied to the post via the Masseran trepan and ultrasonic chisel. 6) Radiograph of the tooth after post removal. 7) The removed fragment.
  79. 79. 4)Root canal obturation :  Ultrasonic condensation of gutta percha  That can use in softening the gutta percha  Plastisizing gutta percha
  80. 80. 5) Endo Surgery :  a) apicoectomy with retrofilling
  81. 81. B) root-end cavity preparation
  82. 82. Advantages of ultrasonics :-  the cutting of dentin is facilitated and transfer of vibrational energy along the shaft.  filing action to take place along the total length of the root canal  High efficiency of Ultrasonics in dentin removal with reduced operator fatigue in shaping of root canals
  83. 83. Conclusion Due to these disadvantages , ultrasonics is no longer used in root canal enlargement but limited only to access cavity refinement , root canal irrigation & obturation ,endodonic retreament and endodontic surgery
  84. 84. Conclusions  the development of new files is a fast and the clinician may find it difficult to pick the file and technique most suitable for an individual case
  85. 85. Conclusions  Clinicians must always keep in mind that all file systems have benefits and weaknesses. Ultimately, clinical experience, handling properties, safety, and case outcomes, rather than marketing or the inventor’s name, should decide the fate of a particular design.
  86. 86. At the end we wish you many “endodontic” success and satisfactions!
  87. 87. Thank You