Lecture 4 Endodonty. Determination of concept. Anatomical features of structure of cavity of tooth and root-canals. Stages of opening of cavity of tooth. Endodontical tool: variety, settings, rules of the use



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LECTURE 4

Endodonty. Determination of concept. Anatomical features of structure of cavity of tooth and root-canals. Stages of opening of cavity of tooth.

Endodontical tool: variety, settings, rules of the use. Modern endodontical tool for cleaning and expansion of root-canals. Standards of ISO. Basic manipulations in root-canals: amputation, exterpation of pulp, impregnation and mummification. Medicinal facilities. Modern methods of treatment of root-canals.

Plan of lecture


  1. Determination of concept „endodonty”. Purpose of endodontical treatment.

  2. Topography-anatomical features of the second teeth temporal. Technique of opening cavity of tooth.

  3. Principles and approaches to endodontical treatment.

  4. Endodontical instrument, classification, standardization and settings.

  5. Technique of the use of endodontical instruments.

  6. Technique of instrumental treatment of root-canals by domestic instruments.

  7. Technique of treatment of root-canals forward «step and back step» by modern endodontical instruments.

  8. Hybrid technique of treatment of root-canals with the use of profiles.

1. To practical dentistry of doctors necessary certain sum of knowledges, skills, ability to organize the work so that as possible longer to save the anatomic and functional wholeness of teeth. Special attention patience and knowledges needs treatment of teeth with the complicated caries basis of which there is endodontical interference. Quality of him forecasts subsequent positive removal results.

The complicated caries is widespread enough among the population. He is fixed not less than in 30% people from the incurrence of patients of dentition type. Worsening of epidemiology situation in Ukraine, changes in a structure and organization of health protection, worsening of socio-economic indexes resulted in the considerable increase of percents of pulpitises and periodontites in the population.

The amount of errors was unfortunately multiplied at odontosurgery manipulations, which cause different complications including origins of chronic hearths inflammation, intoxication, and sensibilization of organism. The analysis conducted Borovsky (1999) shows that in 87% cases, ducting is stopped not high-quality, but at treatment of inflammation of pulp and periodont in much roots teeth the percent of unsatisfactory results achieves 95. That is why possible early loss of teeth, diminishing of time of service to prosthetic appliance.

Clinical experience shows that principal reason of medical failures is predefined on the first stage by wrong tactic and incorrect technique of opening of cavity of teeth with the purpose of access to the enter of root-canals.

Treatment of the complicated teeth decay is inflammation of tooth (pulpitis) and periodont (periodontitis) and to today is very important and simultaneously by the thorny problem of dentistry. It is related to considerable prevalence of these diseases, plenty of complications, unfavorable consequences, duration and complication of treatment. Treating these diseases, (pulpitis and periodontitis) a doctor works within the limits of very little space are cavities of tooth and root-canals. For work use the special instruments of small sizes which can break a secret in the case of wrong manipulation by them. Such specificity of these diseases and methods of treatment drove to the selection them to the special section of therapeutic dentistry, which got the name of “endodonty”.

Actually under a concept endodont understands the complex of fabrics of tooth which pulp and dentine adjoining to her enters to. Take into account character and of the same type of treatment of diseases of pulp and periodont, clinicians plugs in this concept also apical periodont, cement, clinicians plate of alveolus and its spongy matter that surrounds the apex of tooth. Thus, endodonty is the section of therapeutic dentistry, which lights medical interferences method and technique of manipulations in the cavity of tooth and root-canals. Correct implementation of these manipulations is the very important stage of treatment of pulpitis and periodontitis.

On the maintenance endodontical interferences attribute to micro-surgical. That is why for their implementation important value has knowledge of topographic-anatomic features of structure of cavities of tooth and root-canals of different groups of teeth, presence of high-quality endodontical tool knowledge of modern technologies of surgical and medicinal treatment of root-canals and methods of their stopping. Thus, success of treatment is determined by abilities of doctor it is correct to use an endodontical tool, high-quality domain by the method of preparing of cavity of tooth, technique of tooling and methods of stopping of root-canals.

Renewal of functions of tooth, characteristic for a healthy tooth, is the purpose of endodontical treatment.


  1. Topographic-anatomic features of the second teeth temporal and. Technique of opening of cavity of tooth.

The cavity of every tooth has an original form and, mainly, repeats the form of crown of the proper tooth. After of the same type of anatomic structure of cavity of tooth select 4 basic groups:

- Cavities of incisives;

- Cavities of canines;

- Cavities of premolars;

- Cavities of molars.

In one-root teeth (incisives, canines) a crown part cavity does not have a bottom and directly passes to the wide enough root-canal. She has the same structure in one-root premolar.

At premolar which has two roots, there is the bottom of cavity, however much it can be such that is absent within the limits of crown in case that the division on two channels takes place near-by the apex of root of tooth.

At molar the bottom of cavity of tooth is well expressed and on him is expressly selected enter of root-canals.

The vault of cavity of tooth repeats the form of cutting edge (in frontal teeth) or masticatory surface of the proper teeth. Early in life on a vault there are the expressed inequalities, which answer knolls, indents and fissure. With age they are smoothed out as a result of laying of the second dentine.

The cavity of overhead central chisel has a chisel form and answers the form of crown of the tooth. Near-by a cutting edge she can have the appearance of the crack constrained in vestibular-oral direction. At children on a vault there can be the small deepenings in accordance with the corners of crown and indents of cutting edge. From the side of palatal surface there can be small hollow in the area of projection of linguistic knoll. Gradually narrowing, the cavity of tooth in the area of neck without a sharp border passes to wide round form root-canal. In the area of neck of tooth he is extended in vestibular-oral direction and in middle and to the apical apex third has the rounded form. Rarely enough meet the additional forks in apical part of channel; he is closed on apex by one apex opening.

The cavity of overhead lateral chisel in crown part is constrained in vestibular-oral direction and has the appearance of crack. On its vault there are the well expressed inequalities in accordance with the form of cutting edge. A cavity also without a sharp border passes to the root-canal of oval form. Sometimes he can be some prolate in vestibular-oral direction. In apical part a channel can crutch and end with one or a few apexes openings.

The cavity of lower central chisel in crown part has the appearance of crack prolate in media-distal direction. On a vault there can be deepening’s in accordance with a form to cutting direction of crack. On a vault there can be deepening’s in accordance with the form of cutting edge. Cavity of tooth sharply enough narrowing, passes to the root-canal. He has an oval form prolate in media-distal direction in future passes to round. There can rarely enough be the delta-shaped forks in the area of apex of root, one apical opening. In a lateral chisel a cavity answers the form of crown and has the appearance of narrow crack. On the roof possible deepenings. Root-canal of the rounded form ends with one apex opening.

At overhead dog-teeth the cavity of tooth has a fusiform form media-distal with most diameters in the area of neck. On a vault there is the good expressed deepening for the horn of pulp. Gradually narrowing, a cavity without a sharp border passes to the wide root-canal, very rarely there are two channels. He has an oval, oblate in direction form and ends with one opening on apex of tooth. A stomach-tooth also has the cavity of fusiform form which passes to the wide root-canal. He has an oval form and ends with one apex opening. A channel can divide rarely enough.

The crown cavity of first overhead premolar answers the external contours of crown of the tooth; she is constrained in media-distal direction. On a vault there are the well expressed deepenings which answer the knolls of masticatory surface. The bottom of cavity is placed below from the level of neck of tooth, on him well evidently two openings – enter root-canals. The palatal and cheek ducting is narrow enough, often curved and have the delta-shaped forks. Possible variants of form and divergence of ducting at different level of length of root, often enough they unite on pulp. In accordance with it there can be two or one apex opening. In second premolar a cavity has a similar form which passes to the narrow root-canal. Often (in 25% cases) enough there are two root-canals: cheek and palatal.

The cavities of lower premolar have the rounded form and answer the outlines of crown. On a vault there are the well expressed deepenings in accordance with the knolls of masticatory surface. Gradually narrowing, a cavity passes to one root-canal of round form, which ends with one opening on apex.

First overhead molar on a transverse section has the cavity of three-cornered form. The expressed deepenings on a vault answer the knolls of masticatory surface. A bottom has the form of triangle on the tops of which placed enter root-canals: palatal and two cheeks – medial and distal. A palatal channel is wide enough, rounded or oval form ends with one or (at presence of deltas forks) a few apexes openings. The cheeks ducting is narrowing, curved in accordance with the form of roots, often have the additional forks.

The cavity of second overhead molar reminds the form of the first; it is oblate in vestibular-oral direction. Root-canals also three, but can be to mean variations depending on the amount of roots: two or even one.

Cavity of wisdom tooth very varied after a form and can have from one to four root-canals. Ducting, as a rule, narrow and curved, with the different amount of branches.

The cavity of first lower molar has a cube form in accordance with the form of crown of the tooth. On a vault the well expressed deepenings in accordance with the knolls of masticatory surface. Bottom of rectangular form with three enter to root-canals. In a distal root one wide enough and direct, sometimes prolate in vestibular-oral direction channel. In a medial root two narrow channels: cheek and tongue. Root-canals often enough have the deltas forks and accordingly one or a few apexes openings. The cavity of second lower molar very reminds the structure of the first and also has similar three channels.

The cavity of lower third molar can have the considerable enough variants of form and amount of roots.

In a clinic select pulp-apical and pulp-periapical tissues complexes. A practical doctor must spare attention of not only topography of cavity of tooth but also amount of root-canals, their form and length. Systems of root-canals difficult enough. The basic main root-canals located in the center of root on all his draught select, and additional, which walk away from basic at different levels. In the case of a few main ducting the last have transversal inosculations. Sometimes the additional ducting in area of apex of root creates the little delta-shaped forks (apical delta). The system of the main ducting in one root has some morphological variants. Most prevalence was got by systematization of ducting Weine is offered in one root.

Mainly the amount of root-canals answers amounts of roots, however at premolar of supramaxilla them there can be two. In lower molar, as a rule, there are two root-canals mainly answer a root which they pass in. Very often root-canals have the deltas forks in apex part; can often form additional channels along a channel. Such deltas forks of channel meet at 50-93% all teeth. Presently often unite the basic main channel of root and his fork under the name “system of root-canal”.

The variants of structure of root-canals can be different enough even in one-roots teeth distinguish their 4 types. (SLIDING SEAT 1)

To I type take teeth which have one root-canal that proceeds to the apex of root.

To II type is taken by teeth that have two root-canals which in the area of apex of root unite and end with one channel.

To III type is taken by teeth that have two root-canals along the whole length of length of root and open on his apex by two separate apexes openings.

The To IV type take teeth, which have one root-canal which is closed on apex by two (or even and more) apexes openings.

Most difficulties arise up at endodontic treatment of root-canals of lower central and lateral incisives in connection with roots oblate in mesio-distal direction. It is special it is expressly possible to trace at a lateral incisive. In 60% cases the root-canals of incisives of lower jaw have the form of ducting of the first type, 35% cases of the second type and only in a 5% third type. When there is one root-canal in incisives, he narrows in mesio-distal direction, has an octagonal form and gradually narrows in the direction of apex of root.

Together with the canine of supramaxilla attribute the canine of lower jaw to the longest teeth, they have usually one well communicating channel which gradually narrow in mesio-distal direction and recurvate distal in area of apex of root.

Root-canal of first lower premolar a little narrow in mesio-distal direction. In 27% cases in first premolar there are 2 channels and very rarely 3 channels of the IV type. The split of root-canal more frequent happens in cheek-language direction. Form of channel on a transverse section oval, and in apexes to the root approaches round

The root-canal of second molar of lower jaw has a few variants of structure, but more frequent behaves to the first type. In apical part of root as a rule, there is a bend in a distal side and there often is the split of root-canal. On occasion toil branch from a main channel.

First molar of lower jaw has two roots. 87% cases in a medial root two roots to the channel. A mesiobuccal channel is anymore recurvate, than medial-tongue. On a transversal cut, ducting is displaced nearer to the distal root which usually has the structure of the first type and only in a 30% second, fourth type.

The structure of second molar of lower jaw in a due form reminds first molar except for the lower split of root-canals. A medial root usually has two channels, but at times is and one. In this case he has a fissural form and narrows in mesio-distal direction. Distal channel usually by a line, well by a clock-house and has the branches which usually badly we see on X-ray. Very rarely there is one root in second molar; here can be the branches from a main channel.

First molar of supramaxilla trudges has two roots in 62% cases. 84% two root-canals at one more frequent divided, or two roots. Root-canals narrow especially in area of apex of root.

Second premolar of supramaxilla has one root and one root-canal, but in 25% cases in a clinic there is the split of ducting, or even two separate roots channels.

First molar of supramaxilla as a rule has three roots and three root-canals. Palatal channel usually by a line has the rounded form. Distobuccal to the line and on a transversal cut, as a rule occupies central part of root. A mesiobuccal root in 60% has two root-canals. Through that in a clinic accepted to consider that in him has 4 roots ducting. When mesiobuccal root-canal one, he usually broadens in cheek-palatal direction, heavily by a clock-house and has the appearance of narrow crack. A mesiobuccal channel is longer than distal on 2 mm due to the arch-out of root.

Native and roots ducting of second molar of supramaxilla (them three) usually on 1-2 mm shorter, than first molar. Cheeks ducting a little narrow, and palatal channel of line, has the rounded, or oval form.

Third molar of supramaxilla has the different variants of structure with the different number of branches in a root-canal.

Following knowledges of clinic-anatomic feature of structure of roots and teeth, by the topographic-anatomic mutual relations of main channel and his branches it is possibly correct to walk up to the choice of method of treatment and correct technology of endodontic treatment.

Coming an anatomy from us accent attention on the variants of opening of cavity of tooth.

Preparing of carious cavity, except for the delete of necrotizing hard fabrics, has for a purpose to create free access to the cavity of tooth. That is why after opening and necretomy of carious cavity of her extend in accordance with the scopes of cavity of tooth. On the whole it answers the projection of cavities of tooth on the masticatory surface of premolar or tongue (palatal) surface of frontal teeth. For this purpose use the fissural coniferous forests of different sizes, but considerably facilitates implementation of this stage of application of turbines drills. If a carious cavity is located on the contact surface of teeth, extend her on a masticatory or linguistic surface, within the limits of projection of cavity of tooth. Preparing a carious cavity in frontal teeth is needed from the cosmetic considering maximally keeping a lip wall and cutting edge. In the case of small size of carious cavity on contact surfaces for its expansion beside the purpose to carve plenty of hard fabrics of tooth. At that rate conduct trepanation of intact masticatory or tongue surface within the limits of projection of cavity of tooth. It is begun in the center of this projection, creating cutting on enamel sharp fissural or back by the cone coniferous forest. Gradually deepen a well-educated cavity and extend fissural and round (spherical) coniferous forests within the limits of projection of cavity of tooth. To prepare the crown of the intact tooth better by a turbine tip, using fissural or reverse coniferous forests. In the case of trepanation of crowns of overhead chisels it is base inclination of their roots toward sky, in order to avoid the perforation of lip surface of tooth. In premolar and molar of lower jaw it should be remembered about possible inclination of their crowns towards a tongue. In lower incisives a corner between a crown and root is shown less, that is why during trepanation of their crowns of trepanations ache dispose opening practically near a cutting edge.



Opening of cavity of tooth. In the lead through of this manipulation it is expedient to select such stages: carving of vault of cavity of tooth, creation of free access to the root-canals and finishing forming of carious cavity and cavity of tooth.

After completion of preparing of carious cavity by the sterile spherical or figured coniferous forest expose the cavity of tooth, perforation its vault in an area the nearest to the cavity of tooth. Thus it should be remembered about the possible perforation of bottom of cavity of tooth, especially if she is low. Trepanation of vault above the cavity of tooth it is better to do in overhead cheek-teeth above the place of placing of enter to channel of palatal root, and in lower native – distal channel. In overhead premolar conduct trepanation above a cheek or palatal channel.

Getting to the cavity of tooth, carve its vault. For this purpose bring the round coniferous forest into a cavity and fragmentary motions from a depth outside take off the vault of cavity. By the fissural coniferous forest carefully, by round motions along the walls of cavity of tooth extend opening within the limits of cavity of tooth. Gradually he takes round, three-cornered or square shape, depending on the form of cavity of tooth. It is possible at once to begin carving of vault by the figured coniferous forest of small sizes. To them get to the trepanation opening and gradually, by round motions, extend him, carving a vault within the limits of cavity of tooth. It is necessary to work very carefully, under the permanent visual control, as possible carving of superfluous array of hard fabrics outside the cavity of tooth and even perforation of lateral its walls. It is special can take place easily, if to use a turbine tip. Control the degree of carving by a probe: during moving of probe on walls from the depth of cavity outside not must be felt no obstacle. Correctly the exposed cavity of tooth almost fully meets with a carious cavity and their walls pass to each other without covers, bends, forming a straight line.

For implementation of subsequent stages of opening of cavity of tooth it is necessary to conduct the delete of crown pulp – its amputation. It must be done because presence of pulp in the cavities of tooth and bleeding from her bother the visual control after implementation of preparing of cavity, and sometimes do him impossible.

SLIDING SEAT 2

CRITERIA OF HIGH-QUALITY PREPARATION OF CROWN CAVITY FOR ENDODONTIC INTERFERENCE

1. A form and size of cavity provide free access by instruments to the root-canals.

2. The walls of carious cavity and cavity of tooth make a straight line.

3. There are no overhanging edges.

4. The anatomic form of cavity concerns expressly.

5. All necrotizing fabrics of tooth are remote.

6. Expressly certain enter to carious ducting.

SLIDING SEAT 3

Algorithm of trepanation of cavity carious the staggered tooth

Tooth intact

Near neck cavity.

Carious cavity on an approximal surface (II class)

Carious cavity (II class) on medial and distal approximal surfaces.


Carious cavities are localized below than an equator on approximal surfaces

Trepanation of crown of the tooth pursuant to the projection of pulp chamber.
Stopping of near neck cavity, trepanation of crown of the tooth in near neck chamber.
A cavity hatches on a masticatory surface in obedience to the projection of pulp chamber
A carious cavity is stopped on a distal surface, from a medial surface a cavity hatches on a masticatory surface in obedience to the projection of pulp chamber.
Carious cavities are stopped; the crown of the tooth is trepanned in obedience to the projection of pulp chamber.


GRAPHOLOGY STRUCTURES OF THEME

Technique of opening of cavity of tooth”

Tooth

Intact

Carious cavity

Filling

Trepanation


Necroectomy

Trepanation

Extraction of filling


Extraction of cover of cavity

Trepanation of pulp chamber.


Creating of free access to the root-chanals.

Founding of enter to the root-chanals.

Finally forming of pulp chamber and carious cavity



Once again we remind the basic rules of opening of cavity of tooth:

a) Preparing must be conducted taking into account the location of tooth in a jaw. Direction of the coniferous forest must answer direction of axis of tooth. Implementation of this requirement allows avoiding the perforations of lateral wall of cavity of tooth;

b) If a carious cavity is located on the contact surface of tooth, connect her with the trepanation opening. If a carious cavity is located in a near neck area, stop it, and trepan a crown from a tongue or masticatory surface;

c) Opening of cavity of tooth must provide a good review and access of instruments to the root-canals. For the sake of providing of these terms the additional delete of intact dental fabrics is assumed;

d) The walls of the carious cavity opening must pass to the walls of crown cavity fluently, without appearances and steps;


e) In the process of opening of cavity of tooth its bottom not must be damaged;

f) Amputation of crown pulp is conducted by the coniferous forest in the process of opening of cavity of tooth, the not remote fragments of pulp then delete by a power-shovel;



g) Basic criterion of the correct opening of cavity of tooth are endodontic instruments must freely, without a bend to be included in all root-canals.

Technique of opening of inwardly-dental cavities of permanent and temporal incisive and canine (SLIDING SEAT 4)

Stages

Character

manipulations

Tool

Criteria of self-control

1.Opening of carious cavity

The overhanging edges of enamel retiring.

Coniferous forest spherical or fissural

Presence of sheer walls of cavity

2.Necrotomy

Nonviable fabrics of tooth retiring

Coniferous forest spherical or fissural

Absence of decalcifical fabrics

3.Forming of cavity

A carious cavity broadens for free access to the root-canal

Coniferous forest of fissural

Expansion of carious cavity on ½ oral surface of tooth.

4. Delete of vault of cavity of tooth.

Everywhere trepanations ache opening the vault of cavity retiring

Coniferous forest spherical №1,2,3 or fissural

Absence of vault of cavity and overhanging edges

5.Delete of crown pulp

Crown pulp is deleted

Coniferous forest spherical №4,5, sharp power-shovel

Absence of fabric of pulp in the cavity of tooth.

6.Finding of enter to root-canal

Find enter to root-canal

Sharp probe

The location of enter to root-canal answers group belonging of tooth.


Technique of opening of inwardly-dental cavities of permanent and temporal trudges molar and premolar (SLIDING SEAT 5)

Stages

Character

manipulations

Tool

Criteria of self-control

1. Opening of carious cavity

The overhanging edges of enamel retiring

Coniferous forest spherical or fissural.

Presence of sheer walls of cavity

2. Necretomy

Nonviable fabrics of tooth retiring

Coniferous forest spherical or fissural

Absence of decalcifical fabrics

3. Forming of cavity

A carious cavity broadens for free access to the root-canal




Expansion of carious cavity on ½ masticatory surface of tooth

4. Delete of vault of cavity of tooth

Everywhere trepanations opening the vault of cavity retiring




Coniferous forest of fissural

5.Delete of crown pulp

crown pulp is deleted

Coniferous forest spherical №4,5, sharp power-shovel

Coniferous forest spherical № 2, 3 or fissural

6. Finding of enter to root-canal.

Find enter to root-canal

Sharp probe

The location of enter to root-canal answers group belonging of tooth.

All manipulations from opening of cavity of tooth it is needed to execute very expressly and carefully, to take into account its anatomic structure, type of tool, sequence of their application, indicated in a chart.

During aggressive, inattentive work or to incompetence of doctor there are complications which have the name “operative perforations”. This artificial creation of connection between the cavity of tooth and periodontal fabrics. By a basic problem which arises up at the perforations, there is high authenticity of development of inflammatory process in periodont with the next delete to the tooth.

The perforations can be in the area of wall of cavity, or, more frequent, bottom of cavity at creation of access to enter to root-canals. That is why before the beginning of opening of cavity of tooth it is needed expressly to collect clinical information, have a x-ray, consider by age of patient, because old people, in teeth with pathological elimination or large stopping the anatomy of teeth very changes.




  1. Principles and approaches to endodontic treatment.

Select 3 basic periods in endodontic treatment:

    • Providing of access to the channel;

    • Delete of maintenance from a channel and preparation of him to stopping;

    • Stopping of channel by inert materials for the strong pressurizing.

The delete of products of disintegration from a channel is inalienable procedure of endodontia. It is executed in various ways, namely: instrumental, medicinal treatment washing of channel. It is impossible to conduct effective treatment without cleaning of channel.

In the process of implementation of manipulations it is necessary to use rabberdam. At first it is needed to make sure, that fabrics around (immobile teeth state of parodontium) allow it to do. Rabberdam sets to the cut-in and any endodontic instrument without him must not be used. His use allows providing asepticness of work not only, and also prevents the axsufflation of instruments, and this is important.



Inwardly channels manipulations treatments. The primary objective of stage is the delete of maintenance of channel, providing of stopping. This not only delete of pulp, products of disintegration, microorganisms, staggered dentine, and also and preparing (preparation) of channel for introduction of stopping material, obturation of the apical opening. A most correct term will be „cleaning and shaping” channel, because term „widening to the channel” is not correct: expansion, the increase of diameter not necessarily provides a necessary form and sufficient cleaning of channel. At preparing of root-canal it is necessary to provide peripheral treatment, when an instrument moves up at first in the direction of cheek (labelial) side. Farther stretches and is carried mesial. So does preparing while all channel will not be treated: cheek side, medial, linguistic, distal.

The choice of instrument concernes by the form of channel. Reamer forms a round channel, a file prepares the own form of channel, underlines it.



Careful attitude toward periapical fabrics. All manipulations must be conducted only into a channel. Output for the apex of instrument, perforation result in post operation pain. With the purpose of avoidance it is necessary to define working length of channel and to execute all manipulations in its scopes. Annoying the matters for medicinal treatment does not use.

The correct stopping is the mortgage of success. Renewal of anatomic and functional value of tooth depends on the high-quality conducted stopping.

After completion of treatment necessity of supervision, this will be instrumental in prevention of complications, lead through of the timely repeated treatment or surgical interference.

  1. Endodontic instrument, classification, standardization and settings.

In a standard ISO 3630 all standard instruments are certain for treatment of root-canals. A form, type, length, thickness, possible industrial permissions, is exactly set and minimum necessary indexes of mechanical durability are most important criteria which characterize reliability of instruments, also set colored code for marking of sizes and symbolism, for the different types of instruments.

Length of working surface of almost all endodontic instruments makes 16 mm Length of all bar of instrument can be and) 25 mm is standard instruments; ) 31 (28) mm are long instruments, use for treatment of ducting of frontal teeth (canines); in) 21 mm are short instruments for work in molar and at the bad opening of mouth. The bars of instruments can have notches, yaks evidently on X-ray, with the purpose of determination of length of root-canals.

The size of basic instruments (files and reamers) concerns by diameter apexes and mark by numbers in hundredth stakes to the millimeter – from 06 to 140. The code of sizes takes place: and) by the color of holder or rings on a working bar: 06 is rose; 08 is grey; 10 is lilac; from 15 to 40, from 45 to 80 and from 85 to 140 – on a standard scale is white, yellow, red, bleu, green, black;) by the amount of the circular overtighting (one ring is a white color, two is yellow). There are the instruments of intermediate sizes (12, 17, 22, 27, 32, and 37) instruments „gold middles”, have a gold mark.

Form of most instruments is cone-shaped is increase of diameter from a tag to basis of working part on 0, 32 mm (0, 02 mm on 1 mm of length).

Make the holder of hand instrument taking into account ergonomics from a metal or the plastic arts, which can survive a high temperature during sterilization.

(Sliding SEAT 6, sliding Seats of instruments)

Classification of endodontic tool

ISO:


1 group is hands files (K and H), reamer (K), pulp extractors, plagers and spreaders (vertical and lateral plagers of gutta-percha);

2 groups are machine Н- files and K- reamer with tailpresss for a tip, chanals fillers;

3 is group are the machine coniferous forests (G-type, P-type), reamer types А, D, О, КО, Т, М.

4 groups are pins are gutta-percha, silver, gilded, paper.


Clinical:

1 group is diagnostic instruments;

2 groups are instruments for the delete of soft fabrics of tooth;

3 groups are instruments for tooling of channel:

3.1 are instruments for expansion of the enter to ducting;

3.2 are instruments for passing of root-canal;

3.3 are instruments for expansion of root-canal;

4 groups are instruments for stopping of root-canal.


5. Technique of the use of endodontic instruments
1 group is diagnostic instruments

Depth-gauge, roots needles: smooth and shiny, with the round transversal cut, cut (Miller). It is possible to use files and reamers.
2 groups are instruments for the delete of soft fabrics of tooth

Pulp extractor is made from soft steel with sharp notches which walk away from a bar. When an instrument is densely included in a channel, notches cuddle to the bar, and he can penetrate too deeply; that is why, if you feel the hard surface of dentinal wall, it is not needed to move forward it farther. The correct use of Pulp extractor foresees careful motion to support in the wall of channel or passing to the apex, then slightly remove him back, do 1-2 turns and take out. Living or necrosing pulp, its tailings are caught and retiring, into the depth does not force one's way. Some authors recommend with the purpose of prevention of break of fabric of pulp from travmatisation of periodontal copula to use a file, to which cuts fabric of pulp at necessary level. Method – after determination of working length of root-canal pulp retiring by a K-types instrument with a maximally large diameter which can be brought into a channel to the apical narrowing. An instrument goes maximally close back to walls, trying „to cut of” pulp at the level of the apical narrowing. At that rate pulp retiring by one mass. Necrotising pulp retiring layer under bath from antiseptic. It is possible to use instrumental-medical treatment of root-canal.

Pulp extractor also uses for the delete from the channel of paper or wadding turundas which were in a channel during treatment of tooth.



A root rasp can be also delivered to this group, although he is used for expansion of root-canal.
3.1 are instruments for expansion of the enter to ducting

Coniferous forest as Gates-Glidden drill (reamer-G) – short length of working part is a feature; the tag of such instruments is usually blunted (non-aggressive). Desired speed of the use – 450-800 round/min

Reamer as Peeso (Largo) (Р-reamer) similar to the prolonged drill with short working length. Desired speeds of the use – 800-1200 round/min. Dilator of enter to root-canal, reamer B1, reamer B2 (it is possible with a carefulness to use for expansion of direct parts of root-canal).


3.2, 3.3 are instruments for passing and for expansion of root-canal

Files are instruments most often use for the delete of hard fabrics from a channel. They are created by the wring of round bar (former drill), it results in appearance of series of cutting appearances (edges) by which it is possible to take off from the walls of channel of portion of dentine by vertical motions, possible work by rotatory motions as reamer. This so-called K-file (firms of Kerr). K-file to move into in the direction of apex; draw out, the same to scrape off dentine from the walls of channel.

H-files have sharp edges, yaks the similar on triangles are put one on one gradually diminishing in sizes (drill). Motions in a channel are vertical, to revolve no more than on 90°. Character is a circle.

K-reamers have a corner between a cutting verge and longitudinal axis 20°. Amount of cutting planes from 17 in little sizes to 5 – in large. Motions are rotatory 90°-180° clockwise. Character is a triangle.

K-flex (file) combines properties of reamer and file, provides cutting properties and possibility of delete of sawdust from a root-canal.

Flex -R-file – has a non-aggressive apex and near apexes verges, that provides passing on the curve of channel without the perforations. Transverse section as a triangle.

Flex-file and flex-reamer are instruments of improving flexibility due to the three-cornered form of transverse section. A safe apex is had. Character is the letter of F.

Farside (dip star) is inflexible short reamer with a thin apex for passing of the thin ducting of molar at diminishing of opening of mouth.

Pathfinder is thin instrument with a sharp tag for passing of the thin obliterated ducting.

With appearance of instruments as profile, protaper, NI-TI- flex, G-T-rotary-file at greater to the measure use the technique of treatment „ crown- down”.


4 groups are instruments for stopping of root-canal

Channel filling is instrument with working part as the centered cone-shaped spiral for introduction of paste stopping materials.

Condenser of gutta-percha is instrument as a reverse H-file, use in an angular tip at a speed of 8000-10000 round/min. During the rotation of softening and push a gutta-percha in a channel and to condenser it in apical part.

Spreader is instrument with smooth and shiny sharp working part, which use for латеральной condensation of gutta-percha pins in a root-canal.

Plager is instrument with working part as a smooth off cut bar, use for vertical condensation of gutta-percha in a channel.

Plager to passing warmly is bilateral instrument: from one side is bar as a spreader which heat and enter in a channel for softening gutta-percha’s and is plager graduated for its condensation.




  1. Technique of instrumental treatment of root-canals by domestic instruments

Conduct determination of communicating of root-canal by an X-ray. By pulp extractor conduct the delete of pulp or putrid the masses. Use a depth-gauge for clarification of working length of root-canal. By a root gimlet delete a near wall dentine. Farther extend a channel by a root rasp, then again use a root gimlet for the leading out of shavings of dentine after work of rasp. After treatment of the first accessible part of channel use that sequence of instruments for next part of channel, gradually reaching to the apex opening.

  1. Technique of treatment of root-canals forward «step and back step» by modern endodontic instruments

Requirements to the lead through of preparing of root cavity of tooth:

1. Creation of cone-shaped form with a minimum diameter in the area of the physiology opening and maximal – in enter; the form of channel after preparing must exactly repeat his original form (to deform not a channel), but must be greater in a diameter.

2. Maintenance of balance between the diameter of channel and thickness of his walls.

3. Maintenance of unchanging position of the apical opening.

4. Creation of retaining form for stopping material.

5. Creation of certain resistance at the apex opening, that prevents pushing through of stopping mass for an apex in periodont.

6. Permanent rest room of cavity of root-canal.

In a channel does not use air-blower (for prevention of embolism).

During work in root-canals use the following receptions:


  1. Reaming is work of reamers and K-files, that successive introduction of instrument to the channel, his rotation and leading out. Most frequent complication is the break of instrument.

  2. Ffilling is work by К- and H-files, when use vertical motions up-down without the rotation. It can be complication is appearance of steps and change of form of channel because there is the effect of unbending of instrument.

Technique „Step back”

At first in a channel enter thin (08-10 size) К-file on all working length of channel. To the robot continue while an instrument will not pass in a channel freely. Farther conduct such procedure from the use of instrument of next size. After achievement of the free passing conduct the control passing of channel by a previous instrument with the purpose of prevention of blocking of the apex opening dentinal necrosis fabric. By such way conduct expansion of root-canal at full length minimum to 25 size of instrument. For example 10-15-10-20-15-25-20, then enter an instrument a 30 working length of which on 1 mm less than the last apical file. Farther conduct recapitulation – control treatment by the last apical file for smoothing of steps and warning of corking of channel dentinal necrosis fabric. After a file 30 use a size a 35 working length must be more small on 2 mm, then 40 – on 3 mm and next. After the use of every size it is necessary to conduct recapitulation for which it is possible to use H-files. Nearer to enter process a root-canal by instruments for expansion of root-canals (coniferous forest of Gate Glade, Largo). During work by instruments for the best sliding of instrument, emulsification fabrics in a channel use liquids – lubricant (glade -oxide, soft soap, septodont. After mechanical expansion of root-canal in apical third of channel abandon solution of antiseptic for cleaning of micro channels.

Technique „step ahead” or „from crowns downward”

Feature – determine working length of channel not before treatment, but after providing of access to apical third of channel.

Eenter channel fill by solution of antiseptic, conduct preparing of enter with the purpose of expansion; 35 bring a file into a channel to resistance and fix length. If entering the file of such size is impossible – enter more small. Conduct treatment by a file to his free motion in a channel on the fixed length. Farther conduct treatment by the coniferous forests (Gate Glade № 80) on that distance, enter in a channel a file 30 to resistance, fix his length and develop a next area, then using to resistance file length 25 and farther –smaller to achievement of working length of channel. Conduct determination of working length; gradually extend apex part to the file 25. Walls align 30-35 by H-files


8. Hybrid technique of treatment of root-canals with the use of profiles („steps ahead” + „step back”)

Begin treatment of root-canal with expansion of enter to one-third of channel by the coniferous forests of Gate Glade. At impossibility of the use of the coniferous forests - beginning expansion of enter is possible by files. After it develop a channel by a technique „step back to distance 1 mm from the prepared part. Smoothing of walls conduct by H-files.

Modifications of all techniques foresee the uses of the newest instruments, as differ by durability, flexibility, non-aggressiveness of apex –profile, protaper, nit flex, G- T- rotary-file. For high-quality treatment of root-canals use endodontycal (3 types tips: rotatory 100-400 rotary/min.; rotary-reverse within the limits of 90 grad.; rotary-reverse within the limits of 90 grad. with combination with vertical motions with amplitude from 0, 4 to 0, 8 mm) voice, ultrasonic and lasers tips.
9. General principles of endodontical interferences at children

Of root-canals of temporal teeth conduct endodontical treatment far rarer than permanent – during stabilizing of root. Well all stages of endodontical treatment it is necessary to pay attention to the anatomic-physiojogy features of temporal teeth. On the stage of opening of cavity of tooth it is necessary to mean its largeness in temporal teeth, less thickness and closeness of hard fabrics, and also topographic-anatomic features of pulp cavity. It is needed to remember about large variation root-canals of temporal teeth, considerable divergence of roots in molar. It is necessary at determination of working length, that of root-canal of temporal tooth conduct instrumental treatment for 1-2 mm from an X-ray apex.

Instrumental treatment of root-canals in temporal teeth must be conducted carefully, because walls are thin, smaller degree of mineralization of dentine and wide apical opening. Of channel conduct irrigation carefully, no-pressure, to push not through solution through the apical opening. As solution use a 3% antiseptic.

Filler material for root-canals not must have negative influence on the embryo of the second teeth and to resolve together with a root (for example zinkoxidevgenol paste).



LITERATURE:


  1. Danylevskyj M.F. Borysenko K. Terapevtical dentistry is Kiev, Health – 2001

  2. Borovsky E.V. and other Therapeutic dentistry. M, 1997

  3. Kurakyna N.V. Therapeutic dentistry. – N. Novgorod, publishing house of “НСМА”, 2001

  4. Nykolyshyn A.K. Modern Endodontic practical doctor. Poltava, 1997.

  5. Nykolaeva A.Y., Cepov L.M. Practical therapeutic dentistry Sankt Petersburg, 2001

  6. Fajberg A.G. Therapeutic dentistry. –K., 2001

  7. Homenko L.A., Bydenko N.V. Practical endodontia. it is Kiev: “Plus book”, 1998.

  8. Homenko L.A., Bydenko N.V. Practical endodontia: instruments, materials and methods, are Kiev:” Plus book”, 1998

  9. Homenko L.A., Therapeutic dentistry of child's age. M.:”Book”, 1999.


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