Irrigation
Irrigants
• Sodium hypochlorite (2 - 6%)
• Chlorhexidin (0,12% - 0,2%)
• Physiological solution
• EDTA - 17% (ethylendiaminotetraacetic acid)
Root canal filling
• Power driven - lentulo
Slow rpm (do 1000/min), in action when pulling out
• Hand - cold and warm techniques using guttapercha and sealer
Cold techniques:
- Single cone technique
- Lateral compaction
Warm techniques: warm lateral compaction, vertical compaction, injection and others.
Lentulo
Function of root canal filling
nal
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Ideal root canal filling (Grossman 1988)
1. Easy mixing
2. Sufficient working time
3. Good seal
4. X- ray contrast
5. Easy removal
6. No shrinkage
7. Long term volume stability
8. No bacterial growing
9. No permeability for fluids
10. Biocompatibility
11. No staining
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Classification of root canal fillings
> Solid
> Semisolid
> Pastes
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Guttapercha
Dried juice of the Taban tree (Isonandra percha) (gutta)
1,4 - polyisoprene Crystallin structure (60%) Brittle
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Guttapercha
* Beta phase
• Alpha phase 42-49 °C
- plastic
- Gamma phase 56 - 62° (amorfni) Cooling process
very slowly (less than 0,5°C) - alpha phase normal cooling- beta phase
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Composition of guttapercha materials
in endodontic
Guttapercha 19%-22% Zinc oxide 59 - 79% Heavy metal salts 1% - 7% Wax or resin 1% - 4%
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Sealers
Chemically curing plastic materials
Good adhesion to root canal walls as well as solid cones
X- ray contrast
Biocompatibility
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Sealers
Zinc Oxide-Eugenol Calcium hydroxide Resins
Glasionomer Silicone
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Sealers
Importance
Filling of the spaces between the solid cones
i
Seal of the root canal filling
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Zinc - Oxid Eugenol
Powder: Zinc oxide
Liquid: Eugenol Acidic resins
Good adhesivity, antimikrobial effect, cytotoxic, resorbable)
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Zink Oxid Eugenol sealers
Pulp Canal Sealer (Kerr, USA)) Tubuli- Seal (Kerr, USA) Caryosan (Spofa Dental, CR)
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Calciumhydroxide sealers
Base ( powder) Calcium hydroxide Zinc oxide
Other components and vehicula
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Calcium hydroxide sealers
Catalyst (paste) Zinc stearat Titanium dioxide Baryum sulphate or
Eugenol,. Eukalypt others
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Calcium hydroxide sealers
> Increase of the healig potential of periapical tissues
> Antibacterial effect
> Easy manipulation But!
Resorbable if not homogeneus
Not suitable for the single cone technique
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Resins
>Rezorcin formaldehyd > Epoxide >Polyketone >Metacrylate
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Rezorcin-formaldehyd resins
Toxicity
N2, Endomethason, Riebler's paste, Foredent
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Epoxide
>Base (powder, paste) Bismuth oxid Titanium dioxide Hexametylentetramine (Silver)
> Catalyst (liquide, paste) Bisphenoldiglycidylether
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EpoxJd resin (odvontoges)
> Long working time
> Hydrophilic (good penetration) >Good adhesion to the root canal walls
> Volume stability >No dissolution >Antibacterial
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Epoxid resin (disadvantages)
> Difficult removal
> Staining
> Initiatiory roxicity
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Polyketone
> Base Zinc oxide Bismuth phosphate Hexametylentetramine
> Liquid
Bisphenolglycidylether and other components
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Polyketon resins
Advantages Good adhesion No contraction No dissolution
Disadvantages High stickness Not removable
Products: Diaket, Diaket A (3M ESPE)
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Methacrylate resins
Endo ReZ (Ultradent) - UDMA
For injection - single cone technique
Epiphany (Pentron)
Bis- GMA, etoxy bif- GMA, hydrophilic bifunctional methacrylates
Calcium hydroxide, baryum sulphate, baryum glass silica.
Sealer in combination with Resilon
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Glasionomer sealers
>Base (powder) Aluminium silicate glass
> Liquid
Polyacrylic acid, polymaleic acid, tartaric acid
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Glasionomer sealers (Advantages and disadvantages)
Advantages:
Curing under wett conditions, chemical bonding to hard dental tissues, no staining
Disadvantages
Short working time, difficult removal,
porous
Products
Ketac Endo (3M ESPE), Endion (VOCO)
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Silicon based sealers
Polyvinylsiloxane (ev. in mixture with powdered guttapercha
Biocompatibility Hydrofillic
Further investigation desirable.
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Root canal filling
• A cone inside the sealer - core material
Guttapercha
Resilon
Silver cones
Custom cones
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Root canal filling
Guttapercha
Trans isomer of polyisoprene
2 crystalline forms (alpha, beta)
Beta - room temperature
Alpha after heating
Various process of cooling
Extremly slow cooling: Aplha phase recrystalize.
65°.
Less shrinkage, more dimensionally stable
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Root canal filling
Guttapercha 20% gutta-percha 65% zink oxide 10% radioopacifiers 5% plasticizers
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Root canal filling
Guttapercha
Cones: conventional and standardized sizes
Conventional: dimension of the tip and body
Standardized cones are designed to match the taper of the instrument.
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Root canal fillings - forms
> Points (Cones)
> Materials for injection
> Plastic materials
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Instruments
• Lentulo
• Compactors
• Compactors - carriers
• Others
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Lentulo
>delivers pastes
>1,5 - 2 mm ahead
>at most for Ca (OH).
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Compactors
Spreader
Pointed
Vertical introduction
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Piu
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Filling techniques
Cold Warm
Paste only
Shrinkage, difficult removal
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Single cone technique
Easy Fast
Good control of WL
Standard round preparation - risk of leakage
Wesselink, P.: Root filling techniques, Textbook of Endodontology; p. 286-299, Blackwell Munksgaard 2003, Oxford
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Vertical condensation (compaction)
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Injection
• Rychla technika
• Mozna extruze sealeru
• Teplo
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Complications of endodontic
treatment
Local Regional Systemic
Zipping a elbow
Local complications
Reasons
Insufficient irrigation and recapitulation
Loss of the working length
Solution
Repeated careful instrumentation with a thin instrument
Irrigation is not effective in this c&se111
Ledging
Reasons
The instrument is not bended in advance!
No control of the WL
No recapitulationLoss of the WL
Solution
The instrument must be bended in advance
Careful but complete rotation
Finishing with the fine filing
No NiTi!!!
Ledging
Zipping a Elbow
The instrument is not bended in advance!
Rotation in curved canals
Reasons
Bad orientation in morphology - no diagnostic Instruments are nod bended Rotary NiTi with a big taper
>. Oblast isthmu
Stripping
Bend the instrument and eventually blunt it!
Insufficient coronal flaring
Old root canal instrument
Aggresive force
Incorrect movement of the root canal instrument
Solution
Enlargement of the root canal till the instrument
Ultrasound tips
Rotating root canal instrument - caution!
Bypass
Leaving in
Surgical treatment
Fractured instrument
Via falsa
• Perforation of the bottom of the pulp chamber or the coronal part of the root canal
• Perforation in the middle part of the root canal
• Apical perforation
#». • •    • • • t»
MfA (Mmofnl Jnoxidc Aggi Root Canal Repair Material
Contents: I gram (I treatment)
0120
Regional complications
Pištěl
Systemic complications
Systemic complications
> Periostitis
> Inflammation of soft tissues (face, neck)
>Gulp of the instrument (X ray, remnant diet, information)- cough
> Aspiration of the instrument (induce emesis, x-ray, evaluation)