#D3/S2/W1
#Endo

CO2 snow or dry ice

• -76 degrees C
• 
  Butane, propane and isobutane
• -28 degrees C
• 
  1,1,1,2- tetrafluroethane, hydrofluorocarbon
• -26 degrees C
• 
  Electric pulp test

Long cone technique (right angle paralleling)

• reproducibility
• more accurate length determination
• less superimposition
• 
• 

Access

Vision

• illumination and magnification compulsory
• 
• long shanked bur to reduce chance of procedural defect

Kit set up

• 
• front surface mirror mandatory to ensure no ghost image

Burs

• high and slow speed round, surgical length burs (010 and .014), pulp burs
• diamond bur to penetrate porcelain

Endodontic explorer DG16

• stainless steel
• double ended
• straight tip for exploring root canals
• enlarge canal orifices once canal has been located, not used to locate canal orifices
• 
  • dont use explore to locate canals, only coronal pulp chamber, root canal treatment is visual not tactile
• Spoon excavator 31L (glick spoon number 2)
  • double ended
  • long shanked
  • removal of debris and caries
  • 
  • 
• plastic instrument
  • glick 1
  • one flat end (beaver tail) for contouring IRM or cavit temporary
  • one plugger end for condensing and contouring temporary restoration
  • can be heated to remove excess gutta percha

Instrumentation

• irrigants
  • Na OCl
    • dissolve organic debris
  • EDTA
    • 15% w/v disodium EDTA salt, pH 7.2, contains 0.85% w/v cetrimide
    • chelating agent for smear layer and biofilm
    • softens dentine, enhance chemomechanical enlargement of canals
    • removes smear layer (inorganic debris)
    • exposes noncollegenous proteins from dentine extracellular matrix
  • must use side venting cannula
• medicaments
  • for canals inbetween appointments
  • calcium hydroxide - pulpdent or UltraCal XS
    • used as interim medication where pulp is necrotic
  • coriticosteroid based medicament - odontopaste
    • used if instrumentation phase is not complete or vital pulp
  • use spiral of paste carrier to introduce paste into canal
  • Maillefer's lentulo spiral
• measuring devices (radiography, rulers, ELD)
  • rulers
    • measure working length for files
  • apex locator
  • 
• files, reamers
• slow speed orifice opener
• paper points

Files

Ideal root canal preparation

• adequate coronal enlargement
• appropriate taper
• minimum foramen enlargement
• easily filled

Flaring and obturation

• 
• appropriate flaring of preparation reduces possibility of gross overfills and reduces reliance on the aplical stop at the apical constriction

Classificiations of instruments used for pulp space preparation

• group 1: hand and finger operated instrument
  • barbed broaches, K-type and H-type instruments
• group 2: low speed instruments - orifice openers
  • latch type of attachment is part of the working section
  • includes gates glidden burs and Peeso raemers
• group 3: engine driven root canal preparation instruments
  • similar to hand and finger operated instruments, however the handles of these engine driven instruments have been replaced with attachment for a latch type handpiece

Files

• usually come in three lengths
  • 21mm
  • 25mm
  • 31mm
• usually have 16mm long section of cutting flute (working part)
• 
• NiTi
• 
• shape of files relates to apical width and taper
• taper is the increased flare from apex of mm increase as progressing per mm from apex
• 

File Materials

• stainless steel
  • permanent plastic deformation
  • all are single use
• Nickel Titanium
  • superelasticity and also plastic deformation, some with shape memory effect
  • only some are single use
• silicon stopper used for working length

Group 2 orifice openers (gates glidden)

Paper points

• used to dry canal

Obturation

Gutta percha core material

• dried juice of a taban tree (isonandra percha)
• gutta percha polymer is a transf-1,4-polyisoprene, more linear and crystalises more easily than the cis isomer (natural rubber)
• harder, more brittle, less elastic than natural rubber
• 2 styles
  • master cone, 0.2, 0.4 etc taper with standardised size (e.g. 30-50)
  • accessory cones
• Niti finger spreader used to compress GP
  • 
• Master cones
  • standardised taper .02mm/mm
  • .02, .04, .06mm/mm etc. taper
  • "#" denotes size at apex
  • "#35" = .35mm at apex
  • 
  • 

smooth sided spreaders

• used to compress gutta percha points
• #25 iso .02 taper spreader apically
• #40 iso 0.02 taper coronally
• 

5-7 and 9-11 plugger

• double ended
• tapered pluggers
• one end larger than the other
• heat with bunsen burner to sear excess gutta percha from canal orifices
• heat and sear with one end, compact with the other
• 

Temporary and interim restoration

• ensure adequacy of provisional restoration (general term of restoration used between visits during root canal treatment)
• provisional restoration is made of:
  • interim restoration: preliminary build up, SS band or composite
  • temporary restoration: filling in the access
  • 

Temporisation materials

• Cavit (better seal)
• GIC - usually pink for contrast (better strength)
  • good sealing from adhesion mechnaism
  • antibacterial activity - release of fluoride
  • brittle and fast speed of setting
• IRM
  • zoe cement reinforced with polymethyl methacrylate
  • improved compressive sttrength
  • sealing ability usually inferior to cavit
• stainless steel band
•