ROTARY ENDODONTICS

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Root Canal Instrumentation

Estimate working length Verify canal patency Estimate canal size Establish actual working length

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Root Canal Instrumentation

Crown down preparation
Coronal third Middle third Apical third

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Armamentarium

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Armamentarium

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Armamentarium
Stainless steel size 10 K-files

Used to explore canal patency Filing or quarter turn pull motion

Do not rotate through 360 degrees

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Armamentarium
Stainless steel size 15 and 20 K files Used to establish actual working length

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Armamentarium

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Armamentarium
Profile orifice shapers

Used to prepare the coronal one third of the root canal

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Profile Orifice Shapers

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Armamentarium
Profile 0.06 taper rotary files

Used to prepare the middle third

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Armamentarium

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Armamentarium
Profile 0.04 taper hand NiTi files

Used to prepare the apical third of the root canal

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Armamentarium

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Estimated Working Length

Estimated working length is the distance from the reference point to the radiographic apex, as measured on a parallel preoperative radiograph

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Estimated working length

Take a pre-operative parallel radiograph Clinically, use a XCP film holder

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Estimated working length

Length from incisal edge to radiographic apex Only an estimate because of radiograph distortion

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Estimate canal size

Radiographic appearance Crown/root morphology Standardized sizes (See table in manual)

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Estimate canal size

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Explore Canal Patency

Ensure that canal can be negotiated to radiographic apex Select #10 K file Precurve file if necessary

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Explore Canal Patency

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Explore Canal Patency

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Establish Actual Working length

Instrumentation should terminate at: The apical constriction 1 mm short of radiographic apex Actual WL = Estimated WL 1 mm

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Establish actual working length

WL can be established using: Radiographs Apex locator

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Establish Actual Working Length

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Establish Actual Working Length

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Establish Actual Working Length

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Establish Actual Working Length

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Crown Down Preparation

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Crown Down Preparation

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Crown-down preparation

Plastic incisor with transparent root

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Crown-down preparation

Place SS K file into canal until the tip is just visible at the apex

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Actual Working Length

Remove file from canal Subtract 1 mm This is the actual working length In this case the WL is 20 mm

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Actual Working Length

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Preparation of Coronal Third

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Preparation of Coronal Third

The coronal third measurement is WL minus 8 mm, that is 12 mm Profile OS do not have rubber stops however the cutting flutes measure 10 mm The goal is to work the largest OS to 12 mm

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Preparation of coronal third

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Preparation of coronal third

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Preparation of the coronal third

Rotate OS at 300 rpm

Note: Orifice shaper should be rotating at 300 rpm before it is placed in the canal

Advance the OS in 1 mm increments When resistance is encountered retract OS while still rotating Never force any instrument apically
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Preparation of coronal third

Blue (#60) OS extends to approx. 9 mm

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Preparation of coronal third

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Preparation of coronal third

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Preparation of coronal third

Gold (#50) OS reaches 12 mm

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Preparation of coronal third

Progress from larger to smaller orifice shaper Each smaller OS will extend further into canal Repeat the sequence until the largest OS extends to 12 mm

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Preparation of coronal third

Blue (#60) OS extend to WL 8 mm = 12 mm

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Preparation of Middle Third

Profile 0.06 taper series 29 rotary files

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Preparation of Middle Third

Profile 0.06 taper series 29 rotary files The middle third measurement is WL minus 4 mm, that is 16 mm The aim is to work the brown (#7) file to 16 mm

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Preparation of Middle Third

Proceed from larger to smaller file Each smaller file will extend further into the canal Repeat the sequence until the largest file extends to 16 mm

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Preparation of middle third

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Preparation of middle third

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Preparation of middle third

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Preparation of middle third

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Preparation of middle third

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Preparation of middle third

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Preparation of middle third

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Preparation of middle third

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Preparation of middle third

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Preparation of middle third

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Preparation of apical third

Profile 0.04 taper nickel titanium hand files

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Preparation of apical third

Profile 0.04 taper nickel titanium hand files The measurement is the full working length, that is 20 mm

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Preparation of apical third

Measure working length on #15 file Set rubber stop at that length Lubricate the canal with Prolube

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Preparation of apical third

Advance size 15 file to working length Rotate file through 360 degrees Irrigate copiously with NaOCl after each file

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Preparation of the apical third

Advance size 20 file to working length Continue through sequence, seating each file to working length

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Preparation of apical third

Progress from smaller to larger files Each file is fully seated at working length Small canals prepared to a minimum of ISO 35 or 40 Large canals prepared to a minimum of ISO 40 50

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Preparation of apical third

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Preparation of apical third

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Preparation of apical third

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Preparation of apical third

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Preparation of apical third

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Preparation of apical third

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Preparation of apical third

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Preparation of apical third

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Preparation of apical third

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Preparation of apical third

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Preparation of apical third

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Preparation of apical third

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File kit on completion of instrumentation

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Master Apical File (MAF)

The largest file that extends to working length MAF film is exposed to confirm length and placement

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Master Apical File

For large canals minimum MAF #40 - 50 For small canals minimum MAF #35 - 40

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Master Apical File

Take a radiograph with MAF in place. This confirms:

Length Placement

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Mission Accomplished!

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