Endodontics. Definition. Clinical and anatomical
structure of teeth’ cavities and root canals of teeth.
Endodontic instruments. Basic endodontic
procedures: tooth cavity disclosure, amputation,
extirpation of the pulp. Methods of medicament and
instrumental treatment of root canals ("Step-Back",
"Crown-down" techniques). Medications. Mistakes
and complications in root canal treatment.
Lecturer: Levkiv Mariana
Department of Therapeutic Dentistry
TSMU
Endodontics it’s the science that study anatomy,
pathology, and treatment of tooth cavity and root
canals.
Under endodontic intervention it should be
understand any interference with the purpose of
treatment, carried out through the cavity of the
tooth.
Under root canal treatment should be understand
odonto-surgical intervention inside the tooth in
order of its preservation with the subsequent
restoration of its form and function with the help of
therapeutic or prosthetic methods.
Anatomy of tooth cavity
Parts of a pulp
cavity.
The pulp cavity
of this
mandibular
second molar is
made up of a
coronal pulp
chamber with
pulp horns and
two root (pulp)
canals.
Anatomy
of root
canal
• Anatomy of apical part of the root
anatomical apical
hole (apical foramen)
- a place of transition
the dentin into cement;
physiological hole
(apical constriction) the border between
pulp and periodontium,
placed 1 mm away
from the X-ray hole;
X-ray hole.
Topographical and anatomical features of teeth cavities
of different group of teeth.
Access preparations into
pulp chambers showing
orifices to canals. Ideally
shaped openings provide
access into the pulp
chamber for endodontic
treatment. Pulp canal
orifices on the floor of
each pulp chamber
correspond with the
number and location of
pulp canals in each tooth.
Anterior - Triangular
Canines - ovoid
Premolar - Round
Molar - Rhomboid
Endodontic instruments
According to ISO endodontic instruments are classified:
Hand instruments: files(K
and H), barbed broaches,
spreader and plugger
(vertical and lateral gutta
percha condensors ).
Rotary instruments: Gates
Glidden drills, Peeso reamer
drills.
Rotary instruments: Hfiles and K-reamers for
slow handpiece, lentulo
spiral filler/rotary paste
filler.
Pins: gutta percha pins,
silver
• But its more convenient to use classification by
Curson(1996) that is based on clinical usage of
endodontic instruments.
Curson’s classification is as follows:
• - diagnostic instruments: root needles(Miller
needles)
• - instruments for removing the soft teeth’
tissues: barbed broaches
• - instruments for passing, enlargement and
shaping the root canals : (K-reamers, K- files,
H-files)
The main endodontic instruments and their use
Barbed broaches
•
•
•
•
•
•
•
•
•
•
Functions and precautions
• Finger instruments
• Disposed of in the sharps’ container
•Used to remove the intact pulp
• ‘Barbs’ on the broach snag the pulp
to facilitate removal
• They need to be used cautiously as
they can bind and break in the canal
Varieties
Available in different sizes and widths
• Gates Glidden drills
• Function, features and precautions
• •To enlarge the coronal third of the canal during endodontic treatment
• • Small flame-shaped cutting instrument used in the
conventional handpiece
• • Different sizes – coded by rings or coloured
bands on shank
• •Are slightly flexible and will follow the canal
shape but can perforate the canal if used too deeply
• • Dispose of in sharps’ container
• • Should be used only in the straight sections of
• the canal
• Peeso reamer drills
Function, features and precautions
• •To remove gutta percha during post preparation
• • Small flame-shaped cutting instrument used in the conventional handpiece
• • Different sizes – coded by rings or coloured
bands on shank
• • Peeso reamers are not flexible or adaptable,
if not used with care can perforate canal
• • Dispose of in sharps’ container
• NiTi (Nickel titanium) rotary instruments
•
•
•
•
•
•
•
•
•
•
•
Function, features and directions for use
• Used to clean and shape the canals
• Used with endodontic handpiece and motor
• NiTi is flexible and instruments follow the
canal outline very well
• Several varieties of systems with different
sequences of instruments are used
• Important to follow the manufacturer’s
recommended speeds and instructions for use
Varieties
Different lengths: 21mm and 25mm
• Reamers Rarely used or indicated. Disadvantages of
reamers include their inflexibility with ⇑ size, which
can result in a wider canal being cut apically. Have
now been replaced by files.
• Files These are used either with a longitudinal rasping
or a rotary action (e.g. clockwise direction).
• The main types of file available are:
• K-type-file. Made by twisting a square metal blank.
• K-flex file. Similar to K-file but made by twisting a
rhomboid shape blank alternating blades with acute
and obtuse angles. More flexible than K-file but
becomes blunt more quickly.
• Hedstroem file.
A. K - style file.
B. K - style reamer.
C. K - flex file.
Hedstroem file. Made by
machining a continuous
groove into a metal blank.
More aggressive than K-file.
Must never be used with a
rotary action as liable to
fracture.
• Endodontic K files. Also called: Root canal hand files
• Function, features and precaution
• • Finger instrument
• • Colour coded by size. The 6 colours used most often are: size 15 (white);
20 (yellow); 25 (red); 30 (blue); 35 (green); 40 (black). Also available in size
6 (pink), 8 (grey) and 10 (purple)
• • Operator gradually increases the size of the
• file to smooth, shape and enlarge canal
• • The larger the number of the file, the larger
• the diameter of the working end
• • Disposed of in the sharps’ container
• Varieties
• • Different lengths: 21mm, 25mm and 30mm
• Lentulo spiral filler/rotary paste filler
• Function and features
• • Small flexible instrument used to place materials into
the canal
• • Fits into the conventional handpiece
• • Use with caution as it can be easily broken
• • Different sizes available
Geometric symbols of endodontic
instruments
Common terms and expressions used in endodontics
Tooth cavity disclosure
Pulpotomy (amputation)
Pulpectomy (extirpation)
The main purpose of root canal treatment
is:
• removal of pulp;
• removal of infected dentine from the
inner wall of the root canal;
• enlargement and shaping a root canal
for its adequate filling.
The procedure of root canal treatment
has such stages:
• - disclosure of the tooth cavity;
• - disclosure of the root canal orifices;
• - the root canal passing;
• - the root canal enlargement;
• - the root canal shaping.
Manipulations of root canal treatment (RCT) are carried out
manually or with the help of rotary instruments by several
treatment methods, the most widespread among them are:
• apical-crown - envisage treatment from the apical hole to
canal orifices with gradually increasing of instrument
diameter( e.g. from №10 -№ 40)
• crown-apical - envisage root canal
treatment that starts from canal orifices
to apical hole with a gradual decrease
in instrument diameter(e.g. from №40 –
№ 10)
• hybrid method of treatment - have been
developed out of the two methods.
 Step-back technique The apical part of the root canal is
prepared first and the canal is then flared from apex to crown.
Blockage of canals may occur using this technique, and irrigation
can be difficult.
Crown-down technique This (along
with several others) prepares the
coronal part of the canal before the
apical part. This has advantages and is
the preferred technique.
Balanced force technique This involves using blunt-tipped files with an
anticlockwise rotation whilst applying an apically directed force. It requires
practise to master but is particularly useful when preparing the apical part of
severely curved canals.
(A) In the balanced force technique the file
is placed to working length and rotated
clockwise 90 degree with light pressure to
engage dentin.
(B)
The
file
is
then
rotated
counterclockwise 120 degree while apical
pressure is maintained to cut and enlarge
the canal. Debris is removed with a final
clockwise rotation that loads the flutes
with loosened debris.
Anticurvature
filing
• Advantages of orifice enlargement
• • Effectively, ⇓ the curvature in the coronal part of the root canal,
allowing straighter access for files to the apical region. It therefore
reduces the likelihood of apical transportation (zipping).
• • It allows improved access for the flow
of irrigant solution within the canal.
• • It reduces the likelihood of apical extrusion
of infected material as most of the canal
debris is removed before apical instrumentation
takes place. This is particularly important
because the majority of bacteria in an infected
root canal are located in the coronal region.
Drugs for chemical enlargement of root
canals
Type of active ingredient
The product, the manufacturing
company
A solution of EDTA
Largal ultra (“Septodont”)
Edetat solution (“Pierre Roland”)
Endofree (“Dencare”)
A solution of citric acid and
propionic acid
Verifix (“Spad”)
Gels based on EDTA
Canal+ (“Septodont”)
HPU15 (“Spad”)
RC-prep (“Premier”)
Канал Глайд («Радуга-Р»)
Root canal treatment should include thorough mechanical
debridement and medicatment treatment as well (antiseptic
solutions), these two procedures should go together.
Irrigants. Dilute sodium hypochlorite is generally
considered to be the best irrigant as it is bacteriocidal and
dissolves organic debris.
Prepared root canal for sealing, regardless of the method of
instrumental treatment, must fulfill the following criteria as follows:
To be sufficiently enlarged;
To have a conical shape (tapered);
To have formed apical ledge;
Do not contain a necrotic dentine;
Do not have typical smell;
To be clean and dry;
Do not have a painful reaction to
percussion.
• Common errors in canal preparation
Lateral
perforation
Incomplete
debridement
Ledge formation
Apical
perforation
Elbow formation
Apical
transportation
Strip perforation
The stiff instrument tends to straighten within the curved root canal (1),
causing ledge formation (2), zipping (3) or perforation (4).