9. Treatment IV

Question 1

We will be using these hand pieces in lab with with the specific endo file setting • always be programmed at ____rpm at ____Ncm

Answer 1

500

1.05

Question 2

NiTi Alloy Properties
Super Elasticity
Shape Memory

These are 2 basic characteristics for this alloy: super elasticity and shape memory
• The alloy has 2 characteristics at the same time BUT at different ____ of the alloy
• Depends on the different ____ and ____ put of the alloy

Answer 2

stages
temps
forces

Question 3

This is NiTi file that can be winded up like this that cannot be done with a regular stainless steel instrument
• has a larger ____ and a larger ____ than the standard ISO taper of 2%
• We will be using files different tapers. Some of them will have a taper of 4,5, or 6
◦We will use all of them to make ends up with a RC shape with a taper
• 6-7 years ago, ppl had to use stainless steel files to file RC
◦This was tedious and difficult b/c when you prepare something that is curved, a root in a RC has a tendency to create problems b/c stainless steel is very stiff

Answer 3

flute

taper

Question 4

NiTi instruments actually center EXTREMELY well
• can see in the pic that the NiTi gave very round, neat, sharp preparations
• The stainless steel one goes away on the side
◦It can cause ____ (when you don’t follow the original root canal outline anymore), ____ (leaving the root somewhere and creating a communication that wasn’t there before between the RC and the outside of the root)

Answer 4

transportation

perforation

Question 5

2 different types of alloy configuration in NiTi

Austenite- more ____ and stiff and has ____
Martensite- ____ and has ____

you can actually induce these different phases in NiTi by the stress you bring on the file or by temp
If you have a particular stage of this alloy and you coo it down -> will get higher percentage of ____ alloy
If you warm it up -> get higher percentage of ____ alloy
If you bring stress on the instrument -> higher percentage of ____ If you relieve the stress -> more ____

Answer 5

rigid
superelasticity

softer
shape memory

martensite
austenite
marstenite
austenite

Question 6

VIDEO
• NiTi is super elastic
• If you bend or kink stainless steel, it will stay where it is
◦Ex: if you bend a paper clip -> it will just stay where it is
• When NiTi is in the Austenite phase of the alloy, it is ____
◦You bend it and it goes back to what it was before
• When you cool this down -> became ____
◦When you bend it, it MEMORIZES the shape you put it in
• When you warm it back up, it goes back to the ____ configuration and will have the
superelasticity you had before

• Manufacturers are trying to preprogram files where you get Martensite in the beginning
(softer and not cut as efficiently) or as Austenite so when you bring stress on them in the
RC, they are softer and easier to go around a curvature.
• after we’ve created a space in our RC, we’ve now figured out how long we need to
prepare to the constriction and working length, we will be starting to enlarge the RC with NiTi instruments

Answer 6

superelastic
martensite
austenite

Question 7

We are looking at the whole root from start to the bottom (apex) of the angle of curvature
• left pic: more shallow curvature
• Middle pic: medium curvature
• Right: extremely abrupt curvature with a almost 90degree angle
• The more sever the curvature, the more ____ for the instrument to access the RC and higher risk for iatrogenic ____

Answer 7

difficult

error

Question 8

In the radius of curvature ONLY looking at the ____ of the root where the curvature of the root is fulfilling the curvature
• Left pic: there’s a very long curvature and then straight at the end. Blue lines denote where he
pointed to the curvature
• Middle pic: straight, then curved, then straight again
• Right pic: straight for a very long portion then it curves very abruptly over a very short distance
and the straight again at the end

• The shorter the distance is where the curvature is fulfilling itself, the ____ the radius of
curvature (red circles put where the tangential areas are showing where the curvature starts
and ends)
• The radius of the pics are getting smaller
• If you have a very extreme curvature angle (like 90deg) and very ____ (like a kink or a very small
radius) it is more difficult (right pic) -> hard to instrument
• The left pic is very easy to do an instrumentation b/c it is not very curved and has a large
radius of curvature
• this is difficult to do with hand instrument b/c you have it is hard to pre-curve a stainless steel instrument to go around these curvatures

Answer 8

smaller

fast

Question 9

It is difficult if suing NiTi files b/c there are 2 different stresses that will lead to the fatigue of the alloy
• it will not last ____ (Ex: if you bend the paperclip in one direction and then the other direction it will end up level of difficulty increases with larger angle of curvature and smaller radius breaking)
• 2 forces we have within a RC with a rotary instrument at 300deg at 500rpm are (1)
____ fatigue/ stress or (2)
____ fatigue or stress
• Stress and fatigue are synonymous

Answer 9

forever
torsional
cyclic

Question 10

Torsional stress

Any kind of work inside a RC will wind itself like wringing a towel and you’ll get wrinkles in the towel over time
• it is straight in the beginning and then you get distortions later
• This is the effect of torsional stress similar efect as wringing towel

You can sometimes get ____
• instrument is spinning in the RC and catches on the ____ -> abruptly stopping the
instrument
◦We have speed zero at the end and 500rpm that the engine is trying to do ultimately
breaking the file
◦This is a source for torsional stress or torsional fractures
◦This is only correct for 10% of the fractures that happen to torsion
• Any type of breakage of instrument in the RC correlates with the forces of torsional stress and cyclic fatigue at the same time b/c every ____ time we work with a spinning instrument in a RC, it never exactly touches the same amount of dentin equal proportion of the top, side, or tip of instrument
◦If it is not cutting equally at the same time over the entire surface of the instrument, you will be experiencing different speeds of the file causing the file to wind itself and cause torsional stress on the file

Answer 10

taper lock
calcifications
single

Question 11

Torsional stress

Clinically one part of a file rotates at a different rate than another causing ____ stress

____ = axial force of being twisted

When ____ limit of metal is exceeded by torque, fracture becomes inevitable

Answer 11

torsional
torsion
elastic

Question 12

When a file has gone under torsional stress, can see the winding portion of the file
• it will look ____ under SCM
• Distorted is circled in blue
• Can also see distorted edges

Answer 12

distorted

Question 13

Cyclic fatigue

Repeated _ and compressive stresses rotating around curvature

Leads to work hardening within the metal and initiation of _

Number of cycles to _ is cumulative

Answer 13

tensile
cracks
fracture

Question 14

Cyclic fatigue

• when he bends his arm, the inside of his sweater is wrinkled/ compressed and the outside (where is elbow is) is stretched
◦The outside of the curvature will be stretched b/c the outside distance is ____ than the ____ on a file
◦If he does a rotation of half a turn, everything that was compressed on the inside will compress again and what was stretched on the outside will be stretched again

Answer 14

longer

inside

Question 15

Cyclic fatigue

The file is stretching and bending 1000 times causing the material to fatigue over time
• if a file that breaks due to cyclic fatigue, you wont see ____. It will just ____
• The snap will happen at the main portion of the curvature

Answer 15

distortions

snap

Question 16

Torsional stress

You can see that there’s less contact on the ____ and more contact on the ____ with different speeds or you can see more contact on top and less on bottom causing a twisting on the axial file

Answer 16

top

bottom

Question 17

Cyclic fatigue

• the file is just spinning and not cutting
• file is in a metal block and it is only spinning around a curvature
• The red portion is where the stress is the ____ and where the file will break
• It will snap at the ____deg curvature

Answer 17

largest

90

Question 18

Instrumentation w rotary nickel-titanium files

The diameter of these two files are the same, but they have different ____
• the core of the left file compared to the core of the right file has a much smaller center mass
• Whenever you take a file and push it around a curvature, the thicker the file and more massive the core diameter is, the more ____ you’ll put on the file around the curvature inside in terms of compression and the more forces put on the ____ in terms of stretching of the curvature

• If there is a wider distance between the inside and outside portion of the curvature, you will
have the squeeze and stretch it more

• Therefore Files larger in diameter are more prone to ____ in a curved area b/c of the added stresses from the squeezing on the inside of the curvature and stretching on the outside
• Even if you have a larger core diameter with the same diameter where you cut them at a specific point, they are still prone to ____ and the curved area- that’s the BAD news

Answer 18

cross sections
forces
outside
fractures
fracture

Question 19

Insturment cross-section

Good news is that there’s so many different files
• some of the smallest core diameters are more ideal to go around a curvature
◦The ____ file has a very small core diameter making it more flexible and less prone to fracture if you use this in a curved canal
◦GOOD NEWS is that we are using this to instrument teeth in the lab and in clinic
• If you take a file that has a taper 2 or a file that has a taper 4, and you are going to the next size of file to instrument the canal and sticking it in with the same ____, it may be very difficult to continue with the instrumentation of the RC b/c if you have exactly the taper with every single file you increase in the tip ____ you are going to touch a lot of ____ wall every single time you go back in and cut a lot of the wall

Answer 19

RaCe
taper
diameter
RC

Question 20

The effect of instrument tapers

If you have the same taper from file 1 to file 2 to file 3 and etc, you are getting into a problem called ____

• The file always cut exactly at the same portions of RC wall
• The next file that comes in will be thicker and larger cutting at the same ____
• The file might not be able to work down into the RC b/c the cutting ____ of this much contact with the RC wall will make it difficult to bring it down
• Manufacturers use a variation of ____ with different or a file that doesnt have a constant taper (taper 5 on the tip and taper 6 on the end of the file) to make instrumentation of RC much more efficient

Answer 20

taper lock
place
efficiency
tapers

Question 21

Instrument cross-section

This shows a file with a taper 6 on the left, taper 4 in the middle, and taper 2 on the right
• even if they have the same diameter, the file becomes much faster/ quicker if you move from the D0 up the shaft of the file
• You can start with taper 6 and it gets stuck at the brown spots
◦It wont really cut everywhere b/c the taper is not really conformed to the natural taper of the RC
◦Then you take taper4 and doesnt match the file you brought in before so it wont cut at the same areas where the previous file cut. It will cut somewhere else
◦It wont cut over the same length of instrumentation. It will cut over a smaller ____
• the previous slide showed that it was cutting over a long stretch at the same area if you just increase the size of the diameter of the file going up
• this shows using alternative ____ make instrumentation of RC more efficient even if it doesnt cut over a ____ stretch of the canal, it actually prepares a lot of faster b/c it will cut efficiently over the ____ portions of the canals

Answer 21

area
taper
smaller
small

Question 22

File sequence w/ BioRaCe

• this is a sequence of files and will be used after we have implemented the ____ (meaning we have worked down to the RC to at least a size of 15)
◦Residents and faculty use size 15. We will use size 20 with stainless steel hand instruments to make it less prone to fracture to start instrumenting with rotary instruments
• BR0 is shorter and is about ____mm long. It is different from the standard (21, 25, or 31mm)
◦This is only for ____ of the orifice area of the RC and only to make space in the
coronal portion of the RC
• Following the working length and making the RC wider than size 20 with a stainless steel
instrument which will have the flexibility to go down b/c the size is very small to go down to the ____ of the RC. you are only starting to use the other NiTi rotary to actually work all the way to the working length you have established
• This pre preparation to the working length with a size 20 is called a ____ preparation- we are trying to create the perfect path for these files to follow and there’s no other obstacles in the way where files could get stuck and then break due to torsional stress

Answer 22

working length
17
enlargement
end
glide path

Question 23

There are different tip File Sequence with BioRaCe sizes and tapers.
• BR0 has a taper ____ only used for ____ enlargement
• You also have taper 5,4,6,4,and 4. But the
last 4 has a tip 40 instead of tip30

Answer 23

8

coronal

Question 24

We will have our axis preparation to the tooth in the coronal RC chamber

You will identify the entrances to the RC (the orifices) and then use the smaller files (#10) and #____. Clinically you would use an electronic apex locator to help find the CEJ

Then take a ____ to verify this after we put file15 at least into the RC
A. He doesnt want to see anyone using size 10. Nothing smaller than size15 b/c clinically as soon as you do an X-ray on pt, you wont see #10
B. You will see #10 in the lab b/c there’s no surrounding bone and soft tissue unlike pt. You wont see the tip of #10 file in an actual ____

Then use ____ to make more space coronally. The file cannot prepare all the way down to the end of the RC. It is just making space for the next files to be able to work down
A. The red part is showing where the file is cutting and the green part is not cutting

BR1 is not cutting on the top and on the bottom. Only in the ____

After #____ hand instrument stainless steel will go down to the working length we determined will create the glide path for the NiTi instruments.we will take every single NiTi instrument all the way down to the working length
Penn
Endo
A. DISCLAIMER.We will not need to push it and ____ it
Sometimes you will need to take the file out and clean it one more time

Answer 24

15
working length radiograph
pt

BR0
middle
20
force

Question 25

• everytime you’re using an instrument in the RC, you will have ____ in the RC to make sure that the file wont eat stuck somewhere in the canal
• Clinically, you will ____ for disinfecting purposes
• We will not use it in the lab b/c it will smell and everyone will get dizzy. We will use water in the lab
• Only If you measure the working length with an electronic apex locator, there will be ____ moisture in the RC b/c otherwise will get erratic readings
• But if you are instrumenting, you’ll always want to have the whole RC and pulp chamber filled up with liquid and smear it well so it can glide inside the RC
• Next is the BR2 and is cutting down there. We see a pattern that the thicker file will be cutting on the ____ portion, next cutting in the ____, and the next one cutting down ____- making cutting very efficient
• This allows it to bring it down to the working length
• BR3 has the same tip size but different taper so it will be cutting the walls on the ____
• Then we have BR4 and BR5 that is cutting ____

Answer 25

fluid
sodium hydrochloride
minimal
top
middle
there
top
down

Question 26

• There is so much space on the top that there wont be any interferences. This alternation of the areas where it cuts within the RC makes this very ____. Sometimes it doesnt touch the very ____ at all. The length of the file going to the working length is really only to keep it in ____ and to create the whole shape of the RC
• The bottom slide shows files that were in the canal that have not been cleaned for demonstration purposes. Shows where each file cuts

Answer 26

efficient
end
length

Question 27

then use BR4 and then BR5
• the minimum you will prepare is the green ____ 35/0.04
• But many canals, you may use ____ 40/ 0.04 depending how large the original canal is and what
type of tooth it is

Answer 27

BR4

BR5

Question 28

We will actually get a very precise preparation in the area that is close in proximity to the CEJ
• the ____ is an apical stop just above the working length at the apical constriction what we are aiming for is the CEJ
• If you go to BR5, you will mostly have a ____mm configuration where your an put down a 40/0.04 cone
◦We will not do this in clinic but will give you a precise shaping of the root canal

Answer 28

apical box

7-8

Question 29

It doesnt make sense for us to repair a RC to a size 40 when the original canal is already diameter is 50

• if you take an hr to work your way down starting #10 file to #20 by hand instrumentation for a canal that is very narrow and calcified then it doesnt make sense for you to aim a preparation of 40/0.04 or 50/0.04 to actually do the instrumentation of the canal
• In any other RC we will typically encounter when we see pts b/c they’re not going to be calcified or difficult, you will actually use this table
• Ex: if you have a first maxillary PM, you have 2 canals, then it suggests that you should
instrument the buccal root to a ____ or 40 and the palatial root to a size ____. But if you only have one canal, it wants you to instrument to size ____ or 60

Answer 29

30
40
50

Question 30

There are often RCs that are often larger than the size 40 at the apical diameter that require more preparation b/c they are naturally larger
• it is very typical for a ____ root of maxillary molar or ____ root of lower molars
• This would be typically require instrumentation that exceeds 40/0.04. It would typically be
50/0.04 which is the next size in sequence and could go up to size 60.
• But b/c the larger the file, the stiffer it becomes, the 60 one is not going to be 0.04. It will be
60/____
• This will be the standard kit you will always get. The other ones will be on demand if we
need it

Answer 30

palatal
distal
0.02

Question 31

• Anterior preparations in lab: start with 50 or 60.
• 50/0.04 are for ____ canals
• 35 and 40 /0.02 are for ____ canals, don’t come in a tapered form since that makes files stiffer. (we won’t use these since our canals are easier, we can use 35 and 40 /0.04)

Answer 31

larger

curved

Question 32

Never force a file down at once continuously, use a ____ motion (down up down up). Never have a file for too ____ in the same spot since this will concentrate stress at one point and increase the chance of it breaking. Be gentle as too much strength may also break the file. With BioRase files you progress from 1-5. If you reach the working lenght by file ____, there is no need to move on to file 3 since you already reached the workin length (I don’t understand him)

Answer 32

packing
long
2

Question 33

Fractured instruments

Every time you take a file out of a root canal, you need to rinse the canal with ____ since you don’t want any debris inside which may get stuck between your file and the root canal wall and increase risk of torsional fracture. You should also clean the file after every use (don’t put debris or infected dentin back into root canal). So steps are:
1- Use file down 4 times in ____ movements, moving closer apically with each stroke
2- Clean file after every time you use it and irrigate canal with ____. Do the 4 consecutive strokes until you reach working length
3- Move on to next
4x gentle movement to working length - repeat as needed
4x gentle movement apical
Glide Path
Working Length

Endo
Penn file size and repeat

Answer 33

NaOCl
gentle
NaOCl

Question 34

Fracture prevention

You only really see root canals in ____ dimension, M to D, and rarely see their B to D dimension since you can’t take an x-ray from the proximal side. In lab we do take 2 xrays (from B and from Proximal) which we will never be able to do in a clinical setting.
____-shaped curves make it more likely for files to break since there are 2 points where cyclical fatigue can happen

Answer 34

one

S

Question 35

Root canals that join together at some point are common causes of file fracture.

____ roots very often are configured where the MB canal joins the ML canal. (ML is straighter) Never instrument both canals ____, even if thinner files like a #15 may fit through both.

Always instrument the ____ canal to the apex and the joining canal to the ____ point only. If you instrument the second canal to the apex, you will instrument 2 curvatures and risk file fracture.

Answer 35

lower molar mesial
fully
straighter
merging

Question 36

The image on the left shows a close up of a file that’s been used and is caked with junk. You want to clean this off and it must NOT go back into the ____. Wipe the files with an alcohol soaked gauze which you squeeze around the file as you rotate in a ____ motion (against the ____ direction). Do this every time you take a file out of the root

Answer 36

root canal
counterclockwise
cutting

Question 37

If a file has kinks or is distorted, it is at a point just before breaking. (Torsional fatigue) DO NOT USE THESE ____ FILES, throw them away immediately.

The super-elasticity of the files make them return to their original shape, but when it is used too often and subject to repeated ____ and ____ stress, then it stops being elastic and undergoes ____ deformation. Throw away the file at this point and irrigate the canal with the syringe filled with NaOCl

Answer 37

distorted
torsional
cyclical
plastic

Question 38

Before we fill the root canal, we take one last x-ray with the last file we used to prepare or with a ____ to make sure that we have reached the desired working length.

These images (2) show the x-ray with the filling cone to check for working length and (3, 4) the final filling after the canal has been completely filled and sealed to the correct length.

Answer 38

filling cone

Question 39

Side anecdote on how in the west coast they want to see the little ____ out of the apices to demonstrate having reached the working length. There is no issue since the filling material is biocompatible but they don’t do this in the east coast.

Answer 39

poofs

Question 40

Biological Goals of Filling

• Maintain the ____ environment
• Prevent ____
• ____ within the system any irritant that cannot be fully removed during the Bio-Mechanical Instrumentation (BMI)
• Filling of the root canal system in all its ____
• As close as possible to the ____
• No gross ____ or underfilling
• Radiographic ____

Bacteria or remaining infections will remain entombed by root filling material and either die or be arrested. If the filling is too short or overfilled, then you are reducing the success rate of the RCT. If you are in a range of ____mm from the apex of the tooth you will have the highest success rate for RCT.

Answer 40

clean
leakage
seal
dimensions
CDJ
overextension
density
0-2

Question 41

Appropriate Time for Filling

• Tooth ____
• Intact temporary filling
• No ____ decay
• No sinus tract
• No ____ from canal
• No foul odor
• No visible ____ during NaOCl irrigation
• No visible debris from irrigation
• Adequate ____
• Healthy patient

In cases of periapical periodontitis, there might be some resorbtion of the apex of the root so radiographically we will seem to be .5-1mm from the apex of the tooth but the apex locator might indicate that we are .5mm from the apex. This distance is representative of the cementodentinal junction and apical constriction and the difference comes from the ____ of the root tip.

Answer 41

asymptomatic
recurrent
drainage
effervescence
instrumentation
resorption

Question 42

Appropriate time for filling

Root canal fillings can only be done on ____ pts (you can’t fill if the root is still filling with pus from an abscess). If the pt has irreversible pulpitis, you are taking out ____ tissue and we can do a one visit tx where the patient walks out with a filling in place even though they had symptoms. If the pt has apical periodontitis or an abscess, we are not doing tx in one visit, we are placing ____ (CaOH) in root canal and when pt comes back for the 2nd part of the tx, they should be ____ (no pus, sensitivity, percussion reaction on tooth).

If NaOCl is bubbling after irrigation, there are still ____ being dissolved inside the canal

Answer 42

asymptomatic
inflamed
medication
asymptomatic
tissues

Question 43

Ideal root filling requirements

• Impervious to ____ and nonporous
• Unaffected by tissue fluids and insoluble in tissue fluids: not ____ or oxidize
• ____

In the past, RCTs were filled with silver points? And all sorts of other stuff that can corrode. Nowadays we use Gutta Percha (GP) and sealants. Sealants have become so biocompatible that we could fill RCTs with only sealants, but they ____ a little bit so we don’t want them breaking the root. The pictures show a gp core surrounded with sealant material, in the method taught at Penn we will learn to use a lot more gp to fill the canals.

Answer 43

moisture
corrode
bacteriostatic
expand

Question 44

Ideal Root Filling Requirements

•____
• Not ____ the tooth structure
• Easily and quickly ____ immediately before insertion
4• Easily ____ from the canal, if necessary

1. We want the filling to be visible in an xray so we can evaluate it
2. We don’t want the teeth to become gray or discolored after a couple of years or the pt will be mad
3. The gp cones can be easily sterilized by dipping them into chlorohex or bleach
4. We want to be able to remove them in case we need to do a retreatment of the root canal if
   there is a second infection in the tooth.

Answer 44

radioopaque
discolor
sterilizable
removed

Question 45

Root filling

This is a tooth that has been decalcified and made transparent so we can see the filling. We can see some communications between the canals, the core gp material, some sealant material (the liquid component filling the nooks that the gp can’t fill). He mentions this not being a good canal cause you can see ____ showing through the gp where they used ____ files and wrong

In every RCT filling there is a main central gp cone (the “____” cone) and multiple smaller “____” cones that gradually fill the sides of the root canal space. This technique of using many cones is called ____. Technically gp can’t be condensed so the more accurate term that he prefers is Lateral Compaction but lateral condensation is the more commonly used name.

Answer 45

sealant
gates gliden
master
accessory
lateral compaction

Question 46

Gutta percha

•natural ____ material, from ____ of tropical trees

This is what gp cones look like. They are made from a tropical tree in Brazil and other tropical areas.

There are different sizes (15, 20, 25,…40) that are of different ____. The thinner sizes are for some people who don’t believe in instrumenting to a size where irrigation solution can go down to the end of the root ,which is stupid in his opinion, and also for use as accessory cones in lateral condensation/compaction.

Answer 46

thermoplastic
sap
thicknesses

Question 47

Gutta percha

• First used in 1876 by Dr. Bowman
• ____
• Insoluble in tissue fluids
• Easily ____
• Radiopaque
• Adaptable to the root canal irregularities

Sizes ____ will be the ones we use as our main cones. They come in these small boxes. The cones we use have a ____% taper (ISO taper). Since we prepare the canal to a taper of 4 and our master cone has a taper of 2, we have some extra space that we can fill with accessory cones.

Answer 47

biocompatible
manipulated
35-40
2

Question 48

Gutta percha

GP: ____
Zinc oxide: ____
Heavy metal salts: ____
Wax or resin: ____

The main ingredient in gp cones is not gp but ____.
Bonus question: gp was originally used for ____ (or gp cones were made out of golf balls according to his exact words but that doesn’t make sense).

Answer 48

19-22%
59-79%
1-17%
1-4%
zinc oxide
golf balls

Question 49

Sealer

•A \_\_\_\_ 
•Microbial control 
•\_\_\_\_ 
•Explorer
--•\_\_\_\_ areas
--•Root \_\_\_\_
--•Lateral & accessory \_\_\_\_

Sealer: liquid component that fills in the space that inevitably will remain if you try to compact a bunch of cones laterally to a master cone. Reads slide.

Sealers have a very high pH so they have some antimicrobial properties. Since it is flowable, it may sometimes go into spaces you weren’t aware of such as accessory canals, fractures, missed canals, or the little ____ in the picture.

Answer 49

filler
lubricant
resorptive
fractures
canals
extension

Question 50

Ideal filling

Compared to the pictures in the previous slide where there was more sealant than gp, here we see what we want to achieve ideally with ____ compaction where gp makes up most of the filling material.

Answer 50

lateral

Question 51

Lateral Compaction “Condensation”

Has been used since 1914
Taught in most dental schools (89.6%)
Chosen as the comparative standard in almost all obturation studies
____-term studies are available Good ____ control

Old technique (over 100 years) that is the most taught in dental schools (used to be 90%, nowadays maybe 70-80%). Some schools teach carrier? Materials which use a softened liquidy gp, but he thinks it is terrible to do since it doesn’t seal tightly, is a pita to take out, and he says if you see a practice using these convince them to not.

Most studies support lateral condensation, and you have better length control since you are putting pressure from the ____ rather than from the top of the root canal.

Answer 51

long
length
side

Question 52

Lateral compaction “condensation”

____ cone seated to the working length (have a definite apical seat)

____ is placed beside the master cone, compacting laterally

Smaller, ____ cone is placed in the void created

The spreaders we use are a ____ or ____ (t for thin). The picture is an extreme example of a rct filling with a zillion accessory cones used.

Answer 52

master
spreader
accessory
D11
D11T

Question 53

Lateral Compaction

• The canal must have a continuously ____ shape
• Lateral + vertical forces
  Glickman & Gutmann, DCNA, 1992
• Quality of apical seal was increased when the spreaders penetrated to within ____mm of WL
  Allison et al., JOE, 1979

After instrumentation, take a ____ (NOT the normal one since that is too thick) and put it down the root to check that it goes down to 1mm of the working length. Then you put ____ over your master cone and seat it all the way down.

Answer 53

tapering
1
D11T
sealer

Question 54

Lateral Compaction

1. Mastercone with sealer is inserted to ____ after Master Apical File radiograph.

____ = Mastercone has
resistance to be pulled out of the canal.

Tug back can be checked by using college pliers to hold master cone, seating it all the way down the canal, and then when you try to pull it out you should feel a bit of resistance from it being wedged at the very end.

In lab, we check tug back by putting the master cone into the extracted tooth and then holding the cone which will hold the tooth with the college pliers. The extracted tooth should not fall as it is being held by the master cone.

Answer 54

working length

tug back

Question 55

Lateral Compaction

2. ____ spreader is inserted to 1mm before working length. Master cone is condensed against the lateral wall.

After placing the master cone, use the D11T to wedge the ____ cone against the canal wall. The D11T should go down to 1mm from the working length with the master cone in.

Answer 55

D11T

master

Question 56

Lateral Compaction

3. accessory cones plus sealer are added in the same manner.

When using the D11T, move the handle forwards and ____ to wedge it in tighter (don’t twist the instrument side to side) until you are 1mm from the WL and then you wait 5 seconds so it gives way a little bit. Then you pull out the D11T and put in an ____ cone (maybe a 20 or special cones called ‘fine fine’ which are thinner) that is coated in sealer. Then take the D11T again and squeeze in both the accessory and master cones using the same back and forth motion in the same exact spot you put the instrument in before. Don’t put the spreader in a new ____ or you will create voids or hollows in the root canal. Repeat the process ____ or 3 times with more accessory cones and afterwards take an xray (called a ____ xray.)

Answer 56

backwards
accessory
spot
2
mid-obturation

Question 57

Lateral Compaction

4. After 2-3 accessory cones a ____ radiograph is taken.

Obturation is the old word for root canal treatment that is still commonly used in the endo world. The xray checks if your cones are:

1. where you want them to be
2. if the working length is ok
3. that you are apically 3-4 mm filled densely.

Answer 57

midobturation

Question 58

Lateral Compaction

5. If the mid-obturation radiograph is correct, the filling procedure is continued until the spreader cannot penetrate into the ____ of the canal.

He forgot to say that every time you use the spreader, you will not go in as ____ since there are more accessory cones filling up the root canal space. If with the master cone you went down with the spreader to 1mm from the WL, with a master cone and 1 accessory cone you might only go down to ____mm from the WL and so on as you add more accessory cones

Answer 58

apical two thirds
deep
1.5

Question 59

Lateral compaction

6. Gutta-percha excess is removed and packed ____ at the level of the CEJ.

If the midobturation xray looks good, you continue filling the root canal, now switching to the ____ spreader and using ____ cones to fill the wider spacers as you get further from the apex.

Once you fill it up, you take a ____ instrument that you heat up with the induction unit and you cut off the top of the cones near the tooth’s crown area.

Answer 59

vertically
D11
thicker
Glick

Question 60

Coronal gutta percha excess removal

After you heat the glick and cut off the top of the cones, you can condense the vertically to pack them back down into the canal and clean up the tooth. At the end the gp shoud ideally be about ____mm below the orifice of the tooth.

(The image on the left is a short video showing this vertical condensation.

Answer 60

1