Isolation & File ID Flashcards
The rubber dam protects the patient from
swallowing or
aspirating instruments and materials
DENTAL DAM
(3)
- ESSENTIAL FOR ENDODONTICS
- Defined as the “STANDARD OF CARE”
- ANYTIME YOU DO NOT USE DAM YOU ARE
SIMPLY LIABLE WITHOUT DEFENSE
Effective Isolation Crucial to:
(3)
- RCT Success
- Patient Protection
- Provider Protection
NEVER place anything small
enough to be swallowed or
aspirated into the mouth without
the
protection of an effective dental
dam
— is one of the basic objectives of successful
contemporary RCT
The elimination of Micro-organisms within the pulpal
spaces
It is simply impossible to eliminate micro-organisms in the
presence of
saliva with its multitude of micro-organisms
ONLY a properly applied Dental Dam can insure the
absence of
saliva in the surgical field
Salivary Contamination turns out to be a major factor in
controlling
Aerosol danger of droplet contamination in dental
treatment. (COVID-19
Failure to eliminate salivary leakage by proper placement of the rubber dam
creates — contamination which has the potential of turning a simple,
routine, uncomplicated RCT into life threatening cellulitis by
salivary
introducing
additional micro-organisms which can greatly complicate the infection
This is precisely WHY we never leave a tooth open to
salivary contamination
— is commonly used for
flushing out debris and cleaning the
prepared canal system.
8.3% NaOCl
If saliva is not effectively sealed by
your dam placement, you can be
assured that
NaOCl will leak into the
mouth as you irrigate
— Dam is available in Black White, Blue or Green color in various weights & thickness
— is available in the Clinic and is necessary to prevent
problems arising from latex allergies
Latex
Non-latex Nitrile Dam
Examples of Rubber dam frames:
There are many types available.
Select one which is — and
leave it in place when taking radiographs
radiolucent
Isolate ONLY the tooth to be treated IF POSSIBLE*
(Exception:
some Regional Board Exams where multiple isolation is required.)
Whatever approach you take, Leave Rubber Dam & Frame ON when
taking Radiographs
You may find the “—” Labial
Clamp useful for most anterior teeth
and even for some premolars. This part
to the facial.
Butterfly
Clamps without wings are also
available and are designed to
first be
placed on the tooth with the RD later
stretched over the clamp and tooth.
Rubber dam clamp #— is
designed for an anterior tooth.
212
The use of a winged clamp allows clamp and dam to be safely placed as a — unit.
single
Once the Dam is securely placed below the height of contour of the tooth, it is necessary to
push the dam
off the wings of the clamp
using an instrument so that the dam is free to seal around the tooth cervical to the clamp.
Here’s where the Clamp should rest at the
cervical line below the height of contour to be adequately retained.
This is difficult but necessary with young or partially erupted teeth.
Here the dam has not been released from the wings
of the clamp. This is not acceptable:
Leaks
Even after the Dam is released from the wings of the clamp, it may be necessary to use some type of
sealing
agent to caulk around the tooth to insure isolation.
Here Oraseal® by Ultradent (available in dispensary) is being used to caulk around the tooth to eliminate salivary
contamination.
Not Possible to Place a Dam?
* If unable to achieve 100% effective isolation of the
tooth to be treated:
(3)
– Provisionally restore tooth to obtain isolation base*
– Clinical Crown lengthening procedure
– Refer to endodontic specialis
skipped
* If still unable to isolate tooth:
– Consider alternate treatment modality
(3)
- Restorability?
- TE and implant?
- TE and fixed prosthesis?
If you cannot place an effective rubber dam,
you cannot do a RCT on the tooth.
A badly broken down tooth often cannot be isolated following complete caries removal.
In this case, it was necessary to first do
a build-up before RCT.
An orthodontic band was added as a matrix, for strength and to protect against fracture.
Sometimes a badly broken down tooth requiring RCT is
covered over with
hyperplastic gingiva
It may be possible to excise the gingiva with electrosurgery,
laser, or conventional surgery
This procedure may expose sufficient tooth structure to be
able to place a clamp and isolate with dental dam thereby
allowing RCT.
If you can’t isolate —, you can’t do a
successful RCT
saliva
If patient is a copious saliva producer, you
might consider
Rx Pro-banthine 15 mg.
(propantholine) ½-1 hour before appointment
to control extraordinary salivary flow if not
otherwise contraindicated by
patient’s med. histo
Why different types of Files?
(3)
- Each file type has unique attributes
- Each file type can benefit us in a specific
way when used correctly - Each type is important to consistent RCT
success
Stainless Steel Hand File
(6)
– Takes a sharper edge
– Is fairly flexible up to #20
– Can be pre-curved easily to
negotiate very curved canals
(Retains the shape)
– Increases geometrically in
stiffness as diameter
increases
– Efficient when used by hand
– Separates if overused or
abused, usually with some
warning
Nickel-Titanium Motor Driven
(5)
– Edge not as sharp (Motor-driven
for efficient shaping)
– Is extremely flexible (super-elastic
but difficult to pre-curve)
– Has nearly perfect shape memory
(will NOT hold a curve)
– Works efficiently in engine driven
handpieces
– Separates if overused or abused,
usually with NO warning
SS K-Type Hand Files
* Made of
Basically SSK Hand Files are —
twisted tapered Stainless Steel
Wire having a square, triangular or
diamond shaped cross section.
SCREWS
Continual Clockwise Rotation
* Will cause an SSK Hand File to:
(2)
– Screw itself to & out the end of the root . . . or
– Become locked in dentin and fracture
REMEMBER: The SSK Hand File is nothing more than a slightly tapered screw
and it will behave pretty much the same as any screw EXCEPT
it can be easily fractured
(especially in smaller sizes) when it is locked in dentin and torque continues.
Counterclockwise rotation will generally unlock the engagement in dentin.
Hand Files are basic to endodontic shaping. They are essential for:
(4)
-Scouting the canal (#10 or
#08)
- Creating a Glide Path (#10 to patency and #15 to WL only)
- Bypassing a ledge, blockage or separated instrument
- Gaining length
Skill with the use of hand files must be mastered for successful RCT.
Hand Files used will be (2) sizes for most cases but also larger sizes if doing
Serial Step Back fo
10 and maybe #15
Hand Files generally come in sizes — ( the tip diameter in hundredths of a mm.)
If we ignore the .08 color (grey) and the .10 (purple), the pattern of color presentation is white,
yellow, red, blue, green black as we increase in size. The mnemonic “—” may help you remember the sequence which repeats at (4)
Note that .60 is the last file size which increases by only —*
.08 to .140
Will You Really Be Going
Back
.45 to .80 and again at .90 to 1.40
.05mm
ISO Stainless Steel (SS) K- type Hand Files
Hand Files are typically supplied in (3)mm lengths.
21, 25, and 31
No matter which length is supplied, the fluted portion of the file is —- long
16mm
All standardized K-Type hand files are — Taper
.02
which means that from D0 to D16, the diameter
increases regularly by .02 mm. in diameter for each 1mm. that one travels from D0 toward D16.
f we look at a .10 file, the diameter at D0 is — mm. diameter. At D1 ( 1mm. Back from the tip), the
diameter increases — mm. and now becomes .12mm. Diameter
.10
.02
This continues regularly to D16 at which point, the flutes stop &the diameter is
.42mm: (.02 x16 = .32
+ the original tip diameter of .10 = .42)
SS K Hand Files retain a bend
SS will retain a bend which is placed in it . . .
However . . . Beware . . .
If bent too sharply in an angular fashion or distorted in any way, it
cannot be bent back to a useful shape and must be discarded
before placing in a tooth.
- — FILES are BASIC to all RCT and their use must be MASTERED to enjoy RCT
success.
HAND
- Hand Files can BREAK (separate) within the canal when mistreated ; (excessive
engagement during clockwise rotation is a common error) especially in the smaller sizes but
HAND FILES are probably the SAFEST intra-canal instrument that we have in our arsenal
when used in a watch-winding motion.
- HAND FILES give us the GREATEST — SENSE of all intra-canal shaping
instruments and serve as — & basic instrumentation to negotiate (2)
TACTILE
Pathfinders
Canal Curves &
Blockages.
- HAND FILES give us the GREATEST — SENSE of all intra-canal shaping
instruments and serve as — & basic instrumentation to negotiate (2)
TACTILE
Pathfinders
Canal Curves &
Blockages.
Use of Hand Files:
(2)
- Watch-Winding Motion to Advance to Length desired.
- Circumferential Filing from length desired to remove (Press against
alternate walls of canal and pull back for a filing motion)
Don’t go to the next larger file until
you have worked the smaller file
to the point that the next larger file goes to the desired length
WITHOUT PUSHING (this is how blockage and ledging start)
Stainless Steel K-type Hand Files
* Never place a STRAIGHT file in a curved canal
* Hint: (2)
ALL canals are curved (to various degrees)
* Gently curve ALL hand files when entering a canal
Try to —- the greatest curve you observe in the
radiograph of the canal
match or slightly exceed
If you slightly exceed the curvature of the canal, the file (upon insertion) will
track the — wall of the curve and be conformed to the actual curve of the
canal
inner
On the other hand, if you place a straight file in a curved
canal,(remember ALL canals are curved) the file will track the
— wall of the curve and gouge the canal at that point
creating what we call a —
outer
Ledge
Following this initiation of a Ledge, it may be difficult or
impossible to regain the true canal as subsequent file
insertions tend to more easily
follow the path of the Ledge
Forcing a file in this case will ultimately lead from a ledge to a
root perforation or separated instrument and probable failure
of the case.
When a scouting file fails to advance but is LOOSE in the canal;
do not
push but simply realize that the canal takes a bend at this point
- Remove the scouting file and place a — ˚ bend in the most terminal flutes.
45
Use this in a light probing motion to indicate
* the path of the curve as in “picking a lock”
* Once the path is discovered to patency, it may be smoothed and carefully
enlarged (#15) as a “—”
Glide Path
Use this in a light probing motion to indicate
* the path of the curve as in “picking a lock”
* Once the path is discovered to patency, it may be smoothed and carefully
enlarged (#15) as a “—”
Glide Path
- Hand Files are the ONLY way to
(3)
“scout” a canal.
bypass a ledge or separated
instrument.
negotiate and smooth a tight
curve to smooth the Glide Path or to Regain Lost Length
Most are made of — and related Alloys
Nickel Titanium (Ni-Ti)
Most are made of Nickel Titanium (Ni-Ti) and related Alloys
The ability to stay centered in the canal was basic in their
introduction to our armamentaria. This is based on their
quality of performing in a
“Super-Elastic” manner. (Easily
follow a smoothly created “Glide Path” and immediately
return to their designed shape when stress is removed
Rotary
Files are
NOT
designed
to be
used as
scouting
files or
path
finders
These are MOTOR-DRIVEN RECIPROCAL FILES
They tend to — MATERIAL AHEAD of the file
PUSH
These are MOTOR-DRIVEN RECIPROCAL FILES
They tend to PUSH MATERIAL AHEAD of the file
They are used in 3 passes to PREVENT
pushing debris out
the end of the root where it would cause inflammation
Be aware that the Maximum Flute diameter is —mm. (size #120)*
1.20
The.25/.12 may not be appropriate to enlarge a smaller canal and may
need to be carefully used to a depth less than the maximum flute diameter
to avoid
removal of excessive root structure or possible strip perforation of
the root. (about the depth of 12-14mm only)
We will be using Vortex Blue
Files of the following sizes
.25/.04 .30/.04 .35/.04
.40/.04. .45/.04 .50/.04
Vortex Blue files tip sizes are identified by the — of the ring (same as
hand files). This is a size #40 at the tip
color
The taper of the file is identified by the
number of black bands x 2.
Larger than #—, we will do
serial step back with hand files
50
Other Intracanal Instruments: Barbed
Broach
- Intended Use: Rotated in canal to entangle and remove vital pulp
organ
– SS Hand Instrument with plastic handle
– A round wire which is barbed by scoring and prying a tag of metal away from the
long axis of the wire
– If Broach becomes bound within the canal or forced around a canal curvature, it
will routinely break upon removal attempt ***
We do NOT recommend the use of a Barbed Broach except in large, — canals
straight
Other Intracanal Instruments:
Reamer
The REAMER is used only rarely as it is
effective only by advancement & rotation
and useful only in a straight canal. It is
dangerous when used in a curved canal
as ledging is the usual result of its usage.
The tip is cutting in nature.
The reamer is made by twisting a square
or triangular wire but the angle between
the long axis of the instrument and the
cutting blade is small so it is ineffective
when used in a filing motion
Other Intracanal Instruments:
Hedstroem File
(5)
A Ground Round wire
Cuts aggressively on
pull stroke
Vulnerable to rotation
Prone to fracture
Used by Faculty
- Reamers:
(4)
– Manufactured by twisting a tapered triangular SS Blank
– Fewer flutes are created than K-Type files
– Cut only upon rotation. Ineffective with a filing motion
– Tend to stray from natural canal. Dangerous
- K-Type Files: We use these*
(3)
– Manufactured by twisting a tapered square or
rhomboidal SS Blank
– More flutes than Reamers. Effective when used with a
rasping (pulling) motion
– Less prone to fracture. More flexible Tend to follow
natural canal when pre-curved
- Hedstrom Files:
(4)
– Manufactured by machining (grinding) tapered round SS Blank
– Aggressive dentin removal when used in a filing motion
– Weaker due to machining
– If used in a rotational manner, very easily broken. Dangerous if
not used in a prescribed & careful manner.
