Isolation & File ID

Question 1

The rubber dam protects the patient from

Answer 1

swallowing or
aspirating instruments and materials

Question 2

DENTAL DAM
(3)

Answer 2

• ESSENTIAL FOR ENDODONTICS
• Defined as the “STANDARD OF CARE”
• ANYTIME YOU DO NOT USE DAM YOU ARE
  SIMPLY LIABLE WITHOUT DEFENSE

Question 3

Effective Isolation Crucial to:
(3)

Answer 3

• RCT Success
• Patient Protection
• Provider Protection

Question 4

NEVER place anything small
enough to be swallowed or
aspirated into the mouth without

Answer 4

the
protection of an effective dental
dam

Question 5

— is one of the basic objectives of successful
contemporary RCT

Answer 5

The elimination of Micro-organisms within the pulpal
spaces

Question 6

It is simply impossible to eliminate micro-organisms in the
presence of

Answer 6

saliva with its multitude of micro-organisms

Question 7

ONLY a properly applied Dental Dam can insure the
absence of

Answer 7

saliva in the surgical field

Question 8

Salivary Contamination turns out to be a major factor in
controlling

Answer 8

Aerosol danger of droplet contamination in dental
treatment. (COVID-19

Question 9

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

Answer 9

salivary

introducing
additional micro-organisms which can greatly complicate the infection

Question 10

This is precisely WHY we never leave a tooth open to

Answer 10

salivary contamination

Question 11

— is commonly used for
flushing out debris and cleaning the
prepared canal system.

Answer 11

8.3% NaOCl

Question 12

If saliva is not effectively sealed by
your dam placement, you can be
assured that

Answer 12

NaOCl will leak into the
mouth as you irrigate

Question 13

— 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

Answer 13

Latex

Non-latex Nitrile Dam

Question 14

Examples of Rubber dam frames:
There are many types available.
Select one which is — and
leave it in place when taking radiographs

Answer 14

radiolucent

Question 15

Isolate ONLY the tooth to be treated IF POSSIBLE*
(Exception:

Answer 15

some Regional Board Exams where multiple isolation is required.)

Question 16

Whatever approach you take, Leave Rubber Dam & Frame ON when

Answer 16

taking Radiographs

Question 17

You may find the “—” Labial
Clamp useful for most anterior teeth
and even for some premolars. This part
to the facial.

Answer 17

Butterfly

Question 18

Clamps without wings are also
available and are designed to

Answer 18

first be
placed on the tooth with the RD later
stretched over the clamp and tooth.

Question 19

Rubber dam clamp #— is
designed for an anterior tooth.

Answer 19

212

Question 20

The use of a winged clamp allows clamp and dam to be safely placed as a — unit.

Answer 20

single

Question 21

Once the Dam is securely placed below the height of contour of the tooth, it is necessary to

Answer 21

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.

Question 22

Here’s where the Clamp should rest at the

Answer 22

cervical line below the height of contour to be adequately retained.
This is difficult but necessary with young or partially erupted teeth.

Question 23

Here the dam has not been released from the wings
of the clamp. This is not acceptable:

Answer 23

Leaks

Question 24

Even after the Dam is released from the wings of the clamp, it may be necessary to use some type of

Answer 24

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.

Question 25

Not Possible to Place a Dam? * If unable to achieve 100% effective isolation of the tooth to be treated: (3)

Answer 25

– Provisionally restore tooth to obtain isolation base* – Clinical Crown lengthening procedure – Refer to endodontic specialis

Question 26

skipped * If still unable to isolate tooth: – Consider alternate treatment modality (3)

Answer 26

* Restorability? * TE and implant? * TE and fixed prosthesis?

Question 27

If you cannot place an effective rubber dam,

Answer 27

you cannot do a RCT on the tooth.

Question 28

A badly broken down tooth often cannot be isolated following complete caries removal. In this case, it was necessary to first do

Answer 28

a build-up before RCT. An orthodontic band was added as a matrix, for strength and to protect against fracture.

Question 29

Sometimes a badly broken down tooth requiring RCT is covered over with

Answer 29

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.

Question 30

If you can’t isolate ---, you can’t do a successful RCT

Answer 30

saliva

Question 31

If patient is a copious saliva producer, you might consider

Answer 31

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

Question 32

Why different types of Files? (3)

Answer 32

* 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

Question 33

Stainless Steel Hand File (6)

Answer 33

– 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

Question 34

Nickel-Titanium Motor Driven (5)

Answer 34

– 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

Question 35

SS K-Type Hand Files * Made of Basically SSK Hand Files are ---

Answer 35

twisted tapered Stainless Steel Wire having a square, triangular or diamond shaped cross section. SCREWS

Question 36

Continual Clockwise Rotation * Will cause an SSK Hand File to: (2)

Answer 36

– Screw itself to & out the end of the root . . . or – Become locked in dentin and fracture

Question 37

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

Answer 37

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.

Question 38

Hand Files are basic to endodontic shaping. They are essential for: (4)

Answer 38

-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

Question 39

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

Answer 39

#10 and maybe #15

Question 40

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 ---*

Answer 40

.08 to .140 Will You Really Be Going Back .45 to .80 and again at .90 to 1.40 .05mm

Question 41

ISO Stainless Steel (SS) K- type Hand Files Hand Files are typically supplied in (3)mm lengths.

Answer 41

21, 25, and 31

Question 42

No matter which length is supplied, the fluted portion of the file is ---- long

Answer 42

16mm

Question 43

All standardized K-Type hand files are --- Taper

Answer 43

.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.

Question 44

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

Answer 44

.10 .02

Question 45

This continues regularly to D16 at which point, the flutes stop &the diameter is

Answer 45

.42mm: (.02 x16 = .32 + the original tip diameter of .10 = .42)

Question 46

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

Answer 46

cannot be bent back to a useful shape and must be discarded before placing in a tooth.

Question 47

* --- FILES are BASIC to all RCT and their use must be MASTERED to enjoy RCT success.

Answer 47

HAND

Question 48

* 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

Answer 48

HAND FILES are probably the SAFEST intra-canal instrument that we have in our arsenal when used in a watch-winding motion.

Question 49

* HAND FILES give us the GREATEST --- SENSE of all intra-canal shaping instruments and serve as --- & basic instrumentation to negotiate (2)

Answer 49

TACTILE Pathfinders Canal Curves & Blockages.

Question 49

* HAND FILES give us the GREATEST --- SENSE of all intra-canal shaping instruments and serve as --- & basic instrumentation to negotiate (2)

Answer 49

TACTILE Pathfinders Canal Curves & Blockages.

Question 50

Use of Hand Files: (2)

Answer 50

* 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)

Question 51

Don’t go to the next larger file until

Answer 51

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)

Question 52

Stainless Steel K-type Hand Files * Never place a STRAIGHT file in a curved canal * Hint: (2)

Answer 52

ALL canals are curved (to various degrees) * Gently curve ALL hand files when entering a canal

Question 53

Try to ---- the greatest curve you observe in the radiograph of the canal

Answer 53

match or slightly exceed

Question 54

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

Answer 54

inner

Question 55

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 ---

Answer 55

outer Ledge

Question 56

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

Answer 56

follow the path of the Ledge

Question 57

Forcing a file in this case will ultimately lead from a ledge to a

Answer 57

root perforation or separated instrument and probable failure of the case.

Question 58

When a scouting file fails to advance but is LOOSE in the canal;

Answer 58

do not push but simply realize that the canal takes a bend at this point

Question 59

* Remove the scouting file and place a --- ˚ bend in the most terminal flutes.

Answer 59

45

Question 60

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 “---”

Answer 60

Glide Path

Question 61

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 “---”

Answer 61

Glide Path

Question 62

* Hand Files are the ONLY way to (3)

Answer 62

“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

Question 63

Most are made of --- and related Alloys

Answer 63

Nickel Titanium (Ni-Ti)

Question 64

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

Answer 64

“Super-Elastic” manner. (Easily follow a smoothly created “Glide Path” and immediately return to their designed shape when stress is removed

Question 65

Rotary Files are NOT designed to be used as

Answer 65

scouting files or path finders

Question 66

These are MOTOR-DRIVEN RECIPROCAL FILES They tend to --- MATERIAL AHEAD of the file

Answer 66

PUSH

Question 67

These are MOTOR-DRIVEN RECIPROCAL FILES They tend to PUSH MATERIAL AHEAD of the file They are used in 3 passes to PREVENT

Answer 67

pushing debris out the end of the root where it would cause inflammation

Question 68

Be aware that the Maximum Flute diameter is ---mm. (size #120)*

Answer 68

1.20

Question 69

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

Answer 69

removal of excessive root structure or possible strip perforation of the root. (about the depth of 12-14mm only)

Question 70

We will be using Vortex Blue Files of the following sizes

Answer 70

.25/.04 .30/.04 .35/.04 .40/.04. .45/.04 .50/.04

Question 71

Vortex Blue files tip sizes are identified by the --- of the ring (same as hand files). This is a size #40 at the tip

Answer 71

color

Question 72

The taper of the file is identified by the

Answer 72

number of black bands x 2.

Question 73

Larger than #---, we will do serial step back with hand files

Answer 73

50

Question 74

Other Intracanal Instruments: Barbed Broach

Answer 74

* 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 ***

Question 75

We do NOT recommend the use of a Barbed Broach except in large, --- canals

Answer 75

straight

Question 76

Other Intracanal Instruments: Reamer

Answer 76

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

Question 77

Other Intracanal Instruments: Hedstroem File (5)

Answer 77

A Ground Round wire Cuts aggressively on pull stroke Vulnerable to rotation Prone to fracture Used by Faculty

Question 78

* Reamers: (4)

Answer 78

– 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

Question 79

* K-Type Files: We use these* (3)

Answer 79

– 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

Question 80

* Hedstrom Files: (4)

Answer 80

– 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.