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endo files and isolation Flashcards

1
Q

how does the dam protect pts

A

The rubber dam protects the patient from swallowing or
aspirating instruments and materials

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2
Q

dental dam
essential?
standard?
anytime not used?

A

*ESSENTIAL FOR ENDODONTICS
*Defined as the “STANDARD OF CARE”
*ANYTIME YOU DO NOT USE DAM YOU ARE SIMPLY LIABLE WITHOUT DEFENSE Precedent:
Kansas State Supreme Court 1973

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3
Q

Effective Isolation Crucial to:

A

*RCT Success
*Patient Protection
*Provider Protection

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4
Q

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

A

NEVER place anything small
enough to be swallowed or
aspirated into the mouth
without the protection of an
effective dental dam

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5
Q

why and how should there be no microbes when performing endo

A

*The elimination of Micro organisms within the
pulpal spaces is one of the basic objectives of
successful contemporary RCT
*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

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6
Q

failure to elim salivary leakage with dam can result in:

A

*Failure to eliminate salivary leakage by proper placement of the rubber dam creates salivary contamination which has the potential of turning a simple, routine, uncomplicated RCT into life threatening cellulitis by introducing additional micro-organisms which can greatly complicate the infection.

*This is precisely WHY we never leave a tooth open to salivary contamination

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7
Q

leakage of irrigants

A

*8.3% NaOCl is commonly used for flushing out debris and cleaning the prepared canal system.
*If saliva is not effectively sealed by your dam placement, you can be assured that NaOCl will
leak into the mouth as you irrigate.

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8
Q

dental dam saves time/trouble?

A

yes

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9
Q

what should be placed on all dam clamps

A

safety ligature (floss) to avoid accidental loss of the clamp into the airway/esphogus

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10
Q

forms of the dam available

A

latex Dam is available in Black White, Blue or Green color in various weights & thickness

Non-latex Nitrile Dam is available in the Clinic and is necessary to prevent problems arising from latex allergies

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11
Q

Examples of Rubber dam frames:
which to select? why?

A

There are many types available.
Select one which is radiolucent and leave it in place when taking radiographs

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12
Q

how many teeth to isolate with dam

A

Isolate ONLY the tooth to be treated IF POSSIBLE*
(Exception: some Regional Board Exams where multiple isolation is required.)

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13
Q

dam and radiographs

A

leave on

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14
Q

dam clamp for anterior teeth/ PMs

A

You may find the “Butterfly” Labial Clamp useful for most anterior teeth and even for some
premolars.

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15
Q

types of dam clamps

A

can be winged or unwinged

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16
Q

unwinged clamps

A

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.

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17
Q

clamp #212

A

designed for ant

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18
Q

winged clamps allow the dam to be placed as:

A

single unit

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19
Q

once dam is below HOC, what should be done when placing dam as single unit?

A

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. (spoon excavator used)

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20
Q

dif with?

where should dam clamp rest on teeth

A

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.

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21
Q

when might you isolate more than one tooth

A

when interprox caries are present

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22
Q

what if dam not released from the wings

A

leakage

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23
Q

selaing agents

A

may be used to ensure no leakage/salivary contamination once dam is properly placed, we use oraseal

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24
Q

Oraseal procedure

A

Get it if you have any idea that leakage might occur with your dam placement/ Ask for faculty help.

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25
Q

Not Possible to Place a Dam?

A

If unable to achieve 100% effective isolation of the tooth to be treated:
–Provisionally restore tooth to obtain isolation base*
–Clinical Crown lengthening procedure
–Refer to endodontic specialist

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26
Q

still unable to isolate a tooth? next steps?

A

–Consider alternate treatment modality
*Restorability?
*TE and implant?
*TE and fixed prosthesis?

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27
Q

If you cannot place an effective rubber dam, you cannot do:

A

If you cannot place an effective rubber dam, you cannot do a RCT on the tooth.

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28
Q

badly broken down teeth and isolation

A

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.

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29
Q

isolation with badly broken down tooth covered with hyperplastic gingiva

A

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.

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30
Q

split dam technique

A

not possible to place a clamp/ no solution to this so dam stretched over adjacent teeth and sealed using oraseal

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31
Q

pt is a copious saliva producer

A

*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. history

32
Q

why are there different types of files

A

*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

33
Q

*Stainless Steel Hand File
–sharpness?
–flexible up to what size?
–Can be pre-curved?
–stiffness/diameter relation?
–Efficient when used by?
–Separation occurs?

A

–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

34
Q

*Nickel-Titanium Motor Driven files
– sharpness?
–flex?
– shape memory?
–Works efficiently in?
–Separation?

A

–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

35
Q

made of?

SS K-Type Hand Files

A

*Made of twisted tapered Stainless Steel Wire having a square, triangular or diamond shaped cross, possess flutes
Basically SSK Hand Files are SCREWS
have a non cutting bat tip

36
Q

Continual Clockwise Rotation with hand files

A

*Will cause an SSK Hand File to:
–Screw itself to & out the end of the root . . . or
–Become locked in dentin and fracture

37
Q

SSK hand files behavior with rotation, how to counter this?

A

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.

38
Q

hand files are essential for what aspects of RCT

A

-Scouting the canal
- Creating a Glide Path
- Bypassing a ledge, blockage or separated instrument
- Gaining length

39
Q

file # for scouting canal

A

10 and 8

40
Q

file # for making guide path

A

10 and 15

41
Q

Skill with the use of hand files must be mastered for:

A

Skill with the use of hand files must be mastered for successful RCT.

42
Q

when could they be larger?

hand file sizes for most cases

A

Hand Files used will be #10 and maybe #15 sizes for most cases but also larger sizes if doing Serial Step Back for larger canal gauges.

43
Q

SS hand file sizes

A

Hand Files generally come in sizes .08 to .140 ( 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 “Will You Really Be Going Back” may help you remember the sequence which repeats at .45 to .80 and again at .90 to 1.40

Note that .60 is the last file size which increases by only .05mm*

44
Q

hand file taper

A

defined as .02, .04 etc: means that mm increase per 1mm from file end

45
Q

lengths of hand files

A

Hand Files are typically supplied in 21, 25, and 31mm lengths.
No matter which length is supplied, the fluted portion of the file is 16mm long

46
Q

standardized SS hand file taper

A

All standardized K-Type hand files are .02 Taper 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.

47
Q

SS hand files and bends

A

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.

48
Q

when would this occur? safety?

hand file breakage

A

*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.

49
Q

hand files and sensitivity

A

*HAND FILES give us the GREATEST TACTILE SENSE of all intra-canal shaping instruments and serve as Pathfinders & basic instrumentation to negotiate Canal Curves & Blockages.

50
Q

motion used with handfiles

A

watch winding, CW and CCW rotations

51
Q

*Circumferential Filing

A

*Circumferential Filing from length desired to remove (Press against alternate walls of canal and pull back for a filing motion)

52
Q

when to use next larger file

A

*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)

53
Q

can straight files be placed in canals? how do we plcae them?

A

*Never place a STRAIGHT file in a curved canal
*Hint: ALL canals are curved (to various degrees)
*Gently curve ALL hand files when entering a canal
*Try to match or slightly exceed the greatest curve you observe in the radiograph of the canal
*If you slightly exceed the curvature of the canal, the file (upon insertion) will track the inner wall of the curve and be conformed to
the actual curve of the canal

54
Q

result of straight file placed in canal

A

On the other hand, if you place a straight file in a curved canal,(remember ALL canals are curved) the file will track the outer wall of the curve and gouge the canal at that point creating what we call a Ledge.

55
Q

with a ledge formed in canal what is the result

A

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.

56
Q

Dealing with Sharp Canal Turns and Ledges

A

*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 45 ̊ bend in the most terminal flutes.
*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 hand files

57
Q

hand files are the only way to:

A

*Hand Files are the ONLY way to “scout” a canal.
*Hand Files are the ONLY way to bypass a ledge or separated instrument.
*Hand Files are the ONLY way to negotiate and smooth a tight curve to smooth the Glide Path or to Regain Lost Length

58
Q

engine driven rotary and reciprocation files

A

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.

59
Q

can rotary files scout/path find

A

no

60
Q

sizes/taper

what rotary files do we have

A

gold ones,
Small .20/.07
Primary .25/.07
Large .45/.05

61
Q

action of the motor driven reciprocal files

A

They tend to PUSH MATERIAL AHEAD of the file
They are used in 3 passes (coronal, middle, apical) to PREVENT pushing debris out the end of the root where it would cause inflammation

62
Q

max flute diameter

A

1.2mm

63
Q

indication of taper on the rotary files

A

black bands, each one would indicate .02 taper
example: 6 bands= .12 taper

64
Q

.25/.12 Vortex Ni-Ti Rotary Filev

A

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).

65
Q

which ones do we use? seq of use? what if file needed exceeds sizes?

Vortex Blue M-wire Rotary
Files

A

rotary not reciprocation files
We use: 25/.04, .30/.04, .35/.04, .40/.04. , .45/.04, .50/.04 (IN THIS SEQUENCE TOO)
Larger than #50, we will do serial step back with hand files.

66
Q

ID vortex files

A

Vortex Blue files tip sizes are identified by the color of the ring (same as hand files).

The taper of the file is identified by the number of black bands x 2.

67
Q

Barbed Broach intended use

A

Rotated in canal to entangle and remove vital pulp
organ

68
Q

material, design, when could it break?

barbed broach

A

–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 ***

69
Q

when are barbed broaches mainly used

A

large straight canals

70
Q

reamer
used often?
effective only by? in what canals?
use in curved canals?
tip?
made by?

A

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

71
Q

Hedstroem File
design?
cuts?
vulnerable to?
prone to?
used only by?

A

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

72
Q

reamer flutes to SS files

A

fewer than SS

73
Q

when do reamers cut

A

only on rotation

74
Q

reamers tend to?

A

stray from natural canal: dangerous

75
Q

reamers manufactured by:

A

twisting a tapered triangular SS Blank

76
Q

when are SS files effective?

A

pulling motion

endo (22 decks)

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