Endosonics / /certified fixed orthodontic courses by Indian dental academy

ENDOSONICS AND
SONICS

INDIAN DENTAL ACADEMY
Leader in Continuing Dental Education
www.indiandentalacademy.com


PHYSICS BEHIND ULTRASONICS


PHYSICS BEHIND SONICS


BIO PHYSICAL EFFECTS OF
ENDOSONICS


CONTENTS
 Introduction
 History
 Classifcation
 Differences between sonics and ultrasonics
 Endosonics
 Classification
 Principles of endosonics
 Endosonic preparation
 Endosonic mechanical energy
 Endosonic chemical energy
 Endosonic disinfection
 Clinical procedure
 Endosonics obturation



 Sonics
Introduction
Different types of sonic instruments
Clinical procedure
 Comparative conclusion of automated devices
 Endosonics in Retreatment
Classification
Different types of ultrasonic tips
 Endosonics in Periapical surgery
Isthmus prepartion
Retropreparation
 Ultrasonic tips in restorative dentistry
 Conclusion
 References

INTRODUCTION
 Endodontics has entered the high tech era
with advances in ultrasonic biotechnology.

 Endosonic endodontics combines ultrasonic
energy with flow through activated irrigation
to effectively,efficiently and easily
shape,debride,cleanse and disinfect the root
canal system


HISTORY
 Introduced to endodontics by Richman in
1957.
 Developed and promoted by Howard Martin
and Walter Cunningham in 1976


CLASSIFICATION
Based on the frequency of vibration and
the source of power

Ultrasonics
Sonics


ULTRASONICS
 Generates vibration above the audible range
powered by means of electric currents
passing through a lamellar arrangement of
metal plates
 Alternating attractive and replusive forces
between the plates affect the mechanical
vibratory movements, which are then
transferred to the instrument.


SONICS
 Produces vibrations below the audible
frequency range by means of
compressed air, which activates a rotor
and shaft assembly as a source of
vibration.


HOW THESE SYSTEMS DIFFER FROM
ROTARY AND HAND PROCEDURES
 The cutting of dentin is facilitated by a
mechanical device that imparts a sinusoidal
motion to the instrument by the transfer of
vibrational energy along the shaft

 The term ultrasonic instrumentation has been
used to describe these types of systems


SIMILARITY BETWEEN SONIC AND
ULTRASONIC
 Is in imparting vibrational type of
movement for the root canal instrument
which they acitvate


DIFFERENCES BETWEEN SONIC
AND ULTRASONIC
 Source of power
 Frequency of vibration
 Type of handpiece
 Root canal instruments used


ENDOSONICS


CLASSIFICATION
 Based on the source of power and frequency
of vibration

(a) Magnetostrictive

(b) Piezo-electric


DIFFERENCES BETWEEN
MAGNETOSTRICTIVE AND PIEZO ELECTRIC

 20 to 25K Hz  30 to 35 KHz
vibrations vibrations
 Generates heat  Does not generate
 Requires cooling heat
system by flow of  Does not require
water cooling system
 Requires compressed  Built in pump in its
air and special tube body
connections to the
handpiece


PRINCIPLES OF ENDOSONICS

 Transducer element in the endosonic insert
transforms the electrical energy of the
cavitron into the acoustic mechanical energy
necessary to cause the vibratory/oscillatory
waves that energize the files and diamonds
 The resulting sound wave carries the
vibratory energy along the entire length of
the instruments and causes a reciprocal
movement in these files/diamonds


 It is this reciprocal excitation of the
endosonic files/diamonds which shapes the
root canal system
 The operator no longer acts as the moving
force but only as a guide while the ultrasonic
energy waves causes the instruments to move
in the proper filing motion
 The energy wave enables the instruments to
remove contaminated dentin, debris and
tissue


 The endosonic insert is unique in it’s design in
that it allows the traditional endodontic
irrigant NaOCl to used
 The solution will follow a precurved file thus
allowing the deepest penetration into the
canal and leads to complete irrigation of the
root canal system.
 In actuality the root canal system has been
transformed into an ultrasonic bath


ENDOSONIC PREPARATION
 Preparation of the root canal is a
chemo-mechanical procedure whose
purpose is to remove necrotic debris,
and contaminated dentin from the root
canal.
 In addition the denitst must
eliminate/reduce the pathogenic
bacterial component via a process of
disinfection while also preparing the
canal for three dimensional obturation

ENDOSONIC MECHANICAL ENERGY
 The ultrasonic wave energy is a mechanical
vibratory action.
 The file motion used in ultrasonic root canal
preparation is essentially a push-pull action
enhancing dentin removal more effectively
than hand instruments in the same time frame
and with greater control
 Circumferential movement of the files is also
advocated to achieve the smooth tapering
canal shape that is considered optimal for
obturation

 A side-to-side action or lateral movement
activates the irrigant solution which improves
its disinfecting and cleaning qualities.
 The clinical importance of this is improved
control of the obturation technique, ease of
apical obturation and less extrusion


ENDOSONIC CHEMICAL ENERGY

 The activation of the endodontic irrigant is
vital to the effectiveness of the endosonic
system
 The irrigation solution NaOCl will penetrate
the root canal system more effectively due to
the ultrasonic activation of the solution which
can only be achieved when it undergoes
ultrasonation.
 This can not be achieved with sonic systems


 Ultrasonics vibration is unparalleled in its
ability to enhance cleaning with irrigants.

 Ultrasonic activation of NaOCl has been
shown to be most effective in the apical third
of the canal owing to the greater amplitudes
of vibratory movement at the file tip


 The prinicipal effects of ultrasound in
solution are:
(a) Cavitation
(b) Acoustic steaming

 Cavitation occurs when ultrasound generates a
bubble in the irrigant which grows to a critical
point and then undergoes the implosion effect
( Internal collapse) with the concomitant
release of a shock wave and tremendous force
with a vacuum effect


 Cavitation- the growth and subsequent violent
collapse of a small gas filled preexisting
inhomogeneity in the bulk fluid.
(JOE 1987)

o Cavitation, a process by which bubbles
formed from the action of the file,
become unstable, collapse, and cause a
vacuum-like ‘implosion.’ A combined
shock, shear and vacuum action results
(Ingle 4th edition)


 The main debriding action of ultrasonics was
initially thought to be by cavitation.
 It allows for deep penetration into all
ramifications of the canal and draws out all the
debris.
 Guy’s Hospital in London thoroughly studied the
mechanisms involved and questioned the role
that cavitation and implosion play in the
cleansing Endodontics process.
 They believe that a different physical
phenomenon, “acoustic streaming,” is
responsible for the debridement

ACOUSTIC STREAMING
 Acoustic steaming creates small, intense,
circular fluid movement ( i.e., eddy flow )
around the instruments (Cohen 8th edition)
 Acoustic streaming- the rapid movement of
particles of fluid in vortex-like motion about a
vibrating object. (JOE 1987)


Ultrasonically engerized file creates currents of
streaming of irrigant within the root canal

 The eddying occurs closer to the tip than in
the coronal end of the file, with an apically
directed flow at the tip.
 Acoustic streaming increases the cleaning
effect of the irrigant in the pulp space
through hydrodynamic shear stress
 Increased amplitude occuring at smaller file
sizes enhances the acoustic streaming. This
has proven to be of great value in the cleaning
of the root canals because conventional
irrigation solutions do not penetrate small
spaces well.


 Cavitation does not play a role in root canal
debridement. Acoustic streaming appeared to
exert a more important role in root canal
debridement. (JOE 1987)


ENDOSONIC DISINFECTION
 MECHANICAL DISINFECTION:
o Is the physical removal of necrotic debris,
predentin and contaminated dentin.
o Endosonic diamonds/files plane the dentin walls
smooth and remove the detritus which acts a
substrate for bacteria.Also eliminates many of
the ramifications which house and trap debris.
o Another form of mechanical disinfection is the
high volume irrigant flow that has the
capacity to flush debris and bacteria from the
canal.


CHEMICAL DISINFECTION:
 Cavitational effects clean the canal system
of any organic pabulum that would acts as a
substrate for bacterial growth
 Acoustic microstreaming causes a radiating
pressure that shears bacterial cells, making
them more vulnerable to irrigant action
 The physical chemical activation of the
irrigant is also due to ultrasonation increasing
the release of free radicals and the
formation of hypochlorous acid and energy
release catalyzing the solution into a more
active formation

ENDOSONIC CLINICAL TECHNIQUE
 Initial root canal preparation is made using
hand instruments with no.15 instrument
 Smallest endosonic file no.15 is used with
handpiece held in the pen grasp
 Depressing the foot control to the first
position energizes the file while depressing
the control fully causes the irrigant to flow.
 Movement of the file is light, smooth, short,
push-pull stroke up and down first followed by
a circumferential movement


 The sequence of energized filling and
irrigation is carried on through endosonic
files no.20 and no.25 with all files used in the
canal for at least one minute per instrument

 Upon completion of endosonic filing the
endosonic diamond is utilized in the canal

 Diamonds are also used with a push-pull
motion followed by circumferential movement.

 They are also used for at least one minute per
instrument

 One starts with no.25 diamond which feel
tight within the canal gradually works it down
the canal and will feel tight within the canal
and gradually works it down the canal and will
feel it becoming loose within the canal
confines
 The diamond is used to taper and smooth the
straighter portions of the canal- cervical and
middle areas
 The circumferential movement will round,
taper and smooth the canal
 The diamond is safe ended to avoid any
further apical enlargement

 After the canal has been prepared by the
endosonic files/diamonds the apical 1 to 3mm
should undergo recapitulation with no.20 or
no.25 hand files to the established working
length
 A properly prepared endosonic canal maintains
the original canal outline with sufficient flare
coronally ending in a prepared minimal apical
opening with smooth, tapering walls which will
make obturation extremely easy to
accomplish.


 Endosonic files and irrigation were used to
debride the apical and middle thirds, while
the files/diamonds with irrigant debride the
middle and cervical thirds of the canal
 It has also been recently shown that a final
irrigation, prior to obturation, of 1-3 minutes
with NaOCl will give the cleanest canals
achievable
 This was shown to be superior to NaOCl and
EDTA together and demonstrated numerous
tubules and lack of smear


ENDOSONIC IRRIGATION IN
INTERNAL RESORPTION
 In this clinical condition endosonic
irrigation is used.
 Endosonic irrigation disinfects the
resorption site and helps in proper
cleaning of the site


ENDOSONICS IN OBTURATION
 A gutta percha cone was used as master
cone. Ultrasonic tip was used as a
spreader and energized along the gutta
percha.
 Accessory cones were placed and were
compacted using ultrasonic tip as a
spreader and then compacted with
finger pluggers.
 Finally hand plugger was used to
compact them vertically.

 Obturation of internal resorption cavities
with 4 different techniques: An in-vitro
comparative study
 Studies have shown that Lentulospiral gave
the best result for sealer placement at
different levels from the apex in comparison
to K file and ultrasonic file.


Piezon unit with an endosonic insert
and irrigant bottle

DIFFERENT TYPES OF ENDOSONIC
UNITS
 Satelec P5
 MTS-1 and Piezo-Electric Systems
 NSK
 MiniEndo
 Enac


SONICS SYSTEM


SONIC SYSTEM
 Like the air rotor handpiece, it attaches to the
regular airline at a pressure of 0.4 MPa. The air
pressure may be varied
 with an adjustable ring on the handpiece to give
an oscillatory range of 1,500 to 3,000 cycles per
second.
 Tap water irrigant/coolant is delivered into the
preparation from the handpiece.
 Sonic endodontic handpiece available today is
the Micro Mega 1500 (or 1400) Sonic Air Endo
System (Medidenta/ Micro Mega)


 Walmsley et al., in England, studied the
oscillatory pattern of sonically powered files.
They found that out in the air, the sonic file
oscillated in a large elliptical motion at the
tip.
 When loaded, as in a canal, however, they
were pleased to find that the oscillatory
motion changed to a longitudinal motion, up
and down, “a particularly efficient form of
vibration for the preparation of root canals


SONIC INSTRUMENTS

 RispiSonic

 Shaper Sonic

 Trio Sonic (also called in Europe the
Heliosonic and the Triocut File)


RISPI SONIC
 Developed by Dr. Retano Spina in Italy
 Resembles the old rat-tail file
 Has 8 cutting blades
 Safe-ended noncutting tips
 ISO sizes range from 15 to 40


SHAPER SONIC

 Developed by Dr. J. M. Laurichesse in
France
 Resembles a husky barbed broach.
 Has 16 cutting blades


TRIOSONIC
 Also called the Heliosonic and the
Triocut File
 Resembles a triple-helix Hedstroem
file


CANAL PREPARATION
 These instruments must be free to oscillate in
the canal, to rasp away at the walls, and to
remove necrotic debris and pulp remnants.
 To accommodate the smallest instrument, a
size 15, the canal must be enlarged to the
working length with hand instruments through
size No. 20.
 The sonic instruments, with the 1.5 to 2.0 mm
safe tips, begin their rasping action this far
removed from the apical stop. This is known
as the “sonic length.”

 As the instrument becomes loose in the canal,
the next-size instrument is used, and then
the next size, which develops a flaring
preparation.
 The sonic instruments are primarily for step-
down enlarging, not penetration.


CONCLUSIONS OF DENTAL SCHOOL IN
WALES
 Dummer et al. found the Rispi Sonic and
Shaper Sonic files to be the most successful,
the Trio Sonic less so
 The Shaper Sonic files widened the canals
more effectively than the Rispi Sonic files,
whilst the Heliosonic [Trio Sonic] files were
particularly ineffective…”


RECOMMENDATIONS OF RESEARCH GROUP
AT TEMPLE UNIVERSITY
 They recommended that the Shaper
Sonic files be used first and that the
remaining two-thirds of the canal be
finished with the Rispi Sonic.
 Ehrlich et al. compared canal apical
transport using Rispi,Sonic and Trio
Sonic files versus hand instrumentation
with K files.
 They found no difference in zipping
among the three instruments.

 Tronstad and Niemczyk also tested the Rispi
and Shaper files against other instruments.
 They reported no complications(broken
instruments, perforations, etc) with either of
the Sonic instruments
 Miserendino et al. also found that the “Micro
Mega sonic vibratory systems using Rispi
Sonic and Shaper files were significantly
more efficient than the other systems
tested.”


COMPARATIVE CONCLUSION OF
AUTOMATED DEVICES
 It appears safe to say that no one automated
device will answer all needs in canal cleaning
and shaping. Hand instrumentation is essential
to prepare and cleanse the apical canal, no
matter which device, sonic or ultrasonic, is
used.
 The sonic unit Micro Mega 1500 reportedly
enlarges the canal the fastest when Rispi or
Shaper files are used, whereas the Canal
Finder System, using A-style files, leads in
instrumenting narrow curved canals.

 Finally, the ultrasonic CaviEndo and Enac
units, using small K files and half-strength
sodium hypochlorite for an extended time (3
minutes), seem to débride the canal best.
 No technique without sodium hypochlorite
kills bacteria, however.
 One must evaluate one’s practice and decide
which device, no device, or all three best suit
one’s needs.


ULTRASONIC INSTRUMENTS
IN RETREATMENT


APPLICATIONS
 Root canal obstructions
 Identification of missed and hidden canals
 Removal of posts
 Removal of core materials
 Removal of obturating materials
 Removal of broken instrument tips


DESIGNS OF ULTRASONIC TIPS
 Simple curves to multiangled bends
 Long and slender or short and sturdy
 End cutting or side cutting
 Made of Stainless steel or Titanium alloys
 Stainless steel may be coated with Zirconium
nitride or diamond grit
 Desgined to function dry or with water ports
to increase the cooling and washing effect


CLASSIFICATION
The different ultrasonic systems have
been broadly classified as follows:
(1) Access refinement tips

(2) Vibratory tips

(3) Bulk removal tips

(4) Troughing tips

CT TIPS

 First ultrasonic tips for endodontic surgery;
the CT tips made of stainless steel
 Designed by Dr.Gary Carr
 First available in early 1990

 These were set of 5 instruments


KiS TIPS
Introduced in the year
1999 by Dr.Syngcuk Kim

Dramatically increases
cutting efficiency due to
their diamond coating.

Diamond Coating provides a
micro-rough surface of the
inner wall of the retro
prepared cavity


 Location of irrigation port which is on
the tip rather than on the shaft

 Slightly longer than other microsurgical
instruments for better access.


PROULTRA TIPS
Exists in two types namely
 Proultra endo 1-8
 Proultra surgical endo tips
1-6

These tips are designed by Dr.Clifford J.
Ruddle


PROULTRA ENDO
 Remove intracanal obstruction materials
 Disassemble dental restorations and cores
 Trough and chase for calcified or hidden canals
 Dislodge posts and broken instruments
 Efficiently eliminate pulp stones


PROSURGICAL ENDO TIPS

Tip-1 A universal
instrument with a tip
angle of 80º
designed for anterior
roots
Tip-2 Greater diameter
than that of tip of 1 and
is used for larger
apical canals
Tip-3 A double-angled 75º
instrument for roots of
mandibular left and
maxillary right posterior
teeth

Tip-4 A double-angled
110º instrument for
roots of mandibular
left and maxillary
right posterior teeth

75º instrument for
roots of mandibular
right and maxillary
left posterior teeth

110º instrument for
roots of mandibular
right and maxillary
left posterior teeth

CPR TIPS
 Diamond coating enhances cutting efficiency
 Remove intra-canal obturation materials
 Water port allows to cut wet or dry and
reduces heat generation
 Identifies hidden and calcified canals
 Efficiently eliminate pulp stones
and obstructions


 CPR 1-5 are diamond coated and active
along the side of the tips
 CPR 3D,4D,5D are 15, 20 and 25mm in
length respectively .
 These instruments are used in the
coronal, middle and apical third of
canals and their selection depends on
the depth at which they need to be
operated.


CPR TITANIUM SERIES

 Remove Intracanal obstruction materials
 Dislodge posts and broken instruments
 The flexibility and strength of Titanium
allows these Instruments to follow the
anatomy of the Root Canal

 Allows for deep canal instrumentation

 CPR tips 6(red),7(Blue),8(Green), are used in
deeper part of a straight canal which are
20,24 and 27mm long respectively
 These instruments should be used with light
touch


BUC TIPS
 Designed by L. Stephen Buchanan

 BUC-1: The Tapered fine diamond grit -
cutting and refining line angles, smoothing
access walls, cutting MB troughs
 BUC-2: The Planer Disk Tip, medium diamond
grit - planing pulp chamber floors and safely
plane attached pulp stones out without cutting
the chamber floor.

 BUC-2a: Smaller Disk-used for corners of
molar and bicuspid access preps. 1mm in
diamater
 BUC-3: The Sharp Tipped, fine diamond grit -
very active tip for cutting into calcified roots
and around posts


BK 3 TIPS
 BK-3 surgical tips have three bends for easy
access to any preparation including MB2
canals.

 BK-3’s provides increased visibility and can
finish an entire prep with one tip.
 Water is directed down the three bends and
is able to reach the surgical site.
 BK-3s are for use with any application.
 These tips should be used at low power levels

ACCESS REFINEMENT TIPS
 Access cavity preparation is the most
important phase of endodontic therapy
 Recently, a combination of access refinement
ultrasonic tips and magnification has
revolutionized the basic concept of access
cavity preparation.
 There are many advantages to using ultrasonic
tips rather than burs to refine the access
cavity to locate the underlying anatomy


Advantages are:
 No handpiece head to obscure vision and,
therefore, the progressive cutting action can
be observed directly and continuously under
the microscope.
 The size of ultrasonic tips is smaller than the
smallest burs; therefore, the dentine can be
brushed off in smaller increments and with
greater control.
 The process allows for exposure of any missed
or hidden canals or recesses containing
necrotic pulp tissue without gutting down the
tooth structure

 Another advantage of ultrasonic instruments
over burs is the production of-cavitation
within the cooling water that flows over the
tip of the ultrasonic instrument.
 Cavitation may be described simply as bubble
activity in a liquid, which is capable of
generating enough shock waves to cause
disruption of remnants of necrotic pulp tissue
-and any calcific deposits.
 Therefore, it is no wonder that access
cavities prepared with ultrasonic instruments
have a thoroughly washed out and clean
appearance

 A number of tips are available to refine the
access cavity.
 The uncovering of the floor of the pulp
chamber can be accomplished with the help of
the CPR 2D or BUC 1 tips.
 If the dark, colored floor of the pulp chamber
is not visible, it usually is obscured by pulp
stones or tertiary dentine deposits The pulp
stones sometimes can be vibrated or teased out
by the CPR 2D or BUC 1 tips at other times,
they can be planed with the help of a BUC 2 tip
—a process similar to planing the root surface.

VIBRATORY TIPS
 Removal of intraradicular posts has always
been a challenge when performing endodontic
retreatment. This procedure also has been
fraught with unwanted consequences, such as
root fracture or perforation.
 The implementation of ultrasonic energy has
provided the clinician with an important
adjunctive method for removal of posts.
 A number of studies have shown conclusively
that the use of ultrasonic vibration
significantly reduces the amount of tensile
force required to dislodge both the cast and
prefabricated posts.

 The VT , Osada Enac ST09, and CPR 1 are
examples of such instrument tips.
 The tips of these instruments are spherical or
flat and are placed against the post to
transmit vibration
 They are activated at the maximum intensity
and moved circumferentially until the post
loosens or dislodges.
 If this method does not loosen and free the ,
post then alternate methods must be used.


 These tips should not be placed directly on
ceramics because it may cause severe damage to
the prosthesis

 The inability to remove posts by vibration alone
is dependent on many factors such as the type
of luting agent, the length and type of the post,
and the type of core buildup

 The core buildup around the post should be
removed before applying the vibratory tip.


 In some cases, the troughing tip should be
used around the post and then vibratory tips
should be reapplied to obtain the maximum
benefit
 Posts luted with zinc phosphate cement can
be dislodged readily by ultrasonics because of
microcrack formation in the cement
 However, posts luted with resin cements fail
to dislodge by ultrasonic vibration, probably
due to the lack of the micro-fracture
propagation in these materials


BULK REMOVAL TIPS
 Bulk removal tips are extremely sharp and
sturdy tips that are operated at moderate or
maximum intensity of the ultrasonic unit.
 BUC 1 and CPR 2D are examples of tips that
fall into this category.
 These tips are designed primarily to remove
dentine and core material quickly and
expeditiously before subjecting the root
canal obstruction to vibratory or troughing
procedures.


TROUGHING TIPS

 Troughing tips are used to create a
sufficiently deep trough around posts to
maximize the benefits of subsequently applied
vibratory or extraction forces.
 In the past, troughing around the root canal
obstruction was performed with trephine
drills.


 This process was extremely destructive and
frequently led to the gutting down and
perforation of root trunks. Now with the help
of ultrasonic tips, troughing around root canal
obstructions can be performed in a
predictable and controlled manner


REMOVAL OF BROKEN INSTRUMENT
TIPS
 MICROSONICS
 An ultrasonic instrument is selected based on
the depth of the broken file and space
availability
 It is activated at the lowest power setting
and used dry so that the clinician has
constant vision between the energized tip and
the broken instrument


 The selected CPR instrument is moved lightly
in a CCW direction around the obstruction
except when removing reverse-screw files
 This ultrasonic action sands away dentin and
trephines around the coronal few millimeters
of the obstruction
 The obstruction begins to loosen, unwind and
spin
 Gently wedging the energized tip between the
tapered file and the canal wall oftentimes
causes the broken instrument to abruptly
“jump out” of the canal


ENDOSONICS IN ENDODONTIC
SURGERY


ROLE IN PERIAPICAL SURGERY
 After resecting the root surface in periapical
surgery ultrasonic tips are used to carve
Isthmus
 Retropreparation of root surface


ISTHMUS PREPARATION WITH
ULTRASONIC TIPS
 Is the only way to carve an isthmus. Requires
a careful and delicate approach, because the
isthmus is located in the thinner portion of
the root which can be easily be perforated or
stripped.
 The ultrasonic tip with a diameter of less
than 0.2mm is the best tip to treat the
isthmus without causing procedural mishaps.


 Occasionally the dental surgeon encounters an
incomplete isthmus. It is helpful in this case
to provide a guideline for the ultrasonic tip by
creating a shallow groove along the isthmus
line with a microexplorer. This is called
“ Tracking Groove”
 The ultrasonic tip is first activated without
water coolant to make a tracking groove
connecting the two canals, which are usually
oriented buccal to lingual.
 The groove is produced quickly by gently
guiding the tip along the isthmus

 However before proceeding with the
preparation of the isthmus to the full depth
the tracking groove should be examined at
12x to 16x magnification for correct
postioning
 Once the correct position is confirmed the
isthmus is fully prepared with a water-cooled
Kis 1-tip or CT-1 tips.
 The length of the active portion of the tip is
3mm with 0.2mm diameter width
 The entire tip length must be used to prepare
the isthmus.


RETROPREPARATION OF ROOT
SURFACE
Five requirements that a root-end preparation
must fulfill:
 The apical 3 mm of the root canal must be

freshly cleaned and shaped.
 The preparation must be parallel to and

coincident with the anatomic outline of the
pulp space.
 Adequate retention form must be created.

 All isthmus tissue, when present, must be

removed.
 Remaining dentin walls must not be weakened.


ADVANTAGES OF ULTRASONIC TIPS
OVER MICROHEAD BURS
 Better access, especially in difficult-to-reach
areas (e.g., a lingual apex)
 More thorough debridement of tissue debris
 Conservative preparations tracing the long
axis at a precise depth of 3 mm
 Precise isthmus preparations with parallel
canal walls for better retention of filling
materials


ULTRASONIC ROOT END PREPARATION
 This procedure is accomplished under the
microscope at low-to-mid magnifications (4 x 16
x).
 First, a number of appropriate tips are
preselected, depending upon the location of
each apex.
 Second, the resected root surface, stained
with methylene blue, must be critically
examined at high magnification (16 x to 25 x)
to see the microanatomy.
 Third, at low magnification (4 x to 6 x), the
selected ultrasonic tip is positioned at the apex

 It is important at this stage that the tip is
positioned parallel with the long axis of the
root.
 To accomplish this the surgeon must examine
the position of entire tooth at low
magnification (4 x), including the crown and
root eminence and compare this with the
position of the ultrasonic tip.
 Failure to make this comparison will risk an
off-angle root end preparation or perforation.
 Fourth, the ultrasonic tip is activated and the
apical canal is retroprepared with copious
water coolant to a depth of 3 mm

 If an ultrasonic tip is pressed too firmly
it is dampened to deactivatation thus a
light sweeping motion using short
forward-and backward and up and down
strokes is all that is needed for
effective cutting action.
 Depending on the canal configuration a
typical 3mm retropreparation should
take less than 1minute with KiS tips


 Once the retropreparation is completed
the cavity preparation is inspected with
a micromirror at high magnification of
16x to 25x.

 Layton and associates did an in vitro study
evaluating the integrity of the resected root-
end Surfaces, following root-end resection
and after root-end Preparation, with
ultrasonic Instrumentation at low and high
frequencies
 The results indicated that root end resection
alone may result in dentin crack formation
regardless of the type of root-end
preparation.

 Their data also indicated that more dentin
cracks occurred when the ultrasonic tip was
used on the high frequency setting than on
the low-frequency setting
 That more cracks resulted following
ultrasonic root-end cavity preparation,
regardless of the frequency setting, than
after root-end resection alone.


ULTRASONIC TIPS IN RESTORATIVE
DENTISTRY-SL TIPS
 SL (Surface Lesion) tips have
been designed to accomplish
restorative, preventive
procedures while conserving
sound tooth structure
 Designed by Dr.Cherilyn G.
Sheets and Dr. Jacinthe M.
Paquette in conjunction with
the Newport Coast Facial
Institute

 SL-1: For access to disto-buccal areas of the
upper left molars and the lingual aspect of lower
right molars
 SL-2:
accessibility to cervical areas and interproximal
areas
 SL-3:
Useful for conservative treatment of occlusal
surfaces of posterior teeth
 SL-4: For conservative correction with its 0.5mm
tip for early decalcification or stain removal on
occlusal surface

CONCLUSION

Currently endosonics have wider
applications in endodontics. The multiple
effects of endosonics are physical,
Chemical and biological actions. Thus is
developed the
Endosonic Ultrasonic Synergistic System


REFERENCES
Pathways of Pulp – Cohen 4th, 6th,8th
editions
Endodontic practice-Ingle 4th edition
DCNA-Modern endodontic practice
JOE-1987
Current trends in Endodontology-
Dr.A.Parmeswaran, Dr.B.P.Rajan
FACE-1 Tooth Resorption-
Dr.M.R. Srinivasan

Endosonics / /certified fixed orthodontic courses by Indian dental academy

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