Sterilization of endodontic instruments /certified fixed orthodontic courses by Indian dental academy

STERILIZATION OF
ENDODONTIC
INSTRUMENTS

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

CONTENTS
• INTRODUCTION
• CLASSIFICATION
• STANDARDIZATION
EXPLORING INSTRUMENTS
o DG EXPLORER
• ORFICE OPENERS
 MICRO OPENERS
 GATES GLIDDDEN DRILLS
• DEBRIDING INSTRUMENTS
 BARBED BROACHES AND RASPS
• SHAPING INSTRUMENTS
 K files and reamers
 K flex files
 Flex o files www.indiandentalacademy.com
 Canal master

ROTARY INSTRUMENTS
 LIGHT SPEED
 PROFILE SERIES
 GREAT TAPER AND ACCESSORY FILES
 PROTAPER
 QUANTEC
 HERO 642
 RACE
 K3
 ENDOSEQUENCE
• OBTURATING INSTRUMENTS
 SPREADERS
 PLUGGERS
• STERILIZATION OF INSTRUMENTS
• CONCLUSION
• REFERENCES

INTRODUCTION


CLASSFICATION
• ISO and FDI classified root canal
instruments into four groups

• GROUP I- Hand use only

• GROUP II- Engine driven latch type

• GROUP III- Engine driven latch type – drills

• GROUP www.indiandentalacademy.com
IV- Root canal points – gutta

BASED ON THEIR FUNCTION THEY ARE
CLASSIFIED INTO
• EXPLORING INSTRUMENTS
• DEBRIDING INSTRUMENTS
• SHAPING INSTRUMENTS
• OBTURATING INSTRUMENTS


ANSI AND ISO/FDI CLASSIFICATION

GENERAL DESCRIPTION ANSI FDI/ISO
Root canal files (K-type) 28 3630/1
Hedstrom files ( H-type) 58 3630/1
Barbed broaches and rasps 63 3630/1
Root canal enlargers 3630/2
Condensers, pluggers 71 3630/3
Spreaders
Absorbent points 73 7551
Obturating points 78 6877
Root canal sealers
www.indiandentalacademy.com 57 6876

INSTRUMENT STANDARDIZATION
• Historically very little was done to improve the
quality or standardization of instruments until
the 1950’s.
• In 1958 Ingle and Levine first proposed
standardization
• 1962 working committee on standardization
has been formed
• In 1976 first approved specification for root
canal instruments was published.


INGLE AND LEVINE
STANDARDIZATION


PERCENT CHANGE
• FIRST CAUTIONED BY
• METHOD OF CALCULATION
• DISADVANTAGES
• INSTRUMENTS INTRODUCED TO
OVERCOME THIS
• SOLUTION TO OVERCOME THIS
PROBLEM


METALS USED IN ENDODONTIC
INSTRUMENTS
• CARBON STEEL
• STAINLESS STEEL
• Nickel Titantium (Nitinol)


EXPLORING INSTRUMENTS

• Endodontic explorer is
the greatest aid in
finding a minute canal
entrance feeling along
the walls and into the
floor of the chamber in
the area where the
orifices are expected to
be


ORIFICE OPENERS
• Canal orifices are so
restrictive that they need
to be flared so that
instruments may enter
easily
• Orifice openers from
hand operated Micro
openers to contra-
angled powered
reamers with a greater
taper (0.04, 0.06) and
Gates-Glidden drills

GATES GLIDDEN DRILLS
• GGs are side-cutting, safe-ended
instruments, and ideally used to cut
dentin as it is withdrawn from the canal.
• Consists of 6 instruments
• Recommended speed is 750-1000 rpm
• A hand instrument also designed for
apical preparation is the FLEXOGATES
• A safe-tipped variation of the traditional
Gates-Glidden drill, the Flexogates is still
to be tested clinically.

• A hand instrument also
designed for apical
preparation is the
FLEXOGATES
• A safe-tipped variation
of the traditional Gates-
Glidden drill, the
Flexogates is still to be
tested clinically


DEBRIDING INSTRUMENTS
• BARBED BROACHES AND RASPS:
Oldest endodontic instruments
Although similar in design there are some
siginificant differences in taper and barbs of
different heights and shapes.


BROACHES RASPS
• Taper 0.007 to • Taper 0.015 to 0.020
0.010 mm/mm mm/mm
• Barb height should • Barb equal to one
be half the core third the diameter of
diameter the tip


RAKE ANGLE

The rake angle may be seen as the direction
of the cutting edge if visualised as a surface.
If this surface is turned in the same direction as
the force applied the rake angle is positive.
If the blade performs a scraping action faced
away from the direction of the force the rake
angle is said to be negative.


K-TYPE FILES AND REAMERS
• The K-type file and reamer are
the oldest useful instruments
for cutting and machining
dentin.
• Made from a steel wire that is
ground to a tapered square or
triangular cross section.
• This wire is twisted to generate
a file or a reamer. During this
process the steel is work
hardened.
• If the core is twisted more or
the instrument is thicker the
work hardening increases.

HEDSTROM FILE
• more aggressive than the K-type instrument.
• H-type file is ground from a round steel blank.
• Modern computer-assisted machining
technology had made it possible to develop H-
type instruments with very complex forms.


MODIFICATIONS OF H FILES
• UNIFILE
• S FILE
• NT FILE
• A FILE


HYBRID INSTRUMENTS
• Many new designs are simply modifications of
the K-type and H-type files.
• These files are not made to any national or
international standards, but their size
designation often follows the specifications for
K-type or H-type files.
• By changing the cross sectional geometry of a
K-type instrument from a square to rhomboid it
has been possible to create an instrument that
is more flexible because one cross section is
smaller than the cross section determining the
size. These types of files are known as “flex
files”. www.indiandentalacademy.com

CANAL MASTER SYSTEM
• Most revolutionary concepts in root
canal preparation has been presented
by Drs.Senia and Wiley.
• Canal Master System employs both
hand and engine-driven instruments on
unique design which reportedly
facilitates instrumentation of curved
canals.
• Hand version instrument for apical
preparation and engine-driven for flaring

the coronal section of the canal.

• Non-cutting tip for hand operated is 0.75 mm
and for engine-driven is 2mm.
• Hand-operated have cutting head 1mm long
with color handles corresponding to
standardized instrument sizes 20 through 80.
• Engine-driven have cutting head 2mm have
color-coded latch type attachments .


• This instrument incorporates three major
features:
 Replace the usual cutting tip with a non cutting
tip
 Cutting segment of the instrument is reduced
from the standard 16mm to1 to 2mm.
 Diameter of the instrument’s smooth round
shat remains constant and is reduced to
increase its flexibility


SOTOKAWA’S CLASSIFICATION OF
INSTRUMENT DAMAGE


ULTRASONIC INSTRUMENTS
• Ultrasonic endodontics is based on a system in
which sound as an energy source (at 20 to 25
kHz) activates an endodontic file resulting in
three-dimensional activation of the file in the
surrounding medium.
• These handpieces uses K files as canal
instrument.
• Richman must be credited with the first use of
ultrasonics in endodontics
• Martin and Cunningham were the first to
develop a device, test it, and see it marketed in
1976. www.indiandentalacademy.com

• Instruments deliver an irrigant/coolant usually
sodium hypochlorite into the canal space while
cleaning and shaping are carried out by a
vibrating a K file.


SONIC INSTRUMENTS
• Like the air rotor handpiece it attaches to the
regular airline at a pressure of 0.4Mpa.
• Tap water irrigant/coolant is delivered into the
preparation from the handpiece.
• The three choices of the file that are used with
this system are Rispisonic , Shapersonic and
Triosonic.
• Rispisonic is developed by Dr.Retano spina in
Italy
• Shapersonic is by Dr.J.M.Laurichesse in
France www.indiandentalacademy.com

• Rispisonic has 8 cutting blades an the
shaper sonic has 16.
• SONIC LENGTH
• Sonic instruments are primarily for step
down enlarging not penetration
• At the dental school in Wales, Dummer et
al found the Rispi sonic and shaper sonic
files to the most successful the Trio Sonic
less so.
• In general the Shaper sonic files widened
the canals more effectively than the Rispi
Sonic files whilst the Heliosonic files were
particularly ineffective

ROTARY INSTRUMENTS
• TIP DESIGN
cutting tip or non cutting tip
Examples for non cutting tips are Profile, GT and K3
Examples for cutting tips are Protaper and RaCe
• TAPER
Two designs first we can instrument by using files of the
same taper but with varying apical tip diameters
Ex: ISO 0.02 taper hand files,Profile 0.04,0.06 tapers.
second is files with same apical size but their taper
varies from 0.04 to 0.12
Ex: Quantec


• RADIAL LANDS
A Radial land is a surface that projects axially
from the central axis, between flutes as far as
the cutting edge.
Another way of evaluating radial land is blade
support.
Rotary files has full radial lands. Ex: Profile, GT.
Or their lands were recessed Ex: Quantec
• RAKE ANGLE
the rake angle is the angle formed by the
cutting edge and a cross section taken
perpendicular to the long axis of the
instrument

• The cutting angle on the other hand is the
angle formed by the cutting edge and a radius
when the file is sectioned perpendicular to the
cutting edge.
Examples for rotary files with negative rake
angles: Profile, Protaper, Etc.
Files with slightly positive rake angle: K3
• HELICAL ANGLE: is the angle that the cutting
edge makes with the long axis of the file
Variable helical angle debris will be removed in
a more efficient manner and the file will be
less likely to screw into the canal.

• PITCH : is the number of spirals or threads
per unit length.
the result of a constant pitch and constant helical
angles is a “pulling down” or “sucking down
into the canal”.
This is particularly significant in rotary files with a
constant taper.
K3 is the only file that addressed this issue. This
file has purposely been designed with constant
tapers but with variable pitch and helical
angles.


ROTARY INSTRUMENTS DESIGNS


LIGHT SPEED INSTRUMENTS
• so named because of the “light” touch
needed as the “speed” of
instrumentation” is increased
• The set of instruments consists of ISO-
sized rotary files from size 20 through
100, including nine half-sizes ranging
from 22.5 through 65.
• The recommended rpm is between 750
and 2,000, with preference toward the
1,300 to 2,000 range

• Success with the LightSpeed, however, is
predicated on straight-line access, an
adequate coronal preflare, and establishment
of working length prior to its introduction into
a canal
• Comes in sizes 21 mm, 25mm and 31mm.
• Determination of half sizes
• Diameter of cutting tip varies from 0.25 mm to
2.25mm
• Junction of the shank and shaft.
• Markings are present at various distances for
references.


• The LightSpeed instrument
has a cross-sectional U
blade design in which flat
radial lands with neutral
rake angles enhance
planing of the canal walls
and centering of the
instrument within the canal.
The helical blade angle and
narrow shaft diameter
facilitate debris removal
coronally.


PROFILE INSTRUMENTS
• Includes orifice shapers, Profile 0.04 and
0.06 tapers, and Great taper files.
• These instruments share the same cross
sectional geometries and have three
radial lands that each contains
bidirectional cutting edges.
• Radial lands keep the instrument
centered in the canal. Their cutting
edges are intended to scrape rather than
actively engage and screw into dentin.

• Radial lands are
separated by three U-
shaped flutes that provide
space for the
accumulation of debris.
• U-shaped configuration
effectively augers debris
coronally and out of the
canal during clinical use.


• Parallel core to enhance flexibility. Noncutting
tips are designed to follow a pilot hole and
guide the instrument through the canal during
preparation procedures.
• These files have a built-in safety feature, in
which by patented design they purportedly
unwind and then wind up backward prior to
breaking.
• Recommended rotational speed is 275 to
325RPM.
• Kavanaugh and Lumley found no significant
differences between the 0.04 and 0.06 tapers
with respect to canal transportation

ORIFICE SHAPERS
• 19mm in length with a cutting length of
approximately 9mm.
• Comes in 0.06 and 0.07 mm/mm tapers.
• Are designed to replace Gates-Glidden drills for
shaping the coronal portion of the canal.
• The series compromises 6 instruments that are
safe ended and have increasing Do diameters.


PROFILE GT ROTARY INSTRUMENTS
• Designed by Dr. Steven Buchanan they are also
available as hand files.
• Manufactured in 0.06, 0.08, 0.10, and 0.12
tapers all having a constant ISO non cutting tip
diameter of 0.20mm to ensure maintenance of a
small apical preparation.
• They have variably pitched, radiallanded,
clockwise cut U-blade flutes that provide reamer
like efficency at the shank with K-file strength at
their tips
• They have closed flute angles at their tips and
more open flute angles at their shank ends

• The open flute angles at the shank end also
tend to reduce the file’s ability to thread into
the canal a typical problem that occurs with
other rotary design.
• MFD is also set at 1mm safely limiting coronal
enlargement.
• GT files vary by taper but have the same tip
diameters and MFDs the flute lengths become
shorter as the taper increases.


ACCESSORY GT FILES
• Set of 3 accessory GT files is available for
unsually large root canals having apical
diameters greater than 0.3mm.
• Have a taper of 0.12 mm/mm and MFD is
1.5mm and varying tip diameters of 0.35,
0.50, and 0.70mm.


PROTAPER
• Drs. Clifford Ruddle, John West, Pierre Mactou
and Ben Johnson and Gilbert Rota co-
developed Protaper system
• This system consists of three “shaping” and
three “finishing” files.
• Distinguishing feature of the Protaper system is
the progressively variable tapers of each
instrument that develop a “ progressive
preparation” in both vertical and horizontal
directions.


• Shaping files are S-X, S-1 and S-2
• S-X has a increased taper rate taper of from D 0
to D9 than do the other two shapers.
• D0 has a diameter of 0.19mm. This rises to
1.1mm at D9.
• After D9 the rate of taper drops off up to D14 which
thins and increases the flexibility of the
instrument.
• S-1 and S-2 start at tip sizes of 0.17mm and
0.20mm respectively and each file gains in
taper up to 1.2mm.

• But unlike the consistent increase of taper per
millimeter in the ISO instruments the Protaper
shapers have increasingly larger tapers each
millimeter over the 14mm length of their cutting
blades.This is what makes the instrument
unique.


• FINISHING FILES: finishing files have been
designed to plane away the variations in canal
diameter in the apical one third.
• Finishing files F-1, F-2, F-3 have tip diameters
(D0) of ISO sizes 20, 25, and 30 respectivley.
• Their tapers differ as well between D0 and D3
they tapers at rates of 0.07, 0.08, and
0.09mm/mm, respectively.
• From D4 to D14 each instrument show a
decreased taper that improves flexibilty.


QUANTEC SYSTEM
• Consists of a series of 10 graduated nickel-
titanium tapers from 0.02 through 0.06 with
ISO tip sizing.
• Quantec flare series with increased tapers of
0.08, 0.10. and 0.12 all with tip sizes of ISO 25
are designed to quickly and safely shape the
coronal third of the canal.
• In contrast to the basic principles of other
rotary instrument techniques, this system
incorporates a built-in “graduated tapers
technique,”whereby a series of varying tapers
are used to prepare a single canal. The
instruments are used at 300 to 350 rpm in a
high-torque, gear-reduction, slow-speed
handpiece

• Proponents of the graduating tapers technique
claim that, theoretically, using a series of files
of a single taper, whether it is a conventional
0.02 taper or a greater taper, will result in
decreased efficiency as larger instruments are
used, that is, more of the file comes into
contact with the dentinal walls, making it more
difficult to remove dentin as forces are
generated over a larger area.
• Ultimately, each instrument will become fully
engaged along the canal wall, potentially
inhibiting proper cleaning and shaping of the
apical canal.

• In contrast and in accordance with the
graduating tapers technique, by
restricting the surface contact between
instrument and wall, an instrument’s
efficiency is increased since the forces
used are concentrated on a smaller area
• In this technique, for example, once
a0.02 taper has shaped the canal, a
0.03 taper with the same apical diameter
would engage the canal more coronally;
by altering the taper from 0.02, to 0.03,
and up the scale to 0.06, the efficiency
of canal preparation is maximized by
restricting surface contact.

• The Quantec rotary instruments are uniquely
engineered with slightly positive rake or blade
angles on each of their twin flutes; these are
designed to shave rather than scrape dentin
(negative rake angle), which most conventional
files do
• Flute design also includes a30-degree helical
angle with flute space that becomes
progressively larger distal to the cutting blade,
helping channel the debris coronally.
• More peripheral mass has been added to
these files rather than depending on core
strength alone as in other rotary systems.

• Quantec’s wide radial lands are purported to
prevent crack formation in the blades and aid in
deflecting the instrument around curvatures
• By recessing the wide radial lands behind the
blade, there is a concomitant reduction in
frictional resistance while maintaining canal
centering.
• With respect to tip geometry, the clinician has a
choice of two designs. The SC safe-cutting tip
is specifically designed for small, tight
canals,narrow curvatures, and calcified canal
systems. This faceted 60-degree tip cuts as it
moves apically; as the tip approaches a curve,
conceptually, a balance takes place between
file deflection and cutting

• The LX noncutting tip, on the other hand, is
a nonfaceted bullet-nosed tip,acting as a
pilot in the canal and deflecting around
severe curvatures in less constricted canals
• These LX Quantec instruments are also
recommended for enlarging the body and
coronal segments and managing delicate
apical regions


RAPID BODY SHAPERS
• Rapid Body Shaper (RBS) consists of a series
of four nickel-titanium rotary engine reamers
These instruments feature the patented
nonledging Roane bullet tip and allow the
practitioner to rapidly shape the body of the
canal without the problems that can occur
using Gates-Glidden drills
• The RBS instruments develop a parallel-walled
canal shape. The RBS series consists of four
instruments: No. 1 (0.61 mm at the tip), No. 2
(0.66 mm at the tip), No. 3 (0.76 mm at the tip),
and No. 4 (0.86 mm at the tip).

POW R ROTARY FILES

• also with a nonledging Roane bullet tip,
are available in both 0.02 and 0.04
tapers and, owing to their taper design,
allow the practitioner to clean and shape
the middle and apical regions of the
canal in a conservative manner
• These instruments come in standard
ISO instrument sizes as well as in half
sizes 17.5, 22.5, 27.5, 32.5, and 37.5 for
more precise apical refinement.

HERO 642
• Has a trihelical hedstrom design with rather
sharp flutes
• Due to progressively increasing distance
between the flutes there is a reduced risk for
binding in the root canal when used.
• Recommended speed is 500 to 600rpm
• Available in ISO sizes of no 20 to no 45. all
sizes are available in 0.02 taper and n0.25,
and no.30 are available in 0.04 and 0.06 taper.
• Large central core provides extra strength.

RaCe
• These instruments come in the following
taper/size combinations: as Pre RaCe
instruments0.10/40to 30,0.08/35,0.06/30 and
40 and as RaCe instruments 0.06/20 to
30,0.04/25 to 35, 0.02/15 to 40 and 50 and 60.
• Very flexible instruments.
• Their main feature is that the helical angle
after some revolutions has short interruptions
(becomes 0) whereby the blades are straight
for a short distance and parallel to the long
axis of the instrument. The purpose of this
feature is to redce the screw-in-effect of the
instrument

K3 ROTARY INSTRUMENTS
• K3 system was designed by Dr.John
McSpadden
• K3 canal shaping files comes in a fixed
taper of 0.02, 0.04, or 0.06.
• 0.02 are available in tip sizes 15 to 45 in
21,25,30 mm lengths.
• 0.04, 0.06 are available in tip sizes 15 to
60 and in 21,25,30 mm lengths.
• Slightly positive “rake” angle. A positive
rake angle provides a more effective
cutting surface than a negative one.

• A variable core diameter
this feature enhances
flexibility; over the entire
cutting length.
• A series of three radial
lands with a relief behind
two of three radial lands .
This feature reduces
friction on the canal wall.


• Asymmetrically placed three radial lands and
unequaled land widths, flute widths, and flute
depths.
• Asymmetrical flutes allow the K3 to provide
superior canal tracking, virtually eliminate
transportation, and in preventing the file from
screwing into the canal and add peripheral
strength.


• The proportion of the core diameter to the
outside diameter is greatest at the tip where
strength is most needed. The proportion then
decreases uniformly as the fluting moves up
the taper resulting in greater flute depth and
increased flexibility while maintaining strength.
• An “Axxess” handle design which shortens the
file handle by approximately 5mm without
affecting the working length of the file.


ENDOSEQUENCE FILE
• These files come in a pack of four files each in
0.04 and 0.06 tapers in sizes extrasmall/small,
medium, and large. It includes Expeditor file.
• Blank design is ACP
• Metal treatment Electropolishing is done.
• Fully tapered design
• Tip design is a precision tip. A precision tip by
definition is a noncutting tip that becomes
active right at D-1.


• Good cutting efficiency.
• Flexibility of the file is
outstanding. The ability
to create a file that
stays centered without
the need for radial lands
results in greater
flexibility of the file.
• It has both variable
pitch and variable
helical angles.
• Speed range is 450 to
600 rpm.


OBTURATING INSTRUMENTS
• Significant instruments for obturation are
Spreaders , Pluggers and Lentulo spirals.
• The spreader is a tapered-and-pointed
instrument intended to laterally displace
guttapercha for insertion of additional
accessory gutta-percha cones
• The Plugger is a similar instrument but it has
a blunt end.
• The lentulo spiral is a safe instrument if used
correctly and it is used for the placement of
the sealer, cement and calcium hydroxide
dressings.

STERILIZATION OF INSTRUMENTS
• Methods for sterilization in endodontic
practice inclde
 steam or chemical vapor under pressure
 dry heat
 Glutaraldehyde solutions
Repeated sterilization of stainless steel
endodontic files using any heat method
described above will not cause corrosion,
weakness or an increased rate of rotational
failure.

CONCLUSION

• We expect many more endodontic
instruments come in our path to make
our treatment part more ideal.


REFERENCES
• PATHWAYS OF THE PULP-COHEN 6thAND
8thEDITIONS
• ENDODONTICS-INGLE.BAKLAND 3rd,4th ,
5thEDITION
• ENDODONTIC PRACTICE-LOUIS
I.GROSSMAN-11thEDITION
• DCNA-MODERN ENDODONTIC PRACTISE
• JOURNAL OF ORAL HEALTH
• INTERNET SOURCES


Sterilization of endodontic instruments /certified fixed orthodontic courses by Indian dental academy

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