Recent Advances In Endodontics
Endodontic Imaging
F speed film/sensor with rectangular collimation to
conform to ALARA principle.
Wireless sensors: CMOS (Complementory metal oxide
semiconductors)
PSP(photostimulable phospher plates)
• NEWER METHODS
Radiographic Techniques
Xero Radiography
Digital Substraction Radiography
Magnetic Resonance Imaging MRI
Radiovisuography RVG
Tuned aperture computed tomography TACT
Tests To Determine Pulpal Blood Flow
Laser Doppler Flowmetry
Pulse Oximetry
Thermographic imaging
Hughes Probeye Camera
CBCT
Some of the potential applications of CBCT include diagnoses related to
the following:
1.
Initial diagnosis where nonspecific signs and symptoms exist,
2.
dental anomalies and developmental disturbances,
3.
presence of anatomic variations,
4.
calcified canals,
5.
broken instruments,
6.
vertical root fractures,
7.
failure of prior treatment,
8.
nonsurgical and surgical retreatments,
9.
select cases of trauma, resorption (external and internal), and
10. implant placement.
MAGNIFICATION
Endoscope
Designed to enable the practitioner to work inside
the root canal with magnification and instrument
access.
The system includes three parts:
endoscopic compact system,
optical part that includes ocular part and the
endoscope, and
handpiece with a disposable part.
•Diagnosis
•Enhances visualization
•Transillumination
•Apical surgery
•Endodontic observations during RCT
ORASCOPE
flexible fiberoptic orascope is recommended for
intracanal visualization, has a .8mm tip diameter, 0º
lens, and a working portion that is 15mm in length.
The difference between an endoscope and an orascope
is that:
an orascope is made of fibre-optics
an endoscope is made up of glass rods.
LOUPES
MICROSCOPES
Root canal preparation
Healing of apical periodontitis + extended mechanical function of
teeth = successful endodontic outcome.
major factor that increases fracture susceptibility in
endodontically treated teeth is the removal of bulk dentin during
access and canal preparation
strategies are being developed that retain more dentin, specifically
in the coronal root third during shaping.
limit coronal flaring
completely noninstrumental technique without the use of any
canal preparation
oTorque control devices (2nd generation)
•Nouvag TCM ENDO motor
•Endo-Pro Electric
•X- Smart
•Protorq motor handpiece
•Quantec ETM motor
oNewest generation
Tri-Auto ZX
Combined with of the Root ZX Apex
Locator, it can electronically monitor
the root canal before, during and after
instrumentation.
Root canal disinfection
• Current advances in endodontic disinfection are aimed
toward:
a. Improving the fluid dynamics during root canal irrigation —
improving bubble dynamics and activating intensified
cavitational bubbles.
b. Developing newer antimicrobials, which demonstrate potent
antibiofilm effect over sodium hypochlorite
PRESSURE ALTERNATING DEVICES
ENDOVAC SYSTEM
• In the EndoVac system (Discus Dental, Culver City, CA), has
three components:
1. Master delivering tip
2. Macro cannula
3. Micro cannula
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VIBRINGE
• Vibringe (Vibringe BV, Amsterdam, The Netherlands) is a new
sonic irrigation system that combines battery-driven vibrations
(9000 cpm) with manually operated irrigation of the root canal.
•
Vibringe uses the traditional type of syringe/needle delivery but
adds sonic vibration.
Antibacterial nanoparticles (NPs)
• 1-100nm
• Broad spectrum antimicrobial activity
• Far lower tendency to induce microbial resistance
• Electrostatic interaction between positively charged NPs &
negatively charged bacterial cells – loss of membrane
permeability & function
• SEALERS loaded with NPs
Currently, functionalized NPs are being developed to
eliminate bacteria more specifically without damaging the
host cells (targeted antibacterial efficacy) and to repair
previously infected dentin matrix.
Antimicrobial photodynamic therapy
• Step 1: application of a photosensitizer
• Step 2: light illumination of sensitized tissue
PHOTO ACTIVATED DISINFECTION
• It includes PDT/LAT i.e photo dynamic therapy or light activated therapy.
Light of
specific wavelength
Photosensitizer
Activation
(tolonium chloride)
Oxygen based free
radical formed
Multiple Targets
Membrane damage
Genetic damage
inactivation
• Optic fibre may be used to direct the irradiation to the intended side of
application.
Enzyme
SELF ADJUSTING FILE
• It has a hollow thin walled cylinder composed of a thin nickeltitanium lattice.
• It is compressible and adjusts to the anatomy of the root canal.
• SAF operates with a continuous flow of irrigant (5ml/min)
running through the instrument.
• The vibrating movement of SAF within the irrigant facilitates its
cleaning and debriding effects.
• Root canals vary greatly in their cross-sectional anatomy, and
oval, flat, and C-shaped canals are commonly found
• SAF is designed to efficiently prepare root canals that do not
have a round cross section because the compressible file adapts
its shape to the canal anatomy.
• It is operated with a modified KaVo handpiece that generates in
and out vibrations with 5000vibrations/min and 0.4mm
amplitude.
• Irrigation unit is used to deliver a constant flow of irrigant.
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Photon-induced photoacoustic streaming
•It is based on the direct shock wave generated by a
erbium:YAG (Er:YAG) Laser in a liquid irrigant.
•The laser system is equipped with a fiberoptic delivery tip
•When activated in a limited volume of fluid, the high
absorption of Er:YAG wavelength combined with the high
peak power derived from the short pulse duration resulted in
an enhanced bubble dynamics, which improved the irrigant
flow dynamics within the root canal.
Gentlewave irrigation
•It delivers sodium hypochlorite into the root canal under
pressure through a specialized handpiece, which is activated
by a broad spectrum of acoustic waves. At the same time,
suction removes the outflowing fluid through the handpiece.
•A silicon ring surrounding the extremity of the handpiece
•creates a tight seal with the artificially created flat tooth
surface.
•This system is expected to enhance irrigation dynamics in
minimally enlarged root canals.
Obturation
The injectable thermoplasticized
guttapercha obturation techniques
1.
2.
OBTURA II SYSTEM
ULTRAFIL LOW TEMP THERMOPLASTICIZED
GUTTAPERCHA
•
•
•
•
•
3.
INJECTION AND MASTER CONE : REGULAR SET – FIRM SET
INJECTION AND VERTICAL COMPACTION
INJECTION AND LATERAL CONDENSATION – FIRM SET OR
REGULAR SET
TRIFECTA – SUCCESSFIL PLUS ULTRAFIL
MODIFIED TRIFECTA SUCCESSFIL PLUS LATERAL /
VERTICAL COMAPCTION
ENDONTIC OBTURATORS
•
•
•
•
SIMPLIFIL
THERMAFIL
ALPHASEAL
J.S QUICKFIL (THERMOMECHANICAL)
ROOT CANAL SEALANTS
• Calcium silicate sealers:
• Bioactive property
• Promote calcium phosphate precipitation in a wet
environment
• Nano bioactive glass particles based GP:
• Immediate sealing property in heated form
The injectable
thermoplasticized guttapercha
obturation techniques
•Low heat Gutta Percha at 70 degrees celsius
ULTRAFIL
•Pre set heater at 90 deg celsius for 15 mins
•Ultrafil – 3 types
•Regular set – white canule / low viscosity ;
setting time = 30 mins
•Firm set – b;ue canule – moderate visosity –
more condensable with pluggers
•Endo set – Green canule ; setting time 2
mins / high viscosity
Prefilled gutta percha
cannules for Ultrafil
OBTURA II
High heat
Temp 160 deg
celsius
Disposable silver needles
for Obtura II
Loading Obtura Gun with gutta
percha
THERMAFIL
SuccessFil
Expanding Therapeutic Boundaries:
Regenerative Endodontics
 Regenerative endodontics: is a biologically
based procedure designed to replace damaged
structures,
Dentin and root structures
Cells of the pulp-dentin complex
 Vital pulp therapy with pulp stem/progenitor
cells might regenerate dentin-pulp complex
without the removal of the whole pulp.
 Caries, pulpitis, and apical periodontitis
ultimately result in premature tooth loss and
therefore diminishing the quality of life
 Regeneration of parts of the tooth structure
can prevent or delay the loss of the whole
tooth.
The key ingredients for tissue engineering
REVASCULARIZATION
TISSUE ENGINEERING
 Stem cell: ability to;
Continuously divide to either replicate itself
(self-renewing),
or
Produce specialized cells than can differentiate into
various other types of cells or tissues
(multilineage differentiation)
 Embryonic stem cells derive from the early mammalian
embryo at the blastocyst stage and have the capability to
give rise to all kinds of cells.(Pluripotent)
 Adult /Postnatal stem cells are just multipotent because
their differentiation potential is restricted to certain cell
lineages
First human dental pulp stem cells were isolated in 2000.
Currently at least five different types of mesenchymal stem cells
have been isolated from the dental tissues, including
dental pulp stem cells (DPSC),
stem cells of human exfoliated deciduous teeth (SHED),
stem cells of the apical papilla (SCAP),
dental follicle progenitor cells (DFPC) and stem cells from
periodontal ligament.
Among these, DPSC, SHED and SCAP show stronger potential
for pulp regeneration.