Owner and inventor of Kids-e-crowns … Instruments in...Concerns In Paediatric Dentistry Loss of...
Transcript of Owner and inventor of Kids-e-crowns … Instruments in...Concerns In Paediatric Dentistry Loss of...
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Dr Mukul Jain, M.D.S
(Paediatric And Preventive Dentistry) India
Private Practitioner
Owner and inventor of Kids-e-crowns
Namaste………..Jambo…..Salaam
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“A New Smile for Africa”
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Rotary Instruments in paediatric dentistry
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Challenges in paediatric dentistry
Behaviour management Complex root canal system
Ahmed, H., 2013. Anatomical challenges, electronic working length determination and current developments in root canal preparation of primary molar teeth. Int. Endod. J. 46, 1011–1022.
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Concerns In Paediatric Dentistry
Loss of necrotic primary molars leading to space loss
Schafer, E., Erler, M., Dammaschke, T., 2006a. Comparative study on the shaping ability and cleaning efficiency of rotary
MTWO instruments. Part a. Shaping ability in simulated curved canals. Int. Endod. J. 39, 196–202.
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Objectives of cleaning and shaping
Provide irrigation
path
Dis-infection-Remove bacteria
Creating space for
subsequent instruments
Cohen, S., Hargreaves, K.M., 2006. Pathways of the Pulp, 9th ed. Mosby Publishers, St. Louis, pp. 301–311, 842.
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Ideal Pulpectomy Technique
Kuo, C.I., Wang, Y.L., Chang, H.H., Huang, G.F., Lin, C.P., Guo, M.K., et al, 2006. Application of Ni-Ti rotary files
for pulpectomy in primary molars. J. Dent. Sci. 1, 10–15
• Fast procedure
• Effective debridement
• No weakening the tooth structure
• Endangering the underlining permanent teeth.
• Minimal procedural complications.
• Maintaining tooth function until it is naturally exfoliated.
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Yang, S.F., Rivera, E.M., Walton, R.E., Baumgardner, K.R., 1996. Canal debridement: effectiveness of sodium hypochlorite
and calcium hydroxide as medicaments. J. Endod. 22, 521–525
Success of pulpectomy
Elimination of bacteria
By creating irrigation pathways
Through cleaning and shaping
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Why Rotary Endodontics in Pediatric dentistry?????
Tissue and debris are quickly removed
Shashikiran, N.D., 2006. In vitro comparison of Ni Ti rotary instruments and stainless steel hand instruments in root
canal preparation of primary and permanent molars. J. Indian Soc. Pedod. Prev. Dent. 24, 186–191
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Why Rotary Endodontics in Pediatric dentistry ?????
Funnel shaped Preparation Follow and preserve canal anatomy
Silva, L.A., Leonardo, M.R., Nelson-Filho, P., Tanomaru, J.M., 2004. Comparison of rotary and manual instrumentation techniques on cleaning capacity and instrumentation time indeciduous molars. J. Dent. Child 71, 45–47
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40 no file 30 no file 20 no file
Taper of Rotary files
Cohen, S., Hargreaves, K.M., 2006. Pathways of the Pulp, 9th ed. Mosby Publishers, St. Louis, pp. 301–311, 842
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• Shorter than 19 mm
• Extripate pulp completely, not push beyond apex
• Single file system
• Avoid excessive cutting of soft primary dentin
• Cost effective, easily available
• High fatigue & torsional resistance
Ideal rotary file for primary teeth
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• World’s first rotary file for primary teeth• Kids endodontic shaper KEDO-S• 3 published articles – G. Jeevanandan (2018)
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15-Nov-18Pediatric Rotary Endo @ PEDOCON 2018
Dr S Rupesh
• D1 – Narrow canals in primary molars (15K snug fit), 0.025 tip dia• E1 – Wider canals in primary molars (15K loose fit), 0.030 tip dia, mandibular distal, maxillary
palatal• U1 – Incisors, 0.040 tip dia• To be used 1- 2 times and not more than 3 -4 seconds in each canal
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• Heat treated Niti files• M wire technology• Greater resistance to cyclic fatigue than Kedo-S
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15-Nov-18Pediatric Rotary Endo @ PEDOCON 2018
Dr S Rupesh
• 42% higher peak torque strength
• 100% cutting efficiency for first 12 cases
• 90% reduction in efficiency after that due to TiO2 and cutting edge wear
KEDO-SG BLUE
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• Short 17 mm files
• Heat treated NiTi files,
Controlled memory wire
• Reduced separation
• Constant taper files – 4%, 6%
• Conservative canal preparation
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Guidelines
• Gentle, do not force
• Passive brushing---push pull
• Only 4-5 seconds per file
• Speed and torque controlled motor
250-300 RPM, 2-2.5 N
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Guidelines• Use lubricant
• Irrigation– don’t keep canal dry
Musale, P.K., 2013. Rotary instruments in primary teeth. J. Int. Oral Health 5, 140.
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Straight lines acess
Glide pathCoronal
flaring- rotary opener
Canal shaping-Rotary file
H- file hand
Rotary Endodontics protocol
Irrigation Irrigation Irrigation Irrigation Irrigation
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Straight Line access
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Patency Filing- Glide path
• 10 or 15 K File
• Ensure file reaches
radiographic apex
• Pre curve if require
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Coronal Flaring
• Reservoir for irrigants
• Straight line access
• Removes infected tissue
Sx
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Narrow Canal- 4% 20 Medium Canal- 4% 25 Large Canal- 4% 30
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Pulp extirpation - Barbed broaches
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10K – 15K – Rotary - 30/35H
ANY ROTARY SYSTEM
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Adult rotary system in primary teeth
• Length is big
• Cut more dentine
• Stiff
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10 K-hand file
SX 25- H hand file
S2
Chang et al. Applocation of Ni-Ti rotary files for pulpectomy in primary molars. J Dent Sci, 2006.
Pro Taper Protocol in Primary
Molar
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15K - 20K - (+/-SX) -S2Kuo et al 2006
- 30/35H
• Tip size 20, apical taper 4%• Approximates root canal size of
primary molars
OPTIONAL
• Greatest range of taper• Simplifies instrumentation procedures• Replaces GG
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15K - 20K – (– +/-SX) – S2– F1- F2
With teeth undergoing physiologic root resorption (Pinheiro et al 2012) • Apical size of root canal larger• F2 (apical size 25) suggested as appropriate file than S2 • F3 appropriate for lower distal and upper palatal canals
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Neolix in paediatric dentistry
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Disadvantages of rotary instruments in primary teeth
• Primary dentin is softer and less dense
• Roots are shorter, thinner, and more curved
• Root tip resorption is often undetectable
• Rotary instruments are centered in root canals during rotation and leave unclean areas and potentially infected tissue in fins and isthmuses…H file
• Training and cost
Kim, H.C., Kim, H.J., Lee, C.J., Kim, B.M., Park, J.K., Versluis, A., 2009. Mechanical response of nickel-titanium instruments with different cross-sectional designs during shaping of simulated curved canals. Int. Endod. J. 42, 593–602.
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Un-winding Discard files
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10K – 15K – Rotary - 30/35H
ANY ROTARY SYSTEM
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Thank you
“A New Smile for Africa”