Root canal treatment

Root canal treatment concept: special instrumentation methods to clean, shape the root canal, thoroughly remove the source of infection in the root canal (root canal preparation), and then disinfect the root canal (root canal disinfection), and finally fill the root canal tightly to prevent bacteria from re-entering the root canal (root canal filling), to promote the healing of periapical lesions or to prevent periapical lesions from occurring, the endodontics, the first choice of periapical treatment

Two root canals Treatment principle: ① root canal preparation a "clean" thoroughly clean up the infected material ② root canal disinfection a "vaccine" wide elimination of residual bacteria and toxins ③ root canal filling a "suture" tightly sealed Root canal system to prevent re-infection

Fourth, root canal treatment device

Classified by use: ① Detection instruments (root canal probe / apical locator, etc.) ② root canal preparations: (extraction of pulp needles, root canal drilling dilatation drilling and protection of the hole file) ③ root canal filling instruments ④ multi-purpose equipment (ultrasonic endodontics, endodontic boils machine)

According to the form of ① drive: (hand; machine) ② instrumentation Taper (standard taper instruments: 0.02 taper, non-standard taper instruments: 0.04, 0.06 taper, discontinuous taper)

According to the material: stainless steel, nickel-titanium alloy

Five, the indications for root canal treatment: ① all kinds of irreversible endodontic disease ② endodontic and periodontal joint disease ③ orthodontics, prosthetics ④ acute and chronic periapical disease ⑤ not suitable for the temporary preservation of the removal

Root canal treatment contraindications :① no effect or no restoration value of the tooth ② no adequate periodontal support of the tooth ③ poor prognosis of the affected tooth ④ the patient can not cooperate, the patient has a serious systemic disease can not tolerate treatment.

Sixth, the preoperative preparation: X-ray film: to understand the periapical, periodontal, root canal condition

Instrumentation preparation: high-pressure disinfection of metal instruments, 5.25% sodium hypochlorite or 3% hydrogen peroxide, saline, 75% ethanol or iodine povidone, dental glue tip, root canal filling paste, root canal length gauge and so on.

VII, root canal preparation (Root Canall instrumentation

The goal of root canal preparation (cleaning and shaping Cleaning Shaping) ① biological goal of wide removal of diseased pulpal tissues, bacteria and their metabolites (toxins, enzymes, etc.) in the root canal system to eliminate the source of infection ② Mechanical goal: preparation for the largest diameter, the apical foramen. (Ro diameter is the largest, the apical foramen diameter is the smallest diameter of the continuation of the taper pattern wide to maintain the location and size of the apical foramen unchanged; the original shape of the root canal, the taper trend as well as the anatomical direction of unchanged in order to facilitate the thorough cleaning and disinfection, tightly filling the root canal)

(root canal preparation steps: the commonly used method of preparation of the root canal is important for the stainless steel K file, nickel-titanium K file in combination with the use of the G drill gradual penetration technology and gradual backward) Technology, the principles of preparation are as follows 1. 1/3 of the root tip must have the correct working length before preparation. 2. Root canal preparation must adhere to the root canal wet. 3. Preparation process for each exit or change of instruments need to be used to flush the root canal with a root canal flushing solution, to prevent debris clogging. 4. Root canal file can not skip the number of 5. For the zigzagging of root canals, the root canal file should be pre-curved:. 6. In order to facilitate the filling of root canals, the root tip of the smallest expansion of 25#. 7. 7. The main cusp file is generally larger than the primary cusp file 2-3 numbers.

Root canal opening and preparation of posterior teeth: 10# files are usually too thick: 06# files are too soft, Nitinol files are more elastic. 21mm long 08# K files are the most effective tools for root canal penetration. Be careful to pre-bend the tip of the file by Imm. When the root canal is clear, a large number of NAOCI flushes: NAOCI flushes dissolve debris. Each time 1-2mm file into the root canal, NAOCI rinse, repeat each time to deepen 1-2mm. 08 # file to reach the working length, should be determined according to X-ray: and high and low lifting and pulling action, expanding the root canal, until the 10 # 経 can be free to reach the working length. EDTA, ultrasonic root canal preparation and NAOCI can also be prepared to prepare for the calcification of the root canal.)

Medullary inlet preparation: the basic requirements for opening the pulp: ① remove the pulp chamber ② expose all the root canal openings ③ instrument maple can reach the root canal opening in a straight line ④ save as much tooth tissue as possible

Root canal probing and initial opening: ① hand probing with a small stainless steel K-file ② rotate and advance the file back and forth in the 90-degree range ③ probing to the preoperative estimate of the length of the root canal ④ pre-bend the instrument maple if necessary ⑤ probing and initial opening are essential for subsequent preparation. Preparation of the root canal inlet: → (1) The main tool for finding the root canal opening: a straight-tipped dental tip probe (1) Pulpal floor: hard dentin, no sticking sensation. 2) Root canal opening: hard dentin, no sticking sensation. 3) Root canal opening: hard dentin, no sticking sensation. 4) Root canal opening: hard dentin, no sticking sensation. 5) Root canal opening: hard dentin, no sticking sensation. ② root canal mouth: a certain amount of pressure, the probe can enter a little, there is stuck, then you can use X-ray to determine whether the root canal mouth. With 6 #, 8 #, 10 # file, gradually expanding the root canal 2. Some root canal mouth 1-2 mm at the bend, should be removed from the neck of the dentin overhang; if you still can not find the mouth of the root canal, can be used to 2 # long round drill drilling into the mouth of the root canal 1-2 mm. should pay attention to the bottom of the dry pulp chamber at any time, the bottom of the basal pulp chamber and the white restorative dentin of the root canal is to look for the mouth of the root canal of the mark. 3. can be used to make the EDTA, the search for the mouth of the root canal have (Auxiliary.) ① Purpose open root canal into the ロ, remove the dentin collar, the establishment of the upper section of the straight line access ② Instruments GG-type drill, other specialized instruments

Determination of the working length: → (Determination of the determination of the working length is in order to prepare the root canal as far as possible to stop at the narrowest apical point (dentin dentin bone boundary). Quality control criteria: 0.5-1 mm from the root apex is taken as the working length of the root canal preparation. The customary application of parallel projection X-rays + apical locator to determine the working length of the apical preparation before the endodontic, there must be a correct working length. 06 or 08 # file and do the tip of the pre-curved inserted into the estimated length of the root canal, the preparation of the root canal to the 10 or 15 # file into the root canal, and sip feeling, if the beginning of the diameter of the root canal is larger than the 10 or 15 # file, you can directly choose to sip the file to do diagnosis of the length of the length of the root.) ① Purpose to determine the location of apical narrowing ② working length ( working length) apical stop to the cavity edge distance ③ method finger sensory method, the patient's pain method X-ray photo method electrodiagnostic method: apical locator

Root canal preparation methods: (1) standard method: the basic elimination

(2) the traditional step-by-step backward method (step-back):-) 1.apical section preparation 2.root middle section preparation 3.root upper section open 4.root canal re-trimming more shortcomings

three modified step-back method ( modified step-back ): stainless steel standard apparatus maple commonly used methods - 1) pre-pulpal opening, preliminary crown open Root canal probing and dredging work length determination has been completed. 2) Selection of the initial tip file: often choose 10 or 15 3) Root tip preparation: from the initial tip file to prepare in turn than the initial tip file No. 3 (at this time the use of the file that is the main tip file), are up to the length of the work. #10? 20mm, #15? 20mm, #10? 20mm, #20? 20mm, #15? 20mm, #25? 20mm, #20? 20mm

Requirements for preparation:1 The main apical file can enter the root canal to the full working length without any resistance.2 Pressurize so that the main apical file advances in the direction of the root apex, and encounters resistance in the apical stenosis and is not able to move forward.5) Preparation of the crown of root canal The crown of the root canal is enlarged with a #2 or #3 GG drill, and then the main tip file is filed back to the crown of the root canal. #2 root canals on 13, #3 root canals on 1/3 #2520mm step-by-step back method advantages ① good technical compliance, easy to master ② traditional stainless steel preparatory instruments are suitable for

step-by-step back method disadvantages ① filing the entire length of the cutting surface at the same time, more laborious ② prone to instrument jamming, instrument breakage phenomenon ③ apical part of the root canal is difficult to rinse thoroughly, the accumulation of debris ④ easy to push out the infected debris ⑤ the required instruments more frequent exchange of maple, and the root canals are more often than before, the root canals are not able to move forward. More instruments are needed, frequent exchange, time-consuming operation

Four step-down, crown-down method: Nitinol non-standard instruments are used in this method Basic idea: ① the upper part of the root is cleaned and open ② the middle part of the root is cleaned and shaped ③ the apical part of the root is cleaned and shaped

Advantages of the idea: ① eliminates the narrowing of the entrance to the root canal ② the top of the apical area has been cleaned before preparation ③ facilitates the instruments and rinsing solution to reach the root canals. The instrument and rinsing solution can reach the apical region ④Easy to effectively remove infected debris from the apical region ⑤Reduce debris pushing out of the apical foramen ⑥Good tactile feedback during apical preparation

Conventional instruments are not suitable for deeper and deeper preparations

Operation step by step ①Coronal preparation: Determine the length of the entrance to the root canal, determine the temporary working length, determine the actual working length ②Root preparation: Deepen and deepen the root to reach the working length and the main apical file. To the main apical file

Root canal rinsing and lubrication

① root canal rinsing operation basic requirements (1) adequate volume: each time not less than 2 ml (2) repeated: each replacement of the maple need to be rinsed (3) in-depth: rinser unobstructed to the lower and middle

rinsing agent requirements (1) to dissolve necrotic tissue and debris (2) non-toxic, non-harmful to periapical tissues (3) to kill the effect of the role of the lubricant and lubrication

Rinsing liquid role: (rinse), (rinsing), (rinsing and lubrication). role: (rinse, disinfection, lubrication, dissolution of organic matter, bleaching) commonly used rinsing agent (1) 3% 6H2O2, saline (2) sodium hypofluoric acid, EDTA

② root canal lubrication? Root canal lubricant (1) the main component of the chelating agent (2) emulsification of suspended preparatory debris (3) to prevent debris re-adhesion (4) to reduce resistance to improve efficiency (4) to prevent instrument breakage

Eight, root canal disinfection ? (1) drug disinfection ① camphor CP ② formaldehyde cresol FC ③ calcium oxide paste (2) electrolytic disinfection (3) microwave disinfection (4) laser treatment (5) temporary sealing

root canal disinfection (① between treatments, the root canal prepared by the root canal need to be disinfected by sealing the root canal in order to prevent residual bacterial growth and breeding in the root canal. For live pulp teeth such as crown fracture exposed pulp and the restoration of the request for root canal treatment of the tooth can be carried out under local anesthesia for a root canal treatment, need to seal the root canal. Root canal sealing is required. ② After the completion of root preparation, the ultrasonic endodontic instrument can be used to swish and disinfect the root canal. ③ customary to take calcium hydroxide paste root canal sealing, specific operations are as follows (with the appropriate amount of saline or iodized glycerin will be made into a paste of calcium hydroxide powder, can be used with a tip of the paper or cotton twists into the root canal has been prepared, with zinc oxide clove oil adhesive sealing: request at least a week or more sealed.)

Nine root canal filling (Root Canal Obturation) ① Goal: tight plugging of the apical foramen, eliminating the root canal dead space and with the help of slow and continuous disinfection of the sealer of the root canal, eliminating the residual infection in the root canal, and promote the healing of periapical lesions ② location: the root canal filling should be reached at the apical dentin-osseous junction (apical endpoints) ③ Timing: root canal preparation and disinfection After, if there is no conscious symptoms, no obvious knocking pain, no bad smell, no large amount of exudate, no acute attack possible, you can fill the root canal

(Root canals should be prepared, disinfection should be carefully filled, effectively eliminating the dead space, blocking from the apical and coronal side of a variety of micro-leakage, prohibit the outside world of bacteria and pollutants environment. Usually, as long as the affected tooth without pain or its discomfort, the root canal without odor, no 9 fluid, sinus tract complete closure can be root canal filling customary use of lateral compression root canal filling techniques, the material is important to use the scale of the gum tip and root canal sealer

① the main tooth gum tip selection: can be free to enter the apical distance from the root tip of 1-2mm, and compression; and with the main tip of the file in line with the file or a little larger: to reach the length of working Within 0.5mm; blocked in the apical stenosis. ② root filling precautions: root filling paste should only be applied to the root canal wall should be applied to the paper twist or the tip of the tip of the main tooth glue dipped in paste inserted into the working length of the lateral pressure should be able to reach the working length of 1-2mm generally inserted into the 2-3 with the lateral pressure taper consistent with the auxiliary tip of the postoperative apical piece of the invention of the main tip of the main tip of the short or more than 2mm, it should be re-filled. ② Lateral pressure filling technique principle: the secondary tooth glue tip should be consistent with the lateral pressure or less small, the main tooth glue tip should be close to the apical area of the lateral transformer into the root canal before, should be cleaned with a stop piece to mark the depth of the lateral transformer: the taper of the lateral transformer should be less than the taper of the root canal pre-selected, pre-curved and test insertion of the lateral transformer before pulling out the lateral transformer should be pressurized to the side, so that the side of the lateral transformer loosening lateral pressure should not be too much force of the secondary tip of the glue tip should be dipped in a paste.

1. Select the lateral pressurizer: the lateral pressurizer should be able to be inserted without resistance to the working length of 1-2 mm from the 2 test tip: root canal filling before the need to carry out a test tip, the size of the main tip is usually the same as the main tip files. Choose the corresponding size of the standard dental tip as the main tip, according to the length of the operation with tweezers in the main tip of the corresponding part of the clip an indentation, will be inserted into the root canal to just reach the working length of the mark, inserted to the length of the working length should be friction, such as can not reach the length of the working should be replaced with a small one of the tip of the dental tip, if there is no friction, then you need to cut off the tip of the tip of the tip of the tip of the tip of the dental glue, and then try again until there is a friction until the end of the sense of friction. Take X-ray film of the inserted primary tip to determine the specific location of the primary tip in the root canal, such as X-ray film shows that the primary tip is located 1-2mm from the root tip, it is feasible to fill the root canal; if the primary tip is located 2-3mm from the root tip or beyond the root tip, it is necessary to re-test the tip: if the distance from the tip of the root is more than 3mm, then it is necessary to re-execute the apical preparation and testing of the root tip.3. Placement of the primary tip: the selected primary tip of the cementum is dipped in the sealing of the canal to back out the insertion of slow to the working length.4. Lateral pressure method: the lateral pressurizer is inserted against the primary tip with a slow rotation to 1-2mm from the working length, left for a few seconds, rotated 180 degrees and then withdrawn from the lateral pressurizer: the secondary cementum tip is inserted into the gap formed, and the operation is repeated until all the canals are filled tightly, and the pressurizer can only enter into the mouth of the canals by 2-3mm. 5. Vertical pressure: the excess cementum is cut off from the mouth of the canals by using a hot spoon to remove it, and a suitable vertical back pressure is selected. Choose the appropriate vertical back pressure, so that the gum closely fill the root canal neck 1 / 3 area.

Quality control criteria1. Appropriate filling: the root filling material is ≤2mm from the root apex, and the root canal is densely filled.2 Underfilling: the root filling material is more than 2mm from the root apex, or the root canal is not densely filled.3. Overfilling: the root filling material exceeds the root apex.)

Learning hard materials ① including cementum, plastic, metal, etc., cementum is currently the most widely used root canal filling materials ② traditional cementum tip made of β cementum, and standardized root canal instruments ③ non-ISO instruments with the corresponding special cementum tip ④ processed a cementum in the melting point, viscosity and adhesion is more suitable for thermoplastic filling

paste materials ① zinc oxide clove oil (ZOE), zinc oxide oil (ZOE), zinc oxide oil (ZOE), zinc oxide oil (ZOE), zinc oxide oil (ZOE), zinc oxide oil (ZOE), zinc oxide oil (ZOE), and so on. (ZOE) type ② calcium hydroxide type a CRCS, Sealapex ③ glass ionomer type ④ resin type a AH plus

Root canal filling methods (primary tip selection, lateral pressure needle selection, sealant use, lateral pressure and the addition of the secondary tip)

① cold adhesive lateral compression filling Advantages: equipment requirements are simple, easy to master, good control of the operation, retreatment is convenient Disadvantages: larger curvature of the root canal, the use of sealants, the use of cold adhesives, the use of cold adhesives, the use of cold adhesives and the addition of secondary tips. ① cold dental adhesive vertical pressure filling Advantages: able to fill the adhesive and sealant to a variety of irregular root canals, and even lateral root canals Shortcomings: cumbersome steps, poor control, high technical requirements, complex equipment, generally need a four-handed operation. Four-handed operation is required. Vertical pressurization of hot glue filling brief operating procedures drying the root canal, try to close the main cusp, pre-test pressurizer, coated with sealant, inserted into the main cusp, remove the pulp cavity excess glue, with a hot pressurizer vertical pressurization of dental glue block, the completion of the apical filling, and gradually backfill to complete the apical filling

Root canal filling quality evaluation ① Symptoms: no obvious clinical symptoms ② Signs: the tooth, the periodontal situation ③ x-ray: (1) density: whether the density is (2) length: the length: the length of the root canal is (2) the length of the root canal, and the length of the root canal. Dense are (2) length: whether to the working length (3) taper: whether to reflect the shape of the root canal

X. Evaluation of the efficacy of root canal treatment (1) follow-up time: the larger the preoperative lesion, the longer the healing time (2) 3 months for the observation period, 6 months for the initial evaluation period, at this time, if you see the lesion shrinks, indicating that the healing is underway; if it continues to expand, it is the failure of the need to re-do the RCT

The criteria for the success of the root canal treatment (1) Patient's feeling: no discomfort, normal masticatory function, satisfaction with the medical process and results, satisfaction with the function and appearance of the affected teeth (2) clinical examination: no percussion pain, no sinus tracts or sinus tracts in the treatment of 1 ~ 2 weeks closed (3) X-rays: periodontal membrane gap is normal or mild thickening; the original apical lesion shrinkage or disappearance; the root canal cavity dense three-dimensional filling, the root filled with the root from the apical X-rays of the apices of the 0.5 ~ 1.5mm

Xー, root canal treatment complications :? Acute inflammatory reaction, separation of instruments in the root canal, perforation of the pulp cavity, subcutaneous emphysema, fracture of the tooth, accidental swallowing of instruments or aspiration