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Recent advances in endodontics

Recent advances in endodontics

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Recent advances in endodontics

  1. 1. RECENT ADVANCES IN ENDODONTICS By Dr. Hope Inegbenosun
  2. 2. OUTLINE • Introduction • Recent advances in diagnosis • Recent advances in radiography • Recent advances in endodontic visualization • Recent advances in working length determination • Recent advances in instrumentation • Lasers in endodontics • Newer irrigating solutions • Recent advances in irrigation devices • Recent advances in root canal sealers • Advances in obturation techniques • Regenerative endodontics • Conclusion • References
  3. 3. INTRODUCTION •The practice of endodontics have witnessed several changes and advances in the past decades and this has resulted in better diagnosis and improved treatment outcome.
  4. 4. •The main steps in endodontics affected are; o Diagnosis o Working length determination o Biomechanical preparation o Obturation
  5. 5. RECENT ADVANCES IN DIAGNOSIS A. RECENT ADVANCES IN PULP VITALITY TESTING •The assessment of pulp vitality is a crucial diagnostic procedure in dentistry. •Current routine methods rely on stimulation of A delta fibres and give no direct indication of blood flow within the pulp. These include thermal stimulation, electrical or direct dentine stimulation. •These testing methods have the potential to produce an unpleasant and occasionally painful sensation and inaccurate results. In addition, each is a subjective test that depend on the patient’s perceived response to a stimulus as well as the dentist’s interpretation of that response
  6. 6. • Recent studies have shown that blood circulation and not innervation is the most accurate determinant in assessing pulp vitality as it provides an objective differentiation between necrotic and vital pulp tissue. • The recent available pulp vitality tests are: 1. Pulp oximetry 2. Laser Doppler flowmetry (LDF) 3. Dual wavelength spectrophotometry 4. Measurement of temperature of tooth surface 5. Transillumination with fibre-optic light 6. Plethysmography 7. Detection of interleukin-1 beta 8. Xenon-133 9. Hughes probeye camera 10. Gas desaturation 11. Radiolabelled microspheres 12. Electromagnetic flowmetry
  7. 7. 1. DENTAL PULSE OXIMETRY •Pulse oximetry is a non-invasive device for determining pulp vitality. •The principle of this technology is based on modification of Beer’s law and the absorbency characteristics of haemoglobin in red and infrared range
  8. 8. 2. LASER DOPPLER FLOWMETRY •The technique depends on Doppler principle in which light that contacts a moving object is Doppler shifted and a portion of that light will be back scattered out of a tooth into a photodetector. •Since RBCs represents the majority of moving object within the tooth, measurement of Doppler shifted back scattered light may be interpreted as an index of pulpal blood flow
  9. 9. B. RECENT ADVANCES IN RADIOGRAPHY •Newer advances in endodontic imaging include: 1. Tuned aperture computed tomography (TACT) 2. Magnetic resonance imaging (MRI) 3. Ultrasound (US) 4. Optical coherence tomography (OCT) 5. Cone beam computerized tomography (CBCT) 6. Micro computed tomography (Micro CT) 7. Spiral computed tomography (SCT)
  10. 10. CONE BEAM COMPUTERIZED TOMOGRAPHY (CBCT) •More sensitive in detecting periradicular images compared with periapical radiographs (PARs) •A reliable method to detect the MB2 canal in the maxillary first molars •Effective for detecting vertical root fractures •Has a better diagnostic performance in evaluating inflammatory root resorption •Invaluable in determining the prognosis of an endodontic treatment. •May be the future standard to determine if periapical disease has resolved after completion of RCT.
  11. 11. C. RECENT ADVANCES IN ENDODONTIC VISUALIZATION • The use of optical magnification instruments enables the endodontist to magnify a specified treatment field beyond that perceived by the naked eye. • Examples of the magnification instruments include: - Endoscopes - Orascopes - Dental loupes - Operating microscope
  12. 12. RECENT ADVANCES IN WORKING LENGTH DETERMINATION ELECTRONIC APEX LOCATOR - AN ENDODONTIC ADJUNCT FIFTH GENERATION APEX LOCATORS • It uses multiple frequencies rather than the dual frequencies of the third and fourth generations of apex locators, so it works in dry or wet canals and requires no calibration. Eg :RAYPEX
  13. 13. SIXTH GENERATION APEX LOCATORS • Also called adaptive apex locators • Multi-frequency Operating System • Sound operated switching device can produce different kinds of sound to indicate the different positions of file in the root canal. •Dry and wet condition are also available for accurate reading
  14. 14. COMBINATION OF APEX LOCATORS & ENDODONTIC HANDPIECES 1. ENDY 7000 •Endodontic handpiece connected to an endy apex locator •Reverses the rotation of the instrument when it reaches a point in the apical region preset by the clinician.
  15. 15. (i.e. Contrary to manufacturer claims, Apex Locators can only reliably determine when the file is actually touching the PDL at the apex. Set your working length 1 to 1.5 mm back from this length to avoid over-instrumentation) [Ounsi HF, Naaman A, 1999]. 2. TRIAUTO ZX o Is cordless electric endodontic handpiece with built in RootZx apex locator. The handpiece uses Ni-Ti rotary instruments that rotate at 280±50 rpm. o The Root ZX is not capable of detecting the '0.5 mm from the foramen' position and thus, should only be used to detect the major diameter.
  16. 16. 3. SAFY ZX • New development of ultrasonic systems • Handpiece + apex locator • Uses Root ZX to monitor location of file during instrumentation • Minimizes danger of over instrumentation
  17. 17. RECENT ADVANCES IN INSTRUMENTATION •Innovation in instrument shape, design and standardization. •Change in material of manufacture i.e NiTi Alloy •Use of engine driven instrument and instrument motion.
  18. 18. Rotary NiTi instruments Light speed instrument e.g. canal master U, light speed LSX Profile instrument GT rotary instrument K3 instrument Hero(high elasticity in rotation) instrument RACE(Reamer with Alternating Cutting Edges) instrument Pro Taper instrument (mostly readily available and widely use)
  19. 19. Self – adjusting file (SAF) •First introduced in April 2010. •This action has a scrubbing, sand paper like effect on the canal walls. •Research showed that SAF operation resulted in RC walls that were free of debris and smear layer to a large extent.
  20. 20. Apexum Device • Based on minimally invasive removal of chronically inflamed periapical tissues through a RC access. • Consists of 2 instruments: • an Apexum NiTi ablator and • an Apexum polyglycolic acid (PGA) ablator.
  21. 21. LASERS IN ENDODONTICS •Diagnosis – Laser Doppler flowmetry (LDF) detects blood circulation in pulp tissue •Pulp capping and pulpectomy – CO2 lasers •Nd: YAG – shown to significantly reduce the number of bacteria - Reduced apical leakage after RC obturarion - Can soften gutta percha for retreatment •Er: Cr: YSGG – Used to remove smear layer and debris from the RC and reduce bacteria. •Er: YAG – might be suitable for clinical application as a suppressive and removal device of biofilms in endodontic treatments.
  22. 22. NEWER IRRIGATING SOLUTIONS •Ozonated water irrigant •Ruddle’s solution – introduced in an attempt to visualise the microanatomy of the canal system. –Composition- 17% EDTA, 5% NaOCl, Hypaque – an aqeous solution of Iodide salts ( Ditrizoate and sodium iodide). •MTAD : Contains 3% doxycycline hydrate, 4.25% Citric acid and 0.5% polysorbate-80 detergent (Tween80). •Tetraclean: •Similar to MTAD but differs in antibiotic concentration and the type of detergent •150mg/5ml for MTAD but 50mg/5ml for Tetraclean •Detergent for MTAD is Tween80 while it is polypropylene glycol for Tetraclean.
  23. 23. RECENT ADVANCES IN IRRIGATION i) Endo Activator ii) Endo Vac iii) Light – activated Disinfection (LAD) Iv)Safety irrigator
  24. 24. RECENT ADVANCES IN RC SEALERS •Meta SEAL – 4th generation resin based sealer - An etchant, a primer and a sealer are all combined into an all – in – one self etching, self adhesive sealer •Calcium phosphate sealer : still in the experimental stages , yet to be commercialised •MTA based sealers: produces calcium hydroxide in solution and induces formation of hydroxyapatite structures in simulated body fluid. Currently , 3 types are available; Endo CPM sealer, MTA Obtura and ProEndo Sealer •Calcium enriched mixture: A new biomaterial recently introduced. CEM releases calcium hydroxide during and after setting.
  25. 25. RESILON a) The Resilon core material – a thermoplastic synthetic polymer based RC core material containing bioactive glass, bismuth oxychloride and barium sulphate filler b) The Resin sealer – a dual curing resin based composite sealer. •Resilon forms a monoblock consisting of Filling material – resin sealer – bonding agent/ primer – dentin •The monoblock concept means the creation of a solid, bonded, continuous material from one dentine wall of the canal to the other. This has been shown to strengthen the root by≈ 20%
  26. 26. ADVANCES IN OBTURATION TECHNIQUES Obtura III technique •The obtura III system consists of a hand gun that contains a chamber surrounded by a heating element into which pellets of GP are loaded. •Other new techniques are: Ultrafil 3D Simplifill Thermalfil obturation Successfil
  27. 27. REGENERATIVE ENDODONTICS •Regenerative endodontic procedures (REPs) are biologically based procedures designed to replace damaged, diseased or missing structures such as dentin, root structures and cells of pulp dentine complex. Objectives •Regenerate pulp – like tissue •Regenerate damaged coronal dentine e.g. following a carious exposure •Regenerate resorbed root, cervical or apical dentine
  28. 28. •It comprises research in adult stem cells, growth factors, organ tissue culture and tissue engineering •REPs •Pulp capping and partial pulpotomy •Root canal revascularisation •Apexogenesis and Apexification •Stem cell therapy •Tissue engineering
  29. 29. CONCLUSION •Advances in the field of endodontics are ongoing ,revolutionizing the specialty improving the treatment outcome thus making endodontic procedures less stressful.
  30. 30. REFERENCES • Bahcall J, Barss J. Orascopic visualization technique for conventional and surgical endodontics. IntEndod J 2003: 36: 441–447. • Detsch S, Cunningham W, Langloss J. Endoscopy as an aid to endodontic diagnosis. J Endod 1979: 5: 60–62. • Ounsi HF, Naaman A. In vitro evaluation of the reliability of the Root ZX electronic apex locator. Int Endod J 1999;32:120- 23. • Patel S, Dawood A, Whaites E, Pitt Ford T. New dimensions in endodontic imaging: part 1. Conventional and alternative radiographic systems. Int Endod J. 2009 Jun;42(6):447-62.
  31. 31. THANKS FOR LISTENING

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