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Endodontics , and War.

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hytham Aziz

on 28 June 2013

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Transcript of Endodontics , and War.

Blue on Blue
Some Science
Solution
Conclusion
friendly fire concept,

During battle, Soldiers fire, and fire is deadly for everyone in the field,
friend or enemy, good or bad...
Carl von Clausewitz, wrote:

(War is an area of uncertainty; three quarters of the things on which all action in War is based on are lying in a fog of uncertainty to a greater or lesser extent. The first thing (needed) here is a fine, piercing mind, to feel the truth with the measure of its judgment)
See who you are fighting and know what to fight with!
is important
Tactics
Carl von Clausewitz, wrote:

"Der Krieg ist das Gebiet der Ungewissheit; drei Vierteile derjenigen Dinge, worauf das Handeln im Kriege gebaut wird, liegen im Nebel einer mehr oder weniger groen Ungewissheit. Her ist es also zuerst, wo ein feiner, durchdringender Verstand in Anspruch genommen wird, um mit dem Takte seines Urteils die Wahrheit herauszufühlen."
Fog of War
Causes
Where friendly troops are mistakenly attacked in the belief that they are the enemy
Poor terrain and visibility are major factors
Error of Identification
Where fire aimed at enemy forces accidentally ends up hitting one's own. Such incidents are exacerbated by close proximity of combatants
Error of Position
Solution
Solution
Solution
Technology
Training
Properties of endodontic hand instruments used in rotary motion. instrumentation of curved canals
Undesirable changes in the canal shape as a result of instrumentation occurred in all cases.
None of the instruments were able to remove material on the whole length of the inner side of the curvature, whereas all instruments removed material on the whole length of the outer side of the curvature
Best instrumentation results were obtained with flexible instruments with noncutting tips.
Shaping Ability of Four Nickel-Titanium Rotary Instruments in Simulated S-Shaped Canals

NiTi systems including less tapered and more flexible instruments like S-Apex seem to be favorable when preparing S-shaped canals.
Antonio Bonaccorso MD, Corresponding Author Contact Information, E-mail The Corresponding Author, Giuseppe Cantatore MD, PhD, Guglielmo Guido Condorelli MD, PhD
Cutting efficiency of Five Different Types of Rotary Nickel–Titanium Instruments

Mtwo and RaCe displayed the greatest cutting efficiency with maximum flexibility.
The purpose of this study was to compare apical transportation and changes in canal curvature of three nickel-titanium (Ni-Ti)

The results suggest that ProTaper file system be implemented in combination with other less tapered more flexible systems, like RaCe, in preparing curved canals.
Department of Endodontics, Dental Research Center, Shaheed Beheshti University, Evin, Tehran Iran.
Edgar Schäfer Prof Dr⁎, Corresponding Author Contact Information, E-mail The Corresponding Author, Mirjam Oitzinger DDS
⁎ Department of Operative Dentistry, University of Münster, Germany
† Private Practice, Münster, German
the purpose of this study was to compare the previous termcuttingnext termprevious termefficiencynext term of the following previous termrotarynext term nickel-titanium instruments: Alpha-File (Komet, Lemgo, Germany), FlexMaster (VDW, Munich, Germany), Mtwo (VDW, Munich, Germany), ProFile (Dentsply Maillefer, Ballaigues, Switzerland), and RaCe (FKG, La-Chaux-de-Fonds, Switzerland). New .06/25 and .04/35 instruments were used; sample size was 12 for each group. previous termCuttingnext termprevious termefficiencynext term of all 120 instruments was determined in a previous termrotarynext term working motion by means of a computer-driven testing device. Special plastic samples with a cylindrical canal were used, and the maximum penetration depth of the instruments into the lumen was the criterion for previous termcuttingnext termprevious termefficiencynext term. Statistical analysis was performed by using analysis of variance and post hoc Student-Newman-Keuls test. Out of all .06/25 instruments, Mtwo and RaCe displayed significantly greater penetration depths than all other instruments, whereas for the other size FlexMaster, Mtwo, and RaCe were significantly superior to all other instruments (p < 0.05). For both sizes, the significantly lowest values were obtained by ProFile (p < 0.05). Under the condition of this study, Mtwo and RaCe displayed the greatest previous termcuttingprevious termefficiency.
Relationship between design features of endodontic instruments and their properties. Part 1. Cuttingnext termprevious termefficiencynext term

Edgar Schäfer Priv-Doz Dr med dent1, Corresponding Author Contact Information
Purchase

Available online 16 August 2007.

Little is known about the relationship between the cross-sectional configuration or the number of flutes and the previous termcuttingnext termprevious termefficiencynext term of endodontic hand instruments. Therefore, in this study, previous termcuttingnext termprevious termefficiencynext term of different prototypes made of one welldefined stainless-steel alloy was determined. The prototypes had five different cross-sectional shapes (square, triangular, rhomboidal, “S”-shaped, and the cross-sectional design of H-type files) and three different numbers of flutes (16, 24, and 32). previous termCuttingnext termprevious termefficiencynext term, both in a previous termrotarynext term and in a linear motion, was assessed by use of two computer-driven testing devices. With respect to previous termcuttingnext termprevious termefficiencynext term in a previous termrotarynext term motion, the rhombusshaped prototype with 24 flutes showed the greatest previous termcuttingnext termprevious termefficiencynext term. Moreover, the previous termcuttingnext termprevious termefficiencynext term of the rhombus-shaped prototype with 24 flutes in a linear motion gave the best results, even better than the H-type-shaped prototypes. Results indicate that, in contrast to traditional instrument designs, the rhombus-shaped prototype with 24 flutes is capable of producing the best previous termcuttingnext termprevious termefficiency both in a previous termrotary and in a linear working motion.
Properties of endodontic hand instruments used in rotary motion Part 2. instrumentation of curved canals

Edgar Schäfer Dr.med.dent.1, Corresponding Author Contact Information, Joachim Tepel Dr.med.dent.1, Wolfgang Hoppe Dr.med.dent.1, Prof.


Available online 1 June 2007.

The shaping abilities of nickel-titanium K-files, stainless steel reamers, K-files, and flexible stainless steel instruments with conventional previous termcutting tips and with modified noncutting tips were investigated under standardized conditions using a computer-driven testing device simulating the clinical use of the instruments. Simulated root canals with a 42-degree curvature were sequentially enlarged from #15 to #35.

Undesirable changes in the canal shape as a result of instrumentation occurred in all cases. None of the instruments were able to remove material on the whole length of the inner side of the curvature, whereas all instruments removed material on the whole length of the outer side of the curvature, resulting in slight to severe bulging. The extent of undesirable changes in the canal shape depended typically on the type of instrument used. Best instrumentation results were obtained with flexible instruments with noncutting tips.
Edgar Schäfer Dr.med.dent.1, Corresponding Author Contact Information, Joachim Tepel Dr.med.dent.1, Wolfgang Hoppe Dr.med.dent.1, Prof.

Available online 1 June 2007.
Shaping Ability of Four Nickel-Titanium Rotary Instruments in Simulated S-Shaped Canals

Antonio Bonaccorso MD∗, Corresponding Author Contact Information, E-mail The Corresponding Author, Giuseppe Cantatore MD, PhD†, Guglielmo Guido Condorelli MD, PhD‡, Edgar Schäfer MD, PhD§, Teresa Roberta Tripi MD, PhD‖
Purchase
∗ Private practice, Catania, Italy
† Faculty of Dentistry, University of Verona, Verona, Italy
‡ Department of Chemical Science, University of Catania, Catania, Italy
‖ Faculty of Dentistry, University of Catania, Catania, Sicily, Italy
§ Department of Operative Dentistry, University of Münster, Münster, Germany

Available online 22 April 2009.
Abstract
Introduction

The purpose of this study was to compare the shaping ability of ProTaper, Mtwo, BioRaCe, and BioRaCe + S-Apex instruments in simulated canals with an S-shaped curvature.
Methods

Canal transportation and aberrations were assessed by comparing the preinstrumentation and postinstrumentation images under a stereomicroscope. Analysis of variance and post hoc Student-Newman-Keuls test were used for statistical analysis.
Results

ProTaper instruments caused more pronounced canal transportation in the apical curvature (P < .01) than all other instruments. The use of ProTaper, Mtwo, and BioRaCe instruments resulted in more canal aberrations compared with BioRaCe + S-Apex (P < .05).
Conclusions

NiTi systems including less tapered and more flexible instruments like S-Apex seem to be favorable when preparing S-shaped canals.
A Comparison of Three Ni-Ti Rotarynext term Instruments in Apical Transportation

Homan Hossein Javaheri DDS Corresponding Author Contact Information, E-mail The Corresponding Author, Ghasem Hossein Javaheri DDS, MSD
Purchase
Department of previous termEndodonticsnext term, Dental Research Center, Shaheed Beheshti University, Evin, Tehran Iran.

Available online 20 February 2007.
Abstract

The purpose of this study was to compare apical transportation and changes in canal curvature of three nickel-titanium (Ni-Ti) previous termrotary instruments: Hero 642, RaCe, and ProTaper. Mesiobuccal canals of 60 maxillary first molars (with angles of curvature between 25 degrees and 35 degrees) were prepared with a torque-control, low-speed engine. Canals were prepared using the crown-down technique to the size of #30. Using a radiographic platform, reproducible preinstrumentation and postinstrumentation radiographs were taken. A computer analysis allowed magnification and superimposition of the images. The central axes of initial and final instruments were radiographically superimposed to measure transportation at 1 mm from WL. Data were analyzed using repeated-measures ANOVA. A statistically significant difference in apical transportation was found in ProTaper group. The results suggest that ProTaper file system be implemented in combination with other less tapered more flexible systems, like RaCe, in preparing curved canals.
A Retrospective Study of Endodontic Treatment Outcome between Nickel-Titanium Rotarynext term and Stainless Steel Hand Filing Techniques

Gary S.P. Cheung BDS, MDS, MSc, PhD, FRACDS, FDSRCSEd∗, Corresponding Author Contact Information, E-mail The Corresponding Author, Christopher S.Y. Liu BSc, DDS, MDS†
Purchase
∗ Area of previous termEndodonticsnext term, Faculty of Dentistry, The University of Hong Kong, Hong Kong
† Private Practice, Hong Kong

Available online 28 June 2009.
Abstract
Aim

The purpose of this study was to compare the periapical healing of molar root canal treatment using two instrumentation techniques.
Methods

A total of 225 maxillary and mandibular first and second permanent molars endodontically treated by undergraduate or postgraduate students were randomly selected from a computerized hospital database of which 110 molars had been prepared using a hybrid previous termrotary technique with nickel-titanium instruments (group NR) and 115 with hand stainless steel files (group HF). Patients were recalled and the teeth were examined both clinically and radiographically for signs of periapical inflammation.
Results

Some 19% and 39% of teeth in the NR and HF group, respectively, were judged to have some form of procedural errors. A higher rate of periapical healing was noted for NR (77%) than the HF group (60%) (p < 0.05). Factors contributing favorably to treatment outcome included the use of previous termrotary technique, maxillary molar, experienced operator, and absence of preoperative radiolucent lesion.
Conclusion

There was a higher incidence of procedural errors and a lower success rate for primary root canal treatment of teeth prepared with stainless steel files compared with the use of NiTi instruments in a continuous reaming action.

Update on lasers in endodontics: Adam Stabholz, DMD (Jerusalem)

John Dermody BDSa
in press

a Graduate Endodontics, University of Maryland, Baltimore College of Dental Surgery, Baltimore, MD
Effect of EDTA, Sonic, and Ultrasonic Activation on the Penetration of Sodium Hypochlorite into Simulated Lateral Canals: An In Vitro Study

Cesar de Gregorio DDS, MS, Roberto Estevez DDS, Rafael Cisneros DDS, Carlos Heilborn DDS†, ‡, Nestor Cohenca DDS‡, Corresponding Author Contact Information, E-mail The Corresponding Author
Purchase
Department of Endodonticsnext term, Universidad Europea de Madrid, Madrid, Spain
†Department of previous termEndodonticsnext term, Universidad del Pacífico, Asunción, Paraguay
‡Department of previous termEndodontics, School of Dentistry, University of Washington, Seattle, WA

Available online 29 May 2009.
Abstract
Introduction

The purpose of this study was to evaluate the penetration of 5.25% sodium hypochlorite alone or in combination with 17% EDTA in simulated lateral canals using sonic and ultrasonic activation.
Methods

Four hundred and eighty simulated lateral canals were created in 80 single rooted cleared teeth by inserting 06 K-files at 2, 4.5 and 6 mm of working length. Samples were mounted on clear silicon to simulate the presence of surrounding periodontal tissues and its effects on fluid dynamics and then randomly assigned to four experimental groups: 1 (n = 20) 5.25% NaOCl + sonic activation; 2 (n = 20) 5.25% NaOCl + ultrasonic activation; 3 (n = 20) 5.25% NaOCl + 17% EDTA + sonic activation and 4 (n = 20) 5.25% NaOCl + 17% EDTA + ultrasonic activation. Sonic activation was delivered using the Endoactivator® inserted 2 mm short of working length and activated for 1 minute. Ultrasonic activation was performed with a stainless steel ultrasonic file inserted 2 mm short of working length and passively activated for 3 cycles of 20 seconds each. Samples were evaluated by direct observation of the images recorded under the operating microscope and by radiographic evaluation after irrigation with a contrast solution.
Results

Sonic and ultrasonic activation resulted in a better irrigation of the lateral canals at 4.5 and 2 mm from working length compared to traditional needle irrigation alone. Traditional needle irrigation alone demonstrated significantly less penetration of irrigant into the lateral canals and was limited to the level of penetration of the needle.
Conclusion

The addition of EDTA did not result in better penetration of irrigants into the lateral canals.
Comparison of nickel-titanium and stainless steel hand-file instrumentation using computed tomography*

James M. Gambill DDS1, Marden Alder DDS, MS2, Carlos E. del Rio DDS3, Corresponding Author Contact Information
Purchase

Available online 1 June 2007.

Computed tomography was used to evaluate root canals prepared by nickel-titanium (Ni-Ti) hand and stainless steel hand endodontic instruments. Thirty-six single-rooted teeth of similar shape and canal size were divided into three groups. The teeth were scanned by computed tomography before instrumentation. In group A, canals were instrumented using a quarter turn/pull technique with K-flex files. In group B, canals were prepared with Ni-Ti hand files (Mity files) using the same technique as group A. Group C was prepared with Ni-Ti hand files (Mity files) using a reaming technique. Instrumented teeth were again scanned using computed tomography, and reformated images of the uninstrumented canals were compared with images of the instrumented canals.

Ni-Ti instruments (Mity file) used in a reaming technique caused significantly less canal transportation (p < 0.05), removed significantly less volume of dentin (p < 0.05), required less instrumentation time (p < 0.05), and produced more centered and rounder canal preparations than K-flex stainless steel files used in a quarter turn/pull technique.
Ni-Ti instruments (Mity file) used in a reaming technique caused significantly less canal transportation (p < 0.05), removed significantly less volume of dentin (p < 0.05), required less instrumentation time (p < 0.05), and produced more centered and rounder canal preparations than K-flex stainless steel files used in a quarter turn/pull technique.
James M. Gambill DDS1, Marden Alder DDS, MS2, Carlos E. del Rio DDS3
Comparison of shaping ability of RaCe and Hero Shaper instruments in simulated curved canals

Cumhur Aydin DDS, PhDa, Ugur Inan DDS, PhDb, Corresponding Author Contact Information, E-mail The Corresponding Author, Senay Yasar DDSa, Bilinc Bulucu DDS, PhDb, Yasar M. Tunca DDS, PhDa
Purchase
aDepartment of Endodonticsnext term and Conservative Treatment, Center for Dental Sciences, Gulhane Military Medical Academy, Ankara, Turkey.
bDepartment of Restorative Dentistry and previous termEndodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey.

Received 27 September 2007; revised 16 October 2007; Accepted 7 November 2007. Available online 14 February 2008.
Objective

This study compared the shaping ability of Hero Shaper and RaCe instruments in simulated curved canals.
Study design

Forty simulated canals in resin blocks were divided into 2 experimental groups, each comprising 20 resin blocks, and prepared with Hero Shaper and RaCe using the crown-down technique. Preoperative and postoperative photographs, recorded using a digital camera, were superimposed and aberrations were recorded. Material removal was measured at 10 points beginning 1 mm from the end point of the canal. Mean total widths, outer and inner width measurements, were determined on each central canal path and differences were statistically analyzed using Student t test.
Results

The Hero Shaper and RaCe instruments removed almost the same amount of material from the inner side of the simulated canals. On the outer canal wall, the RaCe instruments removed significantly more material from the first 3 mm (P < .05). However, Hero Shaper removed more material from the middle and coronal aspects of the canal and the differences were statistically significant (P < .01).
Conclusion

RaCe instruments removed more resin from the outside of the curvature at the apical thirds, while Hero Shaper removed more material from the middle and coronal thirds on the outer canal wall. Hero Shaper instruments showed better centering ability and fewer aberrations. No instrument fractures but some deformations were observed for both systems.
What does this remind us of??
Relationship between design features of endodontic instruments and their properties. Part 1. Cutting efficiency

the rhombus-shaped prototype with 24 flutes is capable of producing the best cutting efficiency both in a rotary and in a linear working motion.
James M. Gambill DDS1, Marden Alder DDS, MS2, Carlos E. del Rio DDS3
During canal preparation dentin which is healthy dies, we as Dentists (fighting) want to kill only the enemy..

we want to be tough, strong and unmerciful with those enemies of ours, the bacteria and the infected dentin...

yet soft, gentle and even delicate to our friends ... sound dentin...
we shall choose smarter weapons and selective methodology

that is how endodontics develop
Cutting efficiency affects primarily the canal shaping ability of the files.

Flexibility and "smarter" instruments are the tool to selectively cut through the canals.


we fight smarter...

Apical transportation is less with rotary instruments and even lesser with more flexible designs.

File design, material and manufacturing affects file flexibility.
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