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Preface and acknowledgements
Contents
 

ENDODONTICS - Vol. 2

CASTELLUCCI A.

Pages 399 - color illustrations

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Preface and acknowledgements

In the eleven years that have passed since the publication of the first edition in Italian of my book Endodontics, there has been a real explosion in new technology, new instruments and new materials, necessitating the need for revision and updating. The new rotary instruments in Nichel Titanium are widely and universally accepted, and have simplified the most complex part of the root canal treatment, namely the shaping. Their use in fact makes root canal preparation more rapid, more efficient, with results that are certainly more predictable. Consequently there is reduced stress for both patient and clinician and ultimately one can obtain a preparation that is extremely conservative having the advantage of maintaining the strength of the endodontically treated tooth and therefore increasing its longevity.

Apart from the gutta-percha vertical compaction technique described by Prof. Schilder, well known and widely used around the world, other techniques of heated filling have been affirmed or introduced in the past decade namely, the Thermafil Technique presented by Dr. Ben Johnson and the Continuous Wave Technique described by Dr. Stephen Buchanan.

A new canal obturation material has recently become available as a substitute for gutta-percha: this material is resinous with all the physical characteristics of gutta-percha (thermoplastic, soluble in chloroform) but also guarantees adhesion to the dentinal wall and therefore an even better seal.

Prof. Mamoud Torabinejad, from the Loma Linda University in California, has studied and validated a biocompatible and above all hydrophilic material for the treatment of perforations, imature apices, pulp exposures and that can also be used in surgery for retrograde filling, has literally changed the approach of operators confronted with the above clinical situations enabling large numbers of teeth to be saved, which would have otherwise been condemned to extraction or a certainly long treatment time, with a more uncertain prognosis.

Ultrasonics currently are not used exclusively for oral hygiene procedures on our patients, but have an infinite number of uses in the endodontic field, namely removal of posts and screws, the removal of calcifications, old filling material in the pulp chamber, the finishing of the access cavity, the exposure of the mesio palatine canal of the mesio buccal root of the upper first molar, the removal of fractured instruments and silver cones, as well as retrograde cavity preparation in the endodontic surgery.

But the greatest revolution that has occurred in the last decade has certainly been the widespread use of the operatory microscope. This is essentially clue to people like Gary Carr of San Diego California. Today in the specialist endodontic schools of North America and in many other parts of the world, endodontics is taught and carried out using the microscope. The canal has ceased to be "a black hole" in which one works aided by tactile sensitivity and that which one can "see" only by attentive examination of a radiograph. Currently, whatever difficulty that is present in the straight part of the root canal, even if in the most apical third, is easily seen and resolved thanks to the magnification and coaxial illumination that an operatory microscope guarantees.

The operating microscope has radicallly transformed Surgical Endodontics into a microsurgical procedure. All the surgical phases can be carried out with the use of the microscope: the incision, the root end preparation and filling as well as the suturing. This has dramatically increased the predictability of the results, improved the prognosis, raised the quality of success and by no means last, reduced the operator's stress.

In surgical endodontics the microscope enables careful examination of the accuracy of ones incision, preparation, retrograde filling and suturing, with an increase in predictability of results, and a better prognosis and higher percentage of success.

For all these reasons after eleven years since the publication of the first edition I felt the need to update it, making available to students and clinitians the necessary information. Furthermore, driven by the success which the preceeding edition also had abroad, the work is published in English with the contribution of many colleagues and friends that offered to help me with this by no means easy task.

Concerning this I would like to express my acknowledgement to the numerous Italian and foreign contributors, who with their contribution have given prestige to this work.

Therefore my thanks to:

To Dr. Mario Lendini from Turin, Italy, author of the chapter on Digital Radiography To Dr. Uziel Blumenkranz from Washington, Washington DC, coauthor of the chapter on Periapical Pathology and in particular on the section about The Cracked Tooth Syndrome To Dr. Kirk A. Coury from Amarillo, Texas coauthor of the chapter on Anaesthesia

To Dr. Stefano Patroni from Piacenza and to Dr. Paolo Ferrari from Parma, Italy, authors of the chapter on Pretreatment

To Prof. Elio Berutti from Turin, Italy, coauthor of the chapters on Endoclontic Instruments, Shaping and Cleaning and Nickel Titanium

To Prof. Giuseppe Cantatore from Rome, Italy, coauthor of the chapters on Endoclontic Instruments, Nickel Titanium and the Thermafil System

To Dr. Michael Scianamblo from San Francisco, California, author of the chapter on The Technique of Precocious Coronal Enlargement

To Dr. Clifford J. Ruddle from Santa Barbara, California, author of the chapter on The Protaper System and the chapter on Retreatment

To Dr. Stephen L. Buchanan from Santa Barbara, California, author of the chapter on The GT System and The Continuous Wave Condensation

To Dr. Richard E. Mounce from Portland, Oregon, author of the chapter on The K3 System To Dr. John T. McSpadden from Lookout Mountain, Georgia, coauthor of the chapter on The Quantec System

To Dr. Gary D. Glassman and Kenneth Serota from Toronto, Canada, coauthor of the chapter on The Quantec System

To Dr. W. Ben Johnson from Tulsa, Oklahoma, coauthor of the chapter on The Thermafil System To Prof. Vito Antonio Malagnino and to Dr. Paola Passariello from Rome, Italy, coauthors of the chapter on the Microseal System

To Dr.Ronal R. Lemon from New Orleans, Louisiana, coauthor of the chapter on Bleaching To Dr. Gary B. Carr from San Diego, California, coauthor of the chapter on Microscopes To Dr. John J. Stropko from Scottsdale, Arizona, author of the chapter on Endodontic Microsurgery To Dr. Riccardo Becciani from Florence, Italy, author of the chapter on the Testoration of the Endodontically Treated Teeth

My thanks go to Dr. lan Watson from Toronto, Canada and to Dr. John Theunissen from Massa, Italy, for their valuable help with the English translation of this work.

Furthermore I would like to express profound gratitude to my friend John D. West from Tacoma, Washington, for the touching words he has seen fit to use in the preface of this work.

Finally I would like to dedicate this book to he, whom I owe everything to, and who has literally changed the course of my life, from whom I learned everything which I am now proud to teach. That is my esteemed Teacher, Prof. Herbert Schilder.

Arnaldo Castellucci

Contents

Volume II

CHAPTER 13 - ENDODONTIC INSTRUMENTS
Elio BERUTTI, GIUSEPPE CANTATORE, ARNALDO CASTELLUCCI

Brief History

Standardization of Endodontic Instruments

Hand Instruments with a Conventional .02 Taper

Files
Reamers
Hedstroem Files
Barbed Broach

Hand Instruments with Greater Taper

Profiles .04 Hand Files
Hand GT Files
Micro-Openers

Steel Rotary Instruments

Gates-Glidden Drills
Largo Drills
LA Axxess Burs
Endo-Eze A.E.T. Files

Mechanical Instruments in Nickel Titanium

ProFiles
ProFile Orifice Shapers
Quantec
LightSpeed
Rotary GT Files
Hero
Sybron Endo K3
Protapers
FlexMaster
RaCe

Bibliography


CHAPTER 14 - CLEANING AND SHAPING THE ROOT CANAL SYSTEM
ELIO BERUTTI, ARNALDO CASTELLUCCI

Cleaning

The Removal of Vital Pulp Tissue
The Removal of Necrotic Pulp Tissue and Microorganisms
Irrigating Solutions
Chelating Agents

Shaping

Mechanical Objectives
Biological Objectives

Bibliography


CHAPTER 15 - SCHILDER'S TECHNIQUE FOR SHAPING THE ROOT CANAL SYSTEM
ARNALDO CASTELLUCCI

Introduction

Precurvature

Rubber Stops

Negotiation of the Root Canal and Determination of the Instrument's Working Length
Negotiation of the Root Canal
Determining the Working Length
Electronic Apex Locators

New Generation Electronic Apex Locators

Maintaining the Patency of the Apical Foramen

Enlargement of the Body of the Canal

Radiographic Evaluations

Cleaning and Shaping of Confluent Root Canals

Ten Rules to Follow

Bibliography


CHAPTER 16 - A CONTEMPORARY APPROACH TO CLEANING AND SHAPING OF THE ROOT CANAL SYSTEM EMPHATIZING "EARLY CORONAL ENLARGEMENT"
MICHAEL J. SCIANAMBLO

Introduction

Requirements

Complete Access
The Cavity is Continuously Tapering
Maintenance of the Original Anatomy
Conservation of Tooth Structure

Instruments & Materials

Instruments
Irrigating Agents
Lubricating and Chelating Agents
Intracanal Medicaments

Concepts

Broaching - Gross Removal of Debris
Working Length Instrumentation to the Radiographic Terminus and Patency
Precurvature of Instruments
Recapitulation
Reaming
Filing
Step-back
Crown-Down
Balanced Force
Method of DeDeus
Blending
Signature

Technique

Strategy
Initial Access and Gross Debridement
Preliminary Enlargement
Establishment of Patency
Enlargement
Blending
Apical Finishing and Refinements

Summary

Bibliography


CHAPTER 17 - CURVED CANALS
ARNALDO CASTELLUCCI

Curves of the Apical Third

Curves of the Middle Third

Curves of the Coronal Third

Anticurvature Filing Method

Bibliography


CHAPTER 18 - ROTARY INSTRUMENTS IN NICKEL TITANIUM
ELIO BERUTTJ, GIUSEPPE CANTATORE

Characteristics of NiTi Alloy

Shape Memory
Superelasticity
Strength
Metallurgy of Nickel-Titanium Alloys
Advantages

Functioning of the NiTi Rotary Instruments

Torsional Stress
Bending Stresses

Importance of the Section of the NiTi Rotary Instrument

Endodontic Motors

Characteristics
Formulation

Life of the NiTi Rotary Instrument

Original Anatomy of the Canal
Mechanical Characteristics of the Selected Instruments
Rotational Speed and Maximum Torque Values for NiTi Rotary Instruments
Characteristics of the Work Carried Out
Operator Ability

Bibliography


CHAPTER 19 - THE PROTAPER TECHNIQUE. SHAPING THE FUTURE OF ENDODONTICS
CLIFFORD J. RUDDLE

Protaper Geometries

The Shaping Files
The Finishing Files
Convex Triangular Cross-Section
Helical Angle & Pitch
Modified Guiding Tip

Protaper Concepts & Guidelines

Straightline Access
Irrigation & Lubrication
Reproducible Glide Path
Working Length & Patency
Directions for Use
Multiple vs. Single Use
Motors

The Protaper Technique

Scout the Coronal Two-Thirds
Shape the Coronal Two-Thirds
Scout the Apical One-Third
Shape the Apical One-Third
ProTaper Finishing Criteria
Finishing Larger Systems
Expanding the Deep Shape
Evidence for Clinical Success

Conclusion

Bibliography


CHAPTER 20 - PROSYSTEM GT
L. STEPHEN BUCHANAN

File Design

Basic Technique

Initial Shaping
Apical Gauging
Final Shaping

Tough Cases

Tortuous Canals
Hidden Curves
Impediments

Choosing and Using GT System Materials

Gutta-Percha
GT Paper Points
GT Obturators
GT Posts

Conclusion

Bibliography


CHAPTER 21 - THE K3 ROTARY NICKEL TITANIUM INSTRUMENT SYSTEM
RICHARD E. MOUNCE

The K3 System Features

Literature Review

Enhancing K3 Performance

Clinical K3 Technique

K3 Technique Summary

Additional Considearations

K3LS Hybrid Technique

Summary

Bibliography


CHAPTER 22 - THE QUANTEC™ ROTARY NiTi INSTRUMENTATION SYSTEM
JOHN T. McSPADDEN, GARY D. GLASSMAN, KENNETH S. SEROTA

Why Nickel-Titanium?

Why Rotary Instrumentation?

What Causes Breakage? What is Torsion?

What is Fatigue?

What are the Smallest File Diameters that can be Used to Meet the Torque Requirements that we are Likely to Encounter in Canals?

What Causes Fatigue?

What is the Largest File Diameter or Taper that can be Used in Curvatures that we are Likely to Encounter?

How can Files of the Same Diameter have Different Flexibilities?

What Tactile Sensations are there with Rotary Instrumentation?

How does File Engagement Affect Breakage?

How do I Determine the Optimum Rotation Speed?

The Quantec File™

Cutting Angle
Flute Design
Helical Angle
Blade Support (Radial Lands)
Balanced Forces of the Working Surface
Non-Cutting "Safe Tip" vs. Cutting Tip
The Quantec™ Series by Analytic
The Working Surface Taper

Crown Down vs. Step Back Technique

Does the Location of a Curvature Make a Difference with either Technique?
Access
Initial Preparation
Canal Length Determination
Deep Preparation - Crown-Down
The Zone Technique for Canal Preparation
Does Irrigation Reduce Torque Requirements?
Apical Patency
Irrigant Delivery
Sodium Hypochlorite
Thermo-Acceleration
Antimicrobial Effect of Irrigant Combinations within Dentinal Tubules
Efficacy of the Crown Down Approach in Reservoir Creation
Chlorhexidine
Time
Ultrasonic Instrumentation
Optimizing Clinical Success

Conclusion

Bibliography


CHAPTER 23 - OBTURATION OF THE ROOT CANAL SYSTEM: BIOLOGICAL PRINCIPLES, MATERIALS, AND TECHNIQUES
ARNALDO CASTELLUCCI

Biological Considerations on Root Canal Obturation

Properties of the Obturating Materials

Requirements for the Ideal Root Canal Filling Material

Endodontic Pastes and Cements

Solid Materials

Semi-Solid Materials

Techniques for Root Canal Obturation with Gutta-Percha

Lateral Condensation of Gutta-Percha

Thermoplastic Gutta-Percha

Chemical Softening of Gutta-Percha

Technique of Warm Lateral Condensation

The EndoTwinn

Adhesive Endodontics: Resilon (RichardE. Mounce, Gary D. Classman)

Clinical Technique

Bibliography


CHAPTER 24 - THE SCHILDER TECHNIQUE OF VERTICAL COMPACTION OF WARM GUTTA-PERCHA
ARNALDO CASTELLUCCI

Armamentarium

Gutta-Percha Cones

Sealer

Selecting the Right Time for the Obturation

Preparation of the Tray

Phases of Obturation

Cone Fit

Sealer and Master Cone Placement

Down-Packing

Reverse Filling or "Back-Packing"

"Back-Packing" with Thermoplastic Gutta-Percha

Vertical Extent of the Three-Dimensional Obturation

Cemento-dentinal Junction
Radiographic Terminus of the Canal

Overfilling and Overextension

Obturation of Communicating and Confluent Root Canals

Bibliography


CHAPTER 25 - THE CONTINUOUS WAVE OF CONDENSATION OBTURATION TECHNIQUE
L. STEPHEN BUCHANAN

The Predecessors

The Touch'n Heat Electric Heat Carrier
The Obtura III Gutta-Percha Gun
The One-Shot Birth of the Continuous Wave of Condensation Technique
The Conceptual Basis for the Continuous Wave of Condensation Technique
Instruments and Devices
The System-B Heat Source
The System-B/Elements Obturation Device

Procedures

Conefitting
Plugger Fitting
Downpacking
Backfilling with a Warm Gutta-Percha Syringe
Obtura Gun Backfilling
System-B/Elements Extruder Backfilling

Conclusion

Bibliography


CHAPTER 26 - THE THERMAFIL SYSTEM
GIUSEPPE CANTATORE, W. BEN JOHNSON

Components of the Thermafil Obturation System

Thermafil Obturators
The Thermafil Gutta-Percha
Size Verifiers
ThermaPrep Plus Over
Therma-Cut Burs
Post Space Burs

Operative Sequence for a Thermafil Obturation

Canal Preparation
Obturator Selection and Preparation
Pre-obturation Irrigation
Sealer Placement
Obturation
Post Endodontic Restoration
Post Operative Sequelae

Hermetic Seal and Quality of Thermafil Canal Obturation

Flow and Filling Capacity
Adaptation to the Canal Walls
Checking Coronal Infiltration
Hermetic Apical Seal

Preparation for Post Space in a Thermafil Obturation

Retreatment of Thermanl Treated Teeth

Advantages of the Thermafil System

Rapid Learning Curve
Conservative Canal Preparation
Obturation of Curved Canals
Quality of the Results

Disadvantages of the Thermafil System

Complex Use in Cases with Particular Endodontic Anatomy
The Risk of Overfilling

How to Achieve the Best Results Using the Thermafil Technique

Bibliography


CHAPTER 27 - MICROSEAL TECHNIQUE
VITO ANTONIO MALAGNINO, PAOLA PASSARIELLO

The Microseal Technique

Phase 1
Phase 2

Experimental Evaluation of the Microseal Technique

Materials and Methods

Results

Radiographic Evaluation
Observation Using Stereo Microscope
Diaphanization

Bibliography