Endodontic Disinfection: Factors Influencing Success: Advanced Endodontics: Dr. Cliff Ruddle

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There are enormous differences in opinion regarding the potential to three-dimensionally clean a root canal system. Elimination of pulpal tissue, bacteria when present, and their related breakdown products is directly influenced by a series of procedural steps that comprise start-to-finish endodontics.
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it's remarkable the internal anatomy of virtually any tooth by position in the mouth through micro CT we've learned through non-invasive procedures to better appreciate their root canal systems and a course and were shaping canals our instruments pretty much just follow the primary system but in fact it's good to appreciate that the shaping allows for arrogance to penetrate three erratically into all aspects of the root canal system many colleagues were trained to work short of the full working length and so a block is oftentimes related to the inability to pass a ten file to length but I would like to bring your attention to another kind of block that happens every day in the big city and in fact instruments that shape canals commonly spend debris off into tubules eccentricities off the rounder parts of canals and intoanastomosis in a simulate plastic block you can see exactly how this works and every rotation of the instrument just provides deeper penetration of the dental mud so there's a lot of factors that we need to appreciate that will influence disinfection this is not a complete list and probably one of the most controversial things not on this list is one versus two visit endodontics but let's get started and look at the anatomy well we just saw the spinning tooth and when you begin to see the anatomy in its entirety it's a little sobering how we're going to get these things completely cleaned out and disinfected but recall the extraction is successful because it serves to remove 100% of the dental pulp and the good news today is we can remove all the contents of the root canal system when we have some ideas of course another variable or factor that will influence disinfection is complete access and finding all the orifices there is a lot of different methods used to shape canals and prepare them for operation but since the late 1970s I've always advocated using small sized hand files in the upper two-thirds of the canal and once there's a glide path we can shape that region of the canal with better access into the apical 1/3 we are now free to Scout the apical 1/3 establish working length and patency and see if we have a glide path for rotary instruments to follow sequencing the preparation is a major factor influencing disinfection carrying small files to length initially means we're working virtually with no reagents in the root canal system as I said earlier in this show many students internationally have been taught to work to the cementum dentinal Junction this is a rather arbitrary reference point and so as such most schools have just taught working about a millimeter short but we all know when we don't work to the full working length mud accumulates in over a series of a few files in a little bit of time we end up even working shorter than was our intention so it's important to negotiate the full length of canals and have a glide path to the radiographic terminus even the cross section of a file will directly dictate how much mud is produced if the mud is picked up more effectively on the instrument or if the debris is more likely burnished into the lateral anatomy in a cutting instrument they cut cleaner they pick up debris more effectively and they don't tend to burnish debris as much as a radial landed instrument so radio landed instruments or modified landed instruments more effectively burnish debris and this was more or less the first generation of files that launched back in the early 1990s there's significant controversy even regarding canal preparation there's basically two schools of thought one school of thought thinks we need take the terminal parts of canals up to a minimum size 40 file they advocate we do this for two reasons to make them rounder and to help us exchange arrogant more effectively the other school of thought wants to keep the Freeman as small as anatomically practical and in this school of thought there is more emphasis on deep shape it has been shown by Baumgartner in the Journal of endodontics that there's no statistically significant difference between a 4006 preparation and a 2010 the irrigants we use will directly affect our ability to disinfect and clean root canal systems obviously