The endodontically treated tooth is usually more fragile then a healthy tooth, but this should not be considered like a negative factor on the durability of a treatment. With a proper reconstruction and using techniques and tools in order to improve the rigidity of the tooth, your treatment can be a great success!
Find out more in this lecture by dr. Marc Habib about his approach in the management of the endodontically treated tooth when using fiber posts.
Dr. Francesca Cerutti, dr. Riccardo Tonini and dr. Massimo Giovarruscio will discuss about Disinfection of the root canal system while trying to maintain a minimally invasive approach. From the literature and scientific consideration, passing to in vitro evaluation to the actual difficulties and techniques that you can use in vivo, they will show the modern possibilities to face the disinfection process nowadays.
Join Francesca Cerutti in this lecture about the status of art of Irrigation in Endodontics.
She will discuss about the past, the present and the most probable future of Irrigation.
Join dr. Francesca Cerutti in this POP Lecture about the use of the Fanta Essential kit, developed with Style Italiano Endodontics.
Join dr. Massimo Giovarruscio and dr. Francesca Cerutti in this lecture about the Management of Endodontic & Restorative complex cases.
Wide canals can be challenging when you need to place a big amount of MTA.
One of the difficulties in using MTA, is how to deliver it into wide canal. MAP System in combination with the new formula of White MTA, is the answer.
In this case Dott. Massimo Giovarruscio shares a clinical case of a treatment of an upper incisor with a wide canal and wide apex. Watch the video to find out how MAP system and White MTA played a strategical role for a predictable successfully result.
One of the main characteristics of Irriflex in addition to its renown flexibility, is the particular shape of the tip, with double lateral exits. This feature reduces the risks of extrusion of liquids even in the case of perforations.
In this case, prof. Fabio Gorni shares a case of a retreatment of a lower incisor with a missed canal and a perforation. Watch the video to find out how Irriflex played a strategical role in the treatment.
Mesial Buccal canal in maxillary first molar can be a big problem while doing endodontic treatments because it is quite difficult to find.
In this lesson Dr. Marino Sutedjo will briefly review the literature about this canal and share his approach on locating it.
Irrigation in endodontics is a crucial step in order to clean the canal space from bacteria and achieve the success in our treatments. In order to adequately clean the canals the needles available are not optimized and sometimes are simply not enough: till now. Irriflex has a innovative design that allow clinicians to clean in a more effective and efficient way all the canal space, even if it presents curved and complex shapes.
Hi my name is Grzergorz Witkowski and I'm an endodontist. I'm also a member of Style Italiano Endodontics. And today I would like to share you with a very very important subject, which is ledges.
In order to deal with the ledge, the first thing we should understand is how the ledge is created. So we have two possibilities. The first possibility that we can have is when you use the file which is too stiff. It means that you take two big size, for example, you start to prep the curvature of the canal which if ISO 15 or 20 or 25: this is not a good idea, and with this approach we will create the ledge very fast and very efficiently. The second possibility for creating the ledge is just to use the files. You use the mechanical file and you create ledge sometimes especially when the system is very sharp, you can create the ledge easier than we've not so efficient system, but still, this can happen.
And let me explain you how we can create the ledge with the mechanical file. Well when you move with your file on the curvature and you stay on the curvature with the file rotating, this is wrong because the file with the outstenight state so it means that this file is more like shape memory then it will love to come back to its original shape. So when it comes to original shape again it transport the canal space and it creates, I think what is called a ZIP or canal transportation or a ledge in general. Now we know how to. Create the ledge but the most important thing is how to deal with these in everyday practice. As we are all clinicians and we want to have all these information clinically, that we can use it on in everyday practice, I will give you some tips on how to deal we have these ledges. Okay so let's start the details. We we are creating the ledges only on the outer curvature of the canal space. It means that the inner curvature is always free from ledges. What does it mean for us clinicians. It means that we have proper pre banding often to file. We can easily promote the file to past the ledge and we can easily prep the ledge with these outer curvature of the thigh.
So, how to prebend the file to pass the ledge. Well before you start prebending the file the most important thing when you create the ledge or you find the ledge in a canal is to pre-irrigate the canal. Before you start any file introduction into the ledge, please keep in mind that you need to irrigate before. So put a lot of fluid inside the canal space. After putting these irrigation, you activate you activate a lot. Why is that? Because when you irrigate and activate before introducing any file you remove the debris that the file which caused the ledge created.Well after this procedure you can go directly with the prebended file and I will repeat how to prebend the file. The file should be prebended in kind of a fishing hook. It means that it is very much prebended. As you can see here this is not small prebending. Have in mind that the size of the file should not be too big. So I think the most, the initial size of the file should be no more than ISO 10. I strongly recommend you to use a C file which is the file very flexible on the other hand very predictable. When you introduce the file into the canal space, you should follow the inner curvature so these prebended file the very tip of the file should go down in the inner curvature it will help you to locate the original canal space. After doing this, you pass the ledge and the outer curvature of the file we'll be able to prep the saddle. Which was created from the creating the ledge. So you just start to move the file up and down up and down with very slow motion and of course you're turning these in 60 degrees left and the right. Why is that movement is important? Because when you use these movement, you will remove the saddle and you will be able to introduce bigger files into the canal space. And as we talk about ledges then the final possibility will be to pass all the ledges like in this situation. These patient came to me with a lot of edges on to curvature so we can call this case as a festival of ledges. Lucky for us because of these simple and predictable and feasible and really teachable technique we can pass all the ledges.
Thank you very much for your attention. I hope you find this movie interesting and I hope that you will use these deep in your everyday practice just from scratch thank you very much for watching and we are inviting you to see more of our movies on Style Italiano Endodontics.
Hi guys. Hi Calogero Bugea from Italy. I'm a Gold member of the Style Italiano Endodontics. During this lesson I will talk about how to identify confluences, because their comprehension of the anatomy of the root canal system is an important factor when using the rotary nickel titanium instruments.
Wayne classified merging canals in four types depending on the configuration of the main root. Canal along its course from the floor of the pulp chamber to the apex. This classification may be very practical to use in our daily practice when we have to treat two canals in one root. In type 1, 1 horifice, 1 root canal, 1 apical foramen. In type 2: 2 horifices, 2 root canals, 1 apical foramen. In type 3, we have 2 horifices, 2 root canals, 2 apical foramina. In type 4: 1 horifice, 2 root canals, 2 apical foramina. In type 1 and 3 the existing canal can be clean and shaped and obturated separately as if they were in different roots. In no situation in which we treat canals with possible confluences, we have to treat each canal root separately and not together. For example in 50 percent of cases, they mesio vestibular lower molar canal shares an apex with the mesio lingual canal. This canal, if it is confluent, it can be prepared in a conservative manner with less risk of weakening and stripping the root.
Early diagnosis is fundamental to prevent over instrumentation and transportation of the apical foramen. If we shape the apex twice from two different directions we increase the possibility to transport the apex and create at drop foramen, difficult to manage during obturation. Fortunately, in a high percentage of cases an early diagnosis can be made. Great care must be taken during the cleaning, shaping and packing procedures. Another advantage of an early diagnosis is to prevent and reduce the risk of instrument fracture. In fact, in this area the abroupt change of direction in the common area can cause a lot of stress to the endodontic instrument. How to evaluate the presence of a confluence?
There are different methods that we can use in different steps of the endodontic treatment to identify and confirm the confluence. Gutta percha cones and key files, apex locator, gutta percha cones and plastic carrier. The best method in my opinion to evaluate the presence of a confluence is with the use of gutta percha cones and k-files. I can visualize directly the confluence on a gutta percha cone. In a upper molar due to the presence of a MB2, that in a high percentage of cases is confluent, the first canal to prepare is the mesio-buccal canal. When we finish the preparation and the canal is ready to receive a gutta percha cone, we can introduce in the MB2 canal a small file. Sometimes it's possible to feel that contact with the cone, sometimes it is impossible, but in both cases when we extract the cone always after the k-file, if the conference exists we can see more some grooves scratches or folds, left by the non-invasive instrumentation of the MB2. This method is very efficient as it only requires few minutes to investigate the presence of a conference. This methods can fail in rare situations in which the k-file on the confluent canal is somehow unable to scratch their master cone. Another method requires the use of an electronic apex locator. After that the canal has been prepared, the operator checks the working length on the second canal with the use of an electronic apex locator. Then the operation is repeated leaving the last apical file inserted in the prepared canal at the foramen. If the working length of the second canal this time appears to be shorter by several millimeters, this would indicate that the second canal is sharing the foramen with their first canal. These method can be affected by the presence of irrigants or closed canals. Another method that we can use to confirm the presence of a confluence, is the use of a plastic carrier or gutta percha cones.
In case of confluence, for example, in a lower molar if we put the carrier into the mesio-lingual or in the mesio-vestibular canal, each carrier reach the working length. When are placed simultaneously, they can only advance alternatevely, if thevestibular goes to the working length, the lingual stay shorter and vice versa. The same operation may be done with gutta percha cones obtaining the same results. If only at this time we note the presence of a confluence, we have shaped the canal more than necessary, with the risk of over instrumentation and drop-foramen formation.
This method is very useful to confirm the presence of a confluence and to prepare in a perfect manner the gutta percha cone and the carrier for the obturation. During the irrigation in order to change frequently the solution, aspiration of the irrigant solution is recommended. In this manner, when the tip of the needle goes beyond the confluence, the solution will be drained from two canals at the same time. Aspiration and can be done with a dedicated endodontic irrigation tip. It's advisable to do these not only to confirm the confluence, but also to clean the confluence area. Even in the presence of multiple canals in one root, the procedures regarding the identification are the same.
With traditional X-ray, it's impossible to analyze a confluence of prior the treatment. It's very important for an endodontist to know very well all the possible variation. Canals might share part of the root canal system and have different ports of exit. I hope that you find these tips and tricks about how to identify and manage confluent canals very useful in your practice.
Thank you for your attention.
Welcome to Pop Dentistry. The real place where you can find endodontics on-demand. I'm Riccardo Tonini, gold certified member of Style Italiano Endodonticss.
And today my talk will be about plasma, plasma in dentistry. What is plasma? Plasma is a pure energy, energy that we need in our daily practice for many many reasons. First of all: disinfection. Plasma, we discovered that plasma has an incredible power againts disinfection and in the second place I would like to place adhesion, adhesion of our adhesive systems for the hybrid layer or our composite. So plasma is a something that we can define as a magic wand. But what is plasma so plasma I can define plasma as a magic wand because plasma is a ionized gas able to conduct heat and the electricity, consisting of electrons, neutrons, radicals and ions. The plasma project starts with the cooperation between two universities one that is Brescia University of Dentistry and the second one that is the University of Engineer of Bologna and the owner of this University, the professor Colombo, and met me in a Congress, and we started agreed since the beginning a great collaboration and that we started with the idea of transforming something that is basically inside the laboratories in something that maybe we can use in our daily practice in endo and the rest of practice.
Physically, what is plasma? Plasma is the fourth state of matter. We have a solid. We have liquid, and we have gas and we have plasma in the middle and on right, you can see a picture that we recently published on Science. This can really explain you what is plasma.
So how can we produce plasma. It's simple because it is enough to have to apply a sufficiently high energy in betweens two dielectric parts. And we can see that in the middle of two dielectric parts we have a gas, and we can see that the particles are starting colliding each are. When a gas in this way becomes plasma it contains a relatively equal number of positive and negative particles. In addition with neutron particles. As a result electrons and iones are producer and the gas has an electric charge. This state of matter is clearly called plasma which is the fourth state of matter, as I said before.
Here there is a brief video that's going to explain you how it works. We apply an high voltage and we can see that the particles we can break the bonds between particles and we produce lot of reactive parts like ROS, like hydroxide radicals. These kind of radicals are really important against bacteria because they are able to digest and break the bacteria membranes. So basically thanks to all of these active particles we are able to fight and destroy a lot of bacteria.
This is the clear theory of plasma okay. But how can we transfer for from a laboratory to our dental office. It's easy because it enough to modify and work on the device with a small tip. A tip that maybe we can use as for adhesion and for disinfecting dentine instead of clorhexidine. Or maybe is smaller tip that we can apply inside the pulp chamber and we can see that maybe plasma can penetrate in an easy way inside the root canal system. Why? Because plasma is attracted by the root canal system. So this gas has no pressure and can penetrate easily inside the any part of root canal system better than any kind of liquid. And by yourself maybe you understood the importance of these research and the powerful idea of plasma.
But let's talk about the device. I want to share also with you the device that we designed and maybe the future of this device and the researches that we did about it inside our device. And we have for sure it a tip and that we need a generator, a generator able to produce enough energy. After that we moved from the lab and we designed a prototype of this medical device. And basically sequences that we have inside the generator and we have inside a helium tank. The last part, here, is the handpiece. a small handpiece that can easily go inside the mouth. This is the the part that we keep inside our in our hands. We have a removable and autoclavable terminal glass capillary but glass and maybe also made in plastic, if we want to reach the apical region, we have the other most important part that took us lot of time in development is an insulator and the dielectric inside this device we can produce plasma directly here. So the generator is only a energy generator. Our plasma is produced inside this handpiece directly not on the back. We tested, we try to test it and we understood that plasma is something safe, first of all, that can penetrate in an easy way inside the root canal system. Is a gas without any pressure, is a plump. So something that is gently can really touch all the surface of our root canal system.
This is what happens when we apply the plasma on a dentine disk. We can see that surface tension is basically close to zero. So thanks to a treatment of 20 second of plasma, we can apply a drop of any liquid and we can see the capacity of the liquid to touch any part of the dentine disk. Instead, if we apply a drop of liquid on on a dentine disk without any kind of treatment, we can see that the drop remains exactly where we place it. So the difference is extremely high. Is evident. We need plasma. We understood that we need plasma. Now I want to show you what happens inside the root canal system.
This is a simulator of a root canal system: we apply plasma inside and the plasma is attracted from the external or so part of the periodontal. As we can see from these images, we can appreciate how plasma can penetrate easily in the endodonto anatomy and can also penetrate in a lateral canal. So plasma is also attracted from the periodontum and it means that it's safe, is not dangerous. Why? Because plasma usually it's in is adopted has a treatment for the wound of the patient. So you know plastic surgery or everywhere for his efficacy. We started with some investigation. First of all antibacterial efficacy of plasma and so how can we apply plasma. Can we apply it directly inside the root canal system and while we are using maybe hypoclorite? Or is better to apply it in a dry condition? The other choice coulr be also to treat our irrigant, any kind of irrigant outside the mouth of the patient and introduce it only once it's activated from plasma.
We did a lot of samples. We did a lot of experiments and at the end we understood that the best way of employing plasma in endodontics is use it in a dry condition. It means that the efficacy of plasma is really high when the root canal system is completely dry, not wet. It means that the gas is able to penetrate better inside dentinal tubules and inside the lateral canals and is able to do something that our liquids are not able to do. So plasma in endodontics can be used first of all at the end of the treatment in order to induce a really deeper antibacterial efficacy and disinfection.
So at the end of our root canal treatment, at the end of our cleaning protocol the employment of plasma for one or two minutes is extremely suggested in dry condition. And plasma also can when we treat the surface of plasma, try to imagine during filling, what can happen. So try to imagine also what can happen when we have to seal our root canal system. We treated the surface with plasma. Now while our surface is active ready to receive our sealer and gutta percha and we found, we discovered that the sealer penetration is higher and the gutta percha adhesion isn't really high. And in terms of numbers we can say that the gutta percha alone when we treat the root canal system first has a better sealing and the better adhesion power then we can when we use sealer and gutta percha together. So plasma is able to improve our sealing, our filling with gutta percha and any kind of sealer and is something that is absolutely extremely useful, also during this stage of our root canal treatment during filling.
The next step of our root canal treatment is the resto or part, the adhesion inside the root canal system. The adhesion may be of our fiber post and composite end adhesives, and we tested also these we treated dentine and we apply, We treat the dentine with plasma and we apply our conventional lootings system bonding and composite. We discovered that plasma can really increase the adhesion and that we are talking about 30 40 percent more in terms of push out bond strength. It means that plasma can really enhance, can really help us, also during this procedure.
So you discover it with me, how much is important with powerful energy something that maybe can disinfect and sterilize our root canal system something that can induce improve the adhesion of our root filling materials and something that can really improve the adhesion of our composite and adhesives disease improving the hybrid layer. So plasma source is something incredible. Is it really a magic wand! Something that in my dreams is for the next future a new device that we can use now our daily practice in order to disinfect and maybe, why not, we can use also the ultraviolet light that is produced by plasma, so a double use of plasma.
And in my opinion exactly: this is not the end. It's only the beginning. Follow us on Pop Dentistry and you will discover next development on this fantastic technology.