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Endodontic treatment in a row
Here you can see shortly the many practicle aspects of the endodontic (re)treatment which ascertain all together a good and predictable result. If you miss an aspect, please react on 
Diagnostic procedures (medical history, dental history, prognosis)
A recent radiograph available (contour element, lucency, caries, fractures, perforations, false route)
Intraoral check of the contour of the radices (extra radices, direction radices)
Try to prepare the endodontic access cavity in the middle of the pulp chamber (safe)
Use an access bur which is so short that it is almost impossible to prepare a perforation in the floor of the pulp chamber
With the Operating Microscope one "reads" the pulp chamber
Remove the rest of the roof of the pulp chamber. (with access bur)
Place Rubberdam
With methylene blue the floor of the pulp chamber will be coloured
Try to detect the entrance to the root canals with the Operating Microscope and remove dentin with LN-burs (Thin round burs which are extra long)
Natriumhypochlorite with syringe in pulp chamber (NaOCl should be in the pulp chamber as long as possible)
Eventually put a little EDTA (Glyde)in small root canals (dissolves and files get more easy to the apical foramen)
Read the floor of the pulp chamber with the Operating Microscope. Be aware of fractures. When the operator is used to the Operating Microscope, the Microscope will be used during the whole root canal treatment. The normal operating lamp will not be used any more.
With LN-burs the floor of the pulp chamber will be cleaned thoroughly (search for extra root canals and eventually fractures)
Make access to the root canals with thinhand files (prevent to get debris in the peri apex. Many 006 en 008 files should be in stock)
Place file 006 in the needle holder. With the aid of the Operating Microscope the 006 file will be placed in the access of the root canal (with a needle holder one has a better view on the entrance of the root canal)
If possible, the pulp chamber always is full with hypochlorite (5 %, warmed "au bain Marie" till approximately 50 degrees Celcius. Hypochlorite dissolves better when it is warm)
Immediately measure the length of the root canal with a thin file with the electronic apex locator and write it down. (Prevents getting files trough the apex unnecessary)
Cleaning and shaping of the coronal third of the root canal with hand files and Rotary files (Profile 0.6 nr.40). Most of the debris is removed
When the pulp chamber is full with hypochlorite, Rotary Files can be cleaned easily by rotating the files in the hypochlorite. Centrifugal power takes care of the cleaning of the files
The apical two third of the root canal will be cleaned till a file 015 comes to length as measured by the electronic apex locator. (The file should be visable on the radiograph)
With Gates Glidden Drills(1, 2 and 3) the coronal part of the root canals will be shaped (quick, good access, never breaks at a wrong place)
Take a radiograph with the files at the same length as measured with the electronic apex locator. Of course the referent points should be noted also. Watch for curved canals!
Write down the working length per canal on base of the radiograph and the apex locator)
Cleaning and shaping of the root canals till at least a file 035 comes at the apex (a good method is: crown down with Profile 06 40, than 35 than 30 than 25. Every file one or two millimeters further crown down to the apex. In between using a small hand file (008) which comes to working length. Again crown down with the Profiles till working length has been reached
Bigger (oval) canals should have bigger working lenght files. Minimal 5 files should take of dentin in the apical area
During shaping, rinse regularely with hypochlorite. Especially at the end the needle should come till about 3 mm of the apex. Prevent that the needle locks in the root canal. With high pressure hypochlorite can go through the apical foramen!
Rinsing with ultrasonics can clean the canal better (movement of the hypochlorite, temperature gets higher. Be aware of making a step!)
The cleaned and shaped canals will be rinsed with hypochlorite thoroughly at the end of the treatment (at least 10 ml)
Than at least one minute rinsing with EDTA 17% (removes smearlayer)
At least one minute rinsing with chlorhexidine-digluconate 2% (eliminating Enterococcus Faecalis. Take care: hypochlorite and chlorhexidine give a brown colourisation of the dentin!)
Again one minute rinsing with EDTA (removing chlorhexidine)
Rinsing a last time with hypochlorite (EDTA should be removed). Preventing weakening of the radice by EDTA
Remove the hypochlorite by putting the needle deep in the root canal and aspirate
With paperpoints(1 size smaller than the working length file) the canals will be dried (Often one paperpoint is enough. The paperpoint should come at working length. With the paperpoint in situ, the pulp chamber will be dried with dry air. The paperpoints prevent that air can come periapically
Coloured paperpoints discolour when there is hypochlorite in the canals
The root canals and the floor of the pulp chamber will be inspected a last time with the Operating Microscope (to read the floor). Extra canals and fractures can be detected
With a paperpoint on working length will be checked a last time if possibly there is blood at the point of the paperpoint. (working lenght too long or blood comes out of the peri apex)
With a small handplugger or a paperpoint cement will be put in the root canals (Also possible with a lentulo needle), Too much cement will be removed with a paperpoint
The guttaperchamain point (same measure as the working length file, For example: Profile 0.6 nr. 40 will be a GP point 0.6 nr. 40) will be put in the root canal at the formerly measured length.
When the guttapercha point will not get at the right length (seldomly happens), one size smaller can be tried or shaping again with the working length file
When a guttapercha point gets too far (possibly trough the apex), shorten the point one millimeter and try again
With a plugger of System B the GP point will be cut off at the binding point of the System B plugger (approximately 4 mm from the apex)
The warm guttapercha will be condensed with fitting handpuggers till it has cooled down (prevent shrinkage)
The "back fill" finishing with Obtura II (prevent shrinkage)
Remove too much guttapercha with System B
Cleaning of the pulp chamber thoroughly (alcohol, hypochlorite)
Fill the pulp chamber with composite or eventully with glasionomer cement. Take care that the filling is not too high, because that always gives complaints afterwards!
Make a last radiograph (evaluation of the treatment, beginning of recovery or beginning of pathology)
Instructions to the patient about eventually post operative complaints
From this page you can order the following products in our catalogue:
- Operating Microscope
- Burs
- Methylene blue
- Rubberdam
- Needle holder
- Files
- Lentulo needles
- Gates Glidden Drills
- LN-burs
- Rotary-files
- Ultrasonic files (EMS)
- Electronic apex locator
- Paper-Points
- Gutta Percha Points
- Glyde
- Access bur
- System B
- System B pluggers
- Obtura II
- Handplugger
- Rinse needles
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