معالجة لبية للضاحك الاول العلوي لطلاب طب الاسنان

1. DrQwizany
Project #2-1
1Dr Qwizany Dr Doumani

2. DrQwizany
 Demonstration of rubber dam isolation.
 Access cavity preparation on the lower 1st PM tooth and the upper 1st PM
tooth.
 Preoperative radiographs (mesial angulated) for mounted lower 1st PM
tooth and the upper 1st PM tooth should be taken and approved by the
instructors.
 Endodontic Radiography Basic Concepts (SLOB)
 Working length determination
 radiographs for initial file should be taken ( mesial angulations)
 Demonstration of gates glidden drills, practice of gates glidden use on
teeth mounted
Project #2-1 Check List
2Dr Qwizany Dr Doumani

3. DrQwizany
Rubber Dam
• Rubber Dam sheet
• Clamp forceps
• Puncher
• Metal/Plastic Frame
• Clamps
• Dental Floss
• Lubricant
Project #2-1
3Dr Qwizany Dr Doumani

4. DrQwizany
Rubber Dam
• Clamps
• PREMOLARS:
• IVORY.......# 1
• IVORY.......# 2
• IVORY.......# 2A
Project #3-1
4Dr Qwizany Dr Doumani

5. DrQwizany
Rubber Dam
• Puncher
– It is used to make round
holes of different
diameters (0,7 – 2 mm),
depending on the tooth
to be isolated.
Project #3-1
5Dr Qwizany Dr Doumani

6. DrQwizany
Project #3-1
Rubber Dam Technique
Winged Clamp
 Rubber Dam+Clamp  Frame
6Dr Qwizany Dr Doumani

7. DrQwizany
Project #3-1
Rubber Dam Technique
Winged/Wingless Clamp
 Rubber Dam Clamp  Frame
7Dr Qwizany Dr Doumani

8. DrQwizany
Project #3-1
Rubber Dam Technique
Wingless Clamp
 Clamp+Rubber Dam sheet 
Frame
8Dr Qwizany Dr Doumani

9. DrQwizany
Project #2-1
Access Cavity
– 1st Upper Premolar
• The access opening is oval on the
occlusal surface and should be in
the middle third of the tooth,
both mesiodistally and
buccolingually.
– 1st Lower Premolar
• The chamber shape is usually
oval or rounded, as is the access
opening on the occlusal surface.
9Dr Qwizany Dr Doumani

10. DrQwizany
Project #2-1
Access Cavity
– 1st Upper Premolar
• Starting point:
– Max. premolars:
central groove
between the cusp tip.
– 1st Lower Premolar
• Mand. premolars: 1/3 to ½ up the
incline of the buccal cusp on a
line connecting the two cusps.
10Dr Qwizany Dr Doumani

11. DrQwizany
Preoperative
radiographs (mesial
angulated) for
mounted lower 1st PM
tooth and the upper 1st
PM
Project #2-1
Horizontal Sift
11Dr Qwizany Dr Doumani

12. DrQwizany
 Image Shift Principle (SLOB Rule)
(also called: Buccal shift rule):
• SLOB = ( Same lingual / Opposite Buccal )
We should know:
 To which direction the cone is
displaced.
 To which direction the object is
displaced (according to a fixed
anatomical land mark = reference line)
 If the structure is
located buccally moves to
the opposite direction of the cone
 If the structure is
located lingually moves to
the same direction of the cone
Project #2-1
12Dr Qwizany Dr Doumani

13. DrQwizany
 Image Shift Principle (SLOB Rule)
(also called: Buccal shift rule):
• SLOB = ( Same lingual / Opposite Buccal )
We should know:
 To which direction the cone is
displaced.
 To which direction the object is
displaced (according to a fixed
anatomical land mark = reference line)
 If the structure is
located buccally moves to
the opposite direction of the cone
 If the structure is
located lingually moves to
the same direction of the cone
Project #2-1
13Dr Qwizany Dr Doumani

14. DrQwizany
 Image Shift Principle (SLOB Rule)
(also called: Buccal shift rule):
• SLOB = ( Same lingual / Opposite Buccal )
We should know:
 To which direction the cone is
displaced.
 To which direction the object is
displaced (according to a fixed
anatomical land mark = reference line)
 If the structure is
located buccally moves to
the opposite direction of the cone
 If the structure is
located lingually moves to
the same direction of the cone
Project #2-1
14Dr Qwizany Dr Doumani

15. DrQwizany
• Radiographs for initial file
should be taken ( mesial
angulations)
Project #2-1
15Dr Qwizany Dr Doumani

16. DrQwizany
• From your initial
radiograph
measure the
distance from your
reference point to
the apex.
Project #2-1
Reference
point
Radiographic
apex
16Dr Qwizany Dr Doumani

17. DrQwizany
Estimated length for upper
1st Premolar
Buccal root ----- ---22mm
Palatal root --------20mm
• Reference point for Buccal
root is Buccal cusp
Reference point for palatal
root is lingual cusp
Project #2-1
Palatal
cusp
Buccal
cusp
Palatal
Root
Buccal
Root
17Dr Qwizany Dr Doumani

18. DrQwizany
• Correct position of rubber
stopper on your file
Project #2-1
IncorrectCorrect 18Dr Qwizany Dr Doumani

19. DrQwizany
• Measure a size 10 file to this
estimated working length
 Buccal root ----- ---22mm
 Palatal root --------20mm
Project #2-1
19Dr Qwizany Dr Doumani

20. DrQwizany
• Place the files size 10 in the
canal-- rubber stopper to RP
Project #2-1
20Dr Qwizany Dr Doumani

21. DrQwizany
• Take an angulated
Radiograph
Project #2-1
Flush
At the radiographic
apex
Flush
At the radiographic
apex
21Dr Qwizany Dr Doumani

22. DrQwizany
• From this measurement,
subtract 0.5 – 1.0 mm for
the estimated working
length. This 0.5 – 1.0 mm
includes:
The distance between the
radiographic apex and the
apical constriction.
Project #2-1
22Dr Qwizany Dr Doumani

23. DrQwizany
 initial working length
• Buccal root
22-0.5=21.5mm
• Palatal root
20- 0.5=19.5mm
Project #2-1
23Dr Qwizany Dr Doumani

24. DrQwizany
• Take an angulated
Radiograph
Project #2-1
24Dr Qwizany Dr Doumani

25. DrQwizany
• The first file that binds
(feels tight) at or near the
estimated working length
will be your Initial file
Project #2-1
25Dr Qwizany Dr Doumani

26. DrQwizany
Project #2-1
Buccal cusp tip
Lingual cusp tip
BCT
PCT
10
10
15
15
23
20
21.5
19.5
26Dr Qwizany Dr Doumani

27. DrQwizany
• Practice of gates glidden
use on teeth mounted
Project #2-1
No. 1 No. 2 No. 3 No. 4 No. 5 No. 6
0.50 0.70 0.90 1.10 1.30 1.50
27Dr Qwizany Dr Doumani

28. DrQwizany
Project #2-2
28Dr Qwizany Dr Doumani

29. DrQwizany
• Initial Apical Preparation
(Phase I):
After creating a straight-line
access, ream or file the first
file to bind in the canal three
to five sizes larger.
Project #2-2
29Dr Qwizany Dr Doumani

30. DrQwizany
Watch winding motion
technique:
Half turn clockwise and half
turn counterclockwise with
apical pressure then
withdrawal
Project #2-2
30Dr Qwizany Dr Doumani

31. DrQwizany
Patency file:
A small (#10) file used to the
terminus (major foramen), i.e.
WL + 1 mm.
PM Buccal
21.5mm+1mm=22.5mm
PM Palatal
19.5mm+1mm=20.5mm
Project #2-2
1 mm
31Dr Qwizany Dr Doumani

32. DrQwizany
Start
15
WL 21.5
Patency
file
Irrigation
Cleaning
the file
20
WL 21.5
Patency
file
Irrigation
Cleaning
the file
25
WL 21.5
Patency
file
Irrigation
Cleaning
the file
30
WL 21.5
Patency
file
Irrigation
Cleaning
the file
30 is now
the MAF
Take RG
for the
MAF
DoneBuccal
Canal
32Dr Qwizany Dr Doumani

33. DrQwizany
Start
15
WL 19.5
Patency
file
Irrigation
Cleaning
the file
20
WL 19.5
Patency
file
Irrigation
Cleaning
the file
25
WL 19.5
Patency
file
Irrigation
Cleaning
the file
30
WL 19.5
Patency
file
Irrigation
Cleaning
the file
30 is now
the MAF
Take RG
for the
MAF
Done
Palatal
Canal
33Dr Qwizany Dr Doumani

34. DrQwizany
• MAF Radiograph:
After reaching your MAF,
expose a radiograph with
the MAF in the canal.
Project #2-2
34Dr Qwizany Dr Doumani

35. DrQwizany
Project #2-2
10
10
15
15
30
30
23 21.5 21.5
20 19.5 19.5
B
P
BCT
PCT
Buccal
cusp tip
Lingual
cusp tip
35Dr Qwizany Dr Doumani

36. DrQwizany
• Step back technique
phase II
After reaching your MAF.
Consecutively use larger
sizes, 1mm shorter than
your working length
• Ex MAF 30, WL 20
• The working length for size
35 is 19, and for 40 is 18, etc
Project #2-2
36Dr Qwizany Dr Doumani

37. DrQwizany
• Recapitulation All canals
After each step-back file
is used, you should insert
your MAF to WL.
• After that Patency File
• Irrigation, file cleaning
• The go to the next file
Project #2-2
37Dr Qwizany Dr Doumani

38. DrQwizany
START
MAF 30
WL 21.5
35
WL 20.5
Recap
Patency
file
Irrigation
Cleaning
the file
40
WL 19.5
Recap
Patency
file
Irrigation
Cleaning
the file
45
WL 18.5
Recap
Patency
file
Irrigation
Cleaning
the file
50
WL 17.5
Recap
Patency
file
Irrigation
Cleaning
the file
55
WL 16.5
Recap Patency file
Irrigation
Cleaning
the file
60
WL 15.5
Recap
Patency
file
Irrigation
Cleaning
the file
Done
Buccal Canal- StepBack
38Dr Qwizany Dr Doumani

39. DrQwizany
START
MAF 30
WL 19.5
35
WL 18.5
Recap
Patency
file
Irrigation
Cleaning
the file
40
WL 17.5
Recap
Patency
file
Irrigation
Cleaning
the file
45
WL 16.5
Recap
Patency
file
Irrigation
Cleaning
the file
50
WL 15.5
Recap
Patency
file
Irrigation
Cleaning
the file
55
WL 14.5
Recap Patency file
Irrigation
Cleaning
the file
60
WL 13.5
Recap
Patency
file
Irrigation
Cleaning
the file
Done
Palatal Canal- StepBack
39Dr Qwizany Dr Doumani

40. DrQwizany
Refining with MAF
• Use your MAF size 30 to
 Buccal root = WL 21.5mm
and place the file to
RP(buccal cusp tip)
 Palatal root = WL 19.5mm
and place the file to
RP(lingual cusp tip )
Project #2-2
40Dr Qwizany Dr Doumani

41. DrQwizany
Project #2-3
41Dr Qwizany Dr Doumani

42. DrQwizany
• Drying the canals
Using paper points measured
to your WL
Project #2-3
42Dr Qwizany Dr Doumani

43. DrQwizany
• Master Apical Cone (MAC)
• Select the GP cone matching
the MAF size
 PM Buccal --30
 PM Palatal --30
Project #2-3
43Dr Qwizany Dr Doumani

44. DrQwizany
• Master Apical Cone (MAC)
• Buccal canal 21.5mm
Palatal canal 19.5mm
Project #2-3
44Dr Qwizany Dr Doumani

45. DrQwizany
• Master Apical Cone (MAC)
• Mark your cone at the RP
• Place the MAC to length
• Take a Radiograph
Project #2-3
45Dr Qwizany Dr Doumani

46. DrQwizany
• Finger spreader
Choose a spreader that
matches accessory cone size
Use a rubber stopper
Move the spreader in 180o
arc
Project #2-3
46Dr Qwizany Dr Doumani

47. DrQwizany
• BE SURE your spreader must
fit within 1-2 mm of your
working length
Project #2-3
47Dr Qwizany Dr Doumani

48. DrQwizany
Project #2-3
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49. DrQwizany
Project #2-3
49Dr Qwizany Dr Doumani

50. DrQwizany
• Application of sealer Using
MAF, Lentola spiral, or MAC
Project #2-3
50Dr Qwizany Dr Doumani

51. DrQwizany
• Place the MAC to length
Project #2-3
51Dr Qwizany Dr Doumani

52. DrQwizany
• Lateral
condensation
technique
• Add more
accessory cones
• Stop adding when
the spreader can
penetrate only 2-3
mm into the canal
orifice
Project #2-3
1234
52Dr Qwizany Dr Doumani

53. DrQwizany
• Where to cut the gutta
percha?
– At the level of the orifice or
CEJ level
Project #2-3
53Dr Qwizany Dr Doumani

54. DrQwizany
• How to cut gutta percha?
– Heated Glick (plastic)
instrument, plugger, or Touch
n’ Heat
Project #2-3
54Dr Qwizany Dr Doumani

55. DrQwizany
• Temporization
Project #2-3
55Dr Qwizany Dr Doumani

56. DrQwizany
• Final Radiograph
Project #2-3
56Dr Qwizany Dr Doumani