PREPARASI SALURAN AKAR

PREPARASI SALURAN
AKAR
Epita Sarah Pane
Bagian Konservasi FKG USU
Inside the pulp area……
What we would like to have
?
Konsep preparasi
Koronal dan apikal.
A= Apex radiografik
B = Resistance form
C = Retention form
D = Convenience form
E = Outline form
What are we going to do?
Apical instrumentation
Aims
Cleaning
Membersihkan saluran akar dari sisasisa-sisa organik
Shaping
Membentuk saluran akar agar bisa diisi secara
optimal
Cleaning
Membersihkan saluran akar dengan melakukan
debridemen.
Debridemen = mengeluarkan iritan yang ada
maupun yang mampu menjadi iritan dari
seluruh sistem saluran akar.
Iritan = bakteri, produk bakteri, jaringan
nektorik, debris organik, jaringan vital, produk
dari saliva, darah, dll.
Teknik debridemen
Menggunakan
instrumen dengan
menyentuh / menekan
/ menyusuri seluruh
dinding saluran akar
Access errors
Access errors = canal prep errors
Access errors = canal prep errors
Access error = canal prep error
Access errors = canal prep errors
Carefull of radiograph interpretation !!!
Instrumentation
Teknik Dasar menggerakkan file
1.
File
2.
Ream
Teknik kombinasi file dan ream
1.
Turn and pull
2.
Watch--winding
Watch
3.
Serial shaping
4.
Balanced force
Filing motion
Push-pull action with instruments ((Filing
PushFiling
technique))
technique
With KK-file but capable of damaging the canal
very quickly
Effective with HedstromHedstrom-type file
Limitation:
Easily cut the middle of a curvature and cause a
strip perforation
Reaming motion
Reaming technique
Clockwise or rightright-hand rotation of an
instrument.
Risk of rotating instruments: instrument
fracture
Effective with reamer (reamer’s use a more
axial orientation of their cutting edge)
Turn and Pull motions
One quarter turn to the right (reaming)is
followed by a straight outward pull (filing).
Effective if the instrument is not forcefully
pushed toward the apex and subsequent
instruments are steppedstepped-back from the apical
terminus
Limitation: tendency towards “hourglass”
canal shape
Watch – winding motions
Back and forth oscillation of a file (30 to 60
degrees) right and 30 to 60 degrees left as the
instruments is pushed forward into the canal
Effective with KK-file, can be used with reamer
The instrument is not to be pushed
aggressively into the canal
Watch--winding and pull motions
Watch
When used with Hedstrom files, watchwatchwinding motion cannot cut dentin.
Watch--winding is maintained while the file is
Watch
gently rocked right and left until meets
resistance, then it is time freed by a pull stroke.
Serial shaping motions
With six unique motions of files and reamers:
follow, followfollow-withdraw, cart, carve, smooth
and patency.
Balanced force motions
The most effective technique to cut dentin
The oscillation of the preparation instruments
right and left with a different arc in each
direction.
Light inward pressure, initiating ¼ turn to the
right, larger arc is used when the file is rotated
to the left to drill the canal open. Alternate
these two directions until the working depth is
reached.
Steps in root canal preparation
Initial measurements
Tentative working length
Radiograph of Initial Apical File (IAF)
Setting instruments
Canal preparations
Initial Apical File
File apikal awal
File pertama yang bisa dimasukkan ke dalam
saluran akar sepanjang kerja
File pertama bisa nomor berapa saja,
tergantung besar saluran akar. File tidak boleh
longgar, tidak boleh ketat.
Masukkan file ke saluran akar sesuai panjang
kerja estimasi dan ambil radiographnya.
Root canal preparation - Objectives
A continuously tapering preparation
Original anatomy maintained
Position of the foramen maintained
Foramen as small as is practical
TOTAL SPACE OBTURATION
Root canal preparationpreparation-technique
Standardized technique
Step back technique = serial technique
Step down technique = crown down
Starting at the apex
Starting at the orifice of the canal
Combination or hybrid technique = step down
– step back technique, modified double
double--flared
technique
Standardized technique
Round, tapperred, almost paralell
Step back technique
Starting at the apex with fine instruments and
working one’s way backback-up or down with
progressively larger instruments.
Introduced by Mullaney.
Designed to avoid apical zipping in curved
canal
Still suitable in curved canals
A. Phase I – Apical preparation up to file
no.25 with recapitulation using prior size
file
B. Phase II – Stepping back
procedure in 1mm increments, nos
25 through 45. Recapitulation with
a no.25 file to full working length.
C. Refining phase IIA-gates glidden drill
nos 2, 3 and 4 used to create coronal and
midroot preparation
D. Refining Phase II-B – No.25 file,
circumferential filing smooths stepback
E. Completed preparation – a continuos flowing
flared preparation from the
cementodentinoenamel junction to the crown.
In curved canals
Always curved files
Always use lubricant
Step down technique
Advocated by Marshall and Pappin, called
Crown--down pressureless preparation
Crown
Using gates glidden and larger files in the
coronal third of the canals and progressively
smaller files are used from the ‘crown‘crown-down’
until the desired length is reached
Known as Step down = crown down
technique.
Primary purpose: to minimize or eliminate the
amount of necrotic debris that could be
extruded through the apical foramen during
instrumentation.
Will prevent post treatment discomfort,
incomplete cleansing and difficulty in
achieving a biocompatible seal at the apical
constriction.
Advantage: freedom from constraint of the
apical enlarging instruments by coronal
flaring.
Hybrid technique
Step-down step back
StepK-file series step down technique
Modified technique
Ruddle technique
Profile GT taper technique
Quantec instrument technique
Stainless steel instrumentation
limitations
Too many instruments and steps needed
Each resultant shape is different
Canal transportation
Excessive dentin removal with rotary
instrument such as gates glidden burs
Nickel titanium
Flexible
Fatigue and fail if overstressed, especially
during rotation - fracture
Nickel titanium rotary
instrumentation
Profile system
Protaper system
Light speed system
Ultra--sonic Instrumentation
Ultra
File dibengkokkan