P2-ENDO LEC-PPT 1ST LECTURE

Disinfection

This is Reduces the number of viable microorganisms but doesn't kill all of them

High level

Intermediate level

Low level

List the 3 levels of disinfection

Sterilization

This Destroys all microorganisms, including viruses, bacteria, fungi, and spores

Steam autoclave

Dry heat

Chemiclave

Ethylene oxide glass

Immersion in liquid chemical disinfectants/ sterilizers

5 types of sterilization

1. Autoclaving

2. Chemiclave

3. Dry Heat

4. Cold Chemicals

4 Common Sterilization methods in Dentistry

Autoclaving

THis common sterilization method is

Most common method in healthcare

Chemiclave

THis common sterilization method

Uses a mix of 72% ethanol and 0.23% formaldehyde instead of water (as in autoclaves)

Dry heat

THis common sterilization method

Uses high-temperature air

Cold chemicals

THis common sterilization method

Used only for heat sensitive instruments

Steam

In autoclaving/steam sterilization, what is used under pressure to sterilzie instruments

Steam

Time

Pressure

Temperature

Key parameters of Autoclaving

Autoclaving/steam sterilization

This sterilization method in dentistry is most common in healhtcare

30 mins at 250F (121C) and 15psi

WHat is the standard cycle in autoclaving

10 mins at 273F (134C) and 30 psi

What is the flahs sterilization of autoclaving

Statim Autoclave

Uses higher temperature for faster cycles

Excellent penetration of moist heat

Instruments can be wrapped, extending shelf life

Safe for most dental tools and cloth materials

Advantages of Autoclaving

Dull or corrode sharp tools

Not suitable for heat/moisture sensitive items like plastic or rubber

Requires air drying to prevent dust

Disadvantages of Autoclaving

Chemiclave/chemical vapor sterilization

This sterilization method Uses a mix of 72% ethanol and 0.23% formaldehyde instead of water (as in autoclaves)

72% ethanol & 0.23% formaldehyde

IN chemiclave/ chemical vapor sterilization, what mixture does it use instead of water

270F (132C) at 20 psi for 20 minutes (including drying time)

Chemiclave/chemical vapor sterilization, what is the cycle

Releases strong chemical odors (formaldehyde)

Requires proper ventilation

Instruments may retain smell

Not suitable for sterilizing liquids

Use steam autoclave instead

Disadvantages of Chemiclave

Prevents rust and dulling of instruments

Ideal for carbon steel tools

Fast turn around time

Advantages of Chemiclave

Dry heat sterilzer

THis sterilziation method Uses still or forced air, prevent instruments corrosion and require no water or chemicals

Still-air models

THis model of dry heat sterilizers would

sterilize in 1 hour at 375F (191C)

Forced-air models (Cox)

THis model of dry heat sterilizer sterilize in 6 minutes

Glass Bead Sterilizer/ Salt Sterilizer

This sterilization method Has glass beads (pebble/ crystal) that heat up and sterilize the instruments

Salt sterilizer

Other name for glass bead sterilizer

Glass Bead Sterilizer/ Salt sterilizer

THis sterilization method :

Chair-side sterilization between appointments

No longer recommended because it is ineffective in killing spores and bacteria in endodontic instruments

Used glass beads to transfer dry heat

450F (218C)

Glass bead sterilizer Previously used for sterilizing endodontic instruments during treatment at _____ for a few seconds

CRitical items

This category of items is:

-Touch sterile areas or enter the vascular system; penetrate oral mucosa

-MUst be sterilized; single-use items disdcarded

-E.G: FIles, nerve broaches, most of endo materials since they are introduced in the canals

SEmi-critical items

This category of items is:

-Touch mucous membranes but do not penetrate tissues

-Sterilize if possible; otherwise ,high-level disinfection

-e.g Examiantion & operative instruments, impression trays, nonsurgical burs and stones, othdontic tools, saliva ejectors, water syringe tops, lab prostheses

Non-critical items

This category of items is:

-Do not contact mucosa; touched by contaminated hands or fluids

-DIsinfection required

-E.g: X-ray tube head, dental chair headrest, instrument tables, suction and saliva ejector handles, dental light handles, spittoon

Critical items

Endodontic files are considered as what cateroy of items

1. Gutto percha

2. Sealers

3. Endo points

In sterilizaton of endo materials, what are the 3 materials palced inside the canal afte rcleaning and sealing

Sodium Hypochlorite (NaOCl)

What is the common disinfectant used for RCT

Disinfection

This is a process that reduces the number of viable microorganisms to an acceptable viruses or bacterial spores

Disinfeciton

This is Used when sterilization is not possible, to help prevent cross-contamination

Chlorine Dioxide

SOdium hypochlorite

Iodophors

Alcohols

Quaternary Ammonium Compounds

CLean Surface In A Quarentine

5 examples of disinfectants

Chlorine dioxide

This disinfectant is:

Uses: Instruments and operatory surface disinfection

Advantages: Fast acting (1-3 mins), n rinsing, no residue

Disadvantage: Corrosive to oxidized metals, must prepare fresh solution each time

Sodium hypochlorite

This disinfectant is:

Uses:Surface disinfection (not for instruments)

Advantages: Effective, relatively quick( 3-30 mins depending on debris)

Disadvantage: Highly corrosive to metals

Iodophors

This disinfectant is:

Uses:Broad-spectrum disinfection (HBV, TB, etc.)

Advantages: Effective against many pathogens, slow iodine release enhances effect

Disadvantages: Inactivated by hard water, slower action(~30 mins)

Alcohols

This disinfectant is:

Uses:----

Advantages:----

Disadvantages: Not accepted by ADA for surface or isntrument disinfection

Quaternary ammonium compounds

This disinfectant is:

Uses:----

Advantages:----

Disadvantages: Disapproved by ADA for dental use

Sensitivity

THis is If the test is able to identify which tooth is diseased

Specificity

This is the Ability of the test to identify if the tooth is healthy

Pulpal Response

THis is Reaction of the tooth to stimulation

Ability of the pulp to react to the stimulus, to give a neural response

Vitality testing

THis is

Assessment of the blood supply in the pulp

Checks for vascularity

Test for pulp vascularity

The second part of the vitality test is called

Cold test

In assessment of pulp sensibility, This is the First type of pulp sensitivity test

Adelta fibers (Acute pain)

In the cold test, what fibers are affected if there is contractin of dentinal fluid within the dentinal tubules

Ice in Gauze/ Ice pencil

In assessment of pulp sensibility, application methods, this si teh simple and most inexpensive,

Disadvantage is that ice melts, going to other teeth, giving a reaction from it

Ethyl chloride

Application method in cold test

-41C sprayed onto cotton pledge

Dichlorodifluoromethane (ddM)

Application method in cold test

-50C refrigerant spray

Dry ice (Frozen Co2)

Application method in cold test

-78C effective on metal restoration but damage porcelain in 5 seconds

Ice cold water

Application method in cold test

Rubber dam isolation required useful across all tooth types

Heat test

This test is Less commonly used due to: Greater patient sensitivity to cold

Heated gutta percha

Application method in heat test

Softens at 65C heated to -150C

Hot water

Application method in heat test

Syringe delivery under rubber dam

Frictional Heat

Application method in heat test

Generated via rubber prophylaxis cup

System B devices

Application method in heat test

Allows preset temperature

Heat test

This test is Stimulating the A-delta fibers first, followed by C-fibers (main fiber stimulated): Chronic, dull, lingering pain

Electric Pulp Test

This test is battery-operated with probe

Toothpaste

In Electric Pulp Test (EPT), what is the best conducting medium?

1. Bipolar

2. Monopolar

In Electric Pulp Test (EPT), what are the 2 stimulation modes

Bipolar

Which mode of Electric Pulp Test is More accurate and Current confined to coronal pulp

Monopolar

Which mode of Electric Pulp Test is More common in practice

Incisal thirds near pulp horn

Best sites for EPT IN ANTERIOR TEETH

Mid-third region or mesiobuccal cusp in molars

Best sites for EPT IN POSTERIOR TEETH

Incisors

What teeth has lowest reaction for EPT

Molars

What teeth has highest reaction in EPT

Crown surface temperature

In assessment of pulp vascularity, This

Measures the temperature of the crown

Specifically, the changes of the temperature of the blood flow inside the crown

Transmitted Light Photoplethysmography (TLP)

In assessment of pulp vascularity, Utilizes scattered light towards a tooth

Xenon-133 radiographs

In assessment of pulp vascularity, this

Does not test temperature of blood flow but would tell that there is flow of blood

Uses expensive materials

Utilizes xenon gas

Used in researches and in clinic setting

Dual Wavelength Spectrophotometry

In assessment of pulp vascularity

Laser Doppler Flowmetry (LDF)

In assessment of pulp vascularity, this

Uses helium-neon light (632.8nm) or other wavelengths (600-700 nm)

Light is scattered by moving RBCs, producing frequency shifts (Doppler principle)

RBCs would reflect light to the photodetector

Photodetector would quantify/ detect the amount of RBCs

Backscattered light detected, signal reflects red cell flux (number x velocity)

Pulse oximetry

In assessment of pulp vascularity, this

Measures oxygen saturation in tissue via red (640nm) and infrared light

Detects changes in light absorption by oxygenated/ deoxygenated hemoglobin (found in RBCs)

Loupes

In assessment of Cracks and Fractures

Magnification, These are magnifying like eyeglasses, offering around 2-4x magnification

Pros:

Affordable, easy to learn, portable

Cons:

Fixed magnification, limited lighting, requires head movement for focusing

OPerating microscopes

In assessment of Cracks and Fractures

Magnification this:

Provide variable magnification and coaxial illumination

Offers clear 3D vision, excellent depth perception, and ergonomic comfort

Ideal for detecting fractures, extra canals, and perforations in complex endodontic cases

Periodontal probing

In assessment of Cracks and Fractures

Magnification this:

Probing helps detect vertical root fractures (VRFs) and bone defects

1. J shaped/halo-like radiolucency

2. Abscess

in Vertical Root Fracture (VRF), If area has an isolated, deep pocket, 2 are present

Tooth slooth

In bite test, what is used to test one cusp at a time

Staining

In assessment of Cracks and Fractures

Magnification this test:

Dyes that are used to highlight cracks:

Methylene blue

India ink

Iodine tincture

These dyes seep into fracture lines and caries, making them more visible

TRanslummination

In assessment of Cracks and Fractures

Magnification this:

uses LED light to pass through the tooth

Healthy tooth

In transillumination, what is the status of the tooth if light passes through

CRacks/caries

In transillumination, what is the status of the tooth if appear as dark shadows

Files cut with back-and-forth (push-pull) motion

Reamers cut with a rotating motion

Instruments for Cleaning and Shaping of the Root Canal, in group I: Manually Operated Instruments

Differentiate files and reamers

Kerr Co.

K type instruments were first made by?

K-type instruments

These isntruments were Made by twisting square or triangular wire into a spiral

1.K Files

2. K reamers

in K-type instruments there are 2 types

K type instruments

These isntruments are Used to penetrate and increase canal size

TRue

True or false: K type instruments can be precurved

K-files

This type of K isntrument is

Square cross section

More flutes, less aggressive than reamers

Usage:

Filing

Watch-winding

Balanced force

Reamers

This type of k instrument is ;

Triangle cross section

Less flutes, more aggressive, more flexible than k-files

Usage:

Reaming

Hedstrom File(H-file)

This type of instrument is:

Cut only on pull strokes

Made by grinding a spiral groove into a metal shaft

Sharper than K-files but more likely to break if bent or twisted wrong

H type

THis type of instrument is :

Ideal for bulk removal of dentin

More aggressive than K-type

Difficult to bend

Method of manufacturing:

Machined

H-file

THis type of H instrument is

Round/ Teardrop Cross section

Very aggressive

Used more on the coronal part of the canal

Less torsional resistance

Usage:

Filling

Barbeed broaches and rasps

THese are

Oldest instruments used to pull out pulp

Pulp extirpation

Made by creating barbs on a tapered wire

Used to remove soft tissue, not dentin

1. Cutting

2.Non-cuting

3.Partially cutting

In the tip design it can be 3 types

Nickel Titainium

In metal alloys in files, these

Offers superelasticity

Bends and returns to shape

Ideal for curved canals

More flexible and less likely to break than stainless steel

PAtency files

In files, these are first files introduced to the canal after opening (when orifices are already seen)