Advantages and Disadvantages of Rotary NiTi

Advantages Disadvantages
 Consistent, high quality canal shaping  Initial expense and maintenance costs
 Unsurpassed canal centring, even with  Reduced preparation times may limit
greater apical enlargement capacity of NaOCl to clean canals
 Simplified, streamlined, rapid effectively
preparation protocols  Instrument fracture
 Reduced operator fatigue
 Reduced risk of blockage (material
carried out on rotating instruments)
 Improved access for irrigants

Endodontic Irrigants: Advantages and Disadvantages

Irrigant Advantages Disadvantages
Sodium hypochlorite  Flushes debris  Irritant if rubber dam
(NaOCl)  Antimicrobial (bactericidal) leaks/caustic to vital tissues
 Dissolves organic matter  Risk of extrusion injury
 Lubricant  Stains clothes
 Inexpensive
Chlorhexidine  Flushes debris  Risk of allergy
gluconate (0.2%)  Antimicrobial  Expensive
 Lubricant  No solvent action
 Non-irritant
Local anaesthetic  Flushes debris  Expensive
 Lubricant  No antimicrobial action
 Non-irritant  No solvent action
Saline/water  Flushes debris  No antimicrobial action
 Lubricant  No solvent action
 Non-irritant
EDTA (17%)  Flushes debris  Cannot be used with NaOCl:
 Lubricant  Diminishes antimicrobial
 Removes smear layer activity of NaOCl
 Opens dentinal tubules  Demineralistaion with
EDTA + de-proteination
with NaOCl damages
dentine
 Endodontic Sealers
Type Example(s) Advantages Disadvantages
Zinc oxide eugenol Pulp Canal Sealer  Long history of use  Shrinkage on setting
EWT  Will absorb if extruded  Soluble
Roth’s Sealer  Slow setting time  Can stain tooth structure
Tubli-Seal  Antimicrobial effect  Negatively affect bonding of
 Radiopaque core materials
Calcium hydroxide Apexit  Antimicrobial effect  Soluble
Apexit Plus  Radiopaque  May weaken dentine
Sealapex
Glass ionomer Activ GP  Dentine-bonding properties  Hard to remove in re-treatment
Ketac-Endo  No antimicrobial properties  Minimal antimicrobial effect
Resin AH Plus  Long history of use  Some release formaldehyde
EndoREZ  Adheres to canal walls when setting
RealSeal  Can adhere to core  CHX as an irrignat reduces
 Slow setting time bond strength
 Does not contain eugenol
Silicone GuttaFlow  Triturated (fine powder)  Expands slightly on setting
RoekoSeal  Long working time  Setting time is inconsistent
 Fills canal irregularities with  NaOCl delays setting time
consistency
 Biocompatible
Bioceramic SmartSeal  Hydrophilic  Minimal supporting clinical
SmartPaste Bio  Does not shrink on setting data
 Biocompatible  ? ease of removal for re-
 Antimicrobial properties treatment
Calcium silicate MTA Fillapex  Biocompatible  Expensive
(MTA)  Inert  Difficult to handle
 Adequate working time  Difficult to remove

European Society of Endodontology: Endodontic Outcomes

Success
 Intact lamina dura
 Normal periodontal
ligament space
 Absence of clinical signs
and symptoms of disease
 No loss of function
Survival Failure
The tooth is still present,  Persistent or enlarging
although there is: periapical disease
 Radiographic evidence of  Signs and symptoms
periapical disease which associated with the tooth
may still be the same or  Continuing resorption
slightly diminished
 An absence of signs and
symptoms
 Factors that Influence Endodontic Success
Influencing Factors Effect of Likelihood of Success
Presence of periapical lesion  success by 49%
Size of periapical lesion Every 1mm  in size,  success by 14%
Presence of sinus  success by 48%
Presence of perforation  success by 56%
Achieving canal patency Doubles chances of success
Apical extent of canal instrumentation 12%  success for every mm not instrumented
Over extended root filling  success by 62%
Irrigation with CHX and NaOCl  success by 53%
Irrigation with EDTA and NaOCl Doubles success of re-treatment only
Associated pain or swelling between visits  success by 47%
High quality coronal seal 11 x greater success

Factors to Consider Before RCT

Patient factors  Lengthy appointments
 Multiple appointments
 Potentially costly treatment
 Anxiety of patient
 Medical conditions
Mouth factors  Active caries/periodontal disease
elsewhere in the mouth
 Limited mouth opening/unable to
access affected teeth
 Difficulties placing rubber dam
Tooth factors  Diagnosis unclear
 Restorability of tooth
 Periodontal condition
Root factors  Patency
 Root canal anatomy
 Apical development
 Previous RCT
 Separated instruments
 Additional pathology