TRATAMENTO DE CANAL - ENDODONTIA - REVISÃO COMPLETA

Hey everyone, how are you all doing? My

name is Rodrigo, and I'm here today to

do a video lesson about root

canal treatment. I will cover all the steps of

a root canal treatment in a very

clear and straightforward way. So let's go, shall we

? Root canal treatment. I put this

image here, look, it's pretty cool, isn't it? It was there

on Canvas. So, let's go. Here's my

Instagram, follow me there! What are

we going to study in this class? We're

going to look at the clinical examination part, what

we need to do before

diagnosing a root canal, and the

anesthesia part. which is the common part and involves the

anesthetic that we normally use.

We're going to talk about surgical

access, absolute isolation, which is the

basics, and the number of staples. And

a tip here: when we're

locating the canals, how are we

going to find these canals and what is the best way to

outline them, the

odontometry, which many people have

doubts about, how to explore the

canals, for example, which file

we start with, how to raise

or lower the files, the instrumentation of the

middle thirds, cervical and apical, the

obturation and a temporary restoration.

Basically, that's what we're going to cover

in this lesson, everything about the channel in a

very straightforward way. So let's go

. The clinical examination, what is the

clinical examination? It is the anamnesis and the

intraoral and extraoral clinical examination that we will

perform on the patient in order to make

a diagnosis. With the clinical examination alone,

we can already tell if a

tooth has needed a root canal or not, but we

have complementary exams that we

can do, such as the

periapical radiograph, which is the most important.

When we're going to perform a root

canal treatment, we can't do

it using a panoramic X-ray. Therefore, only the

periapical radiograph will

help us make a diagnosis and be able to

carry out this treatment. And we have to

take this X-ray using the

positioner, and with it we'll be

able to analyze the number of

canals and the curvature of that canal so

we can start this treatment already

knowing everything we can

expect. Anesthesia. The

anesthetic techniques used are those that

will anesthetize the pulp, but we

also need to perform

infiltrative anesthesia in the gum,

because it will receive a clamp there and

that clamp ends up causing injury. So,

in addition to anesthetizing the pulp,

we can perform an infiltration there

to be able to place the clamp. We

typically use lidocaine with a

vase or artecaine with a vase. An adult

typically uses around two to three

tubes. If it's a child, we

need to do the calculation. If

you don't know, I can record a

video lesson explaining how to

calculate the anesthetic dosage. And after

we administer the anesthesia,

we need to wait 5 minutes

for it to really take

effect. Otherwise, if we start

working on the tooth, the patient will complain

of pain, but that's because

we didn't wait. And for the

upper arch, we'll wait 5 minutes

for the upper arch and 15 for the

lower arch, because in the

lower arch, the maxillary bone, the mandibular bone

, is denser, so

the anesthesia doesn't penetrate as

easily. The access surgery, I'll

explain, is done according to the teeth:

the incisors, canines, and premolars,

lower premolars (he'll

change a little something), upper molars, and

lower molars. The incisor teeth

form a triangular shape; I'm drawing it

here on the screen. With the base facing the

entrance exam above the symbol. We'll

start with the pen at a

45º angle. After you come down here, okay? The active tip

of the pen, after going down more or less, look,

two active tips, we tilt it and it

comes up vertically, almost vertically.

The drill bits we typically use are

10 12 or 10 111 for accessing the area

. It fell into a void, we use these

here to let them do a refined job,

give the contour there, which is the 3081 and 3082

with an inactive tip or the endoscope. An endoscope

is a drill with a very sharp

cutting edge, so if you're going to do your

first root canal treatment in

college, then it's a drill that requires

a little more

care. I'll explain and

draw as I go. I uploaded an image

I found on Canvas; I couldn't find

a complete image of both arches,

but that's basically it. Here's the

symbol. We're going to make a triangle

with the base here, facing the

incision. That's pretty much it,

okay? This applies

to both upper and

lower incisors. Here's an inferior one, but it

works for both sides. In canines and

preolaries, it is an oval-shaped contour

in the center of the occlusal surface. And we follow the

same parameters as here, the same drills,

the same things. The format is changing, or will change

. So it's canines and

premolars. I'm going to grab a tooth here that

's good for drawing, look. This one's

cool. So it's going to be more or less like this in the

pit. What will change? Why did

I place canines and premolars and

separate the lower premolars?

We're going to make a 45º angle and

then we'll go vertical, because

the inferior preolae, normally

this cusp here, the

lingual cusp, is a little bigger than the

vestibular cusp or usually the same

size. So we have to make

this incline so we can get

in. It's a little different from the

upper premolars. And here we're going to use the

same drill bits, and then we're going to use the

truncated cone bits to create the

outline shape. The upper molars are

triangular in shape with the base facing

buccally, slightly pulled towards the medial side.

So it's going to be something like this, see?

Pull the base of the triangle slightly towards the mesial side

. So it's more or less like this

, more geared towards the mesa which has

this slight incline. And the

lower molars are basically the same

shape. The drill bit here is what will

differentiate it, folks, because here I put

10 11 10 12 and here it's usually 10 12 and

10 14. Remember? They all have to have the

long shaft, which is HL, so we

can make the access fall into the void.

Of the lower molars, it is a

triangular or trapezoidal shape with the base

also facing mesially. The only

difference is that it's not as large as the

top part. So here, look, it's going to be

more or less, giving an example here,

as if it were the top part, it

would be more or less like this

, not quite like the top part.

The bottom one would look something like this

. And here would be the

channels. Oh, and normally we

'll do it the same way. This one

we can come in either completely

vertical, it depends a lot on the anatomy of the

tooth, the patient's opening, we

come in with the spherical bur and then

we use the tapered cone bur to give it this

shape. Let's go. Isolation is

mandatory for root

canal treatment. There's no way to do root

canal treatment without isolating the affected area. And we don't

need to be completely bound by the

rules of restorative dentistry, to follow them to the letter.

Well, like these teeth here, some

teeth have broken crowns, they

can have different anatomy and

characteristics. So, if

we can find a clamp that's

firm, that

really manages to hold the

sheet in place, even if it's not the clamp

used for that tooth, we can

use it, there's no problem at all. We ca

n't pay too much attention to

that. The clasps, right? 210, tooth 211

are for anterior teeth, 206 and 209

for molars, 200 to 205 for molars.

I believe you all have little

doubt here. And then there's the W8A, which is a molar

with little retention for us to

isolate. The location of the canals.

To locate the canals, we're going to

use an exploratory probe.

The front teeth typically

have one to two canals, the premolars have

one to three, and the molars have

three to four canals. This was a

brief explanation, but we'll be

able to see all of this when

we do the X-ray, step by step,

as we already discussed at the beginning of the

video lesson. Now comes the most

important part, which is odontometry and

canal instrumentation.

To determine the

tooth length, we'll take an

initial radiograph using a positioning device to

avoid distortion. And we're going to

measure the apparent length of the tooth,

which is the CAD. So, we took the

x-ray there, and this is the tooth.

We're going to measure it and subtract 3 mm

to get the provisional working length

, which we'll use

to start exploring the

canal. So, we measured here, got x, then it

would be x - 3 mm for us to be able to

arrive at the provisional working length

. So let's begin

exploring the canals. We're going to use the

provisional working length that

I just told you about. First, we

irrigate. This

irrigation must be done very

carefully. Go slowly, put a

little bit on, take it off, put it back on, use the suction device

so we can remove it gradually, because if

hypochlorite gets on clothes, in your mouth,

anywhere, hypochlorite is not good,

not even on your hands. So, be very

careful about that. We're going to

irrigate with hypochlorite, as I've already

told you. Well, add the

hypochlorite slowly and suck it up so it doesn't

overflow. Let's go. Okay, so we can

start exploring this

channel, we're going to begin with file 10

and go into the channels and explore.

So, we do

exploratory movements to really get to know

the canals, and we

irrigate them regularly to

kill these bacteria and

clean them one third at a time

. We did it with file #10, we're going to

switch and do it with file #15,

exploring further. We're not going to go all the way down at

once; we'll proceed

carefully, entering and irrigating, doing it

third by third, so we can

remove these bacteria and prevent them from reaching the

apex. Okay, we did the

initial exploration, we used files

10 and 15. We did the initial exploration and

we did the irrigation. Now we're going to

prepare the mid-cervical region

. We're going to widen the

cervical third to the point of reducing the

bacterial load, and you'll be able to reduce the

strain on the file we'll be

using. Because, you agree with me, if

the canal is very tight, when

we use a file,

if it needs to

bend a little bit when it goes down there, it might

break in that area. So

here, we're going to widen the

cervical third to the point where we can reduce the

bacterial load and also reduce the

strain on the file.

The name of the technique is the crowdol technique

that we're using. We

don't necessarily start with the #80 file, which is

a very large file, but we can

start with a smaller one. So what are

we supposed to do? We'll keep lowering

the 80-grit file until it goes in; there

's no need to force it. Oh, it was

just a little bit there. Okay, clean and rigate.

Let's go, 70. Wherever she goes, she cleans and

rips 60. Same thing. It continues until the

file that reaches the CTP (Central Processing Point) is found, which will be

considered the initial file when

instrumenting another third. So we

went on, look, 60, 50, 40, 30. Ah, so-and-so

managed to get down all the way

down there, there's the provisional working length

. So we're going to go

there and take an

X-ray of this file so we can analyze it. Either

we take an X-ray, or we can

use an

apex locator. And we're going to take this

x-ray with the file inside the tooth,

inside the CTP. What are we going to do? We're

going to measure the length. So let's go

. Let's draw it here. This here

is a tooth,

look. We're going to measure it. The lime went down.

Let me draw the little picture. Imagine

the lime has rolled down this far

. Beauty? Here's the lime entrance.

So we're going to measure the length from the

tip of the file to the root apex.

So, from here to here, vertex, let's

assume the result is 4. Okay? So, what are

we going to do? Subtract 1 mm.

So, 4 -

1 = 3. After that, we saw that

we have to go up 3 mm. So, what do

we do with this? We

'll add it up. The file was lowered to this point, which

was our provisional working length

. So it will be the

provisional working lengths plus

three more, which gives us that

safety margin. So here we begin to

have the actual

working length, which is the length at which

we will perform the instrumentation. How are

we going to perform this

instrumentation of the apical and middle thirds?

It depends. Dente

tabilente necro a gente vai subir quatro

limas. So, we're going to take that

memory file we made up here

, the first one that went all the way

down, for example, which was number

50.

So, let me see if I've included any

examples here. No, I didn't put it there. So,

let's say it was file 25. Then it was file

20. Yeah, let's say we stopped

with file 20. So, here, we're

going to come here with

file 25 and we're going to make that

movement, like a quarter turn. I remove debris,

scrape the walls, and irrigate. I turn it a quarter

turn, clean it, remove it, irrigate it,

and continue filing the walls.

So, we're going to start raising the files from

now on, see? We're going to do it

with a #25 file, okay? It ended? Lima

30, great, is it over? We're going to use the #

15 file to recap, so we can

kind of do a cleanup with the same

measurement. So, using file 30, we did

this recapitulation, then we did it with file

35, we're going to do the irrigation,

we can use this file for

recapitulation, to do this cleaning that

I'm talking about. And then the

number

40 file, and we use number 15. Great, we've finished

the instrumentation, everything's

perfect. So, what are we going to

do now? The filling. Root

canal filling. What are we going to do?

We'll need to test the cone with the

final diameter. So, let's say

we stopped at size 40 with the file,

so for the cone, we're going to use cone

number

40. We

need to check if this cone actually went all the way down

to the apex and stopped. So,

we're going to take another x-ray to

see if our cone worked, if

everything is clean, and if it

actually reached the length we

need to perform this root

canal treatment. When it reached the actual

working length, it locked up. Beauty. Now

we're going to handle the cement. Before

that, we have to dry it. We

dry it with a paper cone, we manipulate the

cement. Positioned cone number 40,

waited for it to dry, then brought

the accessory cones, placed them, then brought

the

presser foot, and cut off the excess. Okay,

filling done. It's very straightforward. It's a

very quick, explanatory video lesson. Then we

'll do the restoration, right? We're going to

make a cotton ball or a

Teflon strip with a stump, and we're going to do this

restoration, which can be done

with composite resin, depending on whether

you want to wait

for another dentist to do a

restoration later. It all depends. We make the

occlusal adjustment and leave that

tooth without any contact. Yes, it just takes

some time, because otherwise the patient

may experience

postoperative pain. So that's it, folks, the

video lesson ends here. I hope

I was able to explain it to

you. It was more of a check-up related

to root canal treatment. I hope I was

able to help you. If you

enjoyed it, leave a like,

subscribe to the channel, and see you next time. Yeah.