Endodontic Clinical Simulation Manual 2014/2015 - kau year Manual 2014-15.pdf · Endodontic...

Conservative Dental Sciences Department

Endodontic Division

Endodontic Clinical Simulation (END 422)

4th

Year Dental Students

Endodontic Clinical Simulation Manual 2014/2015

Head of Department: Dr. Khaled Merdad

Course Director: Co Course Director:

Prof. Rajab Saif Dr. Hadeel Edrees

Student name: ____________________________

Computer no. : _________________

E-mail : ____

2

Welcome Note:

We welcome you to Endodontics for the fourth year. You will notice that this year marks a turning point in the

approach of teaching. What has been known as “preclinical Endodontics” for long years is being replaced by

the new emerging methodology of SIMULATION. Therefore, we are referring to Endodontic Simulation

instead of preclinical Endodontics. This approach will maximize the learning opportunities for the participants

in the course.

Practicing the treatment ergonomics will be emphasized as well as getting acquainted with the new technologic

advancement in the field like Electronic Apex Locators, Rotary semi-automated root canal preparation and

thermo-plasticized obturation. Also, this approach will decrease the need for natural teeth, as it will be replaced

by plastic artificial ones with pre-specified criteria that fit the learning objectives of the course.

This plethora is being conjugated with the dawning of application of Micro-dentistry into the teaching

methodology. This will put you –our students- on the edge of modern endodotnics.

The head of division, course director and the rest of the teaching staff welcome you to this exciting course and

we all wish you fruitful journey ending with golden skills that will set up the stage for your clinical

maneuvering skills.

Endodontic Simulation Course Description:

The simulatory part of the Endodontic Simulation course is designed to provide first hand-on

Endodontic Simulation training and experience utilizing a simulated plastic artificial teeth (Real-T Endo

Series) & extracted human teeth. The course presents demonstrations on the endodontic components of

radiographic interpretation, access preparation, root canal negotiation, tooth length determination,

preparation, and obturation of the root canal systems. After attending and practicing this Endodontic

simulation course, the student will be competent to master the technical procedures in root canal therapy on

mounted teeth.

For simplicity and more controlled procedures' evaluation time, the Endodontic Simulation course was

divided into three due dates for evaluation, specified Projects (P) as P1, P2, and P3 according to the

respective practical step.

The present course manual will guide you in performing each step of the Endodontic procedures. It

details the required activities, the practical steps, the criteria for evaluation of each step, the evaluation

system and methods (including self assessment), the course marks distribution for the continuous assessment

part, and the final practical competence exam.

3

Clinical simulation course objectives:

1. Recognition of pulp space anatomy for maxillary and mandibular anteriors, premolars, and molars teeth

and drawing of their relative access cavities.

2. Access cavities preparation for the required teeth.

3. Locating canal orifices for the assigned teeth.

4. Working length determination for the assigned teeth.

5. Cleaning and shaping of the canal system of the assigned teeth using both hand ‘’St. St.’’ files and rotary

NiTi instruments.

6. Three dimensional obturation of the cleaned and shaped canal system of the assigned teeth.

Clinical Simulation Course ‘’Minimum Procedural Experiences (MPEs)’’:

1. Drawing access cavities for maxillary and mandibular anteriors, premolars,

and molars teeth.

2. Eight artificial and natural teeth -representing a sum of 13 -14 root canals, mounted, and radio

graphed on which all the steps for endodontic treatment are made according to the course objectives.

These will be as follow:

• 3 Single rooted artificial anterior teeth and one natural anterior tooth (Real-T Endo # 8)

• 2 Premolars, one artificial (Real-T Endo # 29) and one natural

(one of them should be double rooted)

• 2 Molars (one artificial and one natural)

Directions:

Familiarize yourself with all chapters of this practical manual guide.

Familiarize yourself with the endodontic evaluation form.

Have each step on this form approved and signed by an instructor before proceeding

to the next phase of treatment.

Have your plastic & natural teeth and your mounted radiographs approved by the assigned endodontic

faculty member.

Be noted that the practical procedures’ deadline for presentation for final evaluation is extremely important

(P1 through P3 as seen in the practical schedule).

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Steps 1-3: Teeth selection, mounting on Modu-Pro segments, and radiographing:

Important notes in teeth selection:

- Wearing personal protective equipment (e.g., gloves, mask, protective eyewear) when

handling extracted teeth is a MUST in natural teeth & to simulate clinical situation in

plastic teeth

- If natural extracted teeth used, certain precautions should be followed:

* Only freshly extracted teeth should be used in this course.

* Selected teeth should have intact, preferably non carious crowns and accessible pulp

chambers and root canals as confirmed radio-graphically.

* Selected teeth should have a mature, non-fractured root, relatively straight roots or

with mild root curvatures.

* Teeth should be cleaned from calculus and/or soft tissues attachment.

* Cleaned teeth should be placed in sodium hypochlorite solution (NaOCl) 1/10 for a

whole night. Teeth should then be removed from the NaOCl solution, washed under

tape water and kept in saline solution ready for sterilization. DO NOT ALLOW

TEETH TO DRY OUT.

Mounting Of Plastic Teeth in Modu-Pro Segments In Carrier Trays: • Each modu-pro has a socket designed to accommodate one natural or artificial plastic Tooth not More

Than 25 Mm In length

• The socket should be clean & dry before mounting the tooth

• Follow the instructions below for proper tooth placement.

Steps: 1- Using round bur, cut a horizontal notch in the coronal third of the tooth root on the buccal or lingual surfaces

this will help the tooth to lock in the fixing gel (Figure 1)

2- Place the apex putty in the bottom of the socket; at least 2 mm in depth beyond all root apices

3- Fill the entire socket around the tooth with fixing gel to cover the entire tooth’s surface to the CEJ.

4- Allow the fixing gel to set approx. 30 minutes (full strength in 24 hours) .

Figure. 1

Sterilizing of human extracted teeth and Mounting:

Before use in the lab, extracted teeth should be heat-sterilized to allow for safe handling. The following are the

steps for sterilization of amalgam-free teeth:

1. Do not heat sterilize any teeth containing amalgam?

2. Clean and thoroughly rinse any amalgam-free teeth to be sterilized.

3. Place amalgam-free teeth in a heat-resistant glass container (Fig 2).

4. Fill the heat-resistant container no more than half–way with distilled water or saline, and

cover loosely (e.g., use a cork to close a flask).

5. Process through a steam sterilizer at 121ºC for 40 minutes using a fluid or liquid cycle .

5

Figure 2

6-Mount the extracted tooth in Mudo-Pro segment as previous artificial (Real-T Endo)

Keep the segments with the natural tooth in saline whenever you are not working with them.

Radio-graphing the mounted teeth:

X-ray units are present in the clinical simulation lab. Familiarize yourself with these units prior to the

first scheduled lab. Their exposure time is fixed. You must hold the timer button down throughout the

entire exposure. To minimize waiting time, know what you want on the radiograph before getting in line,

e.g. are you trying to display two roots with three instruments, check a fill, etc.

1- Place the film on horizontal flat surface

2- Place the Modu-Pro Endo

3- Segment on its side by aligning the tooth to be X-rayed faces the center of the X-ray beam

4- Shoot the radiograph, proceed or digitalized

N.B.

* Prior to the second lab session, one buccal and one proximal exposure are required for each of your

mounted teeth. After developing, films should be dried and mounted on individual filmstrips.

* When exposing your films ALWAYS be sure that the “dot” is positioned at the coronal end of the tooth.

Once dry, identify and mount the film. Mount films as you are taught in radiology (right on the left, etc).

Mount working films in the same sequence in which they were taken using four whole films mounts.

Drawing Endodontic Access Cavity Outline in

Anterior Maxillary & Mandibular Teeth:

Access cavities drawings (HW):

As a prerequisite to practical access cavities drilling in the required natural teeth (step3), the access

cavities outlines should be drawn on the respective teeth on sheets #1-3 as specified in the practical

session schedule

6

Sheet.1

Draw the access cavity outline for the above maxillary central incisors:

Note: The Left is a tooth of a young & adult, while the Right is for an old (Geriatric)

The drawn central tooth shows the exact central position of the access cavity

at the middle of the tooth

Sheet 2

MAXILLARY CENTRAL INCISOR

Supervisor Signature: Date:

7

Sheet. 2

Draw the access cavity outline for the above mandibular central incisors:

Note: The Left is a tooth of a young & adult, while the Right is for an old (Geriatric)

The drawn central tooth shows the exact central position of the access cavity at the middle of the tooth

MANDIBULAR INCISORS


8

Sheet. 3

Draw the access cavity outline for the above maxillary and mandibular canines

MAXILLARY

CANINE

MANDIBULAR

CANINE


9

Sheet. 4


Maxillary & Mandibular Premolars (Bicuspids)Teeth:

Draw the access cavity outline for the above maxillary and mandibular premolars

MANDIBULAR

2nd

PREMOLAR

MAXILLARY

1st PREMOLAR


10

Sheet. 5


Maxillary & Mandibular Molar Teeth:

Locate the orifices of root canals in case of 3 root canals & Draw the access cavity

outline for the above maxillary molars

Sheet 6

MAXILLARY

1ST

MOLAR

MAXILLARY

2ND

MOLAR


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Sheet. 6

MAXILLARY MAXILLARY

1st MOLAR 2

nd Molar

Locate the orifices of root canals in case of 4 (with MB2) root canals & Draw the access cavity outline for

the above maxillary molars

Date:


12

Sheet. 7

Locate the orifices of root canals & Draw the access cavity outline for the above mandibular molars with

3 root canals

MANDIBULAR

1st MOLAR

MANDIBULAR

2nd

MOLAR


13

Sheet. 8

MANDIBULAR MANDIBULAR

1st MOLAR 2

nd MOLAR

te the orifices of root canals & Draw the access cavity outline for the above mandibular molars with 4

root canals


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Sheet. 9

Diagrams illustrating radiographs obtained prior to, during, and at the completion of root canal

therapy-order of mounting.

#1 Preoperative radiograph

#2 Initial file radiograph

#3 Master apical file (MAF) radiograph

#4 Master gutta- percha cone radiograph

#5 Postoperative Radiograph.

1 2 3

4 5

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Sheet. 10 ENDODONTIC INSTRUMENT:

Fig 1 Fig 2

Fig 3

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Sheet. 11

Fig 4

17

Fig 5

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Sheet. 12 Endodontic Clinical Simulation set up of Instruments and Materials

Bur Block:

#2, #4, #6 round carbide burs for coronal access. (Fig. 1)

Taper Diamonds and #16 safe tip carbide bur for refining access. (Fig.2)

Endodontic file Box (insert): (Fig.4)

25 mm Hand Files of the following sizes:

#10, 15, 20, 25 30, 35, 40, 45, 50, 55, 60, 70

80, 90, 100, 110, 120 ,130, 140

GG #1 #2 #3 #4

Rubber Stops

A set of NiTi instruments with 4% and 6% taper

(ProTaper Next )

Endodontic Tray: (Fig.3)

Mirror

Locked Pliers

Endodontic explorer

Spoon Excavator

#1 Glick Plugger

Endodontic Ruler

Irrigating Syringe

Obturation set up: (Fig.5)

AH 26 sealer

Glass Slab

Cement spatula

Assorted Gutta Percha points

Assorted paper points

Assorted finger spreaders

Torch

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Steps 4-7: Access cavity preparations in mounted teeth

Prerequisites:

• Read objectives, principles, and techniques of access preparation (H.W.)

• Drawings of the access cavity outlines of different maxillary and mandibular teeth should have been

done (H.W.)

• Attend the demo made by the assigned instructor of your group.

Directions:

1. Arrange your tray instruments and burs (sheet 10-12).

2. Take a preoperative radiograph for the selected and mounted tooth.

3. Develop, dry and insert the processed x-ray in its place in separate film mounts

(See sheet 9).

4. Have your selected teeth and film mounts approved by the instructor.

5. Start to gain access and canal orifice(s) detection for the selected and mounted anterior tooth (step 4).

6. Consult with the assigned instructor whenever you need.

7. Have your completed preparation signed on your evaluation form.

8. The above directions should be repeated with each of the required teeth (steps 5 through7).

Step 8: Working length determination:

Prerequisites:

• Read working length determination ‘’biometrics in endodontics’’ (H.W.)

• Attend the demo made by the assigned instructor of your group.

Directions:

(A) Radiographic Length Determination

1. Arrange your tray instruments (sheet 8).

2. Experience to determine the exact working length for each of the required-access made teeth.

3. Always select the proper reference point on the tooth you are treating. This should be either the incisal

of an anterior tooth or a cusp tip of a posterior tooth.

4. Detect the reference points for each root canal, so that your rubber stop can rest against a fixed point.


6. Correctly place working length radiographs in the relative endodontic film mount (eg. upper teeth

apex up ….etc) then place the date on the film mount under the radiograph (see sheet 9).

7. Record each tooth’s canal(s) working lengths in its place in the evaluation charts.

8. Have this step approved and assessed by the instructor before proceeding to the next step.

9. The above directions should be repeated with each of the required teeth.

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(B) Electronic Length Determination: (Figure.6) Using the Electronic Apex Locator with the Carrier Trays

Steps:

1. Place a drop of water on the magnet to ensure electric conductivity. Dry when finish

2. Make certain the Apex Locator Loop & the Mudo-Pro Endo apex locator ability are in contact to ensure

electrical continuity

3. Choose suitable file size in the root canal; a smaller file in a large canal may give you a erratic (false)

reading

Figure. 6

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Step 9: Cleaning and shaping of the root canal(s) of the selected mounted teeth

Prerequisites: • Read the chapter on cleaning and shaping of the root canal system (H.W.).

• Attend the demo made by the assigned endodontic instructor of your group.

Note:

* Single rooted maxillary anterior teeth and teeth with wide straight canals to be prepared with hand St. St.

instruments by the conventional step back technique. This includes: maxillary anterior teeth, mandibular

premolars, palatal canals of maxillary molars, and single distal canals in mandibular molars.

* Multi-rooted teeth with narrow, curved canals should be prepared with combination of stainless steel & NiTi

rotary instruments. Start with St.St. & complete with Ni Ti rotary. This includes: mandibular anteriors,

maxillary premolars ‘’double canalled’’, buccal canals of maxillary molars, mesial canals of mandibular

molars.

Directions:

1. Arrange your tray instruments (sheet 10-12).

2. Clean and shape each of the required extracted teeth according to the predetermined working lengths.

3. Start first by making apical preparation.

4. Irrigate each time you are going to change to the next larger enlarging instrument.

5. Clean the files frequently during this procedure.


7. Take an x-ray for the master apical file. Develop, dry, and show to the instructor a diagnostically

accurate radiograph of the final instrument (MAF) in position in the root canal.

8. Place this film in your endodontic film mount and write in the date. TAKE THIS (MAF)

RADIOGRAPH BEFORE YOU PROCEED WITH THE NEXT STEP OF CANAL’S SHAPING

(see sheet 9).

(A) For the hand step back technique:

9. During the step back procedure; make sure your final instrument seats to the full working length

after the use of each backfilling instrument.

10. Irrigate and recapitulate each time you are going to change to the next larger enlarging instrument.

11. Dry the root canal with sterile paper points. These points must be measured at the working length

and placed into the canal this distance. This is true each time paper points are placed in a root canal.

12. Have this step approved and assessed by the instructor for each tooth before proceeding to the next

step.

(B) For rotary NiTi instrumentation: you have to use the crown down preparation technique with the

specific sequence protocol of the NiTi system used.

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N.B.

Important points to remember during cleaning and shaping:

A- When a single root contains more than one root canal, it is important to determine if these

canals remain separate or join before reaching the apical terminus. To accomplish this:

(1) Determine the exact working length of each canal.

(2) Place a file into each canal at the same time. If both files extend to the apical

terminus, the two canals are separate (or join at the apical terminus). If one file

extends to its apical terminus but the other does not, then the two canals join.

B- When instrumenting two root canals which join into one canal in the apical third of

the root, first instrument completely the canal with straight line access to the apex (in these cases

it is Master Canal & is usually the lingual canal) and then, keeping the final instrument in this

canal in place, instrument the second canal to the point where it joins the first canal.

C- Always select the proper reference point on the tooth you are treating. This should

be either the incisal edge of an anterior tooth or a cusp tip of a posterior tooth.

Because rubber stops tend to move slightly on root canal files, the correct working

length should be continuously reconfirmed (measured) on each file during instrumentation.

D- Pay particular attention to the position of your rubber stops in relation to your

reference point. Failure to notice this change will lead to serious problems.

E- During hand instrumentation, do not proceed to the next larger size file until the

file that you are using has been worked sufficiently.

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Step 10: Obturation of the cleaned and shaped root canal system

Prerequisites:

• Read the chapter on obturation of the cleaned and shaped root canal system (H.W.).

• Attend the demo made by the assigned endodontic instructor of your group.

Directions:

1. Arrange your tray instruments (sheet 10-12), added to it assorted standardized master gutta percha

points, auxiliary points, sealer cement, and temporary filling.

2. Irrigate the pulp cavity of the previously cleaned and shaped tooth with sodium hypochlorite solution

3. Place the master apical file to the canal's apical terminus. This should always be done prior to filling the

root canal.

4. Thoroughly dry the root canal with paper points before fitting your master cone.

5. Select and fit a master gutta-percha cone in the root canal of the first tooth in the requirement set

according to the apical preparation size (MAF).

6. Expose and develop a radiograph of the fitted master cone.

7. Place this radiograph in your endodontic film mount and place the date on it (see sheet 9).


9. Have this step signed by the endodontic instructor.

10. Mix the root canal sealer, cements the master gutta-percha cone to the apical terminus.

11. Fill the remaining root canal space by employing the lateral compaction technique.

12. Expose and develop a radiograph at the completion of obturation and. Place this radiograph in your

endodontic film mount.

13. Consult the demonstrator before cutting the excess gutta percha.

14. Remove the excess coronally extruded gutta percha with a heated plastic instrument to the level of the

canal orifice(s).

15. Expose and develop a post-treatment radiograph. Place this radiograph in your endodontic film mount

and place the appropriate date on it (see sheet7).

16. Have this step approved and assessed by the instructor.

17. Repeat stages 2 through 16 for the remaining prepared assigned teeth.

Note:

*Make sure that an instructor has signed all steps on your endodontic evaluation form.

* Submit this completed form together with the PROPERLY MOUNTED RADIOGRAPHS of the teeth on

which you have performed endodontic therapy to the course director in the due time.

*No practical step forms will be accepted after the collection deadline announced in the practical schedule.

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Criteria for Evaluation: The initial practical exercises in this course (steps 1 through 3) are non-graded experiences.

I. CRITERIA FOR THE EVALUATION OF ACCESS CAVITY PREPARATION:

1. The walls of the access opening should extend laterally to, and be confluent with, the walls

of the pulp chamber. The access opening should appear to be an occlusal extension of the

pulp chamber walls.

2. All coronal decay must be removed (in human extracted teeth)

3. No overhanging dentin or pulp chamber roof should remain. As a test, an explorer should

be placed on the floor of the pulp chamber and it should be withdrawn, contacting the

lateral walls of the pulp chamber to the access opening. Any "catches" or impediments to

movement represent an incomplete access opening and those interferences must be

removed.

4. All walls must be divergent toward the access tooth surface

5. (in human extracted teeth only) No pulpal tissue remnants, including that in the pulp horns,

Can be left in the chamber.

While with incisors, incisal enamel triangle and lingual dentin shoulder should be

removed for convenience to assure a straight line access.

6. All root canal orifices must be fully exposed and accessible. An endodontic explorer

placed into each canal orifice must not rub against or bind on the walls of the pulp

chamber or access opening.

7. No bur marks or penetrations into the floor of the pulp chamber are permitted.

8. The final shape of the coronal access opening should conform to the internal anatomy of

the tooth; for example, the second canal in the distal root of the lower first molar.

9. Perforations are unacceptable.

CRITERIA FOR THE EVALUATION OF THE CLEANING AND SHAPING:

1. Canals should be prepared to the predetermined working length(s).

2. Over or under preparations are unacceptable.

3. Canal walls perforations are unacceptable.

4. Canals should be prepared to the optimum size with smooth continuously tapered pattern.

5. The selected spreader should pass easily within 1mm of the working length with space alongside for the

master gutta percha cone.

6. A seal or stop is identified by using a file smaller than the MAF at the working length.

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CRITERIA FOR THE EVALUATION OF COMPLETED GUTTA-PERCHA ROOT CANAL

OBTURATION:

1. The filling material must extend to the working length; from the orifices of the root canal

2. to the apical foramen.

3. No voids should be present within the body of the filling, or between canal wall and filling, for the

entire length of the root canal.

4. Condensation is judged to be completed when:

a. No voids are present as viewed on a radiograph, and

b. A spreader placed into the root canal cannot be pushed into the body of the filling material more

than 2 mm or 3 mm.

5. If a dense root canal filling is not present, the filling may need to be replaced. If replacement is not

possible, another tooth may need to be treated for credit, at the discretion of the instructor.

6. No excess gutta percha should be left in the pulp chamber; this should be removed to the level of canal

orifice(s). Chambers should be cleaned free from remaining sealer material.

7. The single-film verification radiograph should be clean, dry, and unstained when filed in the endodontic

film mount provided.

Student responsibilities to the course:

By the preclinical course attending and practicing you should be able to:

1. Review pulp cavity anatomy and relate its application to endodontic treatment starting from access

preparation to canal system obturation.

2. Demonstrate competence in the use of root canal instruments both in preparation and in obturation of

the single and multirooted teeth.

3. Demonstrate how to prevent and solve procedural problems and mishaps, for example, short or long

preparation.

4. Show competency in obturating the canals of single rooted teeth using Gutta-Percha and sealer.

5. Show competency in obturating the canals of multi rooted teeth using Gutta-Percha and sealer.

6. Evaluate the obturated canal in accordance with the written criteria.

26

Endodontic Clinical Simulation Rubrics

0 1 2

Tooth is too close to one or 2 of

the edges of the film.

Tooth tilted to one side, not

aligned with the film.

Tooth is positioned in the middle

at equal distances from the film

edges. AND tooth is upright in

alignment with the film

Presence of cone cut.

Presence of artifacts (debris or

others).

Image taken on wrong side of the

film.

Image is free of exposure errors

Image is too dark or too light.

Yellow or brown tint across the

film.

Incomplete fixation.

Good contrast and density exists

defining the different parts of the

tooth.

Preoperative

radiograph

Image not labeled (which tooth?

What angle?)

Film not mounted appropriately.

Image is labeled according to

tooth number and exposure angle.

Unable to identify the different

parts of the image or how they

appear.

Able to identify and interpret the

anatomical appearance of

different parts of the image

(crown, pulp chamber, roots, root

canals)

Faulty access cavity location,

outline or size with weakening of

tooth structure

Access cavity outline, size and/or

location is slightly off but

acceptable

No destruction of tooth structure

(marginal ridges, incisal edge,

cusp tip)

Correct outline, size and location

of access cavity

Presence of caries or previous

restoration or unsupported tooth

structure

(natural tooth)

Removal of caries, restoration

and unsupported tooth structure

with some guidance (natural

tooth)

Complete removal of caries,

restoration and unsupported tooth

structure completed

independently

Failure to de-roof the pulp

chamber

Complete de-roofing of the pulp

chamber

Access

Cavity

Failure to detect patent main

canals

Lack of straight line access

Detection of main patent canal/s

with some difficulty

Straight line access to the root

canal/s with Good coronal flaring

with some guidance

Detection of main patent root

canal orifice/s

Detection of extra canals with or

without guidance

Straight line access to the root

canal/s with Good coronal flaring

performed independently

27


0 1 2

Access cavity

Gouging of pulp walls and floor

and incorrect alignment causing

significant weakening of tooth

structure

Perforation with poor prognosis

or unrepairable coronal

perforation

Pulp chamber walls and floor

gouged with bur without

weakening the tooth.

Minimal adequate access cavity

extension

Pulp chamber walls untouched

with bur

Pulp chamber floor untouched

with bur

Incorrect selection of initial

apical file (IF) type or size (very

loose in canal, not resisting

coronal or apical pressure).

Poor file selection corrected

Initial file is K-type file.

IF is the largest file that fits in

the canal to estimated length.

Lack of reproducible reference

point Poor reference point corrected

Selection of reproducible

reference point

Poor quality working length

radiograph

Good quality radiograph

Good interpretation of working

length radiograph with some

guidance

Good quality radiograph (refer to

pre-op radiograph section)

without retake

Good interpretation of W.L

radiograph

Working

Length

Failure to correct long or short

working length in a patent canal

Working length within 1 mm of

canal terminus

Incorrect master file (MAF)

selection (too loose in canal

and/or no resistance to apical

pressure)

MAF fits snugly at WL

Resists apical pressure

Poor quality master apical file

radiograph

Good quality radiograph

Good interpretation of

radiograph with some guidance

Good quality of radiograph

without retake

Good interpretation of master

file radiograph

Lack of adequate irrigation

NaOCl not used for irrigation

(natural tooth)

Irrigation needle too large

Correct solution used for

irrigation with correct needle

gauge and application (loose in

canal)

Canal instrumented beyond WL

or too short form WL

Instrumentation to WL after

some corrections

Instrumentation to WL

independently

Uncorrectable error during

preparation (blockage, separated

instrument, ledge, perforation)

Preparation error corrected with

guidance

Smooth continuous walls free of

errors

Cleaning

&

Shaping

Complete lack of flare (unable to

insert selected spreader to WL-

1mm)

Over-flare significantly

weakening tooth structure

Spreader that is one size smaller

than MAF is loose at full WL.

OR spreader that is same size as

MAF is loose within 1 mm of

WL

Tooth structure respected

28


0 1 2

Master GP cone seated more

than 1 mm short of WL.

Master CP cone extruded beyond

the apical terminus.

Master GP cone not resisting

apical or coronal displacement

Master cone seated within 1 mm

of WL.

Size fits with good resistance to

apical displacement.

Acceptable resistance to coronal

displacement.

Master cone seated within ½ mm

of WL.

Good resistance to coronal and

apical displacement

Master cone radiograph of poor

quality Good quality radiograph

Final obturation length

discrepancy of 2 mm or more

Length discrepancy corrected to

WL

Obturation length comparable to

WL

Gutta percha above cervical

line/on pulp floor

Obturation material on walls or

floor of access cavity

Correction of coronal GP level.

Access cavity completely clean.

GP seared off at cervical line

level (anterior tooth) and pulp

floor (posterior tooth)

Access cavity completely clean

Root Canal

obturation

Lack of tapered root filling

Several voids in root filling

Poor radiographic homogeneity

Root filling with adequate taper

after correction

Acceptable density and

homogeneity of obturation

(minimal voids at mid root level)

Root filling with adequate taper

achieved independently

Dense homogenous root canal

filling

29

Final practical competency exam:

At the end of the course pre-announced final practical competency exam on the endodontic therapy of a

single-canalled mounted tooth will be made during one single session.

Grades will be given on access, cleaning and shaping, and obturation. Your final practical grade will be the

average of these steps, which will be done with no consultation from the instructor.

Course mark distribution:

I. Continuous assessment: 40%

1- MQE I 10 marks

2- Midyear examination 20 marks

3- MQE II 10 marks

4- MPEs 40 marks

________

80 marks

II. Final examination: 60%

1- Written examination 80 marks

2- Written Oral examination 20 marks

3- Competency Practical examination 20 marks

________

120 marks

Total: 200 marks

30

4th Year Endodontics Lecture schedule for the 1

st Semester Academic Year 2014 – 2015

Week

Date Topic:

Lecture Title Lecturer

Assessmen

t

(Quiz/

Assignmen

ts)

Reference

(Page numbers of the

main text or resource)

Practical

Sessions

And supervisors

Monday

8/9/2014

1

Wednesday

10/9/2014

•Introduction, Rational ,

indications &

contraindications Scope of

Endodontics

Prof. Khaled

Balto

MCQ Hargreaves K.M, Cohen S:

Pathways of the pulp, 10th Ed.St

Louis, 2011,Mosby

Project .1

Monday

15/9/2014

2

Wednesday

18/9/2014

•Components of the root

canal system & RC

Anatomy

.Pulp space morphology

and anatomical variation of

anterior permanent teeth

Prof. Sawsan

Abozaid



Louis, 2011,Mosby,

148-233

Project.1

Monday

22/9/2014

3

Wednesday

24/9/2014

.Endodontic Access Cavity

Preparation

Prof. Omar

Fahim



Louis, 2011,Mosby, 148-233

Project.1

Monday

13/10/2014

4

Wednesday

15/10/2014

•Pulp space morphology

and anatomical variation of

posterior permanent teeth

Prof. Sawsan

Abozaid


Pathways of the pulp, 10th Ed. St

Louis, 2011,Mosby,

148-233

Project.1

Monday

20/10/2014

5

Wednesday

22/10/2014

.Endodontic Access Cavity

Preparation

Prof. Omar

Fahim



Louis, 2011,Mosby, 148-233

Project.1

Monday

27/10/2014

6

Wednesday

29/10/2014

•Radiographic length

Determination

(Ingle’s Method)

•Electronic length

determination

Dr.Khaled

Merdad



Louis, 2011,Mosby, 290-400

Project.1

Monday

3/11/2014

7

Wednesday

5/11/2014

•Disinfection of pulp space Prof. Lubna

Alshafie



Louis, 2011,Mosby, 290-400

Project.1

Monday

10/11/2014

8

Wednesday

12/11/2014

•Intracanal medication Prof. Lubna

Alshafie


Pathways of the pulp, 10th Ed. St

Louis, 2011,Mosby,

290-400

Project.1

Monday

17/11/2014

9

Wednesday

19/11/2014

•Intra-canal Instruments

(Standardization)

Prof. Rajab

Saif



Louis, 2011,Mosby, 233-290

Project.1

Monday

24/11/2014

10

Wednesday

26/11/2014

•Material used for

manufacturing of Intra-

canal Inst.

•Intracanal instruments

(Traditional)

Prof. Rajab

Saif



Louis, 2011,Mosby, 233-290

Project.1

Monday

1/12/2014

11

Wednesday

3/12/2014

•Intra-canal Endod

Instruments (Hybird)

Prof. Rajab

Saif



Louis, 2011,Mosby, 233-290

Project.2

12 Monday

8/12/2014 •Intra-canal Endod Prof. Rajab MCQ Hargreaves K.M, Cohen S:

Pathways of the pulp, 10th Ed.St Project.2

31

Monday

8/12/2014

12

Wednesday

10/12/2014

Instruments (NiTi Rotary

Instruments)

Saif MCQ Louis, 2011,Mosby, 233-290 Project.2

Monday

15/12/2014

13

Wednesday

1712/2014

Microbiology Prof. Balto

32

Practical Endodontic Clinical Simulation (2014 – 2015) 1

st semester

La

b #

Stu

den

ts

Tim

e

Da

te

Practical Title Staff and Student activities during the

Lab session

M PM Monday

8/9/2014 1

F AM Wednesday

10/9/2014

Introduction to Clinical Simulation

Endodontics course description and

MPEs

Revision of the technical course description

and MPE’s

M PM Monday

15/9/2014

2

F AM Wednesday

18/9/2014

Simulation Endodontic Project1

(SEP1): 3 Artificial Ant. teeth& one

natural Ant. tooth

Orientation Clinical Simulation

Lecture for:

• Teeth selection and

mounting in Sectional

Endo Dent form (SED)

Teeth selection, radiographing and mounting

M PM Monday

22/9/2014 3

F AM Wednesday

24/9/2014


Lecture:

Demo for Access cavity preparation Ant.

teeth

M PM Monday

13/10/2014 4

F AM Wednesday

15/10/2014

Simulation Endodontic Project1

(SEP- 1)

• Access cavity ( Ant.teeth)

Demo for WL determination for Ant. teeth

M PM Monday

20/10/2014 5

F AM Wednesday

22/10/2014

Simulation Endodontic Project

(SEP- 1)

• Ergonomics

Access cavity preparation & WL

determination for Ant. teeth

M PM Monday

27/10/2014 6

F AM Wednesday

29/10/2014


Lecture:

• W L determination

(Radiographic method)

Demo for Cleaning and shaping of Ant.

Teeth using Step-Back Tech.

M PM Monday

3/11/2014

7

F AM Wednesday

5/11/2014


Lecture:

• Cleaning and shaping

Cleaning and shaping of Ant. Teeth using

Step-Back Tech.

M PM Monday

10/11/2014

8

F AM Wednesday

12/11/2014


Lecture:

• Cleaning & shaping using

rotary Ni-Ti system

Demo for Cleaning and shaping of Natural

ant. Tooth using Crown Down rotary Ni-Ti

system

33

M PM Monday

17/11/2014 9

F AM Wednesday

19/11/2014

Simulation Endodontic Project 1

(SEP- 1)

Cleaning and shaping of Natural Ant. Teeth

using Crown Down rotary Ni-Ti system

M PM Monday

24/11/2014 10

F AM Wednesday

26/11/2014


Lecture:

• 3 Dimensional Obturation of

RCS

Demo for 3 Dimensional Obturation of root

canal system using Cold compaction Tech.

M PM Monday

1/12/2014 11

F AM Wednesday

3/12/2014


(SEP- 1)

3 Dimensional Obturation of root canal system

M PM Monday

8/12/2014

12

F AM Wednesday

10/12/2014


(SEP-2):

One artificial & one natural

premolar Teeth


Lecture :

•Access cavity ( Premolar tooth)

•W L determination (Radiographic

method)

Demo for Access cavity preparation & WL

determination for premolar teeth

M PM Monday

15/12/2014

13

F AM Wednesday

17/12/2014


Lecture:

• Magnification in

Endodontics

Access cavity preparation, WL determination,

cleaning and shaping and 3Dimensional

obturation of premolar

M PM Monday

22/12/2014 14

F AM Wednesday

24/12/2014


(SEP-2)

Access cavity preparation, WL determination,

cleaning and shaping and 3Dimensional

obturation of premolar

Required Teeth For Project 1 , 2 and 3 A minimum of teeth will be required to complete the endodontic procedures in the Endodontic Clinical

Simulation Course. You are urged to have additional teeth preselected in case you need a replacement.

The list of 8 teeth are as follow:

Project 1 (Anterior): 3 Artificial anterior teeth

1 Natural anterior tooth

Project 2 (Premolars): 1 Artificial premolar tooth

1 Natural premolar tooth

Project 3 (Molars): 1 Artificial molar tooth

1 Natural molar tooth

For competency Examination:

1 Artificial anterior tooth

34

Project 1 (P1): Simulated Endodontic Project ( SEP.1) Access cavity preparation for 3 plastic anterior

tooth, working length determination, radiographic method, cleaning and shaping by Hand

instrumentation, and obturation by cold lateral compaction. One natural tooth cleaned and shaped by NiTi

rotary system

Project 2 (P2): Simulated Endodontic Project ( SEP.2) Access cavity preparation for a an single and double

rooted Premolars, working length determination, radiographic method, cleaning and shaping, obturation by

cold lateral compaction.

Project 3 (P3): Simulated Endodontic Project ( SEP.3) Access cavity preparation for a an Maxillary and

Mandibular Molars, working length determination, radiographic method, cleaning and shaping, obturation

by cold lateral compaction.

35

Endodontics Clinical Simulation (CDS 422)

4th

year

Progress Notes Sheet

Student name: …………………………… Computer no. ….…..

Tooth ID: …………………….

Note: Staple tooth’s film mount in the empty space.

Instrumentation Technique Used:

Hand Instrumentation:

Rotary Instrumentation:

Canal ID Estimated

W.L.

Reference

point

Adjusted

W.L,

Initial file

size

Apical size

preparation

Rotary

system /

Taper%

Obturation

Technique

Canal ID Estimated

W.L.

Referenc

e point

Adjuste

d W.L

Initial file

size

Master

apical file

size

Last Step-

back file

size

Obturation

Technique

36

Endodontic Clinical Simulation – CDS 411 4

th Year

MPE Evaluation Form

Pre-operative Radiograph

Mandatory fields:

These MUST be followed at all times. Violation of any of those fields will result in immediate STOPPING of

the exercise.

Procedure evaluation: 0 = incompetent, 1 = competent

Note: • Refer to rubric for evaluation criteria

• Steps with (*) marks are critical steps. The exercise will NOT be considered an MPE if you score

zero in any of them

Student Name

Computer No. Serial

Tooth No. No. of

canals

Date

Tray organization

Yes

No

Knowledge

Yes

No

Communication skills

Yes

No

Infection control (natural tooth)

Yes

No

Self

Assessment

Instructor

Evaluation Steps and procedures

0 1 0 1

Feedback

Position of tooth on the image*

Imaging errors*

Processing of film

Labeling and mounting

Interpretation of the radiograph*

Total /5

Accepted as MPE

Yes

No

Approved by: Date:

37


th Year

MPE Evaluation Form

Access cavity

Mandatory fields:


the exercise.

Procedure evaluation: 0 = incompetent, 1 = competent, 2 = outstanding

Note:

• Refer to rubric for evaluation criteria

• Minimum mark of 6/10 is needed to consider this exercise as MPE


zero in any of them

Tooth No. No. of

canals

Date

Student Name

Computer No. Serial

Tray organization

Yes

No

Knowledge

Yes

No


Yes

No


Yes

No

Self Assessment Instructor


0 1 2 0 1 2

Feedback

Location of access cavity

Cavity outline

Complete de-roofing of the pulp

chamber

Detection and coronal flare of root

canal(S)

Straight line access/adequate

extension (without weakening of the

tooth structure)*

Total /10

Accepted as MPE

Yes

No

Approved by: Date:

38


th Year

MPE Evaluation Form

Working Length Determination

Mandatory fields:


the exercise.

Procedure evaluation: 0 = incompetent, 1 = competent, 2 = outstanding*

Note:


• Minimum mark of 6/10 is needed to consider this exercise as MPE


zero in any of them

• Code 1 =1.25, code 2= 2.5

Student Name

Computer No. Serial

Tooth No. No. of

canals

Date

Tray organization

Yes

No

Knowledge

Yes

No


Yes

No


Yes

No



0 1 2 0 1 2

Feedback

Correct selection of initial file(s)

Reproducible reference point per

canal

Radiograph properly taken and

interpreted

Working length within 1 mm of canal

terminus

Total: / 10

Accepted as MPE

Yes

No

Approved by: Date:

39


th Year

MPE Evaluation Form

Cleaning and Shaping (Part I and II)

Student Name

Computer No. Serial

Mandatory fields:


the exercise.


Note:


• Minimum mark is 6/10 to consider this step as MPE


zero in any of them

Tooth No. No. of

canals

Date

Tray organization

Yes

No

Knowledge

Yes

No


Yes

No


Yes

No



0 1 2 0 1 2

Feedback

Correct MAF size

MAF within 1 mm of canal terminus

Good quality and interpretation of

radiograph

Irrigation used adequately

Canal walls are smooth and

continuous without fatal errors

(perforation, uncorrectable ledge or

separated instrument)*

Proper flare as confirmed by the

selected spreader

Total: /10

Accepted as MPE

Yes

No

Approved by: Date:

40

Endodontic Clinical Simulation – CDS 411

4th

Year

MPE Evaluation Form

Obturation

Mandatory fields:


the exercise.


Note:


• Minimum mark of 6/10 is needed to consider this step as MPE


zero in any of them

Student Name

Computer No. Serial

Tooth No. No. of

canals

Date

Tray organization

Yes

No

Knowledge

Yes

No


Yes

No


Yes

No



0 1 2 0 1 2

Feedback

Master GP fits properly (size and

length)

Radiograph properly taken and

interpreted

Proper apical extension of

obturation*

Proper coronal extension of GP

Tapered, dense and homogenous

radiographic appearance of

obturation*

Total /10

Accepted as MPE

Yes

No

Approved by: Date:

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