Introduction

The complexity of the root canal systems, make it impossible to sterilize

them.
Fortunately in most cases of root canal treatment a reduction in the
microbial content of the canal system in system is sufficient to promote
periradicular healing.
In the mechanical method, metallic instruments of graded sizes are used
to remove intracanal dentine together with microorganisms. The method
largely relies on the ability to clear a significant surface area of molecular walls
of the R system.
!icroorganisms may be destroyed by antibacterial fluids to irrigants.
The combined action of mech and chemical cleaning is more efficient
than either method alone, and allows a more conservative canal preparation.
Objectives : "f leaning and #haping the root canal.
$enerally speaking the two main ob%ectives in canal cleaning and
shaping are biologic and mechanical.
&iologically, the goal of intracanal procedures is to remove all pulp
tissue remnants and microorganisms and their substrates, along with infected
dentin and predentin.
!echanically, three'dimensional shaping of the canal is the ob%ective
I. Biologic objectives :
The biologic ob%ectives are as follows.
(
(. onfine all instruments within the root canal space
). *void pushing contaminated debris past the canal confines of the apical
constriction.
+. Remove all the potential irritants from the entire canal system.
,. -stablish the exact working length and completely clean and shape the
canal system during the first treatment visit.
.. reate sufficient width in the coronal half of canal system to allow for
copious flushing and debridement.
II. Mechanical objectives :
(. /repare a sound apical dentin matrix at the dentine.
Cementum junction 0 The development of this matrix provides the resistance
form to the intraradicular cavity preparation.
- The matrix or canal narrowing prevents over extension of instruments and
controls the apical movement of gutta percha and sealer during obturation.
Matrix resistance
). /repare the canal to taper apically, with the narrowest cross'sectional
diameter at the apical termination 1apical dentin matrix2
The Retention
+. 3evelop a continuously tapering funnel 0 type preparation in three
dimensions within the entire root canal system.
The ob%ective addresses the need to view every root canal system as a
uni4ue individual three dimensional system. *dherence to this concept also
)
parallels the 5extension for prevention6 concept that is, through removal of the
irritant enhances through canal obturation.
,. onfine clearing and shaping procedure to the canal system.
- *dherance to this principle presents violation of periradicular tissues.
- This principle is evident when foramina are transported during excessive
instrumentation.
Foraminal transportation can be either
(. -xternal
). Internal
(. -xternal transportation takes a forms and may occur when instruments is
carried out beyond the apical dentin matrix.
i. "ne result is the ripping of the apical end of the canal resulting in a7
i. teardrop
ii. elliptical
iii. 8ipped foramen
ii. In its grossier form outright perforation of the root results.
). Internal transportation occurs when excessively large instruments are used
in the apical third of a curved canal.
Results in 7
(. 9edging
). anal blockage
+. 9oss of canal length
,. 3evelopment of false canals.
+
$enerally, both types of transportation:s of the apical foramen can be
prevented by containing cleaning and shaping procedure within the canal
system.
.. Remove all residue of cleaning and shaping procedures that could prevent
patency of the apical foramin 0 that is
Removal of debris is accomplished with a ;a"cl or (. file along with
copious and fre4uent irrigation. This is known as R-*/IT<9*TI"; and is
essential to all cleaning and shaping procedures.
Anatomic Considerations in radicular cavity rearation
The primary ob%ectives of precise measuring and confirming of the
length of tooth is to limit instrumentation and subse4uent filling to the root
canal.
The apical termination of the canal is thought to be the %unction of the
internal dentin and the external cementum, the cemento dentinal %unction at the
foramen.
=uttler, $reen and others demonstrated that this cemento dentinal
%unction is after found about >.. to (mm from the external surface of the root
seen in the radiograph.
"nce a good deal of experience is gained, the clinician may be able to
find the foramen.
If the patients are not anesthetized, their reactions may often be counted
upon. There is a decided difference in discomfort reaction between the
instrument touching or even approaching the periradicular tissue at the 3
%unction and an instrument touching a shred of remaining vital pulp.
,
/ulp remnants evoke a sharp instantaneous response where as the
reaction at the cemeto dentinal %unction ranges from a mild awareness to
possibly no reaction at all. *ny warning at all by the patient calls for a
reconfirmation of the tooth length.
Techni!ues o" Radicular Cavity #rearation
"ver the years there has been a gradual change in the ideal configuration
of a prepared root canal. *t one time the shape was round and tapered, almost
parallel.
*fter, schilder:s classic description of 5cleaning and shaping6, the more
accepted shape for the finished canal has become a gradually increasing taper,
with the smallest diameter at the apical constricture, and terminating larger at
the coronal orifice.
This gradually increasing taper is effective in final filling, for a
&uchanan has pointed out, the 5apical movement of the core in to the tapered
apical preparation''''' only tightness the apical seal.
*s previously stated, two approaches to debriding and shaping the canal
have finally emerged
-ither starting at the apex with fine instruments and working one:s way
back up the canal with progressively larger instruments 0 the #-RI*9 "R
5#T-/ 0 &*=6 techni4ue.
"r, starting at the cervical orifice with larger instruments and gradually
progressing towards the apex with smaller and smaller instruments 0 the
5#T-/ 0 3"?;6 0 techni4ue also called 5R"?; 0 3"?;6 techni4ue.
.
Methods o" Instrumentation
!any methods of instrument action within the canal system have been
expressed over the years. The most common of these actions is the /<#@'
T<R; /<99 !"TI";.
In which a ='file is inserted to the working length and given (AB, (AC or D
turn, engaging the canal wall and then with drawn with pressure against the
canal wall.
The push pull action is referred to as the 5filing action6 and is often
considered ade4uate for straight canals is larger teeth.
* 5R-*!I;$ *TI";6 is defined as a boring action designed to drill
out an apical matrix and remove irregularities in the apical third of the
canal this approach is limited to straight rooted larger canals.
The ma%or problem with both of these techni4ues is that neither takes is to
account the degree of irregular canal anatomy often encounted.
5IR<!F-R-;TI*9 FI9I;$6 is defined as moving the file around the
circumference of the canal space while at the same time stroking the
instrument is a ('+mm amplitude.
Favors the development of a flared as funneled canal
preparation
*ids in opening orifices of the canals.
Finally the tooth anatomy dictates the techni4ue or goal of teaching.
*ccording the #T"=, he divided the &iochemical preparation
techni4ues in to
B
I */I*9 0 "R";*9 techni4ue
In which the ?9 is established and the
full length of the canal then preparation,
se4uent increasing in size.
- #tandardized preparation
- #tep back preparation
- The R"*;-# techni4ue
1&alanced force techni4e2
II "R";*9 ' */I*9 techni4ues
oronal potion is prepared before the ?9
is determined, se4uentially prepared from
coronal end to full ?9.
- #tep down techni4e
- 3ouble flared techni4ue
- rown down preassureless
techni4ue
- anal master techni4ue
3isadvantages of */I*9 0 "R";*9 preparations
/otential for extrusion of debris.
*pical blockage
*lteration of working length
Tendency for canal discrepancy, when large inflexible instruments are
used.
Coronal Aical techni!ues $A%&A'TA()*+
-arly debridement , under extension of debris.
-arly coronal widening, better, access, decreases penetration of irrigant
&etter control over apical instrumentation.
E
*te Bac, #rearation
?eine, !artin, ?alton and !ullaney were early advocates of step'back,
also called Telescopic or #erial Root anal /reparation.
3esigned to overcome instrument transportation in the apical third
canal, it has proved 4uite successful.
This method of preparation has been well described by !ullaney.
!ullaney divided the step'back preparation into ) phases.
/hase I 7 *pical preparation starting at the apical constriction.
/hase II 7 /reparation of the remainder of the canal, gradually stepping back
while increasing in size.
*lthough the stepback was designed to avoid zipping the apical area in
curved canals, it applies as well to straight canal preparation.
It has been mentioned that the guide line for the termination of the apical
preparation has been cited as three sizes larger than the first instrument that
binds at the apical terminus.
The fall range of sizes is recommended as a guide time for the shape of
the canal system, type and flexibility of the instrument used.
"ne of the first axions of endodontitis is 5always use a curved
instrument in a curved canal6 curving the file to match the canal is paramount
to success in the step'back more ever.
-igure . / *te0Bac, #rearation :
*. /hase I 0 *pical preparation up to file ;o. ). with recapitulation using
prior size files.
C
&. /hase II 0 #tepping 0&ack procedure in (mm increments ;os. ). through
,., Recapitulation with ). file to full working length.
. Refining phase II'* 0 $reater glidden drill ;o. )+ and , used to create
coronal and mid root perparations.
3. Refining phase II'& ;o.). file, circumferential filing smooths step'back.
-. ompleted preparation 0 a continuous flowing flare preparation.
#tep'&ack 0 /hase I 0 It must be assumed that the canal has been
explored and the working length of the tooth has been established, i.e, the
apical constriction identified.
- The first active instrument to be inserted should be a fine 1;o. >C, (>, or (.2
='file, curved, and coated with a lubricant such as gly'oxide, Root canal
preparation or li4uid soap.
- If a curved ;o.(., for example refuses to go to place easily, are drops back
to a ;o. (> or even a ;o.C.
- The motion of the instrument is 5watch winding6 two or three 4uarter 0
turns clockwise counterclockwise and then retract. <pon removal, the
instrument is wiped clean, recurved, relubricated and repositioned, watch
widening is then repeated. This procedure is repeated until the instrument is
loose in posterior.
- The next size ='file is used in the same manner, very short 1(.>mm2 filing
strokes can also be used at the apex.
- It is most important that a lubricant be used in this area. In very fine canals,
the irrigant that will reach this area, will be insufficient to dissolve tissue,
F
lubrication emulifies tissue allowing instrument tips to macerate and
remove this tissue.
&y the time a size ). ='file has been used to full length, phase I is
complete.
- It is emphasized here that irrigation between each instrument use is now in
older, as well as recapitulation with the previous smaller instrument carried
to full depth and watch wound. *ll these maneuvers will ensure patency of
the canal to the apical constriction.
II #hase II /
- In a fine canal, the step'back process begins with a ;o.+> ='style file. Its
working length is set one millimeter short of the full working length. It is
precurved, lubricated, carried down the canal to the new shortened depth,
watch wound and retracted.
The same process is reported until a ;o.+> is loose at this ad%usted
length 1Figure2. Recapitulation to full length with a ;o. ). file follows to
assure patency of the constriction.
The next curved instrument i.e., ;o. +. again shortened by (.>mm from
the ;o. +>. 1)mm from the apical ;o.).2. It is curved, lubricated, inserted,
watch wound and retracted followed by recapitulation and irrigation.
Figure7
- * step'back Atelescopic preparation. ?orking length of )>mm used as
example.
- oronal part of canal enlarged with circumferential filing or $ater $lidden
drills.
(>
- Thus the preparation step'back up the canal one millimeter and one larger
instrument at a time.
- It is at this point that @'files are effectives, this is also the area of canal
preparation that can be done with power driven, $ater $lidden drills
starting with the smaller drills 1;o.( and )2 and gradually increasing in size
to ;o. ,,. and B. /roper continuing taper is developed to finish phase II *
preparation.
- Refining phase II & is a return to a size ;o.). instrument, smoothing all
round the canal walls with vertical push'pull stroker to perfect the taper
from the apical constriction to the cervical orifice 0 safe ended @'file is
most efficient.
- *t this point &uchanan recommends ;a"cl to left in place to the apex for .
to (> minutes. This is only way the auxiliary canals can be cleaned.
- @and powered $ates $lidden drills may be used for final finish.
According to (rossman
*dvantages of the step'back preparation over the conventional method.
(. 9ess likely to cause periapical trauma.
). Facilitates the removal of more debris
+. $reater flare facilitates packing of additional $./. by lateralAvertical
condensation techni4ue.
,. 3evelopment of apical matrix A prevents overfilling.
.. $reater condensation pressure can be exerted.
((
'egotiation o" narro1ly Curved Root Canals : $According to (rossman+
- The apical segment of the root canal is cleaned and shaped with a prepared
;o.(> file and shaped to canal length.
- Figure 0 modification of an instrument to clean and shape narrow root
canals.
*. #e4uentially larger file is found to be short of the working length.
&. "ne millimeter is cut off a smaller file.
. The tip is reestablished with a diamond file.
- If the next prepared file 1;o.(.2 binds firmly (mm or )mm short of the
working length, it should not be forced apically beyond this point of cotnact
1Figure2.
- The ;o.(. file is removed, and the canal is irrigated with a ..)G solution of
sodium hypochlorite. &ecause the next size file is not available, the operator
can create one by cutting off part the instrument tip of the ;o. (> file.
- utting off (mm of the tip of ;o.(> file converts it into a ;o.() file.
- The stainless steel tip of a file can be cut with sharp iries scissors 1Fig2. *
diamond file is used for reestablish and to smooth the inter tip. The
instrument is curved, sterilized and is ready for use in the apical third of the
preparation.
- Figure )
()
Hariation in cleaning and shaping for double curved or #' shaped root
canals. * small @'file is used to reduce the middle third curve of the root canal
and leaves only the apical curve to be instrumented.
%ouble0Curved Root Canals :
3ouble curved or bayonet shaped canals are cleaned and shaped with
one main variation.
- ?hen the area of the apical foramen has been cleaned and shaped with a
prepared ;o. (> file, the middle third curve is eliminated by filling it with a
@'file that straightens out the enlarged canal. 1Figure2.
- * small @'file is introduced into root canal until the %unction of the middle
and apical thirds reached. The liner portion of their curves is then filed
away.
%ilacerated Root Canals :
3ilacerated or extremely curved canals can be instrumented by
enlarging the middle and cervical third of the root canal first.
Figure 0 !odify of instrument to clean and shape a dilacerated root canal.
* and &, root canal before and after cleaning and shaping.
' the flares of small, curved file are dulled on the outer portion of the
apical third and on the inner portion of the middle third of the root canal.
- * small @'file is inserted to the beginning of the dilaceration 0 without
forcing the file apically circumferential filing is prepared once, and canal
irrigated and refiled to working length with a prepared ;o.(> file.
(+
- Repeat this procedure until the middle and cervical thirds are open wide
enough that the apical third can be instrumented without forcing the
instruments.
- ?hen the cervical and middle thirds of the canal are open, one should
prepare a ;o.(. file by dulling the flutes on the outer portion of the apical
third, and the inner portion of the middle third of the curved instrument
1Figure2.
- This procedure prevents transportation of the apical foramen and over
instrumentation in the dilacerated area.
Modi"ied Maniulation o" Instruments :
Anticurvature "iling :
- 3enotes filing preferentially away from the inner curvatures or facial
aspect, the site of potential perforation.
- This method, involves filing buccal, mesial and ling walls of the root
canal with more strokes than the furcal wall by a ration of +7( is
effective.
*te0%o1n Techni!ue
Initially, !arshall and /appin advocated a 5rown 3own /ressureless
/reparation6 in which $ates $lidden drills and larger size files are first used in
the coronal two thirds of the canals and then progressively smaller files are
used from the 5crown down6 until the desired length is reached. This has
become known as the #tep'down techni4ue.
(,
- The primary purpose of this techni4ue is to minimize or eliminate the
amount of necrotic debris that could be extruded through the apical foramen
during instrumentation.
- "ne of the primary advantages of the step'down preparation is the freedom
from constraint of the apical enlarging instruments.
- &y first flaring the coronal two'thirds of the canal, there is increased access
allowing greater control and less change of zipping near the apical
constriction.
- In addition, it 5provides a coronal escape way that reduce the piston in a
cylinder effect6 responsible for debris extrusion from the apex6.
*te0%o1n techni!ue :
In this method, working length of tooth is not first established. The
access cavity is filled with ;a"cl and the first instrument is introduced into the
canal.
-igure / $*te0%o1n canal rearation+ :
#traight canal used as example 7
*. 5/re'$ates6 preparation of coronal half of canal to receive second phase
instruments.
&. ;o. ) $ates $lidden drill widens preparations to receive.
. ;o. + $ates glidden 1size of C> file2 to provide unobstructed access for
instrument to follow.
3. #tarting with larger instruments 1;o.,>2, canal is progressively enlarged
apically ( to ) mm at a time until.
(.
-. ;o. ). file reaches cemento dentinal %unction.
If it appears that a ;o.+. file until pass, it is carried into the canal to the
point of resistance. If resistance is encountered at 1for instance2 (+mm
1FI$<R-2 the preoperatives radiograph is consulted to determine if it is canal
curvature or narrowing that is stapping the instrument.
Radicular access is now prepared upto this point taking care not to ledge
the wall of a curve begins here.
If ;o.) $ates $lidden drill 1size of a ;o.B> file2followed by a ;o.+
$ates 1size of a ;o.C> file2 is used without apical force to flare out the
radicular access 1FI$<R-2 and copious irrigation follows.
If initially the ;o.+. Instrument does not penetrate to this depth, smaller
instruments must be used to prepare the radicular access upto this size before
the $ates $lidden flaring begins. This is referred to as 5/R-'$*T-#
/R-/*R*TI";6.
*t this point, !organ and !antgomery suggest that 5a provisional
working length6, +mm short of the radiographic apex be established. The next
step of preparation now begins in the presence of ;a"l.
* ;o. +> file is placed in the canal until resistance is encountered and is
rotated twice in a clockwise passive penetrating movement.
Then a ;o.). file repeats this reaming procedure, fall by a ;o.)>, a
;o.(., etc. until the provisional working length is reached.
*t this point, true working length must be established at the apical
construction.
This is the point of resistance form. Irrigation follows.
(B
To make sure the apical area is thoroughly cleaned, successively larger
files are used to reach the construction until a ;o.)., at least is used to full
working depth 1FI$<R-2.
Final smoothening of the walls and perfection of the continuing flaring
shape are accomplished with ;o.+> to +.. #afe end @'files used
circumferential.
-fficacy of the step down techni4ue ompared to the step'back
5circumferential filing tech with precurred files. !organ found that the step'
down tech had better shape and terminus.
*nother study found less belives extruded from the apex with the step
down tech.
#ositive disadvantage include
(. @edges
). *pical blackage
+. /erforations especially in narrow canals but may be overcome by
careful manipulation of files and fre4uent recapitulation.
23BRI% T)C2'I45) $*te / %o1n 6 *te Bac,+
$"-RI$, and later &<@*;*; suggested a combination of the step'
down A #tep 0 back techni4ue
- &uchanan preparation what he calls -arly Radicular *ccess 1-R*2 which is
a step 0 down process, preferably done with $ates glidden drills with ;o(
and advancing up through ;oB. This is carried out in straight part of the
canal.
(E
- In the event a ;o.( $ates cannot be introduced, &uchanan prepares a 5/re'
$ates6 canal space with smaller files until the ;o( $ates will effortlessly
reach full depth. This is followed by a ;o.), then the ;o.+ at half depth and
a ,, . and B only at the orifice level.
- "nce the coronal flaring in complete true working length, may be
established at the apical constriction. This is where resistance form will be
established.
- The #tep'&ack part of the preparation begins with a precurved, lubricated,
fine file 1;o. C, ;o.(> or ;o (.2 inserted passively. #tep back begins with
the next larger inserted passively. #tep back begins with the next larger size
instrument (.>> short of working length. *s each larger precurved
instrument is introduced the step'back is (.>mm until the previously
prepared step down portion of the canal is reached.
- Following extensive irrigation the entire canal is correctly tapered with a
small @'file.
- "ut of these ) methods, The hybrid approach was developed.
#tarting coronally with larger instruments, often power driven, one
works down the straight coronal portion of the canal with progressively smaller
instruments 0 the step'down approach.
Then at this point, the procedure is reversed starting at the apex with
small instruments and gradually increasing in size as one works back up the
canal 0 the step 0 back approach.
This @I&RI3 approach could be called 0 #T-/ 03"?;'#T-/
&*= techni4ue or !"3IFI-3 3"<&9- F9*R-3 T-@;IJ<-.
(C
*ny one of these methods of preparing the root canal will ensure staying
within the confines of the canal and delivering or continuously tapered
preparation and as &uchanan has noted, eliminate blocking apical ledging,
zipping and perforation.
*TA'%AR%I7)% #R)#ARATIO'
The premise of this techni4ue is that most root canals are circular in
cross'section in the apical third, the aim is to prepare the root canal by
enlarging it se4uentially to a selected size as follows.
3etermine the ?9
Introduce the smallest reamer into the canal and rotate it clockwise to
engage dentin and then withdraw.
Repeat with successively larger reamers until the reg. #ize is reached
apically 1size )>2
* canal shape should be produced, which matches the last reamer.
This techni4ue occasionally works, particularly if the canals are narrow,
of circular cross section and enlarged to a large canal size. The techni4ue is
unlikely to debride canals with more complicated shapes.
BA8A'C)% -ORC) CO'C)#T 5*I'( -8)90R0-I8)*:0
*fter () years of experimentation, Roane and #abala introduced their
&alanced force concept of canal preparation.
-ssentially, the entire preparation beginning with flaring of the canal
coronal and middle thirds of the canal with $ates glidden bills, size ( through
(F
B. This essentially increases the radius and decreases the arc of the curve of the
canal, thus making it straighter and more assessable to reaming instruments
*t this point, the balanced force instrumentation begins. It involves
placement, cutting and removal using only rotatory motions.
Insertion is done with a half'turn clockwise ratio with slight apical
pressure.
utting is accomplished using counter clockwise rotation, 5again with
apical pressure, ad%usted to match the files strength is very light for fine
instruments and heavy for large instruments6.
-8)90R0-I8)
!achine from a blank of triangular cross section.
Resembles a twisted instrument.
$reater contract of strength and flexibility.
Increased flexibility and increased strength
3esigned to cut most efficiently in *nti clockwise rotatory motion.
!odified safe ended tip.
T2) ROA') T)C2'I45) $B0T+
Main "eatures
(. anals prep to predesigned dimensions, of which + are recognised and
designated ,., B> and C> accord to size of apical prep
). These dimension refer to size of the file used at the +
rd
#tep back to the size
of !*F.
)>
-ach step back from !*F at the /h is >..mm shorter.
:. #re to Radiograhic length.
Raane firmly believes in enlarging the apical area to sizes larger than
generally recommended up to size C> in single canal teeth, for example and
size ,. for multiple canal teeth. These sizes are not absolute, of course and
final shaping depends upon treat bulk andAor fragility, or extreme curvature of
the canal.
@e also believes in carrying the preparation through to 5full length6 the
radiographic apex of the teath.
/reparation with large instruments 1i.e., +>2 extents to full root length.
<se of larger instruments in the )
nd
and +
rd
steps forms apical constriction.
In canals to the prepared to a ;o.,. instrument, for eg, the ;o.+>
instrument is carried to full root length root length and larger instruments are
stepped back from that ;o.,> at >..mm back, ;o.,. at (.>mm back up the
canal until $ates $lidden preparation is reached.
lockwise rotation, which 5sets6 the instrument, should never exceed
(C> degreesK otherwise the instrument will start to unwind.
In this way and counterclockwise cutting and removal, the instruments
advance toward the apex, continuing this techni4ue, the clinician enlarges the
apical third of the canal by advancing up the scale of larger and larger
instruments. Flex'R files prevent the instruments from gouging into the curved
walls. The Flex'R files are not pre curved and are used in a controlled rotatory
motion, which is said to balance forces acting on a file in a curved canal and
prevent procedural errors.
)(
5?hen enlargement has been accomplished, a final year clockwise
cleaning rotation is used to load canal debris into the flutes and to elevate the
debris away from the apical foramen6. Irrigation follows.
Canal Master:
- The cutting portion of this instrument resembles a reamer with blunted
edges.
- >.E.mm non cutting pilot tip
- !ost efficient means of cutting cutting is using a clockwise rotating motion
thro: B>L.
Canal master ;5<
Canal Master techni!ue:
Redesigned so that only the apical (')mm is engaged in dentin removal.
*pical >.E.mm of inst., is safe'ended to facilitate maintenance of canal
curvature.
laimed this tech avoids the need for recapitulation.
Canal Master ;5< #rearation
#enia and ?ildey completely redesigned endodontic instruments and
introduced the canal master 5<6 instrument. The canal master more closely
resembles a $ates $lidden drill in appearance and action.
Techni!ue : * 1step downA step back2 approach is recommended in using these
instruments.
))
9ength of the tooth is first established, followed by circumferential filing to
the apical constriction up through a ;>. (. file. apious irrigation is used
throughout.
?hen full canal potency is established, the step'down flaring of the
cervical'mid canal is carried out using the canal master rotary instruments
in a slow speed hand piece.
* limit to the depth of the powered rotary penetration is necessary, so a
provisional rotary length 1/R92 is established at either the (
st
curve in the
canal or ..>mm back from the apex.
#tarting with ;o. .> rotary instrument, the canal is enlarged to the /R9.
The ;o. .> is followed by the no. B>, no. E>, no. C> until a flare is
established.
#low gentle apical pressure is used with each rotatory instrument followed
by recapitulation to the apex with the no. (. file and irrigation.
*t this point the canal is flooded with (EG -3T* which is allowed to
remain for . minutes. Then hand instrumentation begins, taking off from
the /R9 with a ;o. )> canal master M<: instrument. It is used in a gentle
pressure, rapid full clockwise motion being constantly rotated as it cuts its
way to full working length.
/reparation continuous, advancing up the instrument sizes until one feels
that the apical area is completely debrided, for e.g., to size +. or ,>.
To complete the flare, a step back procedure follows, shortening by (.>mm
each successively larger canal master 0 ;o. ,., .>, .., B>, E>, C> etc.
)+
Final smoothening of the canals can also done with a non cutting tip @ file
used circumferentially.
Through evaluation of this techni4ue is needed, but early results seem
promising in terms of the shape produced.
Intermediate file sizes are available, enabling cases negotiated of curves.
The instruments have a tendency to fracture. The disadvantages are
those of any techni4ue using purely rotating motion.
'iTi #o1er -ile #rearation:
- !c#padden developed a #-;#"R FI9- a variation of the original
@edstreem files, that varies in design with the size of the instrument, these
instruments have + flutes, the +
rd
flute set at half the angle of the other z
shaped flutes.
- These files are produced in all sizes in stainless steel and in sizes +. and
above in nickel'titanium.
Techni!ue / *fter establishing tooth length, !c#padden begins a step'back
preparation with a ;a. (. ;iTi instrument in a controlled, slow speed 19ess
than oo R/!2 rotating hand piece. The no. +> and ). are similarly used.
#tep down tapering is begun in the cervical mid canal with either the larger
size ;iTi or $ates $lidden drills.
The apical preparation is then completed with step back, larger and larger
instruments to meet the mid canal preparation. Final canal cleaning is done
with a avi-ndo ultrasonic system.
Canal -inder *ystem #rearation
),
anal leaning and shaping with the automated, air driven canal finder
system handpiece and M*: style headstroem filler is best done as a step'down A
step'back preparation.
The uni4ue features of M*: files are 7
(. #tep depth of fillers.
). ,> 3egress helical angle of cutting blades.
+. !ore efficient cutting results.
- The canal finder is more effective than any other techni4ue or deveice in
negotiating very fine, very curved or even partially calcified canals.
- The canal finder delivers a vertical stroke that 5drives the special @'files
apically with the non cutting plane tip.
- The instrument and the canal must be well lubricated with soluset 1contain
-3T* and similar to root canal preparation2.
- *t this point step'back preparation begins, starting with a ;o. C or (>,
followed by ;o.(. up the scale until the apical area is enlarged to atleast
;o.)..
- #tepping back from apex, a fully flared cavity is developed by the files
forced against all of the canal walls as it strokes vertically.
- &ecause @'files cut in a pulling motion, the canal finder is less apt to force
debris apically.
58TRA*O'IC *3*T)M*
).
<ltrasonic endodontics has brought a new era of biotechnology to root
canal therapy. This technology which has ultrasound energy, continues the
traditional endodontic concepts of debridement and irrigates with ultrasonic,
biologic, chemical and physical actions.
Root canal systems are rapidly and effectively cleaned, irrigated,
disinfected and shaped by the clinician using an ultrasonic system.
/reparation of root canal with ultrasonic system for canal obturation
consist of , interrelated and dependent phases.
(. !echanical debridment of hard and soft tissue within the canal system
). hemical debridement the canal system
+. 3isinfection
,. Final shaping of the canal system
3iamond coated files have also been introduced to the combination of
ultrasound energized debridment, activated irrigation and aid in canal cleaning
and disinfection.
Techni!ue : Initial root canal lengths determination and apical preparation are
accomplished with small hand files.
- #ubse4uent canal preparation is performed with smaller sized ultrasonic
files, which are precurved prior to entry into the canal.
- The file motion used in ultrasonic root canal preparation is essentially a
push 0 pull action enhancing dentin removal.
- ircumferential more cement of the files is also associated to achieve the
smooth tapering canal shape.
)B
- * side to side action or lateral morcement activates the irrigant solution,
which improves its disinfecting and cleaning 4ualities.
For -ndosonic system the manufacturer recommends that )..G #odium
hypochlorite solution be used to derive the maximum benefit of ultrasonics.
The continuous, high volume, flow'through irrigation and aspiration,
within the root canal, create the e4uivalent of an 5ultrasonic bath6. This allows
three 0 dimensional debridement of the complex root canal marphology by the
hydrodynamic action and enhanced physical chemistry of the activated irrigant.
- The combination of continuously activated irrigation and the energized files
produces a multidimensional synergistic system that results in a biologically
cleaner root canal systems.
- The combination of ultrasonic waves and a microbiocide results is an
extremely efficient system. The improved effect is due to the
(. *gitation
). *coustic streaming
+. avitation
reated by the ultrasonic waves emitted from the energized file.
@owever, extreme care must be exercised in areas of the canal system
where the canal is close to the external root wall 0 for e.g., !esial roots of
mandibular molars. &ecause of the efficiency of ultrasonic cutting, rapid
perforations may occur.
*O'IC *3*T)M*:
The development of the -ndostar . and the endo sonic air +>>>
introduced sonic vibratory canal cleaning and shaping to endodontics.
)E
- The sonic cutting that accurs, coupled with the sonic irrigating solutions
reduces fatigue and stress during canal preparations.
- For canal cleanliness, ultrasonic activation with a ;o. (. file for + full
minutes in the presence of .G ;a"l produced 5smooth, clean canals, free
of the smear layer and superficial debris.
8aser Canal #rearation
#till to be approved by the <.#. Food and drug administration
committee on devices, is the use of lasers to prepare root canals, nonetheless
the method appears promising.
?eichman was probably the first to suggest laser canal preparation.
9evy has seriously pursued the use of the ;d'I*$ laser mounted with a
fiber optic, to clean and shape the root canal.
5The attached fiber optic has a silicon base and a diameter of )>>
microns, the diameter of a ;o. )> file.
- The laser used in this study was a +. watt pulsed ;d'I*$ which produces
a beam with a wavelength of (.>B microns.
The beam is carried through a silica fiber accompanied by a cleaning
system that delivers a spray of air and water.
9evy compared the results of cleaning and shaping by conventional
step'back procedures to laser beam, using #-! evaluation, 9evy claimed 5that
preparation with a laser beam is possible, with an improvement in the
cleanliness of the canal walls when compared to the conventional techni4ue6.
Techni!ue :
)C
- For a full minute, the apical region of the canal is hand instrumented to the
constriction with a ;o.(. ='file and abundant irrigation.
- /reparation begins with the laser energy level set at (.> milli%oules.
- The spray was reduced or increased so that the plasma effect could be
observed at the end of the fiber when contact was made with the dentin. It
appears as a &right spark.
- The plasma effect is actually a laser 5transformation of the dentin into an
ionized gas levaing no debris in the canal walls.
- The fiber optic was inserted to working length and enlargement was
performed circumferentially starting in the apical third, then the middle and
finally the cervical third to the size ;o.B> instrument. The average time to
accomplish this preparation was one minute.
- The laser preparation, showed remarkable cleanliness of all canals, the
dentin revealed a crusty, waxy aspect with open tubules and no apparent
smear layer.
- ?ilder #mith feels that the eximer laser may have a bright futures in
endodontics. * wavelength of (F+nm the *rF eximer 5is well suited to slow
selective removal of necrotic debris from the root canal.
- The laser appears to have a future in endodontics and only time will tell
how long lasting and efficacious it is.
)F