PRESENTED BY: DR SILNA HAREENDRAN

SECOND YEAR PG
 INTRODUCTION
 HISTORY
 OBJECTIVES
 PRINCIPLES OF CLEANING AND SHAPING
 CHALLENGES OF ROOT CANAL PREPARATION
Anatomical factors
Microbiological challenges
Iatrogenic damage
 INSTRUMENTS USED FOR RADICULAR PREPARATION
 MOVEMENTS OF INSTRUMENTS
Reaming
Filing
Combination of reaming ad filing
Balanced force technique
Watch winding
Watch winding and pull motion
 TECHNIQUES
Apical to coronal
Standardized technique
Step back technique
Modified step back technique
Passive step back technique.
Coronal to apical
Step down technique
Crown down pressureless technique
Hybrid technique
Balanced force technique
Reverse balanced force technique
Double flare technique
Modified double flare technique
 ENGINE DRIVEN ROTARY INSTRUMENTS
 CANAL PREPARATION USING ULTRASONIC INSTRUMENT
 CANAL PREPARATION USING SONIC INSTRUMENT
 LASER ASSISTED CANAL THERAPY
 SPECIAL ANATOMIC PROBLEMS IN CANAL CLEANING AND SHAPING
Managemnet of curved canals
Management of calcified canals
Management of C-shaped canals
Management of S-shaped canals
 CONCLUSION
 REFERENCE
One of the most important stages in root
canal treatment is the preparation of the
root canal system.

It includes the removal of vital and necrotic

tissues from the root canal system, along
with infected root dentin, and removal of
metallic and non-metallic obstacles in cases
of retreatment.
It aims to prepare the canal space to facilitate
disinfection by irrigants and medicaments.

Thus, canal preparation is the essential phase

that eliminates infection.
 Edward Maynard- 1838 development of the
first endodontic hand instruments.

 Notching a round wire (in the beginning

watch springs, later piano wires) he created
small needles for extirpation of pulp tissue.
 In 1852 Arthur used small files for root canal
enlargement.

 In 1885 the Gates Glidden drill.

 In 1915 the K-file were introduced.

 Standardization of instruments had been

proposed in 1929 by Trebitsch and again by
Ingle in 1958.
 First description of the use of rotary
devices is by Oltramare .
 He reported the use of fine needles with a
rectangular cross-section, mounted into a
dental handpiece. These needles were
passively introduced into the root canal to
the apical foramen and then the rotation
started.
 He claimed that usually the pulp stump was
removed immediately from the root canal.
 In 1889 William H. Rollins developed the
first endodontic handpiece for automated
root canal preparation. He used specially
designed needles, which were mounted into a
dental handpiece with a 360˚ rotation. To
avoid instrument fractures rotational speed
was limited to 100 r.p.m.
 In 1928 the ‘Cursor filing contra-angle’ was
developed by the Austrian
company W&H (Bu¨rmoos,
Austria). This handpiece
created a combined rotational
and vertical motion of the file
 Endodontic handpieces became popular in
Europe with the marketing
of the Racer-handpiece
(W&H) in 1958 and the
Giromatic (MicroMega,
Besanc¸on,France) in 1964.
 Introduction of the Canal Finder System
(now distributed by S.E.T., Gro¨benzell,
Germany) by Levy.

 The Canal Finder was the first endodontic

handpiece with a partially flexible motion.
 Richman described the use of ultrasound in
endodontics but it was mainly the work of
Martin & Cunningham in the 1970s that
made ultrasonic devices popular for root
canal preparation.

 The first ultrasonic device was marketed in

1980.

 The first sonic device in 1984

 Since 1971 attempts have been made to use laser
devices for root canal preparation and
disinfection .

 Additionally, some non-instrumental or electro-

physical devices have been described such as
ionophoresis in several different versions,
electrosurgical devices (Endox, Lysis, Munich,
Germany) or the non-instrumental technique
(NIT) of Lussi et al, using a vacuum pump for
cleaning and filling of root canals.
 Instruments made from nickel–titanium
(NiTi), first described as hand instruments
by Walia et al.(1988), have had a major
impact on canal preparation.

 Nickel – titanium was developed in 1964 by

Buehler et al in the Naval Ordinance
Laboratory
Objectives of root canal preparation given by
Schilder

1. Mechanical objectives
2. Biological objectives
3. Clinical objectives
 Continuously tapering funnel from the apex to the
access cavity.
 Cross-sectional diameter should
be narrower at every point apically.
 The root canal preparation should
flow with the shape of the original
canal.
 The apical foramen should remain
in its original position.
 The apical opening should be kept
as small as practical.
 Confinement of instrumentation to the roots
themselves.

 All infected pulp tissue, bacteria and their by

products should be removed from the root canal.

 No forcing of necrotic debris beyond the

foramen.

 Creation of sufficient space for intra-canal

medicaments and irrigants.
 Removal of overlying dentin causes smooth
internal walls and provide straight line access to
root canals.

 After obturation there should be complete sealing

of the pulp chamber and access cavity so as to
prevent microleakage.

 Tooth should be restored with permanent

restoration to maintain its form, function and
esthetics and patient should be recalled on regular
basis for evaluation.
 There should be straight line access to the root canal
system.

 Copius irrigation should be done between

instrumentation.

 Prepared canal should retain its original shape and form.

 Exploration of orifice should be done with smaller file to

gauge the canal size and configuration.

 Canal enlargement should be done using instruments in

sequential order
 Flutes should be cleaned and inspected after each
removal.

 Never force the instrument in the canal.

 Recapitulation is regularly done to loosen debris.

 Over preparation and too aggressive over enlargement

of curved canals should be avoided.

 Overusing of larger files must be avoided as it may

result in further enlargement of apical opening.
Anatomical factors

Microbiological challenges

Iatrogenic damage
Complexity of the anatomy of the root canal
system,is considered as one of the major challenges
in root canal preparation which includes wide
variations in:
 Number , length, curvature and diameter of root
canals.
Complexity of apical anatomy with accessory canals
and ramifications.
Communication between canal space and lateral
periodontium and furcation area.
 Pulp tissue and root dentine may harbor
microorganisms and toxins
potential iatrogenic damage that can occur to
roots during preparation are:
 Zip
 Elbow
 Ledge
 Perforation
 Strip perforation
 Outer widening
 Apical blockage
 Damage to apical foramen
 Tendency of the instrument to straighten inside a
curved root canal.

 This results in over-enlargement of the canal along

the outer side of the curvature and
under-preparation of the inner
aspect of the curvature at the apical
end point.
 The main axis of the root canal is transported, so that
it deviates from its original axis. Therefore, the terms
straightening, deviation, transportation are also used
to describe this type of irregular defect.

 The terms ‘teardrop’ and ‘hour-glass shape’ are used

similarly to describe the resulting shape of the zipped
apical part of the root canal
 ‘Elbow’ is associated with zipping .

 A narrow region of the root canal at the point of

maximum curvature as a result of the irregular
widening that occurs coronally along the inner
aspect and apically along the outer aspect of the
curve.

 The irregular conicity and insufficient taper and

flow associated with elbow may jeopardize
cleaning and filling the apical part of the root canal.
 Occur as a result of preparation with inflexible
instruments with a sharp, inflexible cutting tip
particularly when used in a rotational motion.
 The ledge will be found on the outer side of the
curvature as a platform.
 Difficult to bypass.
 Occurrence of ledges was related to
the degree of curvature and design
of instruments
 Perforations are associated with destruction of
the root cementum and irritation and/or
infection of the periodontal
ligament and are difficult to seal.
 Strip perforations result from over-
preparation and straightening along the inner
aspect of the root canal curvature.
 midroot perforations are again associated
with destruction of the root cementum and
irritation of the periodontal ligament and are
difficult to seal.
 The radicular walls to the furcal aspect of
roots are often extremely thin and were hence
termed ‘danger zones’.
 First described by Bryant et al .
 Describes over preparation and straightening
along the outer side of the curve without
displacement of the apical foramen.
 Occurs as a result of packing of tissue or debris and
results in loss of working length and root canal
patency.

 Complete disinfection
of most apical part of
root canal system becomes
impossible.
 Displacement and enlargement of the apical
foramen may occur as a result of incorrect
determination of working length, straightening of
curved root canals, over-extension and over-
preparation.

 Irritation of the periradicular tissues by extruded

irrigants or filling materials may occur because of
the loss of an apical stop.
 Hand instruments: Broaches
Files
 Rotary : Gates gidden drill
Protaper
Profile
Quantec file series
Light speed
K3 and Hero 642
 Automated ( Sonic / Ultrasonic)
 Lasers
 Reaming
 Filing
 Combination of Reaming and Filing
 Balanced force technique
 Watch winding
 Watch winding and Pull motion
 Involves clockwise, cutting rotation of the file.

 Instruments are placed into the canal until binding is

encountered.

 Instrument is then rotated clockwise 180-360˚ to

plane the walls and enlarge the canal space.

 Reamers are usually

more effective for this
function.
 Term filing indicates push-pull motion with instrument
without rotation and has great efficiency with files than
reamers.

 Defined as placing the file into

the canal and pressing it laterally
while withdrawing it along the
path of insertion to scrape the wall.
 The scraping or rasping action removes the
tissue and cuts superficial dentin from the
canal wall.

 But this active insertion of instrument with

cutting force may lead to canal ledging,
perforation and other procedural errors.
 To avoid such errors passive insertion of
instrument, precurving of instruments and
quarter turn insertion is employed.

 A modification is the turn-pull technique.

 This involves placing the file to the point of

binding, rotating the instrument 90º and
pulling the instrument along the canal wall.
 Circumferential filing is used for canals that are
larger and or not round.

 The file is placed into the canal and withdrawn

in a directional manner sequentially against the
mesial, distal, buccal, and lingual walls.
 Advocated during coronal flaring procedures to
preserve the furcal wall in treatment of molars.

 Canals in mesial roots of molars are often not

centered , and are being located closer to
furcation.

 So stripping perforations can occur during

aggressive enlargement of canal space by using
Gates Glidden drills.
 To prevent this, Gates Glidden drills should be
confined to the canal space coronal to the root
curvature and used in a step-back manner.

 GG can also be used in anti-curvatuire fashion to

selectively remove dentin from bulky wall(safety
zone) toward line angle, protecting inner or furcal
wall ( Danger zone) coronal to the curve.
 In this technique file is inserted with a quarter turn
clockwise and apically directed pressure (reaming)and
then is subsequently withdrawn(filing).

 By performing this combination canal

enlargement takes place.

 Frequent ledge formation, perforation occurs.

 To overcome these shortcomings, schilder
modified this technique.

 Suggested a clockwise rotation of half revolution

followed by instrument apically.

 This method is effective in producing clean canals

but very laborious and time consuming.
Balanced force motion is a most effective way
to cut dentin.

This technique recognizes the fact that

instruments are guided by the canal walls when
rotated.
 Since the files will cut in both a clockwise and
counterclockwise rotation, the balanced force
concept of instrumentation consists of placing the
file to length and then a clockwise rotation (less
than 180 degrees) engages dentin.

 This is followed by a counterclockwise rotation

(at least 120 degrees) with apical pressure to cut
and enlarge the canal.
 The clockwise rotation pulls the instrument into the canal
in an apical direction.

 The counterclockwise cutting rotation forces the file in a

coronal direction while cutting circumferentially.

 Following the cutting rotation the file is repositioned and

the process is repeated until the corrected working length
is reached.

 At this point a final clockwise rotation is employed to

evacuate the debris.
 H files and broaches do not possess left hand
cutting efficiency, hence not used with this
technique.
 Arched arrow indicates a gentle right and left
rocking motion, which causes the instrument to
cut while a light inward pressure keeps the file
engaged and progressively toward the apex.

 Angle of rotation is
usually 30 to 60
degrees.
 This technique is less aggressive than quarter
turn and pull motion because, the instrument
tip is not forced in to the apical area with each
motion, thereby reducing the frequency of
instrumental errors.

 Efficient with K-type instruments.

 Used primarily with H-files.

 Inward pressure is maintained, while the file is gently

rocked left and right , through the arc indicated by the
shaded region in the circle.

 When the instrument feels

 any resistance , it is taken
 out of the canal by pull
 motion.

 H files can cut dentin only in pull motion

There are 6 unique motions of files and reamers used in
serial shaping. They are:
1. Follow : In this file is pre curved to follow canal
curvatures.
2. Follow- withdraw: In and out motion is given to the
instrument. It is done to create path for foramen.
3. Cart : Carting means transporting , refers to the
extension of a reamer to or near the radiographic
terminus. The precurved reamer should gently touch
the dentinal walls at radiographic constriction and
cart away dentinal debris and pulp remnants.
4. Carve :
done for shaping the canal.
reamers are best instruments.
Never press instrument apically
Just touch the dentin with precurved reamer and shape on
withdrawal.
5. Smooth
Smoothening is circumferential filing, usually accomplished
with files.
6. Patency :
Achieved with files and reamers.
It means that portal of exit has been cleared of any debris in its
path.
Two approaches for biomechanical preparation
a. Apical to Coronal technique.
b. Coronal to Apical technique.
Apical to coronal
1. Standardized technique.
2. Step back technique
3. Modified step back technique
4. Passive step back technique.
Coronal to apical
1. Step down technique.
2. Crown down pressureless technique.
3. Hybrid technique.
4. Balanced force technique.
5. Reverse balanced force.
6. Double flare technique.
7. Modified double flare technique.
APICAL TO CORONAL
 Also known as conventional technique.
 One of the first technique to be used ,
 Introduced by Ingle.
 Standardized reamers of increasing sizes were
used sequentially to enlarge tne apical part of
canal.
 Coronal two third were prepared again mainly
by reaming.
 Determine WL and select initial apical file.
 Do circumferential filing by applying lateral
pressure
 Increase the apical constriction 2 to 3 files
more than initial apical file but with same WL.
 Loss of WL.

 Obturation with this technique does not

provide adequate seal.

 Passage of irrigants and medicaments not

adequately obtained through the root canals.

 Increased incidence of ledging, zipping, and

perforation in curved canals.
 First described in 1960 by Mullaney.
 Also known as Telescopic canal preparation or
serial root canal preparation.
 Preparation done in two phases

PHASE 1
 Preparation of apical constriction
PHASE 2
 Preparation of remaining canal
Evaluate the tooth decay Prepare access cavity
and locate canal orifice
 Determine working length.
 Insert first instrument with watch winding
motion .
 Remove instrument and
irrigate the canal
 Recapitulate using smaller file to break up
apical debris and repeat the process until size
25-K file reaches the WL.
 Place next file 1mm short of working length
 Do watch winding motion, circumferential
filing, irrigation and reca[pitulation.
 Repeat above steps with larger files at 1mm
increments from previously used files.
 Refine root canal by master appical file
 Step back
technique creates
a small apical
preparation with
larger instruments
used at
successively
decreasing lengths
to create a taper.
Enlargement of coronal part of Use of smaller GG to prepare
canal using GG drills mid root level
Advantages Limitations
•Proper apical stop •Apical blockage
•Less chance of •Loss of WL
apical •Tendency to
transportation straighten the canal
•Greater flare •Time consuming
coronally
 Preparation is completed in apical third of
canal.

 Step back procedure started 2-3mm short of

apical constriction so as to give an almost
parallel retention from apical area.

 This receives the primary guttapercha point

which shows slight tug back, when point is
removed.
 Developed by Torabinejad in 1994
 Combination of rotary and hand instruments
for canal preparation.
 Provides gradual enlargement of root in
apical to coronal direction.
 Access cavity preparation
 Locate canal orifice
 Determine WL
 Additional files inserted upto WL, this creates
mild flared preparation for insertion of GG
 Copious irrigation
 GG 2 , 3,4 inserted for coronal enlargement.
 WL reconfirmed
 Sequential use of progressively larger
instruments placed successively short of WL.
 Removal of debris and minor canal
obstructions.
 Knowledge of canal morphology.
 Gradual passive enlargement of canal in
apical to coronal direction
 This technique can be used with ultrasonic
instruments.
CORONAL TO
APICAL
 Extrusion of canal contents during
instrumentation techniques has resulted in
postoperative discomfort and delayed
healing.

 To overcome this problem, coronal to apical

approach has been introduced in which
shaping the coronal aspect of root canal first
before apical instrumentation is done.
Also called
 Reverse flaring technique by Weine
 Coronal two-third preenlargement by Cohen
 Cervical flaring by Goerig.

Preparation of coronal third in two phases:

Phase 1: Root canal is penetrated using Hedstrom files.
Phase 2: GG drills are used to flare the coronal segment
of root canal.
This is followed by apical instrumentation , involving 2
steps:
Step 1: determination of WL
Step 2:shaping remaining canal in step down approach.
Advantages
 Straighter access
 Eliminates coronal interferences.
 Removes bulk of tissue and microorganisms
before apical shaping
 WL retention.
 Better and deeper penetration of irrigant
 Canal prepared fro crown of tooth towards the apical
portion of canal.
 This technique results in rounder canal shape than
step back technique.
 Early coronal flaring done withGG drills.
 Incremental removal of dentin from coronal to apical
direction
 K file used in large to small sequence with reaming
motion and no apical pressure
 Access cavity filled
Straight line access
with irrigants
 Excessive use of GG drill
Preflaring of at same level leads to Establish WL
coronal third of excessive cutting of with small
canal using GG dentin , weakening of instrument
Drill (larger first roots and thereby gives after irrigation
smaller a Coke Bottle
and
appearance in
subsequently) radiographs recapitulation
 Preparation Apical
canal at middle preparation of
Use larger file
third with canal with
to prepare
sebsequently frequent
coronal third
smaller no. of irrigation of
file canal system.
Well prepared
tapered
preparation of
tooth
 Removal of tissue debris coronally, minimizing
extrusion of debris periapically.
 Reduction of post operative sensitivity.
 Greater volumes of irrigants can reach canal
irregularities in early stage of canal preparation
because of canal flaring.
 Better dissolution of tissue due to increased
penetration of irrigants.
 Rapid removal of contaminated and infected
tissues from canal system.
 Enhanced tactile sensation due to removal of
coronal interferences.
 Flexible files used at apical portion.
 Files can reach apex in curved canals due to
coronal flaring.
 Provide more space for irrigants.
 Straight line access
 Enhanced movement of debris coronally.
 Desired shape of canal can be obtained.
 Decreased frequency of canal blockages.
Combination of step back and crown down
technique.

Uses both hand and rotary instruments.

 Patency of canal is maintained by using 10 or 15 k

file.
 Coronal third of canal is prepared using GG drills.
 WL determined
 Apical portion prepared using step back technique.
 Recapitulate and maintain apical patency of the
canal
Advantages
 Less chance of ledge formation.
 Maintains intergrity of dentin by avoiding
excessive removal of radicular dentin.
 Developed by Roane.
 It involves the use of instruments with non
cutting tip.
 Instruments with triangular cross section
which has a decreased mass and cutting
flutes, improves flexibility and decrease
restoring force of instrument when placed in
curved canals.
 Use of Flex-R files is recommended having a
safety tip design.
 Requires another light
Engaging dentin with a Cutting action by anti-
quarter clockwise turn to
light quarter clockwise clockwise motion with
pick the debris and finally
turn(60 degree) apical pressure
the file is withdrawn
 ADVANTAGES DISADVANTAGES

•Balance and
maintains the file
•Wide preparation, may
central even in case of
lead to perforation
curved canal.
•Instrument prone to
•Better control of the
fracture
file.
•Improved tactile sense
•Allows selective
required to control
cutting
instrument.
•Avoids transportation
 Proposed by Fava (1983).
 Recommended for straight canals.
 No use of rotary instruments.

Technique
 Canal explored using small file.
 Then, prepared in crown-down manner using k file
in decreasing sizes.
 Then, step back technique is in 1mm increments
with increasing file sizes.
 Frequent irrigation and recapitulation using MAF is
done using instrumentation.
 Contraindications
Indications •Calcified canals.
•Young
•Straight canals
permanent tooth
•Straight •Teeth with open
portion of apex, as they
curved canals have thin dentinal
walls.
 Advocated by Saunders and Saunders

 Uses non cutting tipped instrumentd with

step back technique.

 Preparation starts in coronal part of the canal

 40 flex R file with balance force technique introduced in
straight part of canal.

 Sequentially larger sizes used to instrument straight part.

 Coronal 4-5mm with GG (2 and 3)

 20 file extended to WL and canal prepared using balanced

force technique.

 MAF varies between 35-40

 Step back with Balanced force done to prepare remaining

curved portion.
 Profile
Quantec Greater
2000 taper

K3 Ni-Ti Rotary RACE

Instruments

Hero Light
642 Speed
Self
adjusting
Protaper
file