CONTENTS

• Instrumentation Techniques
• Introduction
• Standardized
• History
• Conventional Stepback
• Guidelines for S & C
• Modified Stepback
• Schilder’s Objectives
• Passive Stepback
• Principles • Crown-down

• Functional Motions • Crown-down Pressureless

• RC working width • Double Flared

• Modified Double Flared

• Balanced Force
• Instrumentation Techniques

• Modified Balanced Force

• Reverse Balanced Force • Evaluation Criteria of Canal Preparation

• Hybrid • Iatrogenic Errors

• Canal Master Technique

• Conclusion
• Non Instrumentation

• References
• Laser Assisted Instrumentation

• Ultrasonic Instrumentation

• Sonic Instrumentation
 INTRODUCTION

Instruments shape the canals and irrigantsclean the canals.

Baumgartner & Madder

• Success – how well the canals are shaped and cleaned.

• Root canal system must be:

• Cleaned of pulp tissue & debris
• Shaped to receive a 3-D filling of the entire RC space
• Principle :
• To remove all organic debris & microorganisms from the root
canal systems
• and to shape the walls of the canals to facilitate further
cleaning
• obturation of the entire RC space.
HISTORY
1733 Pierre Fauchard Trephination of teeth, preparation of root canals &
cauterization of pulps - “ Le Chirurgien Dentiste“

1838 Edward Maynard Endodontic hand instruments

1852 Arthur Used small files for root canalenlargement

1885 Gates Glidden Gates Glidden drills

1889 William HRollins First endodontic handpiece for automated RCpreparation

1915 Kerr K-files

1957 Richmann Ultrasonics in endodontics

1967 Ingle Standardized Technique

1969 Clem First decribed StepbackTechnique

1971 Weichmann & Johnson Lasers in endodontics

HISTORY
1974 Schilder Gave detailed description of StepbackTechnique

1979 Mullaney Stepback Technique

1980 Georig Stepdown (Crown-down) Technique

1980 Marshall & Pappain Crown-down Pressureless Technique

1980 Abou Rass, Glick & Frank Anticurvature Filing

1983 Fava Double Flared Technique

1986 Roane & Sabala Balanced Force Technique

1993 Lussi Non Instrumentation Technique

1994 Torabinejad Passive Stepback Technique

2002 Sequeria Alternate Rotary Motion

GUIDELINES FOR SHAPING (GROSSMAN)
I. Preinstrumentation

Direct access into root canals along a straight line

Working length : accurately determined

II. Instrumentation

Instruments : fitted with instrument stops

Sequential order of instruments & recapitulation

wet canal only
III.Cleaning & Shaping

Instruments : confined to the RC, prevent injury to periradicular tissues

Don’t force an instrument if it binds

Recapitualtion : prevent packing of debris

Apical portion : enlarged to facilitate flow of irrigants

Debris should not be forced through the apex

Precurve file : curved canals – prevents ledging

FUNCTIONAL MOTIONS OFINSTRUMENTATION

• Reaming:
• Clockwise rotation – pushing motion
• Limited to quarter to half turn
• Disengaged with a mild pulling motion when
bound
• Penetration – Rotation - Retraction

• Filing:
• Push-pull motion
• Passive insertion and active withdrawal of the
instrument
Combination of Reaming & Filing:

File is inserted – quarter turn clockwise and

apically directed pressure (reaming) and then

subsequently withdrawn (filing).

Watch-winding: Twiddling motion

Instrument reciprocated back and forth in counter-clockwise direction

Then retracted to remove debris

Movement with quarter turns using small K-files(#8/#10) to

reach till working length before coronal flaring
Ingle
Circumferential Filing:

Instrument is inserted upto the apex

Laterally pressed against one side of canal

Withdrawn with a pulling motion to file the dentinal wall

Procedure is repeated until the next file/reamer is used

Anticurvature Filing Abou Rass et al

Prevent perforation of the furcal wall of the mesial

root of molars. (Danger Zone)

Top of Handle : pulled into the curvature

Shank : pushed away from the inside of the curve

Balances the cutting flutes against the safer part of

the root
Serial Shaping Motion:
Follow :
Movement of smallest instrument to reach the apical foramen
Negotiating any obstructions or curvatures

Follow-withdraw :
As apical foramen is reached, instrument is withdrawn or pulled
coronally.

Carting :
Transporting dentinal debris & pulp remnants coronally
Using reamer or F-flex files
Carve :
Shaping or sculpting the canal to form a continuous tapering
preparation without apical pressure using reamers

Smoothening :
Circumferential filing using K flex files

Patency files :
Smallest file that does not bind to the canal wall at the minor
diameter
Used to check the patency of the canal up to the apical foramen
Scouting :
Estimating the gauge and anatomy of root canal with help of
instrument.

Gauging :
Knowing the cross sectional diameter of the foramen that is
confirmed by the size of the instruments that fits snugly at
working length.

Tuning:
Ensuring that each sequentially larger instrument uniformly backs
out of canal by 0.5mm.
SCHILDERS OBJECTIVES OF CLEANING & SHAPING
Continuously tapering canal from the apex to the
access cavity

Maintain original anatomy

To leave as much radicular dentin (0.2mm-critical)

Maintain the position of apical foramen

Keep apical foramen as small as practically possible

Dent Clin North Am 1974;18:269-96.
BIOLOGICALOBJECTIVES

To confine the instrumentation within the apical foramen

No extrusion of necrotic debris beyond the foramen

Removal of all tissues and debris from the root canal space

Creation of sufficient space for the placement of intra-canal

medicament and for irrigation purposes

PRINCIPLES

Outline form
Basic preparation throughout its length- dictated by the canal
anatomy
Initial anatomy must be maintained throughout the procedure

Convenience form
Access has to be expanded if instruments starts to bind

Sanitation of the cavity

Meticulous cleaning of the cavity walls until they feel glass-smooth
Accompanied by continuous irrigation
Retention form
Nearly parallel walls in the apical 2-3mm of the canal
To ensure firm seating of the GP point

Resistance form
Development of apical stop at CDJ

Extension for prevention

Extension of cavity preparation throughout its entire length and
breadth
A. Radiographic Apex

B. Resistance Form
apical stop at CDJ

C. Retention Form
to retain primary filling point

D. Convenience Form
subject to revision as needed to accommodate
larger, less flexible files

E. Outline Form
basic preparation throughout its length dictated
by canal anatomy
CLASSIFICATION OF ENDODONTIC INSTRUMENTS
(GROSSMAN)
Hand Operated
A. Barbed Broaches & Rasps
Group 1 B. K-type Reamers & Files
C. Hedstroem Files
Low speed instruments with latch type attachments
Group 2 A. Gates-Glidden drills
B. Peeso Reamers
Engine driven instruments
A. Rotary NiTi endo instruments
Group 3 B. Reciprocating instruments
C. Self Adjusting File (SAF)
Group 4 Ultrasonics & Sonic Instruments
INSTRUMENTS USED FOR CLEANINGAND SHAPING

Broaches

Rasp

K- files

H –files

GG drills

NiTi rotary

Light speed

Profile
ROOT CANAL WORKING WIDTH
RC should be widened for following reasons:

To eliminate microorganism on the canal surface mechanically

Completely removing the pulp tissue

Increase the capacity of RC to permit irrigation and debridement

To shape the root canal to receive gutta-percha

Traditional Concept
Enlarge the canal atleast 3 sizes beyond the size of the first instrument
that binds.
Enlarge the canal until clean, white dentinal shavings appear
Not recommended

The color of the dentinal shaving is no indication of presence of infected

dentin or organic debris.

Root canals should be enlarged regardless of initial width to remove

irregularities of dentin and make smooth and tapering canal.

Grossman
Factors affecting the size of canal

Peri-apical pathology or resorption

Narrow canals - initial canal width has to be assessed radiographically
Whether root canal is vital / calcified / infected
Radius of canal curvature which could make the canal preparation
difficult
Complex canal anatomy like C-shaped canals and the isthmus region

Grossman
A study showed that molar tooth canals should be enlarged upto #40 for
effective cleaning

Canals shaped with greater taper NiTi allow irrigants to reach the apical
third without much enlargement of apex too much

Study shown that canals shaped with 6% taper instruments upto #30 have
cleaner canals without smear layer or debris

Grossman
 NARROW APEX
Benefits Drawbacks

Minimal risk of Canal transportation Little removal of infected dentin

Minimal Extrusion of irrigants Questionable rinsing effect in apical

areas during irrigation

Minimal Extrusion of filling material Possibly compromised disinfection

during inter appointment medication

Can be combined with tapered Not ideal for lateral condensation

preparation to counteract some
drawbacks

Cohen
WIDE APEX

Benefits Drawbacks
Removalof infected dentin Risk of preparation errors and
extrusion of irrigants and filling
material

Access of irrigants and Not ideal for thermoplastic obturation

medications to apical third of
root canal

Cohen
ROOT CANAL SHAPING TECHNIQUES

Apico-Coronal Techniques Corono-Apical Techniques

Standardized Technique Crown-down Technique

Stepback Preparation Crown-down Pressureless

Passive Stepback Double FlaredTechnique

Balanced ForceTechnique

Hybrid Technique
STANDARDIZED TECHNIQUE

First formal RC preparation technique Ingle (1961)

Canals prepared by enlarging sequentially to selected size.
Final result : preparation similar in size, shape and taper of a standardized
instrument

Technique:
Working length
Canal negotiated with smallest size instrument, worked upto WL with
sequentially larger file
Finally a canal shape is produced which is similar to the last instrument
used.
2 factors of variations

Canals shaped with standardized technique end up wider than the

instrument size would suggest.

Production quality is insufficient, both for instruments and for gutta-

percha cones, leading to size variations.

Ingle
CONVENTIONAL STEPBACK PREPARATION

Telescopic / Flare / Serial RC preparation

Mullaney, Walton, Weine & Martin : 1979
Preparation : from the apex with fine instrument which is enlarged

first to a size 25/30 and then consecutively larger instruments

are used for shaping the middle and coronal part of the canal.

Technique:
Mullaney divided into 2 phases:
Phase I
Phase II - A & B
Phase I :
Patency
Working length
Initial Apical File (IAF)
Watch-winding motion with copious irrigation
Recapitulation
Canal enlarged upto No. 25 at the working length
Phase II A :
Next file size No.30 used 1mm short of WL
Recapitulation (No. 25)
Next file (No. 35) used 2mm short of WL
Preparation steps back by 1mm till straight mid-canal is
reached
• Phase II B :
• Coronal portion is prepared using GG/Orifice
openers
remove coronal constriction
Phase II B (Refining Phase):
For smoothing the canal walls
To get taper from coronal portion till apex
and will be larger repilca of original canal

Last apical instrument (No.25) used to smoothen the

walls with push-pull strokes with copious irrigation.

This Preparation gives 5% taper to the canal.

Serial Canal Preparation:
By Walton & Torabinejad

After apical preparation, preparation steps back by 0.5mm & one larger
instrument at a time.

This Preparation gives 10% taper to the canal.

 ADVANTAGES:

• Creates only small apical preparation with larger instruments used at

successively decreasing lengths to create a taper.

Taper can be altered in btwn consecutive instruments

DISADVANTAGES:

Difficult to irrigate apical region

More chances of apical extrusion of debris

Time consuming

It has tendency to straighten the curved canal

Increased chances of iatrogenic errors

Loss of working length

MODIFIED STEPBACK PREPARATION

After apical preparation, stepback preparation begins 2-3mm up the canal

Provides short parallel retention form to the master GP point

ADVANTAGES :

Reduced apical transportation

Increases the percentage of canal walls being prepared

DISADVANTAGES :

Increased chance of ledge formation.

Holds only a minimal volume of irrigant and so accumulation of dentinal mud

leads to blockage of the foramen.

WL is most likely to change as coronal constriction is removed.

When GG drills and Peeso drills are advanced past the middle
third of root canal – “COKE BOTTLE”.

Strip perforations and over preparation

Ingle
PASSIVE STEPBACKTECHNIQUE Torabinejad

Combination of hand and rotary files : to attain an adequate coronal flare

before apical RC preparation

Provides gradual enlargement of root canal in an apical to coronal direction

without applying force, thereby reducing procedural errors.
Technique:

Access preparation and WL determination using No.15 file

Additional files of 20,25, 30, 35 and 40 are inserted passively into the canal:
removes debris and mildly flared preparation for insertion of GG.

Copious irrigation

No. 2 GG inserted to a point where it binds slightly, pulled back 1 – 1.5mm and

then activated – canals walls get flared.

Similarly GG No. 3 and 4 are used coronally.

ADVANTAGES:

Removal of debris and minor canal obstructions

Knowledge of canal morphology

Gradual passive enlargement of canal in apico-coronal direction

Can be used with ultrasonic instruments

Reduced incidence of procedural errors.

CROWN-DOWNTECHNIQUE (STEP DOWN)

Aka -
Reverse flaring (Weine),
Coronal 2/3rd enlargement (Cohen),
Cervical Flaring (Goreig)

Shaping of the coronal aspect of root canal first before apical instrumentation.

• Technique:

• Patency with No.8/10 K file

• Coronal 2/3rd prepared using H-files

(#15,20,25) to a WL depth of 16-18mm or to
a point where the file starts to bind.
Flaring coronal segment with GG #2, #3 or #4, each drill being
sequentially shorter.

WL determination

Remaining canal prepared in step-down approach using

descending file sequence, progressing by 1mm.
Apical portion of canal is then enlarged to appropriate MAF
which can vary from canal to canal and from tooth to
tooth.

Final taper attained by the MAF is used in circumferential

filing.
Modifications:

• Crown-down pressureless technique

• Double flare technique

• Balanced force technique

CROWN-DOWN PRESSURELESS TECHNIQUE
Marshall and Pappain

• Early coronal flare with GG drills followed by incremental removal of dentin from
coronal to apical direction : hence termed “CROWN DOWN”

• Straight K-files are used in a large to small sequence with a reaming motion and
no apical pressure. : hence termed “PRESSURELESS”

• Morgan and Montgomery found this technique resulted in rounder shape when
compared to usual stepback technique.
Technique:

After coronal access, provisional WL

#35 K-file introduced into the canal with no apical

pressure

GG # 2 is used for coronal flaring upto or short of

point where #35 file explored.

Followed by GG # 3 & 4 : this shortens the

WL.

Crown-down preparation, #60 file used with no

apical pressure & reaming action is employed to
enlarge the canal.
Followed by use of sequentially smaller files,
deeper into the canal

Radiographs are taken when instrument

penetrates the provisional WL

Final step to enlarge the apical area to

appropriate MAF at WL
BALANCED FORCE TECHNIQUE Roane & Sabala (1985)

Involves the use of instrument with non-cutting tip

Flex-R files are recommended for this technique.

Technique described as “Positioning and Preloading” an instrument

through clockwise rotation and then shaping the canal with a counter
clockwise rotation.
Technique:
Coronal and middle thirds prepared using crown-down

technique, using GG.

First file that binds short of WL is inserted into the canal

Rotated clockwise (quarter turn) using only light pressure

This movement causes flutes to engage a small amount of dentin

Now file is rotated counter-clockwise with apical pressure to keep the
file at the same depth.
This causes shearing off small amount of dentin engaged during
clockwise rotation.

After 2/3 cycles, file is loaded with dentinal shavings and is removed
from the canal with a prolonged clockwise rotation. (loads debris into
the flutes)

Sequential files are used in crown-down fashion before preparing the

apical third.
• Roane recommends minimum enlargement of size 45, 1.5mm short of apical
foramen in curved canals.

• Size 80 in single rooted teeth, carrying the preparation through full length of
the radiographic apex of the root.

• This technique has shown to reduce canal transportation and ledging.

MODIFIED BALANCED FORCETECHNIQUE

• Earlier called Alternated Rotary Movements

• Does not recommend withdrawal of instrument after each set of rotations

• Emphasized incremental apically directed movement and withdrawal when the

file has reached the working length.
REVERSE BALANCED FORCEPREPARATION

NiTi greater Taper hand files are used.

Flutes of Greater taper files are machined in a reverse direction

Technique:

File inserted and rotated 60° in anti-clockwise direction

Then 120° in clockwise direction with apical pressure.

crown-down sequence upto the WL.

WL determination

Apical portion prepared using 2% taper ISO files in balanced force technique.
Effect of coronal-radicular flaring on apical transportation.
Swindle R, Neaverth E, Pantera E, Ringle R.
The purpose of this study was to evaluate the effect early and late radicular
flaring (no flaring was done) has on apical canal transportation when using
balanced force instrumentation.

While early radicular flaring made instrumentation easier, no significant

differences were found when comparing apical transportation between
the two groups when balanced force technique was used.

J Endodon 1991; 17(4):147-149.

DOUBLE FLARETECHNIQUE Fava

Canals prepared in crown-down manner using K-files in decreasing sizes.

Followed by stepback technique in 1mm increments with increasing file sizes.

INDICATIONS:
• Straight root canals
• Straight portions of curved canals

CONTRAINDICATIONS:
• Calcified canals
• Young permanent teeth
• Open apex
Technique:

WL determination using small K-file

Crown-down Preparation : Apical third is enlarged using larger to smaller

K-files until WL is reached.

Apical enlargement done till MAF size

Stepback preparation with descending files with frequent recapitulation with MAF.
ADVANTAGES:
Greater taper in cervical and middle third such that the removal of canal
contents is more effective and RC is better cleaned.

Improved quality of root canal filling compared to conventional technique.

Flared technique maintains the RC shape - no hour glass appearance /

apical zip.

Facilitates irrigation procedure and easier placement of posts.

MODIFIED DOUBLE FLARETECHNIQUE

Saunders & Saunders

• Uses non cutting tipped instruments with stepback technique.

Technique:

Preparation starts in the coronal part of the canal

#40 Flex R file with balanced force introduced into straight part of the canal

Sequential larger sizes used to instrument the straight part

Coronal 4-5mm instrumented with GG (No. 2 & 3)

#20 file extended to WL

Canal prepared sequentially with balanced force technique.

Preparation is continued until clean dentinal shavings are obtained.

MAF varies between #40 - #45 file.

Stepback with balanced force done to prepare remaining curved portion.

ADVANTAGES

Shaping of canal is subjectively easier than stepback

Removal of coronal obstructions allows removal of bulk of tissue, debris and

micro- organisms before apical shaping.

Minimizes extrusion of debris

Allows better access and control over the enlarging instruments decreasing
incidence of zipping

Allows better penetration of irrigants

WL is less likely to change

In vitro Study of Apically Extruded Debris and Irrigant Following the Use of
Conventional and Rotary Instrumentation Techniques

2 groups of 20 extracted teeth with single canals were used.

group 1 (10 teeth), - “step back” technique and stainless steel K-files.
group 2 (10 teeth), “crown-down” technique and nickel-titanium K3 rotary instruments.

Debris and irrigant extruded from the apical foramen during instrumentation were collected and measured.
Debris - group 1 (K-files) was 0.400 mg and in group 2 (K3 files)—0.225 mg.
Irrigant - 0.443 mL in group 1 and 0.247 mL in group 2.

13 min for the step back technique

8.7 min for the crown-down technique
Effect of preflaring on tactile detection of the apical
constriction.
Stabholz A, Rotstein I, Torabinejad M. J

The ability to determine the apical constriction by tactile sensation was

significantly increased when the canals were preflared.

It was possible to detect the apical constriction in the preflared group by

tactile sensation in
75% of the time vs. 32.3% in the nonflared group.

Endodon 1995; 21(02): 92-94.

HYBRIDTECHNIQUE

• Combination of Stepdown followed by Stepback.

• Both rotary and hand instruments are used

Technique:

Patency with #10 K file

Coronal third preparation using hand or GG till point of curvature

WL determination

Apical portion prepared using stepback technique

Recapitulation and irrigation

ADVANTAGES:

• Ability to shape canal predictably

• Less chances of ledge formation

• Maintains the integrity of dentin avoids excessive removal
of radicular dentin.

• Optimises the advantages of crown down & step back techniques

CANAL MASTERTECHNIQUE Wildey & Senia

Instrument used is Canal Master Instrument (SW)

Here cutting portion is reduced to 1-2mm with 0.75mm non-cutting pilot tip

Cutting portion resembles a reamer with blunted edges.

Rest of the instrument is parallel sided shank of round cross section

Maximum efficiency is with clockwise rotary motion

ADVANTAGES:

Prevents transportation of the canal

Small cutting head provides minimum cutting surface & max. control

Increased flexibility

Instrument stays centered in the canal

Gives finer tactile perception

Does not require recapitulation

NON-INSTRUMENTATION TECHNIQUE
Lussi

Minimal Invasive Technique

Uses controlled cavitation & hydrodynamic turbulence in the RC so as to clean them.

Technique uses:

Vaccum pump

A Hose
A special valve to pump irrigant which generates bubbles & cavitation
that loosen the debris

Debris is removed by suction.

Enhances the ability of NaOCl to dissolve the organic pulp tissue.
Technique:
First reduced pressure at 0.7 bar generated, producing macroscopic &
microscopic voids (5-50μm)

Followed by quick pressure rise to 0.1 bar leading to collapse of bubbles,

thus building up cavitation and turbulence.

Allows irrigant to penetrate the whole of RC system

Smooth exchange of irrigant is obtained using double tubing.

ADVANTAGES:

• Cleaning of canal, similar or better than hand instrumentation

• Better results in curved canals

• Less chances of extrusion of irrigant beyond the apex

• Treatment duration is independent of the number of RCs in the tooth

DISADVANTAGES:

• Does not shape the canal

• Tooth has to be insulated

Canal blockage and debris extrusion with eight preparation techniques
Dummer et al

208 canals in extracted human teeth were prepared by one operator using
one type of file.

The techniques included were standardized, stepback with reaming, stepback

with circumferential filing, stepback with anticurvature filing, double-flare,
stepdown, crown-down pressureless, and balanced force.
Dentin debris extruded apically was collected in preweighed containers and
the dry weight of debris determined to 10−5 g precision

Techniques involving a filing (linear) motion caused significantly more

blockages and extruded significantly more apical dentin debris.
LASERASSISTED CANAL PREPARATION

Weichmann & Johnson (1971)

Nd.YAG, Argon, Excimer laser, Erbium Laser

Nd YAG laser energy better absorbed by dark tissue and is transmitted by water.

Excimer lasers and Erbium lasers are strongly absorbed by dental hard tissue.

Dederich et al showed the melting and recrystallizing the dentin surface can create
clean and penetrable canal.

Delivered through optical fibres which have a diameter of 200 – 400 μm equivalent to
#20-40 files
MECHANISM :

• Melting the dentin surface

• Vaporization of debris and pulpal tissue remnants.

INDICATIONS :
• Straight / Slightly curved canals
• Wide root canals

CONTRAINDICATIONS :
• Heat generated may injure the peripical tissues
• Curved canals cannot be assessed
• Expensive
Cleaning and shaping the root canal with an Nd: YAG laser beam:
A comparative study

32 teeth were divided into two groups

Group 1-circumferential filing and the canals were flushed between each file with 3 ml of
2% NaOCl, 25-gauge needle. The preparation was performed to allow a #35 K file till WL
and step back to #60

Group 2 - 20 canals -instrumented # 20 file till working length. NaOCl irrigation

The fiber optic attached to the laser unit was inserted inside the canal and the length of
penetration was recorded.
35-W pulsed Nd : YAG, which produced a beam with a wave length of 1.06 μm

SEM - preparation using Nd:YAG laser results in cleaner dentin walls when compared to
conventional methods.

Moogi et al JCD 2010

CANAL PREPARATION WITH ULTRASONIC INSTRUMENTATION
Richman in 1957
• Barbed broach is connected to US device for preparation

Howard Martin and Walter Cunningham in 1976

• Developed a device, tested and marketed it in 1976.
• Named the Cavitron endodontic system (Dentsply).

• Endosonics refers to the endodontic treatment by sonic,

supersonic or subsonic system (Martin & Cunningham).
Based on sound as an energy source (20-25khz) that activates endodontic files.

Energy source – piezoelectric or magnetostrictive.

Files oscillate at the frequency of 20,000- 25,000 vibrations /seconds.

Magnetostrictive Unit

Electromagnetic energy is converted into mechanical energy.

It needs water coolant because it generates more heat.

Expensive, more clumpsy and less powerful.

Piezoelectric energy is induced by subjecting crystals of quartz or Rochelle salts to
physical force or pressure.

Generates less heat

Doesn’t require water as coolant
Transfers more energy to the file, making it more powerful.

Used for
Location of calcified canals
Retrieval of broken instrument
Root end preparation.
Handpiece holds a K-file, when activated produces movement of
shaft of file between 0.001” & 0.004” at freq. of 25-30KHz.

Oscillating movement produces cutting action & creates ultrasonic

waves of the irrigant.

Ultrasonic vibration - heat : increases the chemical effectiveness

of irrigant solution.
2 significant physical processes that occur :

Cavitation

Acoustic Streaming
ADVANTAGES

• Less time consuming.

• Produces cleaner canals because of synergetic effect.

• Heat produced increase the chemical effectiveness of sodium hypochlorite.

DISADVANTAGE

• Increased frequency of canal transportation.

CANAL PREPARATION WITH SONIC
INSTRUMENTATION

• Sonic endodontic handpiece attach to the regular handpiece at a

pressure of 0.4 Mpa

• Air pressure can be varied with an adjustable ring on the

handpiece to give an oscillatory range of 2 to 3 kHz.

• Tap water irrigant / coolant is delivered into the preparation from

handpiece.
• Sonically powered files oscillate in large elliptical motion at the tip.

• When loaded into the canal oscillation motion changes into a longitudinal
motion, up and down (Walmsley et al); efficient form of vibration for
preparing root canal. (Ingle)

files used in Sonic system

• Rispi Sonic, Shaper Sonic, Trio Sonic, Helio Sonic Files.

• Files have spiral blades protruding along their lengths and non cutting tips.
ADVANTAGES

• Better shaping of canals

• debris extruding beyond apex is less.

• Produces clean canals free of debris and smear layer.

DISADVANTAGES

• Walls of prepared canals are rough.

• Chances of transportation more.

Comparison of balanced forces, endosonic, and step-back filing
instrumentation techniques: quantification of extruded apical debris
McKendry DJ.

15 single-canal, extracted teeth were instrumented by

balanced forces, endosonic, or step-back filing.

Debris extruded from the apical foramen during instrumentation was collected onto
preweighed filters using a suction filtration apparatus

Balanced forces technique apically extruded significantly less debris than either
endosonic or step-back filing techniques
J Endod. 1990 Jan;16(1):24-7.
SPECIALANATOMIC PROBLEMS IN CANAL CLEANING AND
SHAPING

• Management of Curved Canals

• Management of Calcified Canals

• Management of C-shaped Canals

• Management of S-shaped Canals

MANAGEMENT OF CURVED
CANALS

• First step : estimate the angle of curvature

and radii of curvature

• It estimates only the mesio-distal curve but not the bucco-lingual curve.
Curved canals : occurrence of uneven cutting and cause errors

Reproducilbe Glide Path

Defined as a smooth radicular tunnel from canal orifice to physiological

terminus of root canal.
-John west

Infact to achieve a clean root canal system GP should be followed , not

made

# 10 file anatomically follow the canal- then enlarged to # 15

• To avoid occurrence of such errors, there should be even contact of file
to the dentin

• This can be done by:

force - files bend against the curved dentin surface.

length of file which binds to dentin

• Decreasing the force by means of which straight files apt to bend against the curved
dentin surface :

Precurving the file

Extravagant use of smaller number of files

Use of intermediate sizes of files

Use of flexible files

I. PRECURVING THE FILE
2 types of precurving:

• Placing an extremely sharp curve near the tip of an instrument

• Degree of curvature is estimated by holding the file over the

preoperative radiograph and increasing the curvature until the
configurations of the file and canal match.
• Short sharp curve of 30 – 40 degrees is given.

• Uses :-
• To bypass a ledge
• To prepare a tooth with dilacerations
• When retreating a failing case.
• Gradual precurve for the entire length of flutes

• RC instrumented with the precurved files :

significantly lower debris score than those
prepared with straight files.

• Matching the curvature of the file to the curvature

of the canal facilitates its insertion.

• Tear drop shape rubber stop can be used, with the point
showing the correct direction of the curve.
II USE OF SMALLER FILES

Smaller files follow canal curvature because of their

flexibility.

They should be used until larger files are able to

negotiate the canal without force.
III. FLEXIBLE FILES

• Use of flexible files cause less

alteration of canal shape than stiffer
files.

• Maintain the shape of curve and

avoid occurrence of errors.
IV. INTERMEDIATE FILES
• By cutting off a portion of the file tip, a new instrument size is
created which has the size intermediate to two consecutive
instruments.

• In severely curved canals clinician can cut .05 mm of the file to

increase the instrument diameter by .01mm.

• This allows smoother transition of files as the diameter increases

• Decreasing the length of file which is aggressively cutting at the given span

• Anticurvature filing

• Modifying the cutting edges of the instrument

• Changing the canal preparation techniques

ANTICURVATURE FILING Abou-Rass, Frank, and Glick

the anticurvature filing method consists

of working the endodontic instruments constantly
against the external wall of the curve.

prepare the canal, especially at the expense of the

thickest portion of the root, staying far away from
thearea of the curve and from the bifurcation
MODIFIYING CUTTING EDGES

• Cutting edges of curved instrument can be modified by

dulling the flute of outer portion of apical third and inner
portion of middle third.

• Dulling of the flutes.

CHANGING CANAL PREPARATION
TECHNIQUES

• Crown-down technique
Removes the coronal interferences and allow the files to reach up to the
apex more effectively.
• Access preparation

• Location of canal orifice

• DG – 16 explorer

• Canal pathfinder

• Penetration and negotiation of calcified canals

• No .6,8,10 K file

• Before inserting, precurve the file in its apical 1mm.

• Confirm the position of instrument with radiograph.

GUIDELINES FOR NEGOTIATING CALCIFIED
CANALS

• Copious irrigation with 2.5% -5.25% NaOCl.

• Always advance the instrument slowly

• Always clean the instrument on withdrawal & inspect before reinserting.

• When a fine instrument reaches canal length, obtain a radiograph.

• Use chelating agents to assist canal penetration.

• Flaring of canal orifice and enlargement of coronal third of canal space
improves tactile perception.

• Avoid removing large amount of dentin in the hope of finding a canal orifice.

• Small round burs should be used to create a glide path to the orifice.
 MANAGEMENT OF C-SHAPED CANALS

• Difficult to remove pulp tissue & necrotic debris, excessive haemorrhage,

persistent discomfort during instrumentation.

• Continuous circumferential filing + 5.25% NaOCl for tissue removal and

control of bleeding.
• ultrasonic activation

• Over preparation should be avoided : only little dentin between external

root surface and canal system.
MANAGEMENT OF S-SHAPED / BAYONET SHAPED
CANAL
• Involves at least two curves with the apical curve having maximum deviations in anatomy.

• Usually identified radiographically : mesiodistally

• Buccolingually

• Multi-angled radiographs

• When IAF is removed : simulates multiple curves

• Common :

• Maxillary lateral incisors, canines, premolars

• Mandibular molars
Unrestricted access to initial curve :
Flared access preparation.

Once entire canal is negotiated, passive shaping of coronal curve

is done first.

Constant recapitulation and copious irrigation.

• Gradual use of small files with short amplitude strokes is essential to
manage these canals.

• To prevent stripping, anticurvature filing is recommended, with

pressure being placed away from curve of coronal curvature.
CLEANING AND SHAPING OF CONFLUENT ROOT CANALS

Cleaning and shaping of 2 canals in the same

root which merge to a common foramen

Confluence is detected by the impression

that a small file (# 08 or # 10) leaves on the GP
inserted in the canal that has just been
prepared

determine the point of the confluence

(distance from the apical foramen)
and, consequently, regulate the WL
EVALUATION CRITERIA OF CANAL PREPARATION

• Canal should exhibit “glassy smooth” walls

• There should be no evidence of unclean dentin filings, debris, or irrigant in the canal.

• Spreader should be able to reach within 1mm of the working length.

IATROGENIC ERRORS

Those unfortunate occurrences that happen during Rx owing to

inattention to detail, others totally unpredictable. - INGLE

• Ledge formation

• Perforation

• Zipping / Elliptication

• Canal Blockage

• Separated Instruments
LEDGE

An artificially created irregularity on the surface of the root canal wall that
prevents the placement of instruments to the apex of an otherwise patent canal.

Forcing and driving the instrument into the canal

Attempting to prepare calcified root canals

Excessive enlargement of curved canal with files

Packing debris in the apical portion of the canal

Anatomic complexities - roots curvature buccal / lingual

PERFORATION

• Using too large or too long an instrument and either perforating directly
through the apical foramen or wearing a hole in the lateral surface of the root
by over instrumentation.
 ZIP / ELLIPTICATION

• Transportation of the apical portion of the canal

ie. an elliptical shape formed in the apical foramen during preparation of curved canals.

• Creation of an ‘elbow’ is associated with zipping – at the narrow region of the root canal
at the point of maximum curvature

Ie. the irregular widening that occurs coronally along the inner aspect and apically
along the outer aspect of the curve.
Canal Blockage

• Due to lack of recapitulation

• Insufficient irrigation

Instrument Separation

• Overuse of instruments

• Instrumentation in a dry canal

• Excessive pressure applied

• Manufacturing defects
CONCLUSION

• Shaping and cleaning are important interdependent steps in the root canal
treatment.

• The combination of anatomic, biologic & pathophysiologic knowledge of the tooth

and the skill of the operator play a major role in optimizing the quality of the
root canal treatment.
REFERENCES

• Textbook of Endodontics – Ingle

• Principles & Practice – Walton & Torabinejad

• Pathways of the Pulp – Cohen

• Textbook of Endodontics – Nisha Garg

• Endodontic practice – Grossman

• Endodontics – Stock, Walker, Gulabivala

• Endodontic Science – Carlos Estrela