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Endodontic Triad
create a smooth, straight line access to the canal system and
• Length determination the apex. The optimal access cavity results in the straight entry
2. Biomechanical into the canal orifices with line angles forming a funnel which
Preparation drops smoothly into the canals (Fig. 14.6). Sometimes depending
• Cleaning and shaping upon the location and number of canals, modification of the
outline form may be needed.
• Irrigations An ideal access preparation should have following qualities:
• Intracanal medicament 1. An unobstructed view into the canal.
3. Obturation 2. A file should pass into the canal without touching any part
of the access cavity.
Fig. 14.1: Pyramid of endodontic treatment 3. No remaining caries should be present in access cavity.
Danica Anastasia
Unimpeded straight-line access of the instruments in the • Allows modification of the ideal outline form to facilitate
canals to the apical one third unstrained instrument placement and manipulation
Convenience
form
Conservation of the tooth structure
1
Root Canal System
plan the whole treatment so as to obtain the successful treatment
results.
The clinician should evaluate the tooth to be treated to
ensure that the particular tooth has favorable prognosis. Before
performing cleaning and shaping, the straight line access to canal
orifice should be obtained. All the overlying dentin should be 1/22/19
removed and there should be flared and smooth internal walls
to provide straight line access to root canals (Fig. 17.8). Since
shaping facilitates cleaning, in properly shaped canals,
instruments and irrigants can go deeper into the canals to
remove all the debris and contents of root canal. This creates
a smooth tapered opening to the apical terminus for obtaining
Fig. 17.6: Radiograph showing obturated first molar
three-dimension obturation of the root canal system.
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• Objectives:
1. Remove accumulate debris
2. Maintain working length
3
Disadvantages of radiographic methods of working length
determination 10 or 15 size instrument. If it is of average wid
1. Varies with different observers or 25 size instruments. If canal is wide, use 30
2. Superimposition of anatomical structures instrument.
3. Two-dimensional view of three-dimensional object • Insert the selected file in the canal up to the estim
4. Cannot interpret if apical foramen has buccal or lingual exit length and1/22/19
take a radiograph.
was first introduced by John Ingle. Weine modified this 5. Risk of radiation exposure • If file is too long or short by more than 1 mm f
6. Time consuming
Textbook of Endodontics
subtraction rule (Figs 15.8A to C) as follows: diameter, readjust the file and take second rad
7. Limited accuracy
a. If radiograph shows absence of any resorption, i.e. bone • If file reaches major diameter, subtract 0.5 mm
or root apex, shorten the length by 1 mm (Fig. 15.8A). Grossman Method/Mathematic Method of younger patients and 0.67 for older patients.
b. If periapical bone resorption is present, shorten it by Working Length Determination
1.5 mm (Fig. 15.8B). Advantages
Length Determination c. If both bone and root resorption is seen, shorten length
by 2 mm. This is done because if there is root resorption,
It is based on simple mathematical formulations to calculate
the working length. In this, an instrument is inserted into the • Minimal errors
canal, stopper is fixed to the reference point and radiograph • Has shown many successful cases
loss of apical constriction may occur in such cases (Fig.
Radiographic Evaluation Electronic Apex15.8C).
Locators Grossman Formula
is taken. The formula to calculate actual length of the tooth
Figs 15.8A to C: Modification in length by substraction
is as follows: in case of root resorption
• Rapid development of increases the chances o
obturating material.
In curved canals, canal length is reconfirmed because final
• Grossman formula • Patientsworking
with gag reflex
length may shorten up to 1 mm as canal is straightened Actual length of the tooth Apparent length of tooth in radiograph Disadvantages
• Metode Ingle and can’t
outtolerate films
by instrumentation. If root contains two canals, the cone _______________________________
By above,
= _____________________________________________
Actual length ofasthe
we see those threelength
Apparent variables are known and
of instrument • Time consuming and complicated
• Patientsshould be positioned at 20 to 30o horizontal deviation from
with medical
• Metode Weine by applying the formula, 4thinvariable,
instrument radiographi.e. actual length of tooth • Requires excellent quality radiographs.
the standard facial projection. 204
• Metode Kuttler problem that prohibit the can be calculated.
holding ofRadiographic
film/sensormethod of length determination Actual length of the instrument ×
1. Measure the estimated working length from preoperative Apparent length of tooth in radiograph
• Patients with pacemaker
periapical radiograph.
Actual length of tooth = ________________________________________________
Apparent length of instrument in radiograph
(?) 2. Adjust stopper of instrument to this estimated working length
and place it in the canal up to the adjusted stopper.
3. Take the radiograph. Disadvantages
4. On the radiograph measure the difference between the tip of 1. Wrong readings can occur because of:
the instrument and root apex. Add or subtract this length to a. Variations in angles of radiograph
the estimated working length to get the new working length. b. Curved roots
5. Correct working length is finally calculated by subtracting 1 mm c. S-shaped, double curvature roots.
from this new length.
Mechanical Objectives
CDJ always coincide with apical constriction. Location of The mechanics of cleaning and shaping may be viewed as
an extension of the principles of coronal cavity preparation
ranges from 0.5 - 3 mm short of anatomic apex (Fig. 15.5). to the full length of the root canal system. Schilder gave five Fig. 17.4: Prepared root canal shape should
(Schilder)
mechanical objectives for successful cleaning and shaping 30 be continuous tapered
years ago. The objectives taught the clinicians to think and
NIFICANCE OF WORKING LENGTH operate in three dimensions.
1. given
The objectives RC by preparation
Schilder are: should
Working length determines how far into canal, instruments 1 . The root canal preparation should develop a
develop a continuously
continuously tapering cone (Fig. 17.4.) : This shape
an be placed and worked. tapering
mimics the natural cone
canal shape. Funnel shaped preparation
t affects degree of pain and discomfort which patient will of canal should merge with the access cavity so that
2. Making preparation
instruments will slide into the canal. Thus in multiple
access cavity
xperience following appointment by virtue of over and planes
and root canal which
preparation introduces
should the
form a continuous
channel.
nder instrumentation. concept of “flow”
2. Making the preparation in multiple planes which
f placed within correct limits, it plays an important role 3. the
introduces Making
concept ofthe canal
“flow”: narrower
This objective preserves
the natural curve of the canal.
n determining the success of treatment. apically and widest coronally
3. Making the canal narrower apically and widest
Before determining a definite working length, there should Fig. 15.5: CDJ needs not to terminate at apical constriction. 4. ToAvoid
coronally: create a transportation
continuous tapers up toof thethird
apical
CDJ needs not
It can beto0.5-3
terminate at apical
mm short of the constriction.
apex which creates the resistance form to hold gutta-percha in
foramen
be straight line access for the canal orifice for unobstructed the canal (Fig. 17.5).
0.5 – 3 mm short of the apex 4. Avoid 5. transportation
Keep the of the foramen:
apical opening asbe
There should
penetration of instrument into apical constriction. gentle and minute enlargement of the foramen while Fig. 17.5: Diagrammatic representation of objectives
Once apical stop is calculated, monitor the working length cleaning and underfilling. Apical leakage may occur into maintaining small as(Fig.
its position possible
17.6). of canal preparation
232
periodically because working length may change as curved uncleaned and unfilled space short of apical constriction.
anal is straightened. It may support continued existence of viable bacteria and
Failure to accurately determine and maintain working length contributes to the periradicular lesion and thus poor success
may result in length being over than normal which will lead rate.
o postoperative pain, prolonged healing time and lower
uccess rate because of incomplete regeneration of Working Width
ementum, periodontal ligament and alveolar bone. Working width is defined as “initial and post instrumentation
When working length is made short of apical constriction horizontal dimensions of the root canal system at working length
t may cause persistent discomfort because of incomplete and other levels”.
201
Remove the pulp tissue, bacteria and Apical to Coronal Coronal to Apical
their by-products from the RC Step-down
Conventional
Crown-down pressureless
Step-back
Hybrid technique
Modified step-back
Modified double flare
Passive step-back Balanced force technique
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Watch Winding
• Back-forth oscillation, right 4. Carve: Carve is performed with reamers to do shaping of
Textbook of Endodontics
the canals. In this a precurved reamer as touched with
and left dentinal wall and canal is shaped on withdrawal.
• Angle of rotation 30o – 60o 5. Smooth: It is performed with files. In this circumferential
motion is given to smoothen the canal walls.
• Efficient with K-type 6. Patency: It is performed with files or reamers. Patency means
instrument that apical foramen has been cleared of any debris in its
path.
• Less aggressive
BASIC PRINCIPLES OF CANAL INSTRUMENTATION
1. There should be a straight line access to the canal orifices
(Fig 17.19). Creation of a straight line access by removing
overhang dentine influences the forces exerted by a file
in apical third of the canal.
Fig. 17.17: Rotation of file in watch winding motion
2. Files are always worked with in a canal filled with irrigant.
Therefore, copious irrigation is done in between the
instrumentation, i.e. canal must always be prepared in
wet environment.
3. Preparation of canal should be completed while retaining
its original form and the shape (Fig. 17.20).
4. Exploration of the orifice is always done with smaller
file to gauge the canal size and the configuration.