CLEANING AND SHAPING

OF ROOT CANAL

Cleaning and shaping protocol

Cleaning and shaping the root canal consists of removing the

pulp tissue and debris from the canal and shaping the canal to
receive an obturation material

Using sequentially larger size of files and irrigating and

disinfecting the canal to clear it of debris , one shapes the

canal to receive a well condensed filling that seals the root
canal apically and laterally to prevent any leakage

Principles of endodontic cavity preparation

List of preparations of endodontic cavity preparation is

established by slightly modifying Principles Of Cavity

Preparation established by G.V.Black

Endodontic preparations consists of both coronal and radicular

preparation each prepared separately but ultimately flowing

together into a single preparation

ENDODONTIC CORONAL
CAVITY PREPARATION:

ENDODONTIC RADICULAR
CAVITY PREPARATION:

Outline form

Outline form and

Convenience form
Removal of the remaining

carious dentine( and

defective restorations)
Toilet of the cavity

convenience
form(continued)
Toilet of the

cavity( continued)
Resistance form
Retention form

Coronal cavity preparation

PRINCIPLE 1: OUTLINE FORM

The outline form must be correctly shaped to establish complete access for

instrumentation, from cavity margin to apical foramen

To achieve optimal preparation, three factors of internal anatomy must be

considered:

(1) the size of the pulp chamber,

(2) the shape of the pulp chamber, and
(3) the number of individual root canals, their curvature and their position

PRINCIPLE 2: Convenience Form

Convenience form was conceived by Black as a modification of the cavity outline form to establish

greater convenience in the placement of intracoronal restorations.

In endodontic therapy, however, convenience form makes more convenient

(and accurate) the preparation and filling of the root canal.

Four important benefits achieved through convenience form modifications are

1. Unobstructed access to the canal orifice

2. Direct access to the apical foramen

3. Cavity expansion to accommodate filling techniques

4. Complete authority over enlarging instruments

Principle 3: removal of the remaining

carious dentin and defective restorations
Caries and defective restorations remaining in an endodontic

cavity preparation must be removed for three reasons:

(1) to eliminate mechanically as many bacteria as possible from

the interior of the tooth,
(2) to eliminate the discolored tooth structure, that may
ultimately lead to staining of the crown, and
(3) to eliminate the possibility of any bacteria-laden saliva
leaking into the prepared cavity

Principle 4: toilet of the cavity

All of the caries, debris, and necrotic material must be

removed from the chamber before the radicular preparation is

begun.

If the calcified or metallic debris is left in the chamber and

carried into the canal, it may act as an obstruction during

canal enlargement.

Soft debris carried from the chamber might increase the

bacterial population in the canal.

Coronal debris may also stain particularly in anterior teeth

Principle 5: retention form

The final 2-3mm of radicular wall should be nearly parallel to

allow for a snug fitting of gutta percha cone

These final 2- 3mm of canal preparation is most crucial

because this is where the sealing against future percolation or

leakage takes place

Resistance form
There are mainly two objectives of resistance form
Resistance to overfilling is the primary objective of resistance

form

The other objective is maintaining the integrity of the natural

constriction of apical foramen. Voilating this integrity by

overinstrumentation leads to loss of apical patency, which
makes proper compaction of gutta percha cones difficult

PREPARATION

Different techniques

of root canal
preparation

Step back (Telescopic) technique

The canal is enlarged first in the apical third to atlest a no 25

or 30 instrument and then each consecutively larger root

canal instrument is used for shaping the middle third and
coronal part of the root canal

Step back preparation is done in two phases

1. Phase1- apical preparation
2. Phase 2- preparation of the remaining canal by stepping

back

Advantages
1. Better tactile awareness
2. Less chances of periapical trauma
3. The development of apical stop prevents overfilling of root

canal
4. Greater condensation pressure can be exerted which often

fills lateral canals with the sealer

Disadvantages
Apical extrusion of the debris through the apex
Working length likely to change as canal curvatures are

eliminated

Step down technique

Also called as crown down pressureless technique
Gates glidden drills or large sized files are used in the coronal

2/3rd of the canal and progressively smaller files are used from
the coronal preparation until desired length is obtained

Advantages

Eliminates the extrusion of the debris through the apex during

instrumentation

Achieves complete cleansing of the canal.,Helps in achieving a

biocompatible seal at the apex

Provides coronal escape way that reduces the piston in

cylinder effect responsible for debris extrusion from the apex

Increased space for irrigation penetration and debridement

Disadvantages
Incresaed removl of tooth structure
Less tactile sensitivity

Hybrid technique
Proposed by Goenig and Bauchman
Uses both step down and step back concepts of preparation
Early radicular access is obtained with Gates Glidden drill from

no. 1 to 6

The apical region is enlarged with step back technique

Balanced force technique

Uses flex r file with non cutting tip
Reaming action using clock wise insertion and by counter

clockwise cutting and removal with apical force

The entire preparation is step down in nature beginning with

flaring of coronal and mid thirds of canal with gates glidden

drill

Clockwise rotation should never exceed 180 degree

Counter clockwise rotation is 120 degree or greater

Balanced force or Roane technique

Root canal irrigants

Every root canal system has spaces that can not

be cleaned mechanichaly .
The only way to clean webs, fins and anastomoses

is through effective use of irrigation solution.

in order to get the maximum efficiency from

irrigant , irrigant must reach the apical portion of

the canal .

Properties of ideal root canal irrigant

Anti microbial properties
Tissue
Flush

solvent.

debris.

Lubricant.
Eliminate
Low

the smear layer.

toxicity level

COMMONLY USED
IRRIGATING
SOLUTIONS

 CHEMICALLY NONACTIVE

SOLVENTS:

CHEMICALLY ACTIVE SOLVENTS:

1. Water

1. Alkalis : sodium hypochlorite

2. Saline

2. Antibacterial agents :

chlorhexidine
3. Oxidizing agents: hydrogen

peroxide
4. Chelating agents: EDTA

( ethylene diamine tetra

acetic acid)
5. MTAD

Sodium hypochlorite

Sodium hypochlorite, a reducing agent, is a clear straw

coloured solution containing about 5% free available chlorine

Naocl produces hypochlorus acid and hypochlorite ion, these

are responsible for the antimicrobial ability of Naocl

NaOCl has tissue dissolving prope

Mechanisam of action
Sodium hypochlorite (NaOCl) ionizes in water into Na and the

hypochlorite ion, OCl, establishing an equilibrium with

hypochlorous acid (HOCl).
Hypochlorous acid is responsible for the antibacterial activity;

the OCl ion is less effective than the undissolved HOCl.

Hypochloric acid disrupts several vital functions of the

microbial cell, resulting in cell death.

Concentration and temperature

0.5%-5.2% solution is an effective concentration for use as an

irrigant.

2.5% Naocl is a commonly employed concentration as it

decreases the potential for toxicity while maintaining some

tissue dissolving and antimicrobial activity

Increasing the temperature of hypochlorite irrigant to 600C, significantly

increased its antimicrobial and tissue-dissolving effects.

Drawbacks of sodium hypochlorite

Cytotoxicity and toxic effects on healthy periradicular tissues

on inadvertent extrusion during the irrigation procedure.

It doesnot remove the inorganic portion of smear layer.

Unpleasant taste.
Solution should be kept in a cool place away from sunlight

Sodium hypochlorite accident

Immediate severe pain for 2-6 minutes.
immediate edema in adjacent soft tissue because of

perfusion to the loose connective tissue.

Extension of edema to a large site of the face such as

cheeks, peri- orbital region, or lips.

Ecchymosis on skin or mucosa as a result of profuse

interstitial bleeding.

Management
inform the patient about the cause and nature of the complication.
Immediately irrigate with normal saline to decrease the soft-tissue irritation by

diluting the NaOCl.

Let the bleeding response continue as it helps to flush the irritant out of the

tissues.
Recommend ice bag compresses for 24 hours (15-minute intervals)to minimize

swelling.
Recommend warm, moist compresses after 24 hours (15-minute intervals).
pain control with strong analgesics for 3 to 7 days
Prophylactic antibiotic coverage for 7 to 10 days to prevent secondary infection or

spreading of the present infection.

HYDROGEN PEROXIDE

It is a clear, colorless , odorless liquid.

H2O2 is active against viruses, bacteria, and yeasts.

It has been particularly popular in cleaning the pulp chamber

from blood and tissue remnants, but it has also been used in
canal irrigation.

Mechanisam of action
It is highly unstable and easily decomposed by heat and light.
it rapidly dissociate into H2O+O (water+nascent oxygen) . The

liberated nascent oxygen has bactericidal effect but this effect is

transient and diminishes in presence of organic debris .
The rapid release of nascent oxygen on contact with organic tissue

results in effervesce (bubbling) action which aid in mechanical

debridement by dislodging dentin debris and necrotic tissue particles
and floating them to the surface.

 It is recommended to use in 3% conentration for endodontic irrigation.

Advantages of using alternating 3% H2O2 with Naocl solution are :

1.Effervescent reaction (bubbles pushes debris mechanichally out of root
canal)
2.Solvent action of sodium hypochrorite on organic debris.
3.Disinfection and bleaching effect by both solutions.

Limitations
Unable to remove smear layer.
Always use NaOCl last because Hydrogen peroxide release of

nascent oxygen on contact with organic tissue which may

build up pressure on closing tooth and causes pain .
Soft tissue emphysema may occur when hydrogen peroxide

irrigant enforced beyond the apical foramen.

EDTA
EDTA was introduced into endodontic practice by Nygaard

Ostby.

Relatively nontoxic and non irritating

Forms highly soluble metal chelates in combination with heavy

metals

Functions by forming a calcium chelate solution with the

calcium ion in dentin.thus can remove the inorganic portion of

smear layer

The recommended regime for irrigation is to employ 17%

EDTA for 1 minute followed by a final rinse with NaOCl

CHLORHEXIDINE DIGLUCONATE
2% chlorhexidine digluconate possess broad spectrum

antimicrobial activity against most common endodontic

pathogens

CHX is very effective against Enterococcus faecalis, most

common pathogen found in root canal filled teeth exhibiting

clinical failure

CHX shows sustained activity in canal due to its property of

substantivity

Since CHX does not remove the smear layer it should be

employed with other irrigants in conjunction

MTAD
MTAD employs a mixture of a tetracycline

isomer( doxycycline) citric acid,and a detergent TWEEN 80

as a final rinse to remove the smear layer

It is commonly employed after irrigation with 1.3% NaOCl

The combination of MTAD and NaOCl has been advocated to

remove the smear layer and also has substantial antimicrobial

efficacy

Thank you