Good morning

GOOD MORNING
Anatomic Endodontic Technology (AET)
1

COMPARISON OF THREE TECHNIQUES FOR PREPARING OVAL-SHAPED ROOT CANALS

Nessrin A. Taha, Toshiko Ozawa, Harold H. Messer

Journal of Endodontics
March 2010,Vol36(3), Pages 532-535.

Introduction
Thorough debridement of the root canal system is

considered the most important step in endodontic

therapy.
Done to reduce bacterial numbers and to prepare

canals to a uniform shape for obturation.

With techniques currently available, complete

debridement is generally not possible because of the

intricate anatomy of the root canal system.

Accessory canals

Lateral canals

Apical ramifications

Presence of calcifications

C- shaped canals

Isthmus

Oval root canals

 Circumferential filing with hand files and rotary

nickel-titanium (NiTi) preparation are of limited effectiveness, with 30% to 40% or more of the canal wall not contacted by instruments, especially in the polar regions of canal.
(J Endod. 2004;30:559567) (J Endod. 2009;35:10561059)

(Int Endod J. 2001;34:221230)

 Difficulties have been noted in cleaning oval or

ribbon-shaped canals, which occur in approximately

25% of teeth.
(Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89:739743)

Rotary NiTi instruments were reported to leave

unprepared lingual and buccal extensions with debris.

(Int Endod J. 2002;35:919928)

 Hand instrumentation with the balanced force

technique left uninstrumented recesses in 65% of oval canals.

(Int Endod J. 2001;34:137141)

AET was introduced (White 2002) for the preparation of oval-shaped root canals. The system consists of stainless steel instruments used in a reciprocating slow-speed handpiece in a milling-type action claimed to be guided by the anatomic shape of the canal.

10

ANATOMIC ENDODONTIC TECHNOLOGY

(AET)
11

Stainless steel mechanical instruments, specifically

designed for this technique, are manually guided by the operator against every portion of each wall.

The

AET

technique

permits

perimetric

or

circumferential preparation of the coronal and middle

canal thirds.

The dentine is selectively removed and weakening of the walls of the canal or perforation in those areas where they are thinner is avoided.
12

1.

A coronal third extending from the occlusal surface to the pulp chamber floor in multi-rooted teeth and to the neck of the tooth in single rooted teeth.

2.

A middle third extending from the end of the coronal third to 34 mm from the apex.

3.

An apical third corresponding to the final 34 mm of the canal, ending at the

13

apical foramen.

The AET preparation technique comprises three phases:

1) 2) 3)

Coronal access (using the access bur kit.) Coronal-middle preparation (using shaping files) Apical preparation (using apical files).

14

FIRST PHASE : CORONAL ACCESS

1.

Access bur kit comprising

Round and tapered diamond burs to prepare the access cavity. Non end-cutting burs to remove the chamber roof in multi-rooted teeth without damaging the chamber floor and to remove dentine overhangs and residual enamel interferences. Safe-point diamond bur to prepare axial line access by removing dentine interferences.
15

2.

3.

SECOND PHASE : CORONAL MIDDLE PHASE

Circumferential shaping following the anatomic contour

and eliminating interferences in the middle section of

the canal.

The instruments used in this phase are designed to prepare not only the middle third of the operative canal (OC) but also to refine the preparation of the coronal

third that has been initiated during the first phase.

16

Shaping files : Four stainless steel (S1, SC, S2, S3)

Instruments have a square cross-section. The blades of the instrument extend throughout its

length from the tip almost upto the handle.

The flexible tip of the instrument is rounded.

17

METHOD

The coronal-middle working length for the Shaping files is determined as follows: The canal length (CL) is determined with an apex locator and small K-files and confirmed radiographically. Coronal-middle length is obtained by subtracting 3 mm from this length.

Glide path and canal negotiation is done using the first Shaping file before starting mechanical preparation.

Direct the instrument with reciprocating action circumferentially, brushing the

canal walls in order to remove interferences and obtain straight-line coronalradicular access.
(Active brushing should be performed only when the Shapings instruments are being pulled out of the canal.)
18

THIRD PHASE : APICAL PHASE

To shape and clean the apical third of the canals whilst respecting the electronically determined apical limit.

Maintaining the original apical foramen diameter as narrow as possible.

To create an apical stop for obturation.

19

Apical files
Manual Stainless steel files with tip diameters ranging from 0.08 mm up to 0.20 mmwith a square cross-section. Manual NiTi files with tip diameters ranging from 0.25 to 0.50 mm and above with a square cross-section and round noncutting tip. Apical files have a 0.02 taper in sizes 0.820 and a 0.025

taper in sizes 2550 and above, have an active part 10 mm

in length.

20

METHOD

Re-evaluate the canal length (CL) and establish the

Apical Limit in order to obtain the Apical Working

Length (AWL). The AWL is determined by subtracting 0.5 mm from the electronically determined CL.

With manual rotary motion, stainless steel Apical files

with diameters ranging from size 08 up to size 20 and with turn and withdrawal movements until reaching the AWL.
21

Continue with the Apical NiTi (size 30, 35, 40, etc.)

until

reaching

the

final

Diameter

of

Apical

Preparation (DAP).

Apical enlargement should not be considered as having been completed until the Apical files are extracted from the canal filled with clean dentinal

debris.
22

AIM
Evaluate the AET system in preparing oval-shaped canals and to compare it with hand and rotary NiTi preparation with regard to canal shape and cleanliness.
23

Materials and Methods

Tooth

Tooth

Specimen

selection

preparation

preparation

24

Tooth Selection

39 intact human mandibular premolars extracted for orthodontic reasons and documented radiographically to have a

fully formed apex and a single ovalshaped canal were used.

25

Tooth Preparation
Thirty-nine

teeth were randomly assigned to three groups according to the instrumentation technique
Hand Instrumentation Rotary Instrumentation

AET Preparation Group 3 (n=13)

Group 1

Group 2

Coronal access was achieved using diamond burs, and the working length was determined 0.5 mm from the apical

foramen using a # 10 file.

26

Group I: Hand instrumentation by the step-back technique using stainless steel H-files.
After coronal flaring by Gates-Glidden burs #2 and #3.

The canal was enlarged to a final apical size of #40.

Apical preparation was achieved by a pure in-and-out

filing motion.
The preparation was completed using step-back with

recapitulation.
27

Group 2: Rotary NiTi instrumentation

EndoWave files were used in a crown-down manner following

manufacturer's instructions in the following sequence: 35/.08 to

enlarge the coronal one half of the canal followed by 30/.06 and then 25/.06 until 2 to 3 mm short of the working length.
File 20/.06 was then worked to the full working length and the

apical preparation was enlarged to 40/ .06 with circumferential

filing.
28

Group 3: AET preparation

The shaping files are side-cutting with noncutting tips and

are used to clean and shape the canal to about 3 mm short of the apex.
The apical files are designed to cut only the apical portion of

the canal and are used manually.

A

recommended

procedure

was

followed

for

canal

preparation to apical size #40.

29

 For all groups, copious irrigation with 1% NaOCl & 15%

EDTA solution (1 ml/1 minute after each instrument) was used throughout instrumentation along with a final flush with 2 ml, EDTA to remove the smear layer.
All canals were prepared by one operator, experienced in

hand and rotary NiTi instrumentation but without experience with AET.
30

Specimen Preparation

Each root was sectioned at three levels: in the middle of the coronal, middle, and apical thirds. During sectioning, the block was oriented to ensure

that sections were cut perpendicular to the canal.

Digital photographs of the cut surfaces were taken

using an intraoral camera.

31

Specimen Preparation

Root sections were then decalcified with 10% formic acid and processed for routine histologic examination.

One histologic section from each level was selected for measurement and coded so that all specimens

were evaluated blindly.

32

 Canal

shapes were evaluated by three endodontists independently and recorded as : Round-oval Elliptic (ratio of long to short canal diameters equal to or more than 2:1) Irregular including both instrument induced defects and remaining natural
fins.

33

The histologic sections were examined under a light microscope.

Images were recorded digitally.

For canal cleanliness assessment, a software package was used that enables one to trace the canal perimeter as a whole or in sections.

The percentages of untouched canal wall and with debris present were then calculated.

34

Untouched surface was defined as unplaned by the instrument, often with residual predentin.

Debris was defined as dentin chips and residual pulp

tissue attached to the canal wall.

35

The only significant difference among techniques in terms of canal cleanliness was in the apical third where rotary instruments performed significantly better than AET and hand instruments.

No differences were found in the uninstrumented area

among the techniques at any level, with a wide variation among teeth prepared with the same technique.
36

With

respect

to

individual

instrumentation

techniques, both AET and hand instrumentation performed significantly better in the middle third than

in the apical and coronal thirds.

37

Numerous methods have been used to evaluate the technical

standard of instrumentation techniques :

Scanning electron microscopy Reassembly techniques Histologic sections Microcomputed tomography Confocal microscopy
38

Histologic sections were used in this study and the software

package allowed evaluation of the entire canal perimeter, which

is better for systematic evaluation of oval and irregular cross sectional shapes.

Tomography is excellent for mapping regions untouched by instruments and to evaluate cross-sectional shapes but not for

scoring debris.

39

SEM is used mainly for scoring canal wall cleanliness but

evaluates only a small proportion of the canal wall.

Reassembly techniques and histologic sections typically evaluate only three levels (coronal, middle, and apical) but can be used to compare cross-sectional canal shape as well as debris and canal wall planing.

40

The results from this study are in accordance with previous

studies showing that no instrumentation technique completely

planes and cleans root canals.

The wide variation among different teeth prepared by the same technique appears to result from variations in root canal anatomy rather than the instrument or technique itself.

41

Based

on these findings, the new system does

not provide any measurable benefit over alternative techniques for preparing oval canals.

42

Iqbal MK, Brown M, et al. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod. 2004;98:493498.

Wu M-K, Barkis D et al. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 89:739743.

O. Zmener, C. H. Pameijer, Int Endod J. , 2005 ;38:356363. Rdig T, Schfers F. Int Endod J. 2002;35:919928. Wu M-K, Wesselink PR. Int Endod J. 2001;34:137141. Lumley PJ, Walmsley AD, et al. J Endod.1993;19:453457.
43

Thank you

THANK YOU

44