MECHANICAL

I N S T R U M E N TAT I O N
ENDODONTIC SEMINAR
FINAL YEAR BDS IIUM 2017/2018, GROUP 4
OUTLINE
• Introduction
• Main objectives of canal preparation
• Preparation techniques
• Techniques for the manipulation of endodontic
shaping instruments.
INTRODUCTION
• The use of mechanical instrumentation is accepted as being one of
the most important steps in root canal treatment.
• It is also recognised as being one of the more difficult practical
challenges in operative dentistry.
• Mechanical shaping must be accompanied by the thorough
irrigation of the resultant space, a concept often referred to as
‘cleaning and shaping’
AIM OF MECHANICAL
INSTRUMENTATION
Mechanical instrumentation aims to prepare the canal space to facilitate disinfection by irrigants
and medicaments
Removal of vital and necrotic tissue from the main root canal(s).
Creation of sufficient space for irrigation and medication.
Preservation of the integrity and location of the apical canal anatomy.
Avoidance of iatrogenic damage to the canal system and root structure.
Facilitation of canal filling.
Avoidance of further irritation and/or infection of the periradicular tissues.
Preservation of sound root dentine to allow long term function of the tooth.
PREPARATION TECHNIQUES
STANDARDISED SYSTEM
STEP-BACK SYSTEM
STEP-DOWN SYSTEM
TECNHIQUE
STANDARDISED SYSTEM Require each instrument, file or reamer, to be
placed to the full working length. The
Canal was enlarged until clean white dentine shavings
were seen on the apical few millimetres of the
instrument.
Filing was continued for a further two or three sizes, to complete
the preparation.
ADVANTAGE Satisfactory in straight canals

DISADVANTAGE Quite unsuitable for curved canals

As the instrument sizes increase, they become less flexible and
led to iatrogenic errors in curved root canals
Common problems: Ledging, zipping, elbow formation,
perforation and loss of working length owing to compaction of
dentine debris
TECNHIQUE
STEP-BACK •Determine working length
• Serially develop an apical stop
• Step back preparation by shortening the length of the file and
increasing the file sizes
• Flaring technique
ADVANTAGE • Shaping the apical 1/3 with small flexible files while larger stiffer
files are used away from the apex
•Maintain a proper resistance form
•Create spaces for multiple cones

DISADVANTAGE • Extrusion of the debris beyond the apex

• Apical blockage
• Tendency for canal deviation.
TECNHIQUE
STEP-DOWN •Coronal aspect of the root canal is widened and cleaned before
the apical part
•It has been followed by other, similar
techniques such as the double flared and the
crown-down pressureless
ADVANTAGE •Permits straighter access to the apical region.
•Eliminates dentinal interferences found in the coronal two-thirds
of the canal
•Reduce extrusion
•Allows better penetration of the irrigating solution
•Reduces the risk of compacting debris apically
DISADVANTAGE • Increased removal of tooth structure
TECHNIQUES FOR THE MANIPULATION OF
ENDODONTIC SHAPING INSTRUMENTS
• WATCHWINDING AND CIRCUMFERENTIAL FILING
• BALANCED FORCE TECHNIQUE
• NICKEL-TITANIUM ROTARY TECHNIQUE
WATCHWINDING AND
CIRCUMFERENTIAL FILING
• Continuous back and forth rotation with slight
apical pressure, rapidly advances a fine file
down a root canal.
• Slight turn engages the flutes of the file in the
canal wall and removes dentine.
• Only fine files should be advanced to the apex
in this way to avoid danger of compacting
pulpal debris ahead of the file.
• If such a blockage occurs it can be extremely
difficult to remove.
• Once the file has reached the desired length, a push-pull filing action
was used, moving the file circumferentially around the canal walls
• When using K-type files an attempt was made to file on the
outstroke only, again to reduce the apical compaction of debris.
• Research into canal preparation found two distinct problems with
circumferential filing:
-A tendency to preferentially file the inside wall of a curved canal.
-Once the file engaged in the coronal part of the root canal, the apical
flutes tended not to cut dentine but remain passive.
 BALANCED FORCE TECHNIQUE
• considered to be the standard method for
the manual preparation of curved root
canals.
• technique requires flexible files with non-
cutting tips
NICKEL-TITANIUM ROTARY TECHNIQUE
• Each manufacturer of these instruments produces a protocol for use for their own specific
product
• The technique for use is crown-down, with copious irrigation
• The files must be used in a slow-speed, controlled torque motor, or they are prone to
fracture.
REFERENCES

1. Hülsmann, M., Peters, O. A., & Dummer, P. M. (2005). Mechanical preparation of root canals:
shaping goals, techniques and means. Endodontic topics, 10(1), 30-76.
2. Carrotte, P. (2004). Endodontics: Part 7 Preparing the root canal. British dental journal, 197(10),
603-613.
3. Baugh, D., & Wallace, J. (2005). The role of apical instrumentation in root canal treatment: a
review of the literature. Journal of endodontics, 31(5), 333-340.
4. Waplington, M., & McRobert, A. S. (2014). Shaping the root canal system. British dental
journal, 216(6), 293-297.
THANK YOU