Canal

Preparation
Techniques
 to shape the canals to the apical
constriction of the canal space,
regardless of the radiographic
appearance of the actual tooth
 the step-back technique
Telescopic or serial root canal preparation

This instrumentation technique forms an apical stop and

thereby avoids irritation of the periapical tissues by
medicaments or filling material. Because there is very little canal
enlargement and removal of dentin near the apex, the danger of
perforation is reduced.
At the beginning of
instrumentation, the length of
the canal and the size of the
initial apical file (IAF) are
determined on a radiograph
Starting with the IAF, the
root canal is enlarged to the
working length through
four file sizes.
 After the root canal has been enlarged throughout
its entire length to the size of the apical master file, the subsequent files are
each made 1 mm shorter than the previous file.

The drawing clearly shows the tapered root canal preparation that is formed
by this procedure.

The steps are smoothed by the intermittent reintroduction of the AMF.

This simultaneously prevents blockage of the apical canal by dentin chips and
verifies accessibility to the apical constriction.
K files are used exclusively in this preparation technique.
In the step-back technique,
and then the coronal portion is shaped.

After the access opening is made, the working length is determined on a

measurement radiograph.

The first file that binds in the canal at the working length is considered (the
initial apical file IAF).

The root canal must then be enlarged by circumferential filing through an

additional four instrument sizes.

During this initial phase of preparation, no instrument sizes may be skipped or

a blockage may be created.
The last file manipulated to the working length should remove only white dentin
shavings, and is designated the apical master file (AMF).
Its size determines the size of the gutta-percha master point that will be used later.
of the root canal is instrumented in step-
back fashion through four additional sizes.
is set I mm shorter than the
preceding size so that a conical canal configuration with a definite apical stop is
formed.
ensures that the canal
remains patent.
Canal patency must be maintained at all times.
This is accomplished, after each successively larger
file, by irrigating and then returning to a file smaller
than the file which prepared the apical portion of the
canal (No. 15 is frequently used).

is used between each file also to remove

debris.
Failure to recapitulate will result in canal blockage.
Frequently blockage can be difficult to clear and
attempts to do so may result in a ledge or even
perforation
A patency file is a small flexible instrument (08, 10) that
will move passively through the terminus of a root canal
without binding or enlarging the apical constricture. The
aim is to prevent apical blockage, which will, in turn,
reduce the incidence of ledge formation and
transportation of the root canal.
The use of a patency file also helps remove vital or
necrotic pulpal remnants from the end of the canal.
To use a patency technique, therefore, infers an intention
to clean to the full canal length.
Glide Path Canal Shaping
10 15 30 25 20
(Canal Patency) (Repeat until 25 to WL)
 Step-Down Technique
are prepared by means of the coronal-
apical instrumentation technique.
In this method the coronal portion is enlarged first, and only then is the apical region
of the root canal prepared.
of this technique over the apical-coronal technique is that the
coronal enlargement makes it possible to insert the irrigating canula quite deeply into
the root canal.
During the final instrumentation of the apical region necrotic pulp tissue is thus
loosened and flushed away with sodium hypochlorite.
After the access preparation is made, the canal preparation is begun byassuring
completepatencyofthecanal.
This is done byinserting a size 15 Hedstromfile, employing one-eighth circle
rotationsandonlylight pressure.
Next the root canal is enlarged coronally with a Gates-Glidden drill to the
beginningofthecanal'scurvatureusingthestep-backtechnique.
It isimportant tocoat thetipoftheinstrumentswithalubricant (e. g. RC-Prep)
inorder toprevent bindingwithinthecanal.
Followingenlargement ofthecoronal portion, theworkinglength is
determinedradiographically with a size 15 K file in place.
Iftheinstrument tipfallsmorethan2 mmshort, asecondmeasurement
radiographismadeafter further careful instrumentation.
Iftheroot canal istoonarrowtoallowtheK filetobeinserted to the
workinglength, passageto theapex must becarefullyestablishedwith a
Hedstrom file also.
Onlythencanthesize oftheinitialapical filebedetermined and the
canal enlarged by four sizes.
Apical preparation is accomplished by alternating instruments-first a Hedstom
file is used for circumferential fillingand this is followed bya K file (noncutting
tip) inarotatingworkingmovement (balancedforcetechnique).
Followingthis, thecanal iswidenedcoronallywith asize20 Hedstromfile, and
finallythe entire root canal is instrumented to the workinglength with a prebent
size20 K file.
If this file does not reach the workinglength, under no circumstances should any
attempt bemadetoadvancetheinstrument apicallybyrotatingit.
T he root canal is enlarged along its entire length
by using the balanced force technique: first the
instrument is introduced into the canal with
rotations to the right. T hen the file is rotated to
the left to cut dentin from the canal wall.
A prebent K file prior to apical instrumentation.

The instrument has become slightly straightened after being

rotated apically.
Following preparation of the apical region, the canal is tapered
by circumferential filing with Hedstrom files.
Finally, the entire canal is smoothed by using the #35
AMF with balanced force rotations.
The last step in root canal treatment is to create the best possible
withafillingmaterial that is tothetissues.
The basic mechanical instrumentation andshaping of the canal is the most important
prerequisiteforendodonticsuccess.
The root canal filling should leave the tooth in
, and it must prevent reinfection as well as growth of any
microorganismsremaininginthecanal

Fillingtheroot canal withgutta-perchapointsandasealeristhemost biologically

favorableandsurest methodinthelongterm
1. Nonirritating to the pulp tissue.
2. Tightly seal the canal both laterally and vertically.
3. Dimensionally stable so as not to shrink within the canal.
4. Should not support bacterial growth and should even be bacteriostatic.
5. Biologically compatible and nontoxic.
6. Easy to sterilize before use.
7. Radiopaque .
8. Should not discolor the tooth.
9. Should not harden too quickly and after hardening should exhibit good adhesion to
both the dentin and the root canal filling.
10. Insoluble in tissue fluids and have a slight expansion.
– Easilymanipulablewithampleworkingtime
– Easilymixableinveryfinepowderparticlesandliquidform
– Takywhenmixedandadhesivetothecanalwalls
– Biocompatible
– Expansiblewhilesetting
– Absolutelyinert
– Physicallystable(unshrinkableaftersetting)
– Non-resorbable
– Insolubleintissuefluids
– Radiopaque
– Notstainingthetoothstructure
– Bacteriostatic
– Easilyremovablewithcommonsolvents,ifnecessary
– Non-immunogenicintheperiapicaltissues8,10,152
– Neithermutagenicnorcarcinogenic
 Lateral Condensation of Gutta-percha

The root canal filling procedure starts with the selection of the gutta- percha master
point.
Before the gutta- percha master point is tried in the canal, a suitable spreader is selected.
The cement is mixed The apical half of the
and given the spatula master point is coated
test to determine the with sealer and
desired consistency. inserted into the canal
to the predetermined
depth.
Root canal cement should be mixed to a thick, creamy consistency that may be strung
off the slab for
The spreader has been tested previously to reach within
. A thin layer of sealer lines the
canal walls, and the tip of the primary point is coated with
cement.
The primary point is carried fully to place to within 1
mm of the “apical stop.”
Excess in the crown is severed at the cervical with a hot
instrument.
The spreader is inserted to the full depth, allowed to remain 1
full minute as gutta-percha is compacted laterally and
somewhat apically.
A master point is selected that
allows a friction fit in the
apical portion of the root
canal.
When this is marked it is
called 'tug back' (like pulling
a dart out of a dart board).
This may be difficult to
achieve with small size gutta-
percha points; therefore, it is
usual to accept a friction fit in
narrow canals.
A point one size larger than
the master apical file is
usually selected.
If it is not possible to place
the point to working length,
select a point that passes to
full length and trim 0.5 mm
off the end using a scalpel
(this has the effect of
making the point slightly
larger).
Retry the point and adjust
as necessary.
Mark the length of the
point by nipping it with
tweezers at the reference
point and take a check
radiograph with the cone
in place.
 rotation and immediately
replaced by the first auxiliary point previously dipped in sealer.
The spreader is returned to the canal to laterally compact the
mass of filling.

The spreader is again removed, followed by the matching

auxiliary point.
The process continues until the canal is totally obturated.
All excess gutta-percha and sealer are removed from the
crown to .
with a larger plugger completes
root canal filling.
Cut off the gutta-percha 1 mm below the
cementoenamel junction or gingival level
(whichever is the more apical) using a hot
instrument and vertically condense the gutta-
percha.
This is important as remaining root-filling
material may stain the tooth.
is inserted between the canal
wall and the point to a depth
1 mm short of the working
length.
When the working length
is reached, the spreader is
left in place for 15 seconds
before being withdrawn.
This will prevent rebounding
of the gutta-percha The
accessory point, coated with
a small amount of sealer, is
condensed against the
master point with the finger
spreader.
Once the fit of has been
verified radiographically, it is removed from the canal, rinsed, and
dried.
Then is inserted into the dried root canal and, using
balanced force rotating movements, a few more dentin shavings are
removed.
In one-third of root canals studied, less than 50% of the walls in the
apical third were covered with sealer.
The sealer does not coat the wall uniformly, regardless of the method used to carry it
into the canal.
When the sealer was introduced on a K file, which was then removed while being
rotated counterclockwise, only one-third of the canal walls were covered.
Application with an ultrasonic file did not improve the results.
The sealer could be applied well in half of the cases with a Lentulo spiral.
When the gutta-percha point was coated with sealer and pushed into the canal, the
highest success rate was observed at 70%.