Cleaning and shaping of root canal system.

Today we will talk about root canal preparation or chemo-mechanical preparation of root canal system Q > why do we need to prepare the root canal system? For what purpose for a biological region which is , to remove all tissue and necrotic debris from the root canal system . Q> how to clean it? We can clean the canal by chemical means using irrigation solution and by mechanical mean using files in order to remove all necrotic tissues . Those surface which wont reached by these files, like accessory canals throughout main root canals . For example, in molars, we have 3-4 root canals and still we have accessory canals in the furcation area or on the lateral side of the canal >> so we will use irrigate solution or chemical solution.

Instruction while working *Each root canal is unique, its different form the adjacent canal , from adjacent root and from canal of adjacent tooth . *while cleaning we need to maintain the shape of the canal as its is , we shouldnt change the internal shape of the canal by over widening , so conical shape canal wont become rectangular.

*we shouldnt go beyond the apex . Correct the 3rd status in the slide : the apical constriction not position * The apical constriction should be maintained >> apical constriction: its dentin-centum junction in the apical part which is away from the anatomical apex by 0.5 to 1.5 mm.

*Dont over prepare the apical opening, we need an apical stop ( its where my gattaparka will set ) *You need not to force the necrotic tissue beyond the anatomy of the apical apex *try to complete cleaning and shaping in one visit , if u clean one canal and leave others for next visit , root canal system will be still infected .

Slide 5 Its the original shape of the canal , and after preparation we need to maintain the same shape.

This tooth has a lateral canal in the furcation area which causes this defect, so we clean it using irrigant solution then seals it by our obturation and sealers.

Irrigant *they should be antimicrobial. *without irrigant we will be able to clean only 2-40% of canal ( using it will clean 60% of canal ) Q> why we need them?

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To flush out debries - to be anti microbial To dissolve organic material in pulp tissues and dentine Act as lubricant for our instrument

Common irrigant Sodium hypochloride hydrogen peroxide chelating agent (EDTA) saline local anesthesia iodine cholorohexidine

Dr. leave advantages And disadvantage in slide (1o-11) and focused on table on the slide 12

*This is different type of solutions and its main function. *E ficals : Is common bacteria in root canal system
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*If we combine sodium hypo chloride and cholorohexidine we will have an ideal irrigant solution. *the most common solutions nowadays: sodium hypo chloride and cholorohexidine

Stages in cleaning and shaping in root canal system 1- Make coronal flare (widening ) and make strait line axis using gates Glidden . 2- Establish our working length 3- Apical preparation Step 1 Q > why do we need to prepare the coronal portion? 1- We need to remove obstructions to be able to go straight all the way down to the apex , So preparing the canal more efficiently .

*Most effected tissue is in the coronal portion > so we need to get rid of them 2- allow us to irrigate the canal more efficiently and to allow the solution to go out 3- give the straight line access to the canal >>> more accurate length determination

*From the 1st lecture I have mention the gate Glidden which is numbered from 1 to 6 and they are used for coronal flare. *We begin our work form the large size to the smaller. *in this case , we use size number 5 to the coronal part then go down to use size number 1 or 2 * Number 1 is easy breakable and so we usually avoided unless we have very tiny canal and we need to negotiate the orifice of that canal . * we use it in reaching the first of the curvature , we dont go beyond the curvature point ( means : one the canal start to tend right or left we stop the instrument >> means also , we only work form this curvature point to the coronal part UP ) , otherwise if you continue , you will perforate the canal .

stage 2 , determining the working length (slides from 18 22 )

you can see the apical constriction and the anatomical apex , the difference between them is around 2 mm .

Remember , the master apical file is the last file which you use in widening the apical part but in our book , its mentioned that the master apical file is the largest file which reaches the full working length and slightly bend . *After we prepare the apical enlargement, we use the final apical file , and according to that we use the gatta parch point for obturation . * according to our book , the smallest file that you can take A radiograph with in determining the working length is 20 , in other reference , they says : 15 We should follow our book

If there is a part of the coronal portion which is not opened well, we need to go far away from the apex . Means: look to this red area , there is a different between stage (2) and (3) = 1 or 2 mm >> in order to make a straight line access you had to change ur file working direction as in stage (3)

stage 3

preparation of the canal : ( step back process) 1- we insert the master apical file to the full working length ,( we select this file and it should be loose ) 2- Then increasing the file size gradually until 4 to 6 sizes usually To make the apical enlargement but with 1mm. shorter than the full working length ( this is called : recapitulations ) Ex: if ur master file was 25 and the full working length was 20mm , the next file is 30 with length = 19mm . 3-irrigate the canal. 4-re work the steps again until we reach the curvature (above it we use gateglliden) Q > why do you think we re- insert the master file again and re-use irrigation again ? Because while working Ur are condensing the debris in the apical part, so we will end with loosing Ur working length. Q> Why we dont we make all file with one length ? >> Why we are reducing the full working length? Logically, the canal is wide coronally and narrow apically, so if we keep increasing the file size without reducing W.L we will end up with too much preparation and we will break the apex .

DONT GET CONSFUSED Last week we make an apical preparation which is 2- 4 sizes more than the file with F.W.L , the last one u use in apical enlargement , we start using it in the step back process. A student asks: how should we know that we reach the curvature? From the pre -radiograph we can estimate the full working length and we can know the anatomy starting point of our curvature of the root And how many canal we have .Also while inserting file , u can feel the increment in resistant.

Slides: 25-27 >> this is an apical enlargement . same W.L but increasing the in file size

Slides 28 33:step back process increasing the file size and decreasing 1mm from W.L

Slides 34-36 > important Notices

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When u insert the file inside the canal ,this is passive motion (its not cutting dentine) , but when u pull it out , it will be in active motion (cut dentine ) you rotate the file clockwise and half a tern anticlockwise then you pull it out , when you do that it shapes the dentine wall > so prevent packing of dentine debris in the apical part and you maintain ur working length

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*Missing irrigation may end with losing ur W.L * In stepping back, dont try to jump two sizes in order to finish earlier because you will have large step and a part that isnt prepared.

Dr. said that slides alone are not enough Forgive me for any mistake .

MADE BY : FARAH SALEM

Moments in our life may not come back again so live as its the last moment in Ur life . Thanks for who make me feel what moments of happiness mean

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