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LECTURE OUTLINE
Straight Canals V.s. Curved Canals
Canal Irrigation
Standardized Technique
Negotiating Canals
Step-Back Technique
Recapitulation
Step-Down Technique
Instrument Manipulation
Success in endodontic treatment depend largely on shaping and cleaning of root canal system. In recent
years, there has been a significant move away from the hand taper 2% standardized instrumentation into
rotary Ni-Ti variable taper crown-down instrumentation.
In addition to that the concept of cleaning and shaping has been turned into shaping and cleaning. As the
shaping process proceed cleaning process and it determine the quality of root canal cleaning.
STRAIGHT CANALS V.S. CURVED CANALS
Posterior teeth characterize by more than one root.
These roots often exhibit a network system of fins,
ramifications, and lateral canals, and most importantly
curved canals.
Research also has shown that anterior teeth often have
curved canals, that directed bucally or lingually, so we
see them as straight canals in the radiograph.
In the past, all root canals treated as they were straight,
and instrumentation was done using standardized technique. This led to occurrences of procedural errors and
often failure of treatment.
Recent development in the past 60 has led to the invention of new techniques that minimize time and procedural accidents, and guarantee a successful delivery of
treatment
DEVELOPMENT OF PREPARATION
TECHNIQUES
The goal of canal preparation is to clean root canal system and shape it as tapering funnel to receive obutation
material.
This tapering funnel, is wide coronally and start to narrow as it move apically, and ends in the apical stop,
NEGOTIATING CANALS
After access opening and pulp extirpation, the canal is
negotiated using fine files, not reamers, in filing motion
only (up and down). This prevent instrument breakage.
After few files, the balanced motion should be used after the canal has been clean and wide enough.
It worth mentioning that British Dental Journal do not
recommend using reamers, as it lead to more procedural errors
RECAPITULATION
Step-back technique
Steps:
Step-down technique
Coronal flaring
Temporary filling
In multi-visit endodontic treatment it is important to
seal the cavity with temporary filling material between
visits. There are several temporary filling materials
available in the market. Most common one is Cavit. Although it has low wear resistance, it can be used
in combination with GIC temporary filling to provide
strong temporary filling that can lasts for several weeks
and can withstand wearing action of oral environment.
In this concept, Cavit is placed for the lower layers and
GIC for the outer layers that faces oral environment.
The proper way to place temporary filling is by layering
technique shown in this picture:
Apical preparation
After the process of coronal flaring is completed,
further canal preparation is started. Hand file (or rotary)
matching the size of last GG drill is used to prepare the
canal. Then a smaller sizes are used to further works
in the canal. Each files will go deeper into the canal.
When reaching at 3 mm short of the estimated working
length, the file is inserted into the canal and radiograph
is taken. After confirmation of working length, smaller
files are worked into the canal to the size #15. Frequent
irrigation and recapitulating is a must.
This is the best technique available and represent the
modern practice of dentistry. It is also called crowndown technique.
REFERENCES
PDQ Endodontics
Endodontics, Volume II, Arnaldo Castellucci
Cohens Pathways of Pulp
Pocket Atlas of Endodontics, Rudolf Beer
Endodontics Principles and Practice, Mahmoud
Torbinejad
A Clinical Guide to Endodontics, British Dental
Journal, P. Carrote
Hybrid technique
It involve combination of coronal flaring, step-down
technique, then working four files to the full working
length, then step-back technique. It is also highly recommended.
Also many other combination of rotary instruments are
available for the hybrid technique.