CLEANINGCLEANING & &

SHAPING SHAPING

ENDODONTIC STORYENDODONTIC STORY

Successful Successful endodonticsendodontics

Biomechanical preparation

Root canal obturation

DIAGNOSIS

Cleaning:

Is the removal of all potential irritants from the

root canal .

This includes:

1- Bacteria.

2- Infected material.

3- Organic remenants.

The goal is achieved through:

1) Proper instrumentation.

2) Use of irrigants.

Shaping:

Refers to the specific shape, which is a

continuously tapered form from the canal

orifice to the apical constriction, given to the

canal to be compatible with the filling material

and techniques.

BLACKS PRINCIPLESBLACKS PRINCIPLES

IRRIGATION.IRRIGATION.RESISTANCE RESISTANCE

FORM.FORM.RETENTION RETENTION

FORM.FORM.EXTENSION FOR EXTENSION FOR

PREVENTION.PREVENTION.

Biological objectives for cleaning & shaping:Biological objectives for cleaning & shaping:

Totally clean root canal system.

Avoid pushing debris beyond the apex.

Confine all your instrument within the root

canal.

Do no harm.

Mechanical objective for cleaning & Mechanical objective for cleaning &

shaping:shaping:

Mechanical objective for cleaning & Mechanical objective for cleaning &

shaping:shaping:Develop a continuous tapering conical form,

from the canal orifice to the apical foramen.

Make the canal narrower apically with the

narrowest cross section diameter at its

terminus.

Make preparation in multiple planes.

Never transport foramen.

Keep the apical foramen as small as practical.

Tooth length determinationTooth length determination

The optimum length is cleaning until the constriction.

Methods for tooth length

determination

Methods for tooth length

determination

1. Radiographic method.

The file is inserted to the estimated working

length, which is determined by:

a) Average length of the tooth.

b) Preoperative radiograph.

c)  Tactile sensation.

d) Crown- root ratio.

Buccal objective rule for tooth length

determination for posterior teeth. This rule states

that the most distant object from the cone moves

towards the direction of the cone.

2. Electronic apex locator.

ELECTRONIC APEX LOCATORELECTRONIC APEX LOCATOR

A tool that :A tool that : Locates the end point of dentin.Locates the end point of dentin. Locates the minor diameter of the foramen.Locates the minor diameter of the foramen. Not affected by the presence of soft tissues.Not affected by the presence of soft tissues. Not affected by the presence of fluids.Not affected by the presence of fluids. Minimizes radiation exposure.Minimizes radiation exposure. Accurate , painless and safe.Accurate , painless and safe. Shortens the preparation time .Shortens the preparation time . Affordable. Affordable.

Role of irrigant in cleaning & shaping.

IRRIGATIONIRRIGATIONQuality:Quality: ANTIMICROBIALANTIMICROBIAL LUBRICATIONLUBRICATION ORGANIC SOLVENTSORGANIC SOLVENTS INORGANIC SOLVENTSINORGANIC SOLVENTS DEBRIDEMENTDEBRIDEMENT

Quantity:Quantity: 2-3 cc / time.2-3 cc / time. 12- 18 min 12- 18 min Canal soakingCanal soaking

( WEINE F.)( WEINE F.)

IRRIGANTSIRRIGANTS

ANTIMICROBIALSANTIMICROBIALSLUBRICATIONLUBRICATIONORGANIC SOLVENTSORGANIC SOLVENTS INORGANIC SOLVENTSINORGANIC SOLVENTSDEBRIDEMENTDEBRIDEMENT

Saline.

Sodium hypochlorite.

Hydrogen peroxide.

Organic acid irrigants.

Calcium hydroxide.

Chlorohexedin gluconate.

Types of irrigant:

SALINESALINE

ANTIMICROBIAL ANTIMICROBIAL XXMECHANICAL DEBRIDMENTMECHANICAL DEBRIDMENTORGANIC SOLVENT ORGANIC SOLVENT XX IN-ORGANIC SOLVENT IN-ORGANIC SOLVENT XXLUBRICANT LUBRICANT XX

SODIUM HYPOCLORITESODIUM HYPOCLORITE0.5 – 5.25 %0.5 – 5.25 %

ANTIMICROBIAL ANTIMICROBIAL MECHANICAL DEBRIDMENTMECHANICAL DEBRIDMENTORGANIC SOLVENT ORGANIC SOLVENT IN-ORGANIC SOLVENT IN-ORGANIC SOLVENT XXLUBRICANTLUBRICANT

HYDROGEN PEROXIDE 3%HYDROGEN PEROXIDE 3%

ANTIMICROBIAL ANTIMICROBIAL MECHANICAL DEBRIDMENTMECHANICAL DEBRIDMENTORGANIC SOLVENT ORGANIC SOLVENT XX IN-ORGANIC SOLVENT IN-ORGANIC SOLVENT XXLUBRICANT LUBRICANT XX

ORGANIC ACIDS-CHELATORSORGANIC ACIDS-CHELATORSEDETAEDETA

ANTIMICROBIAL ANTIMICROBIAL MECHANICAL DEBRIDMENTMECHANICAL DEBRIDMENTORGANIC SOLVENT ORGANIC SOLVENT XX IN-ORGANIC SOLVENT IN-ORGANIC SOLVENT LUBRICANTLUBRICANT

CALCIUM HYDROXIDECALCIUM HYDROXIDE

ANTIMICROBIAL ANTIMICROBIAL MECHANICAL DEBRIDMENTMECHANICAL DEBRIDMENTORGANIC SOLVENT ORGANIC SOLVENT INORGANIC SOLVENT INORGANIC SOLVENT XXLUBRICANT LUBRICANT XX

CHLOROHEXIDINECHLOROHEXIDINE

ANTIMICROBIAL ANTIMICROBIAL MECHANICAL DEBRIDMENTMECHANICAL DEBRIDMENTORGANIC SOLVENT ORGANIC SOLVENT XX INORGANIC SOLVENT INORGANIC SOLVENT XXLUBRICANT LUBRICANT XX

ANTIBIOTICSANTIBIOTICS

MTAD - TETRACYCLINSMTAD - TETRACYCLINSFLAGYL - METRONIDAZOLFLAGYL - METRONIDAZOL

FACTSFACTS

Root canal irrigants do not penetrate more than 3-5 mm Root canal irrigants do not penetrate more than 3-5 mm beyond needle tipbeyond needle tip

&&Apical canal segments benefit from irrigants at the end of Apical canal segments benefit from irrigants at the end of

the preparation. the preparation.

Senia et al . Oral Surg. 1971Senia et al . Oral Surg. 1971Baker et al . JOE 1977Baker et al . JOE 1977

TECHNICAL TECHNICAL CHALLENGESCHALLENGES

If all root canals were smooth funnel-shaped

from the foramen to the orifice, without

curvatures, ramifications and the foramen

was located exactly at the radiographic apex,

endodontic procedure would be much

simpler.

INDISCREMINATE CUTTINGINDISCREMINATE CUTTING

PROBLEM SOLVINGPROBLEM SOLVING

MODIFICATION IN INSTRUMENTSMODIFICATION IN INSTRUMENTS . .

MODIFICATION IN INSTRUMENTATIONMODIFICATION IN INSTRUMENTATION

Modification in instruments:Modification in instruments:

Modification in cross section e.g. K-flex.

Modification in tip design e.g. flex-R-file.

Modification in blade length e.g. canal master.

Modification in taper e.g. profile 0.04, 0.06.

Modification in numbering system e.g. Golden

medium files.

Modification in standardisation e.g. profile

series.

Modification in

material

Modification in

material

Nickel-Titanium Files

Instrumentation techniquesInstrumentation techniques

TERMINOLOGYTERMINOLOGY

TOOTH LENGTH.TOOTH LENGTH. WORKING LENGTH.WORKING LENGTH. REFERANCE POINT.REFERANCE POINT. PATENCY FILE.PATENCY FILE. INITIAL FILE.{FULL LENGTH-FITNESS}.INITIAL FILE.{FULL LENGTH-FITNESS}. MAF {MAX SIZE OF APICAL PREP.}.MAF {MAX SIZE OF APICAL PREP.}. FLARRING SIZE.FLARRING SIZE. MASTER CONEMASTER CONE..

Shaping is achieved through instrumentation

of the canal, either:

(A) From apical to coronal.

MODIFICATION

(B) From coronal to apical.

MODIFICATION

(C) Combination.

1) Standarized technique.1) Standarized technique.

STANDARDIZED STANDARDIZED TECHNIQUETECHNIQUE

2) Step-back technique.2) Step-back technique.

TELESCOPICTELESCOPICSTEP-BACK TECHNIQUESTEP-BACK TECHNIQUE

3-4 FILES TO MAF3-4 FILES TO MAF 3-4 FILES TO STEP3-4 FILES TO STEP 3-4 FILES TO 3-4 FILES TO FLAREFLARE 3-4 3-4

RECAPITULATIONSRECAPITULATIONS

FACTSFACTS

Root canal irrigants do not penetrate more than 3-5 mm Root canal irrigants do not penetrate more than 3-5 mm beyond needle tipbeyond needle tip

&&Apical canal segments benefit from irrigants at the end of Apical canal segments benefit from irrigants at the end of

the preparation. the preparation.

Senia et al . Oral Surg. 1971Senia et al . Oral Surg. 1971Baker et al . JOE 1977Baker et al . JOE 1977

ANATOMICAL STUDIESANATOMICAL STUDIES

THE CANALS OF THE MESIALROOTS OF THE CANALS OF THE MESIALROOTS OF MANDIBULAR MOLARS AND BUCCAL MANDIBULAR MOLARS AND BUCCAL

CANALS OF MAXILLARY MOLARS CANALS OF MAXILLARY MOLARS SIZED BETWEEN 25#- 35# SIZED BETWEEN 25#- 35#

BEFORE INSTRUMENTATION.BEFORE INSTRUMENTATION.

CANAL CONSTRICTIONCANAL CONSTRICTION

CERVICAL?CERVICAL? MIDDLE?MIDDLE? APICAL?APICAL?

3) Crown-down technique.3) Crown-down technique.

THE CROWN DOWNTHE CROWN DOWN

Canal preflareCanal preflare

THE CROWN- DOWN APPROACH

Advantages of crown-down technique:

Elimination of microbes and infected dentin.

Less extruded debris.

Less postoperative pain.

Better and deeper penetration of irrigant.

Instrument approach apical 1/3 with less strain.

Less liable for canal ledging / inst separation.

Provides more tactile sense in the apical 1/3.

Less time for preparation.

BASIC INSTRUMENTATION BASIC INSTRUMENTATION MOTIONSMOTIONS

END-POINT OF CANAL END-POINT OF CANAL PREPARATIONPREPARATION

ADEQUATE SIZES FOR PARTICULAR ADEQUATE SIZES FOR PARTICULAR CURVATURESCURVATURES..

CLEAN DENTIN.CLEAN DENTIN. ADEQUATE FLARE FOR A ADEQUATE FLARE FOR A

PARTICULAR OBTURATION PARTICULAR OBTURATION TECHNIQUE.TECHNIQUE.

Advantage of mechanical instrumentation:

Instrumentation is physically effortless.

Canals are enlarged quickly.

Debris is removed easily.

Canals are more uniform and smoother.

Disadvantage of mechanical

instrumentation:

Greater chance for canal ledging.

Greater chance for canal perforation.

Greater chance for instrument breakage.

Loss of tactile sensation.

Engine-driven InstrumentsEngine-driven InstrumentsEngine-driven InstrumentsEngine-driven Instruments

PowerPower Cutting Tool Cutting ToolLow speed hpLow speed hp Gates Glidden / Pesso drill Gates Glidden / Pesso drillGear reduction hpGear reduction hp Files with Latch (NiTi)Files with Latch (NiTi)Giromatic (M4)Giromatic (M4) Files with Latch(k-file)Files with Latch(k-file)RacerRacer Files with Latch(k-file)Files with Latch(k-file)Canal leaderCanal leader Files with Latch(A-Files with Latch(A-

file)file)

PowerPower Cutting Tool Cutting ToolLow speed hpLow speed hp Gates Glidden / Pesso drill Gates Glidden / Pesso drillGear reduction hpGear reduction hp Files with Latch (NiTi)Files with Latch (NiTi)Giromatic (M4)Giromatic (M4) Files with Latch(k-file)Files with Latch(k-file)RacerRacer Files with Latch(k-file)Files with Latch(k-file)Canal leaderCanal leader Files with Latch(A-Files with Latch(A-

file)file)

Rotary instruments:Rotary instruments:

1) Engine reamer.

2) Reciprocating hand-pieces as: giromatic hand-piece.

racer hand piece.

3) Vibratory instrument as: sonic.

ultrasonic.

4) Gates Glidden drills.

VIBRATORY INSTRUMENTATIONVIBRATORY INSTRUMENTATION

SONICSSONICS

1.1. Below 20, 000 hzBelow 20, 000 hz

2.2. Compressed airCompressed air

3.3. Water irrigantWater irrigant

4.4. Rispi & shaper filesRispi & shaper files

ULTRASONICSULTRASONICS

1.1. Above 20,000 hzAbove 20,000 hz

2.2. Piezo-electric Piezo-electric

3.3. Water – Naocl Water – Naocl irrigantsirrigants

4.4. Diamond & k-type Diamond & k-type filesfiles

Rotary NiTi instruments:Rotary NiTi instruments:

The unique properties of NiTi alloy have allowed

instruments to be manufactured for use in a

rotary handpiece and these have been shown to

be effective in canal preparation.

PPROROFFILEILE Variable Tapers

PROFILE 0.4 : Angle Taper 4%

PROFILE 0.6 : Angle Taper 6%

ISO Standard : Angle Taper 2%

PROFILE O.S. : Angle Taper from 5 to 8%

Rotary NiTi instruments:

• Profile.

•Light speed.

•Great taper.

•Quantec.

•Protaper.

PPROROFFILEILE Motor and Speeds

Stable speed : 150

– 350 r.p.m.

PPROROTTAPERAPERPPROROTTAPERAPERDESIGN FEATURESDESIGN FEATURES

Step-by-step instructions1. Create straight-line access to canal orifice.

2. Always irrigate and have a reproducible glide path with hand files.

3. Protocol of use :

Operation SequenceOperation Sequence

The auxiliary Shaping file or SX is used to optimally shape canals in shorter roots, relocate canals away from external root concavities and to produce more shape, as desired, in the coronal aspects of canals in longer roots. The SX file provides many advantages over Gates Glidden and other coronal shaping instruments used today.

InstrumentationInstrumentation

Shaping file No. 1 or S1 is designed to prepare the coronal one third of the canal, whereas Shaping file No. 2 or S2 enlarges and prepares the middle one third. Although both instruments optimally prepare the coronal two thirds of a canal, they do progressively enlarge its apical one third. With guiding tips and maximal flute diameters approaching 1.2 mm, Shaping file has 14 mm of cutting blades.

InstrumentationInstrumentation

The Finishing files have been designed to optimally finish the apical one third, and also progressively expand the shape in the middle one third of the canal. Generally, only one Finishing File is required to prepare the apical one third of a canal and the one selected is based on the canal’s curvature and cross-sectional diameter.

InstrumentationInstrumentation