1. CLEANING & SHAPING

2. ENDODONTIC STORY

3. THE ENDO STORY

4. Successful endodontics Root canal Biomechanical obturation preparation
DIAGNOSIS
Biomechanical
preparation
Root canal
obturation

5. BIOMECHANICAL PREPARATION
RC.INSTRUMENTATION
RC.PREPARATION
CHEMICOMECHANICAL
CLEANING & SHAPING

6. Cleaning:
Is the removal of all potential irritants from the root canal .
This includes:
1- Bacteria.
2- Infected material.
3- Organic remenants.

7. The goal is achieved through:
1) Proper instrumentation.
2) Use of irrigants.

8. 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.

9. BLACKS PRINCIPLES IRRIGATION. RESISTANCE FORM. RETENTION FORM.
EXTENSION FOR PREVENTION.

10. 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.

11. Mechanical objective for cleaning & 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.

13. Tooth length determination

14. The optimum length is cleaning until the constriction.

16. Methods for tooth length determination

17. 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.

19. 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.

22. 2. Electronic apex locator.

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

24. Role of irrigant in cleaning & shaping.

25. IRRIGATION Quality: Quantity: 2-3 cc / time. 12- 18 min Canal soaking
ANTIMICROBIAL
LUBRICATION
ORGANIC SOLVENTS
INORGANIC SOLVENTS
DEBRIDEMENT
Quantity:
2-3 cc / time.
min
Canal soaking
( WEINE F.)

26. IRRIGANTS ANTIMICROBIALS LUBRICATION ORGANIC SOLVENTS
INORGANIC SOLVENTS
DEBRIDEMENT

27. Types of irrigant: Saline. Sodium hypochlorite. Hydrogen peroxide.
Organic acid irrigants.
Calcium hydroxide.
Chlorohexedin gluconate.

28. SALINE ANTIMICROBIAL X MECHANICAL DEBRIDMENT ORGANIC SOLVENT X
IN-ORGANIC SOLVENT X
LUBRICANT X

29. SODIUM HYPOCLORITE 0.5 – 5.25 % ANTIMICROBIAL MECHANICAL DEBRIDMENT
ORGANIC SOLVENT
IN-ORGANIC SOLVENT X
LUBRICANT

31. HYDROGEN PEROXIDE 3% ANTIMICROBIAL MECHANICAL DEBRIDMENT
ORGANIC SOLVENT X
IN-ORGANIC SOLVENT X
LUBRICANT X

32. ORGANIC ACIDS-CHELATORS EDETA
ANTIMICROBIAL
MECHANICAL DEBRIDMENT
ORGANIC SOLVENT X
IN-ORGANIC SOLVENT
LUBRICANT

33. CALCIUM HYDROXIDE ANTIMICROBIAL MECHANICAL DEBRIDMENT ORGANIC SOLVENT
INORGANIC SOLVENT X
LUBRICANT X

34. CHLOROHEXIDINE ANTIMICROBIAL MECHANICAL DEBRIDMENT ORGANIC SOLVENT X
INORGANIC SOLVENT X
LUBRICANT X

35. ANTIBIOTICS
MTAD - TETRACYCLINS
FLAGYL - METRONIDAZOL

36. FACTS
Root canal irrigants do not penetrate more than 3-5 mm beyond needle tip
&
Apical canal segments benefit from irrigants at the end of the preparation.
Senia et al . Oral Surg. 1971
Baker et al . JOE 1977

37. TECHNICAL CHALLENGES

38. 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.

40. TUBULAR
BLUNDERBASS

41. INDISCREMINATE CUTTING+ - + -

43. PROBLEM SOLVING MODIFICATION IN INSTRUMENTS .
MODIFICATION IN INSTRUMENTATION

44. 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.

48. Modification in material

49. Nickel-Titanium Files

50. Instrumentation techniques

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

52. Shaping is achieved through instrumentation of the canal, either:
(A) From apical to coronal.
MODIFICATION
(B) From coronal to apical.
(C) Combination.

53. 1) Standarized technique.

54. STANDARDIZED TECHNIQUE
IF + 4# = MAF
ERRORS

56. 2) Step-back technique.

57. TELESCOPIC STEP-BACK TECHNIQUE
3-4 FILES TO MAF
3-4 FILES TO STEP
3-4 FILES TO FLARE
3-4 RECAPITULATIONS
14-16 FILES

59. FACTS
Root canal irrigants do not penetrate more than 3-5 mm beyond needle tip
&
Apical canal segments benefit from irrigants at the end of the preparation.
Senia et al . Oral Surg. 1971
Baker et al . JOE 1977

60. ANATOMICAL STUDIES GREEN 1972 MANDIBULAR MOLARS AND BUCCAL
THE CANALS OF THE MESIALROOTS OF
MANDIBULAR MOLARS AND BUCCAL
CANALS OF MAXILLARY MOLARS
SIZED BETWEEN 25#- 35#
BEFORE INSTRUMENTATION.
GREEN 1972

61. CANAL CONSTRICTION
CERVICAL?
MIDDLE?
APICAL?
LEEB 1972

62. 3) Crown-down technique.

63. THE CROWN DOWN
CANAL PREFLARE

64. Canal preflare

66. 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.

67. BASIC INSTRUMENTATION MOTIONS

68. Filing

69. Reaming

70. QUARTER TURN-PULL

71. Wach-Wind

72. Ballanced-force

73. END-POINT OF CANAL PREPARATION
ADEQUATE SIZES FOR PARTICULAR CURVATURES.
CLEAN DENTIN.
ADEQUATE FLARE FOR A PARTICULAR OBTURATION TECHNIQUE.

74. Mechanized
instrumentation

75. Advantage of mechanical instrumentation:
Instrumentation is physically effortless.
Canals are enlarged quickly.
Debris is removed easily.
Canals are more uniform and smoother.

76. Disadvantage of mechanical instrumentation:
Greater chance for canal ledging.
Greater chance for canal perforation.
Greater chance for instrument breakage.
Loss of tactile sensation.

77. Engine-driven Instruments
Power Cutting Tool
Low speed hp Gates Glidden / Pesso drill
Gear reduction hp Files with Latch (NiTi)
Giromatic (M4) Files with Latch(k-file)
Racer Files with Latch(k-file)
Canal leader Files with Latch(A-file)

79. 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.

81. VIBRATORY INSTRUMENTATION
SONICS
Below 20, 000 hz
Compressed air
Water irrigant
Rispi & shaper files
ULTRASONICS
Above 20,000 hz
Piezo-electric
Water – Naocl irrigants
Diamond & k-type files

82. 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.

83. PROFILE Variable Tapers PROFILE O.S. : Angle Taper from 5 to 8%
PROFILE 0.6 : Angle Taper 6%
PROFILE 0.4 : Angle Taper 4%
ISO Standard : Angle Taper 2%

84. Rotary NiTi instruments:
Profile.
Light speed.
Great taper.
Quantec.
Protaper.

85. PROFILE
Motor and Speeds
Stable speed : 150 – 350 r.p.m.

86. PROTAPER
DESIGN FEATURES

87. Operation Sequence Step-by-step instructions
1. Create straight-line access to canal orifice.
2. Always irrigate and have a reproducible glide path with hand files.
3. Protocol of use :

88. Instrumentation
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.

89. Instrumentation
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.

90. Instrumentation
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.