Endodontic canal preparation

ENDODONTIC
PREPARATION
Dr. Abdalazim Badraldin
Sudanese Dental Center
Khartoum – Sudan
November 2019
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‫الرحيم‬‫الرحمن‬ ‫هللا‬‫بسم‬

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Dr. Abdelazim MohamedBadreldin
Sudanese Dental center
KhartoumSudan
December 2012
Root canal preparation
Mechanical Preparation
Divided into six main parts:
• Preparation of the coronal access cavity
• Preparation of the pulp chamber
• Identification of root canal orifices
• Preparation of a secondary access to the root canals and coronal flaring
• Preparation of a glide path to the apical foramen
• Preparation of the middle and apical parts of the root canal.

History of endodontic treatment
‫الجذور‬ ‫عالجات‬ ‫تاريخ‬
Radiograph of skeletal remains showing maxillary
right lateral incisor with bronze wire (2.5 mm)
implanted in the root canal of a Nabatean warrior
buried in the Negev desert
2,200 years ago (200 BC). Reproduced
with permission from Dr.
Joseph Zias, State of Israel
Department of Antiquities, and J Am
Dent Assoc 1987;114:665….Ingle 5th edition

KhartoumSudan
December 2012

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Objectives (Herbert Schilder in 1974 )
The mechanical objectives
I. Continuously tapering funnel from the apex to the access cavity.
II. Cross-sectional diameter should be narrower at every point apically.
III. The root canal preparation should flow with the shape of the original canal.
IV. The apical foramen should remain in its original position.
V. The apical foramen should be kept as small as practical
The biologic objectives :
I. Confinement of instrumentation to the roots themselves.
II. Not forcing necrotic debris beyond the apical foramen.
III. Removal of all tissue and debris from the root canal space.
IV. Creation of sufficient space for intracanal medicaments.
V. Completion of preparation in one appointment.

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The Goals
The two primary goals for root canal instrumentation :
1. To provide a biological environment that is conducive to healing
2. To provide a canal shape that is conformable to sealing.
JohnT. McSpadden
Cab be achieved by
a) Manual Preparation with different instruments
b) Automated preparation with conventional stainless steel instruments
c) Rotary systems using NiTi-instruments
d) Sonic & Ultrasonic preparation
e) Lasers
f) Non-instrumental techniques

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Basic principles for canal preparation:
• Each root canal has to be addressed individually.
• Root canal preparation should be planned thoroughly
before starting treatment.
• Careful evaluation of radiographs is mandatory.
Factors affecting planning and performing root canal preparation :
 Anatomy of the root canal
 Microbiology of the root canal
 Instruments available for preparation.

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Primary Access Cavity
1- The Coronal Access Cavity Should:
• Allow full control of the pulp chamber
• Allow removal of all tissue from the pulp chamber and
proper disinfection. This will result in elimination of a significant
load of microorganisms.
• Allow a proper intracoronal diagnosis (cracks, dentincolors, pulp
stones, calcifications).
• Allow location of all root canal systems and relevant anatomical
structures (isthmi, lateral extensions).
• Allow fast and straight-line introduction of endodontic
instruments without coronal interferences. Ideally, the
straight-line access should be extended to the beginning of the curvature .

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objectives
• Provide a straight line access to the root canals
• Confirm the etiology of pulp pathosis
• Assess restorability of the tooth
Guidelines
 Determination of the point of penetration
 Assessment of occlusal and external root form
 Radiographic assessment
- shape & depth of pulp chamber
- the angle at which the canal leaves the pulp chamber
- the position of the canal within the root.
 Assessment of complicating factors
- Rotations/tipping of teeth,
- calcifications (pulp stones, mid-root calcification).
- deep restorations, buccal/lingual restorations.
- root length, width.
- curvature of the root that affect the angle of entry
the degree of extension of the access cavity
in the horizontal and vertical dimension

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Coronal Access Cavity Preparation --- Mandibular Teeth

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Coronal Access Cavity ----Maxillary Teeth

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2- Preparation of the Pulp Chamber
Preparation should be extended to a degree allowing complete removal of all tissue remnants
Following proper irrigation and drying, the pulp chamber
should be thoroughly inspected for :
• Remnants of vital or necrotic soft tissue.
• Remnants of filling materials (amalgam, gold or ceramic particles, cement).
• Caries.
• Secondary and tertiary dentin.
• Perforations.
• Fractures, cracks, and craze lines.
• Calcifications.
• Pulp stones.
• Root canal orifices.

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Instruments

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Identification of Root Canal Orifices
Strategies
1. The orifices of the root canals are always located at the
junction of the walls and the floor.
2. The orifices of the root canals are located at the angles in
the floor–wall junction.
3. The orifices of the root canals are located at the terminus
of the root developmental fusion lines.

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Techniques & Devices
1- Troughing & Exploration

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2- Dyes
- Root canal detector…..methylene blue
- Caries detector

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3- Sodium Hypochlorite ….. bubbles evading from a hidden root canal
4- Devices…
Software for automatic
detection of the canal orifices
in video images.The software
communicates via laptop and
USB with intraoral camera.

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Preparation of the Secondary Access Cavity ( Root Canal Orifices)
Principle:
Preparation of the secondary access cavity should never be initiated before preparation of
the primary access and cleaning of the pulp chamber are completed.
Coronal Flaring
Objectives
• Facilitates insertion of instrument without coronal interferences.
• Improves straight-line access to the middle and apical
parts of the root canal.
• Removes reparative dentin at the root canal orifice
• Reduces angle and increases the radius of the root canal curvature.
• Allows early application of sufficient amounts of irrigant into the canal
first step of canal preparation

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Preparation of the Secondary Access Cavity
Instruments for Coronal Flaring
Gate Glidden drills
Small flame-shaped non-cutting tip instrument
used in the conventional hand piece
Different sizes – coded by rings or
colored bands on shank
Are slightly flexible and will follow
the canal shape but can perforate the
canal if used too deeply
functions :
Preparing the coronal two thirds of molars canals.
Removing the lingual shoulder.
Widen the canal when an instrument
has fractured within it

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December 2012
Peeso Drills
used in conventional handpiece
Most often used in preparing
coronal portion of the root canal
for receiving a post core .
Peeso reamers are not flexible
or adaptable, if not used with
care can perforate canal
Safe-ended tip
Tip – Diameter: 0.7 – 1.7
Used in a brushing motion

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Orifice Openers
Open the coronal (1/3) part of the canal
have large tapers and short shafts. Examples are:
 M3 Pro golds system orifice opener ( UDG– China)
17mm tip diameter, 19mm length and o.12% taper
non-cutting tip
 IntroFile (FlexMaster, VDW, Munich, Germany): 12 mm
cutting part, 11% taper, non-cutting tip.
 Orifice Opener (ProTaper U, Maillefer, Ballaigues,
Switzerland) 14 mm cutting part with 19% taper at the
tip decreasing to 3.5% at 9 mm, non-cutting tip.

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Preparation of a Glide Path
manual preparation of a glide path to the apical third of the canal
Objectives
• Early exploration of the root canal system to be prepared.
• Assessment of canal width, content, curvatures, and ledges.
• Reduction of friction of small NiTi instruments thereby
lowering the risk of instrument separation.
K-files (ISO-sizes 06, 08, 10): K-files ISO-sizes 06, 08,
and 10 are regarded as the classical instruments for initial
instrumentation of narrow and calcified root canals.
They are used in a watchwinding motion with slight apical
pressure. Negotiation of a narrow canal can sometimes
require discarding several bent instruments before
completion.

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Preparation of a Glide Path
C+-Files: These instruments are by grinding stainless steel
wires of a square cross-section. The apical 4 mm show a 4%
taper to increase the stiffness of the tip; the coronal part
shows a 2% taper to maintain flexibility
PathFiles: PathFiles are available in sizes 13, 16, and 19
with a taper of 2% and a specially designed tip.
M3 pro gold path files
-Tip diameter
12 mm
-Tape..
0.02 %
-Length 21;25:31mm
-Tip diameter
16 mm
-Tape..
- 0.02 %
-Length 21;25;31

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Preparation of the Root Canal
Instruments for Root Canal Preparation
divided into three types:
 Reamers
 K-files
 Hedstrom files.
The majority of hand root canal instruments are either made of stainless steel (SS) or NiTi alloys.
NiTi V/S SS
-- NiTi endodontic files are entirely fabricated by machining process in contrast to twisting
process of stainless steel files
-- NiTi instruments are more flexible due to its low modulus of elasticity( super elasticity)
-- NiTi file comes back to its original straight form without showing any sign of
lasting deformation ( shape memory).
-- Cutting efficiency of NiTinol is only 60% than that of matching S.S. files.
-- NiTi Does not give any signs of fatigue before they fracture.
-- NiTi More expensive
--- SS is considerably more resistant to sterilization hazards.

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Advances in Nickel-Titanium Metallurgy
1)M-wire NiTi –
Developed by DentsplyTulsa Dental Specialties (Tulsa, OK, USA)
Advantage:
This material has greater flexibility and an increased resistance to cyclic fatigue when compared to
traditional NiTi alloys
2) R-phase NiTi –
Developed by SybronEndo (Orange, CA, USA)
Advantage:
Files have reduced stiffness and more fracture resistance compared to standard NiTi files.
3) Controlled-Memory (CM) NiTi
Advantage:
Files have superior cyclic fatigue resistance and increased torque strength
over traditional NiTi files.

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Standardization of Endodontic Instrument
(International Standardization Organization ISO)

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06 08 10 15
90
20
100
50
25
55
110
30
120
60
35
70
130
40
80
140
45
150

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Taper Size
It is expressed as the amount of file diameter
increases each millimeter along its working surface from
the tip towards the file handle.

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K-reamer
instruments can be manufactured by twisting a triangular blank
by machine . Reamers cut and enlarge canals with rotational motions.
K -Reamers have a rake angle which makes them most efficient in rotary motion
Reaming motion involving
clockwise rotation of instrument

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--1904 Kerr Manufacturing Company
Files are instruments that enlarge canals with reciprocal insertion
and withdrawal motions. K Files blade angle makes them best
suited for cutting dentin in the filing motion .
--- K-files are produced in sizes
06 - 140, all with a taper of 0.02.
K-file design is identified by the
square symbol on the handle.
The tip is active cutting tip
--- Action--- filing and reaming
movement, pull and push ,
penetration, rotation
and retraction

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3-K - Flex Files
1982 –Sybron-endo / Keer
--- The spirals or flutes are produced by
the same twisting procedure used to
produce the cutting edge of the standard
K-type files, but with a rhomboidal
or diamond in cross section .
The diamond cross sectional shape increase
the flexibility , sharpness , cutting efficiency
and act as an auger providing more area
for debris removal

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manufactured from a triangular
steel wire that is twisted to give the typical
shape of a file. The helix angle is small,
and therefore effective only in rotatory
motion. The tip of the instrument is
non-cutting (inactive tip) making flexofiles
well suited for the preparation of evenly
curved canals without risk of ledging.
They are similar to k-flex file except that
they have triangular cross section .
This feature provide them greater
flexibility and thus ability to resist fracture,
but they have less cutting efficiency
4- Flex O Files

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C+ File
-- Used for difficult and calcified canals
-- High flexible
Available in size 8, 10, 15 of length 18, 21 and 25 mm

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Golden Medium File
Were described by Weine.
Comes under intermediate files
provided with half sizes between
conventional instruments.
Available in sizes from 12-37
-- 12, 17, 22, 27, 32, 37.
Used for narrow canals.
They are formed by cutting 1 mm
from tip of instrument

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machined from a tapered cylindrical block or from round steel wire by
girding
--- A series of intersecting cones in cross section.
--- highly efficient at removing dentine on the outstroke when used in a filing
motion, but have poor fracture resistance in rotation.
--- H- files is effective only when using a filing motion (up down movement).
--- Better cutting action than K-file (more positive rake angle)
--- Come in size 08-140 ,All with taper 0.02
--- Identified by the circle symbol on the handle
Action -- withdrawal stroke
Hedstrom File ( H-File )

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Hyflex File (S-File)
Mc Spadden
- S-shaped in cross section-modified
from Hedstrom file .
- designed with two spirals
for cutting blades,
a double-helix design.
-- perfect blend of flexibility,
durability and cutting ability.
filling and reaming motion
-- Marketed as Unifile and Dyantrak

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Cutting Angle ( Helical Angle)
The angle formed by the cutting edge with the long
axis of the file.
The helical angle of instruments used for hand
preparation indicates the most efficient
working motion of the instrument. Instruments
having a helical angle of less than 45°
(reamers and K-files) require a rotary reaming
working motion to effectively cut dentin, while
those having an angle greater than 45°
(Hedstrom files) require a linear filing motion.

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Tip design
Tip configuration has a crucial impact on the shaping ability of root canal instruments
-- Cutting Tip
Enable the tip to cut forward and produce a file-tip shaped cavity, thus creating ledges
-- Non-Cutting Tip
 Perform better in maintaining the original canal curvature.
 Cause less canal transportation and remove material more
equally at the inner and outer aspects of the curved canal

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Pitch
The distance between the edges of two cutting blades (The number of the flute per unit length)
The smaller the pitch, the greater the contact area between the instrument and the root canal walls,
thereby increasing the torsional stress of the instrument. The pitch may be regressive, continuous,
or progressive. Normally, hand instruments possess a continuous pitch.
Most files have a variable pitch, that changes along the working surface.
The result of a constant pitch and constant helical angles is a “thread-in” or “sucking down”
of file within the canal

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Core
It is the cylindrical center part of the file having its
circumference outlined and bordered by the depth of the flutes.
Significance :The flexibility and resistance to torsion is partially
determined by the core diameter.

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Endodontic Files
Flute
It is the groove in the working surface used to collect soft tissue and
dentin chips removed from the walls of the canal. The effectiveness of the
flute depends on its depth, width, configuration, and surface finish.
A progressively larger distance between flute space and blade is required
so as to avoid any compaction of debris and also provides an effective
channel for its removal.

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Endodontic Files
Cutting edge:
-- The surface with the greatest diameter
-- The blade of the file.
Significance : The cutting edge forms and deflects chips from the wall
of the canal and cut or snags soft tissue. Its effectiveness depends on
its angle of incidence and sharpness.

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Endodontic Files
Land or Marginal width
The surface that projects axially from the central axis as
far as the cutting edge between the flutes.
Functions :
-Prevents screwing in of the file
- Supports the cutting edge
- Limits the depth of cut
- Maintains the file in the Centre of root canal
Relief Area
A reduce surface area of the land
Function
reduce friction resistance

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PREPARATION TECHNIQUES
Manual Preparation Techniques
Standardized Technique ( Ingle 1961)
Starting with small instruments, all following instruments are inserted to working length.
Preparation results in a root canal with low conicity that theoretically reproduces
the shape of the last instrument used (Master Apical File [MAF]).
stepwise reduction of working length, once apical
preparation has been finished with the MAF .Each step back is followed by irrigation and
recapitulation with a small file.
Step-Back Technique

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Crown-Down Technique
Following coronal flaring, large instruments are used to enter and enlarge the root canal a few millimeters
apically each time.The instrument is followed by a smaller file,
preparing only a few millimeters deeper than the previous instrument.This is repeated until working length is
reached. As the final step, enlargement of the apical diameter completes the preparation
advantages of the crown-down techniques are:
• Less friction and stress on the instrument thereby reducing
risk of instrument fracture
• Less canal straightening since reduced friction allows a
more controlled preparation
• Less contamination of the apical zone of the root canal by
reducing transportation of infected debris.
• Early coronal and mid-root enlargement allowing early
disinfection of the coronal parts of the root canal system.
• Reduction of extruded debris beyond the apical foramen

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Non-Instrumental Technique (NIT)
uses a vacuum pump and an electrically driven piston, generating alternating pressure and
bubbles in the irrigation solution, inside the root canal. Finally, the root canal may be obturated
with a sealer introduced by the vacuum pump.

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PREPARATION WITH ROTARY NiTi INSTRUMENTS
Development of Rotary NiTi Systems
• Generation 1:
These instruments include rotary NiTi systems with a constant taper and radial
lands and a neutral or negative rank angle. ProFile, LightSpeed, Quantec, Greater
Taper, BioRace, and EndoSequence

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• Generation 2
These instruments are characterized by having
actively cutting blades without radial lands. …
ProTaper, ProTaper U, K3, Mtwo, BioRaCe,
FlexMaster, and S5.
• Generation 3
These instruments include systems
such asTwisted Files,Typhoon, HyFlex, andVortex
Blue.The classical NiTi alloy was replaced withy
improved, thermally pre-treated alloys such as M-wire
or CM-wire, increasing the flexibility and durability of the files.

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• Generation 4
The mode of action of these NiTi systems
was altered from a 360° rotation to reciprocal movements with
Reciproc………..WaveOne.
• Generation 5
This most recent group of rotary NiTi instruments shows an
irregular cross-sectional design…. SAF, Revo-S, and ProTaper Next

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Selection of NiTi Rotary Files
Before you choose a rotary file, you must try it
Correct Choice in Rotary Files depend on Understand the fundamentals of file design
&
combine that with your pre-clinical trial.
1. Assess case difficulty
2. Provide adequate access…. Straight line access
3. Prepare with hand files up to size #20 prior to rotary use--- glide path
4. Use light touch and low rpm --don’t force the file
5. Proceed with crown-down sequence preparation
6. Replace rotary instruments frequent to avoid overuse
7. Avoid Cutting With the Entire Length of File—the more file engaged in the root
canal, the higher potential for instrument fracture.
8. Don’t Start and Stop—sudden changes in the direction of a rotary caused by the
operator must be avoided. A smooth gentle reaming motion is most efficient;
rotaries should be inserted and withdrawn from a canal while rotating.
9. Length Control is Critical—working length should be well established
10. Don’t rotate a file inside a dry canal

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Endodontic Hand-pieces

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These instruments all deliver an irrigant which is usually sodium
hypochlorite into canal space while cleaning and shaping are carried
out by a vibrating K-file
Ultrasonic

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Endodontic Motors
GENERATIONSOF MOTORS
a) First generation motor without torque control.
b) Second generation motor with torque limiter.
c) Third generation motor with simple torque control.
d) Forth generation motor with apex locator and torque control
First-generation motor
without torque control
second-generation motor
with sensitive torque limiter.
Third-generation simple
torque-controlled motor
Forth-generation motor with
built-in apex locator and torque control

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Setting Endodontic Motors
Speed reverse
Torque Gear
Program Memorize
auto reverse Power

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Apical Extent of Canal Preparation ; Where & Why?
-- Controversial ….No General Agreement.
-- Canal preparation & obturation must stop at the
cemento-dentinal junction, that corresponds to the
maximal apical constriction.
Grove 1929
-- Instrumentation and Obturation should be
Contain within the Root Canal.
Most North American & European Schools
Cailleteau & Mullaney1997
- Ideal to Dentino-Cemental Junction
without Overextension or overfilling.
A-anatomic apex
F-radiographic apex
D-cemento-dentinal
junction
E-endodontic apex
(apical foramen).
KhartoumSudan
December 2012

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 The site of the cemento-dentinal junction is so variable that attempting to
use it as a landmark is of little help to the endodontist. This junction often has
unclear limits and can be found at different levels within the root canal.
Coolidge 1929
 It is also histologically impossible to find a point within the root canal where
the pulpal tissue ends and the periodontal tissue begins.
Skillen WG.
Why root canal should be filled to the dentine-cemental junction
J Am Dent Assoc. 1930
 From a practical point of view it is not possible to use the cemento-dentinal
junction as a boundary of endodontic obturation. When
identified, more often than not, it is by chance.
Orban B.
Why root canal should be filled to the dentino-cemental
junction. J Am Dent Assoc. 1930;

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The apical limit of canal instrumentation and obturation should not be the
radiographic terminus of the canal, nor should it be the cemento-dentinal
junction or the distance of 1 mm from the radiographic apex, but rather the
“apical constriction.”
This anatomical location, however, cannot be determined clinically with accuracy
since it is “ever-changing.
Ricucci &Langeland
Apical limit of root canal instrumentation and obturation,
part 2. A histological study. Int Endod J.1998

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 Relying on tactile sensation to locate the cemento-dentinal junction
can be misleading. The maximal constriction of the canal lumen may
be due to the narrowing of the canal or to a calcification that may vary in
distance from the true end of the endodontium.
Arnaldo Castellucci
Obturation of the Radicular Spaces Ingle’7

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 The arbitrary rule that canal preparation should terminate 1 mm short of
the radiographic apex should not be accepted in modern endodontic
therapy. The “one millimeter” technique could result in instrumentation
short of the true canal terminus, possibly leaving necrotic and infected
debris behind, leading to treatment failure.
Gutierrez JH, Aguayo P.
Apical foraminal openings in human teeth. Number and location. Oral
Surg Oral Med Oral Pathol Oral radiol Endod. 1995.
Blasković-SubatV, Maricić B, Sutalo J.
Asymmetry of the root canal foramen. Int Endod J. 1992

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 Because no one can insure sterility in any given root canal space, the surest chance of
clinical success is gained when root canal systems, in all of their complexities, are filled to
their full apical and lateral extents,
Peters et al
 The difference between the “radiographic apex” and the “radiographic terminus of the
canal” must be well understood. If the root canal is not straight and the foramen is on the
distal, or on the mesial aspect of the root, it is obvious that it has nothing to do with the
“radiographic apex”,
therefore it makes no sense to advocate an instrumentation and then an
obturation .05 mm or more from the radiographic apex.
On the other hand, when the foramen in on the buccal or on the
lingual aspect of the root it is impossible to radiographically
see the terminus of the canal.
all of our endodontic treatments are performed at the
“electronic apex”,
Arnaldo Castellucci
Obturation of the Radicular Spaces
Ingle’7
Radiographic Terminus of the Canal

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An electronic apex locator is an electronic device used in
endodontics determine the position of the apical constriction
and thus determine the length of the root
KhartoumSudan
December 2012

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An electronic apex locator is an electronic device used in
endodontics determine the position of the apical constriction and
thus determine the length of the root

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The functions of Rubber dam are:
1. To prevent contamination by saliva.
2. To prevent slipping of instrument into the
throat (ingestion of instruments).
3. Prevent contamination between the patient
and dentist.
4. It prevents the strong irrigating solutions
and medicaments contacting oral mucosa
KhartoumSudan
December 2012

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The components of rubber dam :
1. Rubber dam frame
2. Rubber dam sheets
3. Rubber dam punch
4. Rubber dam clamp holder
5. Rubber dam clamps for
posterior and anterior teeth
6. Rubber dam template

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