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IR Nov Bellamy/clinical 30/9/03 12:18 pm Page 1

CLINICAL

Explaining Schilder’s Five


Mechanical Objectives
Dr Raphael Bellamy addresses each of Schilder’s Mechanical Objectives
from a practical, clinical standpoint

Last issue I discussed the generated endodontics. I will instrument fracture or transmit realistic compaction
concept of cleaning and discuss the biological transportation by freeing up pressures to the warm gutta
shaping the root canal system objectives in a future issue. the instrument in the canal. percha. This potentiates the
from a historical perspective Before explaining the likelihood of obturating
and compared this with the mechanical objectives and Decreasing cross-sectional accessory foramina in the
goals laid down in present- their fulfilment, it is assumed diameters at every point apical one third of the system.
day endodontics. Schilder that the operator has apically and increasing at The sole exception to this
outlined the modern concept prepared an adequate access each point as the access cavity second principle is in the case
concisely in his article cavity. In other words, there is approached of internal resorption, where
Cleaning and Shaping the Root is straight line access to the The second objective is a adherence to it would greatly
Canal in 1974 and this is body of the canal. corollary of the first. This weaken the remaining tooth
widely regarded as the shape creates control at every structure.
definitive document on the The root canal preparation level of the preparation. It
subject. Within the document should develop a continuously facilitates the removal of …In multiple planes, which
he laid down strict tapering cone organic debris coronally by introduces the concept of
mechanical and biological This shape mimics the shape the action of instruments and ‘flow’
objectives for attaining of the canals before they irrigating solutions. It allows The third objective
predictably the goal of undergo calcifications and the placement of condensing encourages us to think in the
successful anatomically the formation of secondary instruments deep into the third dimension. As stated in
dentine. The canal should root canal preparation to my previous artcle, this is
develop a continuously critical in root
tapering cone from the access Decreasing cross sectional diameters at every canal therapy.
cavity to the apical foramen. point apically The root canals
This conical shape allows within curved
effective cleansing of the roots are
canal, as well as allowing similarly
hydraulic principles to curved, and
operate by the restricted flow when these are
principle. As flow is preserved and
restricted by the conical cleaned the
form, compaction of warm system exhibits
gutta percha and sealer natural ‘flow’.
generates vertical and The greatest
horizontal vectors of force problem lies in
that take the path of least the apical
resistance, obturating and portion of the
Raphael Bellamy BDS (NUI) sealing the apical and lateral canal and the
Cert. Endo. is a graduate of foramina. This shape greatest care
University College Cork and enhances the uses of reamers must be taken
The Goldman School of and files by allowing close to maintain the
Dental Medicine in Boston, contact with the root canal direction of
Massachusetts, where he surface. Additionally, the curves in
completed his postgraduate appropriate funnelling this region.
studies in endodontics. He is enhances irrigation, debris Properly
currently in private practice removal and tactility and prepared root
limited to endodontics in Dublin reduces the potential for canals will

14 Irish Dentist November 2003


IR Nov Bellamy/clinical 30/9/03 12:18 pm Page 2

working length.
Remember what I
said about thinking in
three dimensions? We
must continue to feel
with hand
instruments for the
ribbons, flags and
banners that are the
norm of root canal
systems.
Keeping the
foramen as small as
practical, not the
much misquoted
small as possible,
restricts the gutta
Multiple planes that introduce the concept of flow percha in compaction
and facilitates
compaction. Large
maintain these fine apical the root in the adjacent bone. vertical and
curvatures, as should be The number of root canals direction away from the horizontal forces are
evident radiographically in that have left the confines of natural curve of the canal. As subsequently generated in the
the finished case. the original canal but not the process develops a correct shape that will find
perforated the root surface teardrop opening is created. and seal lateral anatomy.
Do not transport the foramen are far greater. Success It ought to be remembered Some of the most difficult
The apical opening should involves the treatment of the that an inadequate access cases to obturate are those
remain it its original spatial naturally existing root canal. cavity that restricts the shafts with enlarged apical openings.
relationship both to the bone Boring pathways in roots may of instruments encourages Although gutta percha does
and to the root surface. The make for good radiographs transportation as well as exhibit excellent rheological
movement or transportation but it is not a successful restrictions in the body of properties to facilitate the
of the apical opening is a therapeutic measure. It is this the canal. obturation of the open apex.
common error in root canal common and potentially In cases of pulpal necrosis,
preparation that leads all too disastrous outcome to which Keep the foramen as small as sufficient enlargement must
frequently to chronic root the fourth mechanical object practical in all cases take place to ensure the
canal discomfort or outright alludes. Numerous studies confirm cleanliness of the region, but
failure in treatment. No Foramen transportation that although natural apical excessive removal of apical
straightening is permitted in most commonly takes two foramina are not entirely dentine and cementum should
the apical few millimetres of forms, namely the round, root canals do tend to be avoided. Clearly in a vital,
any canal without severe risk development of an elliptical be rounder in their apical early, pulpitic case the same
to the outcome of the case. It or teardrop foramen and an one third. This anatomical would not apply. Adherence
is common to observe, outright root perforation. reality is of benefit to us, to the principle that the
during surgical endodontics, Since apical foramina are especially in the use of foramen should be as small as
root canal fillings that usually found short and to perfectly round rotary practical places no maximum
radiographically appeared to the side of the radiographic instruments. However, we limitation on its size since this
be within the confines of the apex, repeated passages of should never fall into the is determined by the clinical
root but which have in reamers and files tend to comfort zone of assuming we situation presented. The large
actuality left the root canal straighten these delicate have cleaned the apical area foraminal openings in cases of
several millimetres short of passageways and actually simply because our apical resorption may still be
the apex and have paralleled enlarge the opening in the instrument has reached the as small as practical. Studies

Perforation Tear or rip

Irish Dentist November 2003 15


IR Nov Bellamy/clinical 30/9/03 12:18 pm Page 3

CLINICAL

increase the risk of


tearing, it also
increases the
potential for
microleakage.
In summary, the
goal is to produce a
three dimensional,
continuously
tapering,
multiplaned cone
from access cavity to
radiographic
terminus while
preserving foraminal
position and size.
Violation of mechanical It all sounds a bit daunting
objectives four and five (L to R) doesn’t it? Well, no, not
really, because on close
by Green (1956) and Kuttler analysis each of the
(1955) determined the extent mechanical objectives is a
of changes in the apical corollary of the one before.
foramen with increased age. Believe me when I say that
However, the diameters were these objectives are the road
rarely greater than the 0.3mm map to predictable
to 0.5mm range in any teeth. endodontics. Remember the
I baulk at the conversations I burglar analogy I mentioned
hear and cases I see that have in my previous article? Well
been cleaned to and beyond the mechanical and biological
0.6mm, and even 0.8mm! It objectives are the rules that
is surely no coincidence that have to be adhered to if the
these teeth are often burglar is to remain
symptomatic and weep undetected. If the rules are
continually, greatly violated then we run the risk
complicating obturation. of awaking the sleeping giant.
Once these sizes are attained Next issue I will discuss the
by cleaning and shaping, it little known biological
becomes very difficult indeed objectives of cleaning and
to generate a continuously shaping.
tapering cone to obturate.
The goal is to clean but not References
to enlarge the foramen. If the Schilder H (1974) Cleaning and
diameter of a foramen is shaping the root canal. Dental
increased from 0.2mm to Clinics of North America 18(2)
0.4mm, the area of the
foramen has increased by West JD et al (1994) Cleaning and
four times! Not only does this shaping the root canal system. In:
Pathways of the Pulp, 6th Edition,
Keep the foramen as small as chapter 8
practical
Green D (1956) Stereomicroscopic
study of the root apices of 400
maxillary and mandibular teeth.
OOO 9(11): 1224-1232

Kuttler Y (1955) Microscopic


investigation of root apices. OOO
50: 544-552

Acknowledgement

All images provided for this


article are digital and captured
with a Trophy RVG system,
Trophy Radiologie SA, France

Irish Dentist November 2003 17