Lecture six--------------------------------------------------------------------------------- ‫احمد غانم‬.

‫د‬

:Master apical file

In addition to determining the correct length for canal preparation, a method of
for calculating the correct degree of enlargement must be clarified. The optimal
enlargement of each canal should be calculated separately; there is no hard fast rule
that is universally acceptable. However, the initial size of file that binds at the apical
portion of the canal is of great helpful in the determining the final canal length.

Master apical file (MAF) MAY BE DEFINE AS A THREE SIZES LARGER THAN
THE FIRST FILE THAT BINDS AT THE FULL WORKING LENGTH PASSIVELY
AFTER STRAIGHT LINE ACCESS. ALSO CAN BE DEFINDED AS A LARGEST
FILE USED AT THE WORKING LENGTH PSSIVELY AFTER STRAIGHT LINE
ACCESS.
In the other word, if a size 10 file put into a relatively small canal but is loose
and does not remove dentin, it does not bind. In the same canal a size 20 or 25 files does
work against the canal walls but does not reach the apical portion of the canal. A size 15
does reach the apical portion and the file cut against the wall; thus it is the initial size of
that binds at the full working length, and the master apical file for this canal was size
30. The classic test for determining correct width of any canal preparation has been that
finding of clean white dentin shavings on the flute of the reamers and files. This test is
relatively incorrect. Many canals are oval or ribbon shaped in cross section. Clean white
dentin shavings are attainable from walls close to each other, but the far walls may be
completely untouched while this sign is obtain.

Root Canal Preparation Techniques

Currently employed methods of canal preparation can be divided into two distinct
approaches: those which prepare the coronal section of the canal system with large
instruments and progress towards the apex (coronal-apical technique) and those which
start at the apex with fine instruments and progress back towards the cervical orifice
with larger instruments (apical-coronal technique). Furthermore, a hybrid technique
might be used combining more than one technique.
Apical-Coronal Techniques
1. Standardized Technique.
2. Step-back Technique
3. Balance Force.

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Lecture six--------------------------------------------------------------------------------- ‫احمد غانم‬.‫د‬

Step-back Technique
(Also known as flaring or serial preparation).
The "Step Back" method indicates that the dentist works from the bottom of the canal
back towards the crown.

General guide lines

 Establish working length using small flexible file and locate the apex.
 Step back from the apex, while increasing file size accompanied by reduction in
the instrument length (0.5mm).
 Once we get to the middle portion of the canal, you may switch back to Gates
Gliddens , Peeso Reamers or Hedström files.
 Your goal is to achieve a funnel shape.

The step-back technique done, by dividing the preparation into two phases.
Phase I: is the apical preparation starting at the apical constriction. Apical area is
prepared up to #30 file with recapitulation by using prior size files and irrigation with
2ml after each instrument .
Phase II is the preparation of the reminder of the canal, gradually stepping back while
increasing in size. The preparation step back up the canal in 0.5mm increments from
#30 file through #45 file. Recapitulation is with #30 file to full working length.
The completion of the preparation is the refining phase IIA and IIB to produce a perfect
continuing taper from the apex to coronal area.
Refining IIA done using Gates-Glidden drills 2, and 3 to create coronal and middle root
preparation.
Refining phase IIB is done by using #30 file, through circumferential filing smoothes
step back to produce a perfect continuing taper from the apex to the cervical portion of
the canal.

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Lecture six--------------------------------------------------------------------------------- ‫احمد غانم‬.‫د‬

Coronal-Apical Techniques
1. Step-down Technique.
2. Double-flare Technique
3. Continuous Wave Shaping.
4. Crown-down Pressureless Technique
In "Crown-Down Pressureless technique". the dentist essentially works from the crown
of the tooth, shaping the canal as he or she moves towards the apex.
General guide lines:
 Begin at the coronal portion, The first instruments are Gates Gliddens The
instruments are used in a large to small sequence.
 The Peeso Reamers or Hedstrom files follow in the mid-root region
 Continue down the canal, reducing the size of each file as you get closer to the
apex
 Your goal is to achieve a funnel shape.
 Finally, progressively smaller files take the dentist towards the apex.
Preparation of the coronal part of the canal system first is now considered to be
superior as these results in a number of significant advantages:
1. Most of the microorganisms will be in the coronal third of the root canal system
.Hydrostatic pressure can occur within the root canal if working length confirmation
or apical preparation is initiated at the start of preparation because the file will act
like a piston in a cylinder and this pressure may force pulp debris, dentine chips,
irrigant solution and microorganisms through the apical foramen.
2. Early coronal flaring allows better penetration of the irrigant solution.
3. Also, early flaring of the coronal part of the canal system prevents binding of the
instruments as they are unencumbered throughout most of their length
4. And also give better access to the apical part of root canal.
5. These concepts lead to the advocating of the coronal-apical preparation. When a
dentist instruments a molar with a hand file and feels the #25 or #30 binding, the
impression historically has been that the file is binding in the apical few millimeters.
In actuality the file is not binding in the apical third. It is binding in the coronal half
of the tooth. Therefore, when we use a crown down technique, we eliminate the
cervical constricture and by opening up the coronal half first, we now let a file
proceed unhindered into the apical third of the canal.
6. The result of this is an increased tactile awareness in the apical third of the canal. By
having a file that is not binding in the coronal half of the tooth, we now have a file
that possesses exquisite proprioceptive abilities. Additionally, the crown down
technique enhances the efficacy of our irrigation agent, which we recommend as

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Lecture six--------------------------------------------------------------------------------- ‫احمد غانم‬.‫د‬

either 2.6% or 5.25% sodium hypochlorite. The result of this is an increased tactile
awareness in the apical third of the canal. By having a file that is not binding in the
coronal half of the tooth, we now have a file that possess exquisite proprioceptive
abilities
.
Method of Crown-down Pressureless Technique
As described by Morgan and Montgomery (1984). A #35 file was inserted or glide
to the point of first resistance without using apical pressure. This file was used as a
depth guide to use files of larger sizes and the Gates-Glidden drills. Files #40 through
60 and #2. #3 Gates-Glidden drills were then used to the same length by outward
stroking of the instruments without using apical force (each instrument used should be
followed by 2ml irrigation). Next a provisional working length (PWL) is established
from pre-operative x-ray film at a point 3mm short of radiographic apex starting with
the insertion of a #35 file. When the binding of the file against the canal walls was
noticed, the file was rotated clockwise two full revolutions (720 degree) without apical
pressure. The sequence was repeated with successively smaller files until the PWL was
reached. The canal is prepared the same way with size 40 and 45 files until FWL was
reached. The full working length (FWL) is then verified with a X-ray. Then a #40 file
was inserted and rotated clockwise two full revolutions without apical pressure. This is
repeated with successively smaller files until the FWL was reached. Finally the apical
cleaning and shaping is completed with #15 through #30 files by using a push-pull
circumferential motion.

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Lecture six--------------------------------------------------------------------------------- ‫احمد غانم‬.‫د‬

Mechanized Technique of Root Canal Preparation

In an attempt to speed up and facilitate root canal preparation, automated

techniques have been developed. These include ultrasonic and sonic, vibratory and
rotary system.

1. Ultrasonic Technique.
2. Sonic Preparation

3. Rotary Nickel-Titanium Techniques

Hybrid Techniques

Most experienced operators mix the desirable aspects of different techniques used
for instrumentation of the root canal. The most techniques are differ little from any
other, the important aspect being that the operator is aware of the limitation of each
technique to suit individual needs and the instructions of each technique should be
not followed as
‘cook-book’ style, except in the early stages of learning.

Other Methods of Preparation

Lasers.
Reduced-Pressure Technique

Rotary Nickel-Titanium Techniques

Iatrogenic complication arising from cleaning and shaping
1. Blockage: the canal may suddenly lose patency during a cleaning and shaping
process. This can be result of tissues compression, debris accumulation, wall
perforation, or instrument separation.
2. furcal perforations (strip): a furcal perforation is a mid-curvature root
perforation into the periodontal ligament and is the worst possible out come,
especially as the closers to the crown (why). Anticurvature pressure is extremely
effective when used Gates-Glidden drills in early radicular access preparations.

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Lecture six--------------------------------------------------------------------------------- ‫احمد غانم‬.‫د‬

Another way to prevent furcal perforation is to never take large Gates-Glidden

drills or pesos deep into the root canal.
3. Apical perforation: when the apical third of is curved (almost all canals are
curved) there is a risk of carving out a new portal of exit. This portal of exit is
most often, a result of uncontrolled transportation and ledge formation. Attempts
to reestablish the length past a ledge result in the file tip cutting straight through
the root structure and into the periodontal ligament.
4. Altered foramina: Rip or Zip (tear drop transportation) when files are
passed through the apical foramen they can change its shape very rapidly and
irreversibly. A few in-and-out movements can convert a round apical foramen
into a delta shape (zipped). This apical transportation may severely
compromised apical repair. Apical foramen and canals may be transported
(apical transportation) externally or internally. External transportation is caused
by failing to precurved files, using large instruments, or being too heavy handed.
The original apical foramen is torn. When the instrument overused, the elastic
memory of the instrument may create the teardrop and tearing of the apical
foramen. Many endodontic failures result from external transportation due to
lake of properly Obturation. The second form of external transportation is direct
perforation. This egregious error usually begins with a ledge or apical blockage.
The deflected instrument continues its misdirection until it perforates the root
surface. Internal transportation occurs when the foramen becomes clogged with
dentin mud or denticles. The particles may irritate the attachment apparatuses
after root canal filling or the particles may prevent Obturation of other apical
foramen that branch off the main canal. Finally, this internally transported
foramen may perforate the external root surface through a false path.