Monday morning, the doctor walks into the clinic relaxed after the

weekend and opens the appointment register. Call on my first case he

remarks, full of enthusiasm and vigor and then what does he see-the first
case is Oh no! My God-M!.
Good morning and welcome to today"s seminar on iomechanical
preparation during endodontic therapy.
Lets delve deeper under the following subheadings:
CONTENTS
#ntroduction
$efinition and o%&ectives
asic terms and motions of instrumentation
General principles and 'echni(ues of %iomechanical preparation
a) *and +pical coronal
Coronal apical
%) +utomated
Curvatures and cleaning and shaping
+dvances in automated instrumentation and ad&uvant techni(ues
Conclusion and i%liography
INTRODUCTION
,es, the root canal system is complicatedly complex. +ccessory and
lateral canals, isthmuses, calcifications, curvatures and what not com%ine
to form a daunting challenge to the astute clinician. +chieving not &ust
vertical access %ut true - dimensional preparation is an issue that has and
still vexes a ma&ority of clinicians as evidenced %y the myriad techni(ues
and instrumentation that have spawned in the (uest for ideal cleaning and
shaping. .ust as nothing is constant %ut change so too in the root canal
nothing is predicta%le except the unpredicta%le.
+long with diligent access preparation, canal location and working
length determination only through %iomechanical preparation, will ensure
good o%turation and healing. /nderstanding that a denture is as good as its
initial impression, an inlay as good as the tooth preparation and an
o%turation as good as the %iomechanical preparation, let us explore the
rationale and techni(ues to achieve that perfect canal preparation.
0
DEFINITION AND OBJECTIVES:
1childer introduced the concept of 2Cleaning and 1haping3 almost --4
decades ago.
iomechanical preparation refers to the controlled removal of dentin
and root canal contents %y manipulation of root canal instruments and
materials. #t consists of cleaning and shaping.
Cleaning:
5efers to the removal of all contents of the root canal system %efore
and during shaping including su%strates, microflora, %acterial products,
foods, caries etc.
Shaping:
5efers to a specific root canal form with particular design
o%&ectives. #t involves the carving and predetermined removal of root canal
structure to achieve a uniform, tapering homogeneous design. 'he final
shape permits effective irrigation, o%turating instrumentation and general
hydraulics re(uired to transform and capture a maximum cushion of gutta-
percha and sealer into all foramina with three dimensionality and no
extrusion %eing achieved.
'he purpose of this seminar is to provide the rationale and
techni(ues for proper cleaning and shaping of the root canal system, which
will ena%le the clinician to o%turate the system.
+s with many aspects of dental profession, such as a denture %eing
no %etter than the initial impression, or an inlay %eing no %etter than the
tooth preparation, it follows that canal o%turation will %e no %etter than the
cleaning and shaping of the entire system.
Generally speaking, the 6 main o%&ectives in canal cleaning and
shaping are7
Biological: iologically, the goal of intracanal procedures is to remove all
pulp tissue remnants and micro-organisms and their su%strates along with
infected dentin.
Mechanical: Mechanically --$ shaping of the canal is the o%&ective which
must %e accomplished to achieve %iologic cleaning.
Biologic objectie! incl"#e:
0. Confine all instrumentation within the root canal space 8apical
constriction) to maintain its spatial integrity. 5epeated
instrumentation extending %eyond the constriction is unwarranted. #t
6
causes peri-radicular inflammation and often destroys the normal
%iologic constriction of the root apex.
6. +void pushing contaminated de%ris past the confines of the apical
constriction.
Many instances of post treatment pain and swelling can %e
attri%uted to necrotic tissue and micro-organisms and their toxins
%eing inoculated into the peri-radicular tissues as a result of
indiscriminate cleaning procedures. 'his induces a rapid
immunologic response.
-. 5emove all the potential irritants from the entire canal system. 'his
avoids recurrent peri-radicular inflammation and creates a condition
that permits prompt, uneventful healing.
4. 9sta%lish the exact :.; and completely clean and shape the canal
system.
<. Create sufficient width in the coronal half of the canal system to
allow for copious flushing and de%ridement.
Mechanical Objectie! incl"#e:
0. $evelop a continuously tapering form in the root canal preparation.
'he final preparation of this system should %e an exact replica of
the original canal configuration in shape, taper, and flow only larger.
Only too often, canals are simply 2%ored out3 with the clinician failing
to consider the spatial relationship of the canal to the overall root
anatomy.
6. !repare a sound apical dentin matrix at the $C &unction.
'his provides the resistance form to the intraradicular cavity
preparation. 'his also prevents the over-extension of instruments
and controls the apical movement of gutta-percha sealer during
o%turation.
-. !repare the canal to taper apically, with the narrowest cross-
sectional diameter at the apical termination 8apical dentin matrix).
'he apical third of the canal preparation must provide a
tapering = parallel, spatial configuration in order to ensure a firm
seating of the gutta-percha and sealer.
'he three-dimensional shape of the preparation, especially of
the apical 0=-
rd
, must provide a retentive cavity to enhance
condensation procedures.
-
4. Confine cleaning and shaping procedures to the canal system,
there%y maintaining the spatial integrity of the apical foramen.
+dherence to this principle prevents violation of the peri-
radicular tissues. 'his principle is evident when foramina are
transported 8moved) 8>ip and el%ow)during excessive apical
instrumentation. 'his can %e internal or external transportation.
<. 5emove all residue of cleaning and shaping procedures that could
prevent patency of the apical foramen i.e. dentin shavings and tissue
de%ris. 'his will help prevent complications like ledges, loss of
canal length, development of false canals etc.
5ecapitulation is essential to all cleaning procedures as ignoring
this important step will often lead to ledges, loss of canal length, dev of
false canals etc.
$%oce#"%al te%&!:
0) MAF-Master apical file: #t is the largest file that %inds slightly at
correct :; after straight line access. #t is determined %y passively
placing the successively larger files at the C.:.;. until correct si>e is
reached which %inds at the tip. 'he file %inding at first or smallest file
to %ind is initial apical file.
2) Pre curving of instruments
!recurving of stainless steel instruments is mandatory while
negotiating curved canals. #t is a valua%le tool for feeling canal passages
and for moving around calcifications, ledges and around curved foramina.
#t helps to prevent procedural pro%lems and perform ade(uate shaping in
curvatures. !recurving can %e done either with cotton or gau>e or using
commercialy availa%le devices utili>ing the diagnostic x-ray.
-) 5ecapitulation 7 +n essential step especially in apical coronal
techni(ues ? it means the use of instruments in the correct si>e
se(uence smaller to larger and returning to smaller instruments from
time to time %efore advancing to a larger si>e. 9.g. after 0< no. 0@mm
them proceed to 6@, then use 0@ and 0< and proceed to 6< and so on.
'his helps prevent packing of dentinal filings and ensures patency of
root canal through to the apical foramen.
4) +nticurvature filing-Ailing away from curvatures and danger areas
descri%ed in detail under curvatures.
Ba!ic te%&! o' Motion! o' in!t%"&entation ? M! is a dynamically
delicate motion ? flowing, rhythmic and energetic. Barious motions
involved are7
4
Metho#! o' Cleaning an# Shaping
Cleaning and shaping are dynamically delicate motions, flowing,
rhythmic, and energetic. #n order to use files and reamers efficiently, the
movements re(uire distinction. 'here are C distinctive motions of files and
reamers.
A) Follow:
/sually performed with files. +re used initially during cleaning
and shaping or any time an o%struction %locks the foramen.
#rrigating, precurving different kinds of curves, curving all the
way to the tip of the instrument and multiple curves in multiple
directions of the instrument are all part of follow.
A) Follow-withdraw
Ailes are used. 'his motion is used once the foramen has %een
reached and the next step is to create the path from access cavity to
foramen. 'he motion is follow, then withdraw or 2follow and pull3 or
2follow and remove3. #t is simply an in ? and ? out passive motion that
makes no attempt to shape the canal.
) !art
5efers to the extension of a reamer to or near the radiographic
terminus. 'he reamer should gently and randomly touch the dentinal walls
and 2cart3 away de%ris.
!) !arve
5eamers are used for shaping. 'he key is not to press the
instrument apically %ut simply to touch the dentin with a
precurved reamer and shape on withdrawal randomly.
") #mooth
#s accomplished with files. #n the past, most endo procedures
were performed with a smoothing or circumferential filing
motion. #f the previous four motions are followed smoothing is
rarely re(uired.
$) Patenc%
#s achieved with files= reamers.
#t means that the portal of exit has %een cleared of any de%ris
in the path.
<
+lso included are 6 other terms given %y 5uddle-Gauging and
'uning.
Gauging refers to the knowing the cross sectional diameter of the
foramen that is confirmed %y the si>e of the instrument that
2snugs in3 at working length.
'uning is ensuring that each se(uentially larger instrument
uniformly %acks out of the canal %y @.< mm.
+lso included is scouting that refers to using instruments to
gauge and estimate the root canal anatomy, form and variations
and is same as follow.
Motion o' in!t%"&entation ( enelope! o' &otion:
+) Filing: #ndicates a push-pull motion of the instrument. 'he
inward passage is powered %y hand and file rigidity. Cutting is done
during withdrawal or pull stroke. $one using files and usually in
circumferential manner.
) &eaming
#ndicates clockwise = right-hand rotation of an instrument.
'he instrument must %e restrained from insertion to generate
a cutting effect. #nstrument D is increased when this motion is
employed. #t is a rotating-pushing motion limited to a (uarter
to half turn.
!) 'urn-and-pull(!ombination)
#s a com%ination of reaming and filling, the file is inserted
with a E turn clockwise and inwardly directed hand pressure
8i.e. reaming) positioned into the canal %y this action, the file
is su%se(uently withdrawn 8i.e. filling).
'he rotation during placement sets the cutting edges of the file
into dentin and the non-rotating withdrawal %reaks local the
dentin that has %een engaged.
Di!a#antage!:
*ourglass canal shapes were o%served %y :eine.
According to #childer
Clockwise rotation of a half-revolution followed %y
withdrawal. 'he file is not inserted towards the apex, rather,
C
he gradually allows the preparation to progress out of the
canal.
E turn to right followed %y straight pull out
") )atch-winding
#s the %ack-and-forth oscillation of a file 8-@-C@F) right and
left as the instrument is pushed into the canal.
#t is an expanded use of the 2Baiven3 techni(ue descri%ed %y
#ngle. 'his %ack and forth motion can %e com%ined with a
pull stroke and effectively planes walls. #t has various
advantages like canal centering, not necessitating precurving
and %alancing tooth structure cutting with instrument
mechanics.
'his %ack-and-forth movement causes the files and reamers
to plane the walls efficiently.
#n a way, this is a predecessor to the %alanced force
techni(ue, as the -@-C@F of clockwise rotation pushes the file
tip and working edges into the canal and the -@-C@F of
counter clockwise motion partially cuts away the engaged
dentin.
$) )atch-winding and pull
:hen used with *-files, watch winding cannot cut dentin
with the %ackstroke. #t can only wiggle and wedge the edges
tightly into the wall.
:ith each clockwise turn, the instrument moves apically
until it meets resistance and must %e freed with a pull stroke.
F) alanced force techni*ue
'his calls for oscillation of the preparation instruments right
and left with different arcs in either direction.
'o insert an instrument, it is rotated to the right 8clockwise) a
(uarter turn. 'his pulls the instrument into the canal and
positions the cutting edges into the walls.
Gext, it is rotated left 8counterclockwise) at least 0=-
rd
of the
revolution to unthread the instrument and drive it from the
canal.
H
A#antage!:
1imultaneous apical and counter-clockwise rotation of file
strikes a %alance %etween the tooth structure and instrument
elastic memory. 'his %alance locates the instrument very near
the canal axis, even in severely curved canals, so this
techni(ue avoids transportation.
#t works effectively without pre-curving.
)ene%al )"i#eline! 'o% cleaning an# !haping:
0. $irect straight line access should %e o%tained.
6. ru%%er dam is a prere(uisite and microscopes are an
asset.
-. +ccurate length determination is a prere(uisite.
5emem%er canal length may shorten on instrumentation of curved
canals.
4. #nstruments should %e used se(uentially with
recapitulation.
<. #nstrument stops and reproduci%le reference points
should %e used.
C. $o not force instruments and regularly inspect and
de%ride instruments.
H. /se copious irrigation and instrument in wet canals.
Barious chemical aids can %e used to supplement preparation like
5C prep, 9$'+, Glyde etc.
I. Confine instruments to root canal and do not force
de%ris apically.
J. *ow much to enlarge is a priceless (uestion- *ow
large and how much to enlarge is dictated %y the anatomic structure,
accessi%ility of the canal and skill of the operator. #nade(uate
enlargement limits cleaning, de%ridement, disinfection and
o%turation while over>ealous preparation leads to iatrogenic
pro%lems, unnecessary weaking of tooth and suscepti%ility to
fracture, perforations, spatial movement of apical foramen etc.
9arlier 6 guidelines were considered sacrosanct- enlarge a root canal
at least - si>es %eyond the si>e of the first instrument that %inds and
enlarge a canal until clean white dentinal shavings appear in the
flutes. *owever, these are not considered valid criteria today %y any
researcher or clinician. 1tudies have shown that only enlargement
I
upto -@ to 4@ num%er permits effective irrigation though this may
not %e always possi%le. 'hus enlarging the root canal should %e
done %ased on myriad factors to achieve %oth %iological and
mechanical o%&ectives.
Techni*"e! 'o% p%epa%ing %oot canal!:
Apical co%onal techni*"e Co%onal+apical techni*"e
#n which the :; is esta%lished
and the full length of the canal is
then prepared.
#n which the coronal portion of the canal
is prepared %efore determining the :;
e.g.
- 1tandardi>ed.
- 1tep-%ack.
- 5oane 8%alanced force)
Advantages:
+llows early de%ridement
of the coronal part of canal which
may contain %ulk of organic de%ris.
9na%les %etter and deeper
penetration of irrigant early in the
preparation.
'ends to shorten the
effective :; and determining the
:; after such enlargement will
reduce the pro%lem of its alteration
during preparation.
+llows %etter control over
apical instrumentation.
5educes the piston-in-a-
cylinder effect responsi%le for de%ris
extrusion
*owever, there are risks of
ledging, %lockage and perforation.
e.g. 7
- 1tep-down.
- $ou%le-flare.
J
- Crown-down pressureless.
- Canal-master
Apical co%onal
+) #tandardi,ed preparation:
- $one in narrow canals with circular cross-sections.
:; determined.

1mallest instrument ad&usted to :;.

1e(uentially enlarged entire canal.

O%turation with silver cone.

Di!a#antage!:
- 5isk of extrusion of de%ris.
- +lteration of :;.
- Bertical root D is overinstrumentation is carried out.
- /nlikely to de%ride complex canals
- !ossi%ility of canal deviation.
'o overcome deficiencies a hy%rid techni(ue consisting of reaming the
apical third and filing the coronal twothird has %een recommended with
coronal preparation o%turated with gutta percha.
#tep bac- preparation:
:; determined.

#nstrument that fills to correct :; is chosen.

0@
9nlarge - Go"s larger at the apex.

5educe the :; length %y 0mm and continue to enlarge canal = flaring.

5ecapitulate, irrigate for patency.

Coronal preparation done using GG$.

Di!a#antage!:
- 9xtrusion of de%ris.
- +pical %lockage.
- +lteration of :.;.
- 'endency for canal deviations.
2) &oane 'echni*ue (alanced Force)
'hree of its main features are7
- Canals are prepared to predesigned dimensions of which - are
recogni>ed and are 4<, C@ and I@ according to the si>e of apical
preparation.
- 'hese dimensions refer to the si>e of the file used at the third step
%ack.
- 9ach step-%ack from the master apical file at the !$; is @.<mm
shorter than the previous one. 'his is termed as the 2apical control
>one3.
- Alex 5 files are used.
- :; determined to the radiographic apex with the largest file placed
without force. 'his helps in determining the selection of
predesigned preparation 84<, C@, I@).
Co%onal apical techni*"e
+) #tep down techni*ue:(Marshall and Papus)
- #s a modification of the step-%ack techni(ue.
00
!repare the coronal portion to 0C-0I mm =%eginning of the curve with
anti-curvature filling.

GG$"s are used to refine the coronal part.

$etermine :;.

/sing step-%ack, complete the apical preparation.

Di!a#antage!:
- ;edge formation.
- +pical %lockage.
- !erforation.
'hrough this techni(ue overcomes most of the disadvantages of the
step-%ack techni(ue.
2) "ouble Flared 'echni*ue:
$etermine :.;.

!repare till 04 mm = coronal to the curve.

#rrigate and clean.

Go 0mm deeper, maintaining instrumentation coronal to the curve and

file.

+gain 0mm deeper.

Continue till :; is achieved.

06

!repare using step-%ack

In#ication!:
- Aor straight canals or
- Aor straight portions of curved canals.
0-
Cont%a in#ication!:
- #n calcified canals.
- #n young permanent teeth with open apices.
.) !rown-down pressureless techni*ue:
- Aor curved canals without causing deviations. 5otary action is used
to cut dentine with the apical part of files.
$etermine :; and prepare till D -< till 0Cmm 8widen the canal with
smaller files first)

5educe si>e K go down and enlarge till apex.

Change to D4@ K repeat.

/) !anal master techni*ue:
- #ts aim is to aid the maintenance of curves using a rotary instrument
designed so that only the apical 0-6mm is engaged in dentine
removal.
A#antage!:
- +voids the need for recapitulation.
- 'he apical @.H<mm of the hand instrument is safe-ended to facilitate
maintenance of canal curvature.
$etermine :;

!repare to the %eginning of the curve

/se canal master in step-%ack fashion.

,-b%i#+techni*"e
- +n amalgamation of various techni(ues can %e used com%ing
different desira%le aspects and convenience to achieve thorough
%iomechanical preparation.
04
S$ECIA. CONSIDERATIONS IN CURVATURES+CONVENTIONS
AND COM$.ICATIONS
C"%at"%e+The Engine O' Co&plication!
- +s an instrument is curved, elastic forces develop internally. 'hese
forces attempt to return the instrument to its original shape and are
responsi%le for straightening of the final canal shape and location.
- 'hese internal elastic forces 8i.e. restoring forces) act on the canal
wall during preparation and influence the amount of dentin
removed. 'hey are particularly influential at the &unction of the
instrument tip and its cutting edges. 'his region is the most efficient
cutting surface along an instrument, and when activated %y the
restoring forces, it removes more tissue. 'his phenomenon is
responsi%le for apical transportation and its conse(uences.
/0 $%e+c"%ing o' in!t%"&ent!1
20 Anti+c"%at"%e 'iling
- #s the controlled and directed preparation into the %ulky=safety >ones
and away from the thinner portions or danger >ones of the root
structure, where perforation or stripping of the canal walls can
occur.
0eed:
- #t is a method of applying instrument pressure so that shaping will
occur away from the inside of the root curvature in the coronal and
middle 0=-
rd
of a canal.
- :as descri%ed %y +%ou-5ose, Arank and Glick. 'hey emphasi>ed
that during shaping procedures, files should %e pulled from canals as
pressure is applied to the outside canal wall. 'his dimensionally
applied pressure, prevents dangerous midcurvature straightening in
curved canals.
A#antage!:
- #t maintains the integrity of canal walls at their thin portion and
reduces the possi%ility of root perforation = stripping.
- Maintains digital control over the instrument and the preparation of
the curved canal is used.
a1 Ra#ic"la% acce!!
- :as first promoted %y 1childer.
0<
- 'his creates space in the more coronal regions of the canal which
enhances placing and manipulating su%se(uent files as it increases
the depth and effectiveness of irrigation.
- May %e accompanied %y rotary instrument = circumferential filing.
b1 Ree%!e Fla%ing ( $%e+'la%ing
- #s the presently preferred development of flaring where%y the
coronal portion of the preparation is flared %efore the completion of
the apical portion.
- #n the standard flaring techni(ue, the apical portion of the tooth is
completed %efore any filling is performed.
- #n the reverse flaring and aspects of preparations are carried out.
- Minimal filling at the tip enlargement of the coronal part apex
is completed apical flaring.
A#antage!:
- #rrigants are allowed to get down the canal earlier and farther to
produce cleaning.
- #n curved canals, more effective preparation of the apical area is
provided when the file has fewer o%structions in the coronal part.
- Ailes, pluggers, filling material can penetrate to the apex more easily
three a larger orifice.
In!t%"&ent! "!e# 'o% Ree%!e Fla%ing
- @.4 taper instruments 8Gi-'i).
- MeL#M
+vaila%le in < instruments ? 6<.@.6< at $o 8@.@-, @.@4, @.@4<,
@.@<, @.@<< =mm ? tapers).
/sed in gear reduction handpieces at -4@ rpm.
Made from Gi-'i in *-style.
$esigned %y Mac1padden.
5itano Ailes.
*and instrument with *-configuration with several tapers.
0C
Made in lengths shorter than 60mm.
4 +lso for curved canals copious irrigation is
mandatory.
< 1afe sided instruments and files dulled on one side
can %e employed or Gi'i instruments can %e used.
C 9xtremely narrow canals re(uire the use of smaller
instruments and mid si>e Golden Medium files along with chemical
chelators etc.
H $ou%le curved or %ayonet shaped canals-*ere after
the apical foramen has %een cleaned and shaped the middle third curve
is eliminated with *-files taking care not to strip and perforate and then
regular instrumentation carried out. 'his is done %y introducing a small
*-file at the &unction of middle an apical third and filing away inner
portion of the curve.
I $ilacerated roots re(uire coronal flaring and then
using flexi%le and safe sided instruments.
$%epa%ation "!ing A"to&ate# Deice! o% Mechanical In!t%"&entation
'he lure of faster, easier and more efficient cleaning and shaping has
spawned various types of automated devices. 'here is literally a revolution
going on in automated devices with new %rands and techni(ues introduced
everyday.
Di!a#antage!:
- ;oss of tactile sense and lack of control of where and how much
dentine is removed from the root canal wall.
Cla!!i'ication:
1) &otar%
- /sed in slow running standard handpiece e.g., GG$, !eeso, Canal
master ? used only in the structure part.
- ;atest addition is the new 0C70 gear reduction handpiece Gi'i matic
at -@@rpm.
- Gi-'i files are used.
- /sed for preparation of severely curved canals.
- Ailes are manufactured with an off-centre tip that facilitates
negotiating around curvatures and ledges.
0H
- Myriad nickel titanium generation of instruments and devices like
!roAile, !ro'aper, Muantec, ;ight 1peed, O1 etc have %een
introduced.
II0 &eciprocal *uarter turn:
- 'his uses a special handpiece that contrarotates the instrument three
J@F.
- 9.g. Giromatic 80JC4).
- 9ndocursor.
- 9ndolift ? has a vertical component in addition to the rotation.
Di!a#antage! o' A"to&ate#
- *and instrument re(uires the same amount of time as automated.
- Alare preparation with hand instrument tends to remove de%ris from
within the canal system than automated.
- +utomated is difficult to use in the most post regions of the oral
cavity.
- 'here is greater propensity for the automated system to produce
>ipped canals, ledges etc.
- + controlled power-assisted system designed to eliminate the
original pro%lems encountered %y Giromatic appeared in 0JI0.
- $ynatrak
- /ses stainless steel instruments with increased flexi%ility consist
flute depth and curved canals and rounded tip to minimi>e and
control ledges, >ips, etc.
III0 2ertical
- Canal finder.
- *as a vertical movement of --0 mm and free rotational movement.
- #nstrument used is canal master 8*-file with a safe ended tip).
- Canal ;ender.
- Bertical movement of @.4-@.I mm
- instrument N-file with a safe ended tip.
0I
*-file.
/niversal file 8flexi%le *-file with a safe-ended tip).
'here are few %asic guidelines for rotary shaping7
6) 1traight line access.
-) 9stimating the cross-sectional diameter.
4) Aamilari>ing with specific root canal anatomy and seating.
<) 1peed and se(uencing with gear reduction and electric motor
and using large to small files.
C) ;u%rication and a light or feather touch e(uivalent to using
sharp lead pencil.
IV0 &andom
- 9.g. 9xcali%ur.
- N-files.
- 6@,@@@-6<,@@@rpm.
V0 #onics
- 9ndostar <
- 9ndosonic +ir -@@@
A#antage!:
- 5educes fatigue and stress during preparation.
VI0 3ltrasonics
Magneto!t%ictie $ie3oelect%ic
- 5e(uires *
6
O cooling - Most common
- Go *
6
O cooling
- May produce apical widening
and ledges in curved canals.
A#antage!:
- Cleaning effect is %y acoustic streaming.
0J
I0 Mic%ob%"!he!:
+dvancement in small wire technology, in&ection molding, %ristle materials
and %ristle attachment have ena%led the creation of endodontic
micro%rushes. 'hese can %e activated %y rotary or ultrasonics and are
primarily intended for finishing root canals. 'hey contain 0Cmm %ristle
with $@ diameter of @.4, @.<, @.C and @.I. 5otary %rushes are run at a%out
-@@ rpm while ultrasonic ones are run with GaOCl and 0HO 9$'+.
II0 .a!e%!:
#n 0JH0, :eichman and .ohnson were pro%a%ly the first to suggest the use
of laser in endodontics.
#nitially Gd7,+G and CO6 lasers were used. 'hey are mainly advocated as
a coad&unct for micro%ial reduction and to readily root surface.
5ecently, argon lasers, excimer laser, holmium7,+G laser, diode laser and
er%ium 7 ,+G laser with various wavelength have %een investigated. 'hese
can %e delivered using a optical fi%re 6@@-4@@Pm diameter e(uivalent to D
6@-4@ file cooling systems with air water sprays may accessory this.
;evy compared the laser techni(ue with a step %ack procedure finding the
form %etter. 'he techni(ue was7
0. 9nlarge apical region with D 0< file K copious
irrigation.
6. !reparation %egins with the laser energy level set at
0<@milli &oules.
-. Ai%re optic is inserted to :7; and enlargement done
circumferentially first apically tehn moving coronally to enlarges upto
DC@ instrument.
'he avg. time to complete the preparation was 0 minute.
+lthough hand instruments left some walls untouched and smear layer was
found covering walls, laser preparation showed remarka%le cleanliness.
*owever ;evy also found melting of dentin and closing off of tu%ules and
melting of silicon fi%er optic.
1imilarly various other lasers have %een experimented with.
Currently wavelength at /B plaster appears promising. 'he +rA excimer
laser at 0J-nm and LeCl 8-@Inm) laser appear well suited. 1econd
harmonic alexandrite laser 8-HHnm) also shows promise.
6@
Mainly today lasers are advocated for cleaning or sterili>ing the root canal
and shaping is a modality under investigation. 'he laser is excellent at
satisfying the root canal. Auture promises of efficient preparation, sterile
canals, shorter treatment time and minimum effort with maximum result
are fuelling laser research at %reak neck speed. !otential disadvantages of
cost, safety, coolants, effective control etc have to %e overcome. ;asers
have a definitive future in endodontics only the direction has to %e
delineated.
Non in!t%"&ente# %oot canal clean!ing:
;ussi et al introduced devices to cleanse the root canal without
instrumentation. 'he 0
st
device reported in 0JJ- consisted of a Qpump" that
inserted an irrigant 8like GaOCl) creating %u%%les and cavitation that
loosened de%ris. 'his process was followed %y negative pressure 8suction)
that removed de%ris.
More recently a smaller new improved machine was introduced. +lso
o>one pumps like heali>ae have %een veritified in cleansing root canal
systems.
Finali3ing the p%epa%ation:
+fter cleaning and shaping %y any of the mind %aggling variety of
techni(ues it is necessary to finagling the preparation and manage the
smear layer. 'hrough a controversial topic, if divided to %e removed, smear
layer removal and final finishing is accomplished cutter with 9$'+ and
ultrasonics, 9$'+ and micro%rushes with GaOCl or other newly availa%le
chemicals for its management to provide a root canal now ready for
o%struction.
CONC.USION:
2'ry cleaning a house after a wild party.3 Cleaning and shaping root
canals is &ust more difficult. 'he complex anatomy, convoluted curvatures,
non-negotia%le interconnections and hard to reach nooks and crevices
make for a challenging and daunting task. 2!urity is considered the
hallmark of sanctity3. O%taining clean and sterile root canals is the secret
of good healing.
+lso the revolution of automated endodontic com%ined with advances in
hand instrumentation have changed the long we shape and clean canals.
'hus com%ining the art of proper shaping and the science of immaculate
cleaning will culminate in ideal %iomechanical preparation that will lay the
foundation for ideal o%turation and healing and ultimately successful
therapy.
Bibliog%aph-:
60
0. 9ndodontics ? 1tock, Gula%ivala, :alker, Goodman.
6. 9ndodontics ? #ngle and akeland.
-. 9ndodontic practice ? Grossman, Oliet, 5io.
4. 9ndodontics ? Cohen and urn.
<. $CG+.
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