Instruments For Canal

Preparation
Endodontic Week For 5th Year Students
Universiti Sains Malaysia
10-14 September, 2007
Dr. Saman Masudi

Introduction
Success and failures of RCT
Objectives of canal preparation
History of endodontic files
Design - Conventional file and greater
taper files
W Techniques used:
W
W
W
W

W Crown Down concept

W 2 Techniques - Modified Double Flare &
Hand Protaper Preparation

Success and Failure

W Depends on thorough cleaning of the
canal
W How?
WIsolation
WChemomechanical debridement cleaning and shaping
WGood obturation
WCoronal seal

Success Case
46

Pre - operative

46

2 years review

Failure
36

Pre - operative

36

1 year review

Objective of Root Canal Preparation

1.
2.
3.
4.

Eliminate microorganisms.
Remove remaining pulp tissues.
Remove debris.
Shape the root canal system so that it may
be obturated.
[1,2,3 are Cleaning process]
[4 is Shaping process]
W Debridement of the root canal created
during cleaning and shaping process.
W Irrigation and disinfection are integral parts
of debridement

The principle of shaping

W Develop a continuously tapering funnel
from the apex to coronal orifice.
W Maintain the original shape of the canal
W Maintain the apical foramen in its
original position
W Keep the apical opening as small as
possible.

Root Canal Preparation

W 2 approaches
1) prepare the coronal section of the canal
system 1st with large instruments and
progress towards the apex [Crown Down]
2) start at the apex with fine instruments and
progress back towards the cervical orifice
with
large
instruments
[Step
Back
preparation]

RC Preparation (Contd)
W Advantages of (1) method:
1. Reduce the possibility of microbial
inoculation into the apical portion of
the canal and then into the periapical
tissues
2. Early coronal flaring allows better
penetration of irrigation solution
3. Early coronal flaring gives better
access to the apical part of root canal

Techniques
1.
2.
3.
4.
5.

Step-back
Step-down
Double-flare
Crown down pressure-less
Mechanized techniques of root canal
preparation(e.g. rotary technique)

Objectives of Canal Prep :

Aim :
W To clean and eliminate
microorganisms (??), remove infected
pulp tissue and debris.
W To shape the pulp space so that it
takes on a tapering form, being widest
coronally and narrowest apically

Access cavity
W The most important
phase of the technical
aspect of root canal
treatment
W Without adequate
access preparation
instrument preparation
and material
placement would be
very tedious and often
result in despair and
frustration.

W Most indefinitely will

affect the outcome
and success rate of
the treatment

Lets look at some of these

access cavities

Why access so crucial

W

Access
W Most important especially
when using rotary
instrument*
W Curved canal can be
W Naturally occurring
W Artificially created
via poor access
W When an instrument
bends in the canal the
metal experiences
compressing forces on
the inner curvature and
stretching forces on the
outer curvature

How much can we

clean the canal?

Problems in cleaning canal :

W Single rooted tooth

Problems in cleaning canal :

W Multi-rooted/complex root canal system

Chemomechanical Debridement

Chemical Irrigant Protocol

WIrrigant
WAntibacterial
NaOCl (2.5 - 5%) as main irrigant. Alternative?
WSmear layer removal
EDTA solution (17%) as final rinse
MTAD

WLubricant - Glyde, RC Prep

Effects of irrigations

Mechanical Shaping
W What are we trying to
achieve ?
WA tapering conical shape from
the canal orifice to the apex
WOriginal shape of the canal is
preserved
WOriginal location and size of
the apical foramen is
preserved

Endodontic Files
(Manual Instrumentation)

Types of Hand Files

Conventional Files

Greater Taper Files

W ISO sized files

W Made from stainless
steel/Niti
W Design

W Non standardised
files
W Made from NiTi

W K-File
W Flexofile
W Headstrom file
W Reamer

W Design
W GT files
W Protaper files

Conventional Files

Conventional Files
W Standard file - follow the ISO numbering
WSize of the file represents the diameter at
the tip
WConstant taper : 0.02 mm per mm length
WLength of blade : 16 mm
WLength of file : comes in 21mm, 25mm,
31mm

16 mm

Design:
KFiles/Flexofiles
- Made by twisting grounded wire
- Can be square or triangular in
cross section
- Sharp flutes
- Non-cutting tip
- Flexible esp if the cross section
is triangular. Therefore it will
follow the canal curvature

Design: Headstrom File

W Made by machining rod
wire to make the flutes
W Sharp and aggressive
W Cut dentine by updown movement in
canal
W Smaller size - tend to
break easily

How to use K-file ?

Technique of
Canal Preparation
Modified Double Flare Technique

Canal Preparation
Traditional concept:
WApical coronal preparation
Canal preparation starts from the apex to the coronal part

Current concept:
WCoronal apical preparation
Preparation of the coronal part first before preparation of the
apical part

Crown-down Approach
W Using a combination of hand files and
rotary (GG burs)
W Sequence :
WAccess cavity - straight line access
WCoronal Flaring
WWL determination
WApical Preparation

Canal Preparation

Crown-down Approach
Advantages :
W Removal of bulk microorganisms at the
coronal third to prevent accidental
pushing the apical part
W Reduces the hydrostatic pressure that
can occur in the canal
W Give better access to the apical part of
the root canal
W Allows better penetration of the irrigant
solution
W Minimise loss of working length

Modified Double Flare:

Stages:
Coronal Flare
Working length
Apical preparation
(Step- back)

Access Cavity

Straight Line Access

Coronal Flare

2/3 WL

EWL

How big is your coronal flaring

?
Enough for
irrigation needle to
enter 2/3 into the

Coronal Flaring

Coronal Flaring
WWhat if the coronal part is
already big ?
WWhich tooth ?
WAnterior central incisors
WCanines
WPremolars (lower 1st and
upper 2nd)

Working Length
W Estimation of working length
WUse apex locator

W Confirm with radiograph

Apical Preparation
W Enlarge the diameter of the apical part
W Aim :
WTo enlarge enough to allow penetration of
needle and irrigant
WTo remove infected tissues
WTo allow good exchange of irrigant
WTo determine the apical stop

Apical Preparation
IAS

MAF

G
a
u
g
e
2/3
I
A
S

WL

Step Back

Apical Preparation
W Step-back technique - to form apical taper

Technique - Step Back

MAF

2/3 WL

WL

Shape of Final Preparation

W Continuous taper
W Original curvature
maintained
W Original size and
position of apical
foramen maintained
W Apex remained patent

Common Error

Greater Taper Files

Designed based on
crown-down concept

Nickel Titanium
Advantages:
W Flexibility
W Strength
W Shape memory
W Anti-corrosive
W Does not weaken following sterilization

Earlier File
W GT files

PROTAPER
S2
S1

FOR HAND USE

F1

F2

F3

SX

SHAPERS SX, S1, S2

FINISHERS F1, F2, F3

Protaper Files
W Initially introduced as rotary files only
W Based on crown down concept
W Using a sequence of 6 files
WS1, Sx and S2 --> coronal flare
WF1/F2/F3 --> apical preparation

Taper of file
Multiple & Progressive Taper
0.80

F3

0.70

F2

F1

S2

0.60
0.50

S1

0.40
0.30
0.20
0.10
0.00
-0.10
-0.20
-0.30
-0.40

SX

-0.50
-0.60
-0.70
-0.80
0

Root canal length [mm]

10

11

12

13

14

15

16

Benefits of design:
WIncreased flexibility
WEach instrument produces its own 'crown down
effect' as larger tapers make way for smaller
tapers
WProtaper files engage a smaller area of dentine
reducing torsional loads and file fatigue
WThe cross section reduces the contact area
between file and dentin
WIncreased cutting efficiency without 'screwing'
WCanal shapes which are uniformly tapered over
length

ProTaper New Shaping File S2

Modification of Taper For S2

New ProTaper S2
Change : slight modification of tapers along the flute
Result : work is better balanced between S1 S2 and F1
Benefit : transition from S2 to F1 is smoother
0.80
0.70
0.60

New sequence

0.50
0.40
0.30

S2 outshape

0.20
0.10
0.00
-0.10

F1 out shape

-0.20
-0.30
-0.40
-0.50
-0.60
-0.70

Current sequence

-0.80
Root canal length [mm]

10

11

12

13

14

15

16

S1 out shape

Cross Section

Triangular Convex

Tip of Finishing Files

Earlier - modified active tip

Removal of
Transition Angle

Result : tip is now more

rounded Safer, less
transportation

Blade Design

Variable Helical Flute Angle

Overall Design of Protaper

W Nickel-Titanium
W Multiple & Progressive Taper
W Triangular Convex X- Section
W Modified Rounded Tip
W Variable Helical Flute Angle

Improvements of Design
W X-section of F3
W Introduction of F4 & F5

ProTaper New Finishing File F3

New ProTaper F3
Changes : cross section has been reduced by
making grooves along the flute
Result : improved flexibility reduced stiffness
Benefit : better respect the canal path

New Cross Section

ProTaper New Finishing File F4

Tip Size : 040

ProTaper F4

Taper (first mm) : 6%

Easy to recognize :
Black handle +
marking F4 on the
top for the manual
version, double black
rings for the rotary
version

Feature
Lightened Cross Section
Large Tip Size
Benefits
Improved flexibility
Respect the root canal path

ProTaper New Finishing File F5

ProTaper F5

Tip Size : 050

Taper (first mm) : 5%

Easy to recognize :
Yellow handle +
marking F5 on the
top for the manual
version, double
yellow rings for the
rotary version

Feature
Lightened Cross Section
Large Tip Size
Benefits
Improved flexibility
Respect the root canal path

Hand Protaper
- Clinical Procedures

Files Sequence:

ProTaper for Hand Use

Clinical Procedures
W Explore canal w/ #10
hand file

ProTaper for Hand Use

Clinical Procedures
W Explore Canal w/ #10 hand
file

W Negotiate to #15 w/
hand file

ProTaper for Hand Use

Clinical Procedures
W Explore Canal w/ #10 hand file
W Negotiate to #15 w/ hand file

W Coronal Flaring w/ S1
Insert file with slight apical
pressure until resistance
turn clockwise
turn anticlockwise
Withdraw
Clean

S1

Insert w/ slight apical

pressure until resistance

S1

to turn clockwise

S1

to turn anticlockwise

=
S1

Withdraw & clean file

ProTaper for Hand Use

Clinical Procedures
W Explore Canal w/ #10 hand
file
W Negotiate to #15 w/ hand file
W Coronal Flaring w/ S1

WCoronal Flaring w/ SX
(optional) using same
motion
WMay replace w/ GG Drill

4
2
3

SX

SX

ProTaper for Hand Use

Clinical Procedures
W Explore Canal w/ #10 hand
file
W Negotiate to #15 w/ hand
file
W Coronal Flaring (S1, SX)

W Working Length
Determination

ProTaper for Hand Use

Clinical Procedures
W Explore Canal w/ #10 hand file
W Negotiate to #15 w/ hand file
W Coronal Flaring (S1, SX)
W Working Length Determination

WCoronal 1/3 Preparation w/

S1 again (up to full working
length) using same motion

ProTaper for Hand Use

Clinical Procedures
W Explore Canal w/ #10 hand file
W Negotiate to #15 w/ hand file
W Coronal Flaring (S1, SX)
W Working Length Determination
W Coronal 1/3 Preparation w/ S1

WMiddle 1/3 Preparation w/

S2 (up to full working length)
using same motion

S1,S2 TO WORKING
LENGTH

ProTaper for Hand Use

Clinical Procedures
W Explore Canal w/ #10 hand file
W Negotiate to #15 w/ hand file
W Coronal Flaring (S1, SX)
W Working Length Determination
W Coronal 1/3 Preparation w/ S1
W Middle 1/3 Preparation w/ S2

WApical 1/3 Preparation w/ F1 & F2, using the

same motion

F1, F2 TO WORKING
LENGTH

ProTaper for Hand Use

Clinical Procedures
W Explore Canal w/ #10 hand file
W Negotiate to #15 w/ hand file
W Coronal Flaring (S1, SX)
W Working Length Determination
W Coronal 1/3 Preparation w/ S1
W Middle 1/3 Preparation w/ S2
W Apical 1/3 Preparation w/ F1 & F2

W Gauge w/ #25 hand file

ProTaper for Hand Use

Clinical Procedures
W Explore Canal w/ #10 hand file
W Negotiate to #15 w/ hand file
W Coronal Flaring (S1, SX)
W Working Length Determination
W Coronal 1/3 Preparation w/ S1
W Middle 1/3 Preparation w/ S2
W Apical 1/3 Preparation (F1F2)

W For larger canals, continue apical

prep w/ F3, using also the same
motion

F3 TO WORKING
LENGTH

ProTaper for Hand Use

Clinical Procedures
W Explore Canal w/ #10 hand file
W Negotiate to #15 w/ hand file
W Coronal Flaring (S1, SX)
W Working Length Determination
W Coronal 1/3 Preparation w/ S1
W Middle 1/3 Preparation w/ S2
W Apical 1/3 Preparation (F1F2
F3)

W Gauge w/ #30 hand file

ProTaper for Hand Use

Clinical Sequence
a.
b.
c.
d.
e.
f.
g.
h.
i.

Establish straight line access

Explore canal w/ #10, then #15
Flare coronal w/ S1, followed
by SX if necessary (penetration
#15)
Measure/confirm working
length w/ #15
Use S1 to length
Use S2 to length
Use F1 to length
Use F2 to length
(recommended min.), followed Cut by rotating clockwise with sufficient
by apical gauging
apical pressure until engages the
Use F3 to length (optional for
dentin. Rotate counter-clockwise to
larger canals)
disengage, remove and wipe the file
clean. Repeat rotating motions until
desired length is achieved

ProTaper for Hand Use

User Guidelines
a.
b.
c.
d.
e.
f.

Prepare straight line access

Use patency files
Check instruments before use
Use files in correct motion
Clean flutes and irrigate regularly
Use lubricants, e.g. Glyde

Comparison
Protaper Hand Files

SS Files

WFewer instruments needed

for preparation
WThe canal can be prepared
with moderate speed
WProTaper design increases
cutting efficiency
WCanal curvature is well
maintained

WMany instruments are needed

for preparation
WPreparation is slow

WConsistent tapered
preparation coronal to apical
with minimal foramen
enlargement

WTapered preparation always

inconsistent with over
enlargement apically highly
probable

WCutting efficiency poor due to

poor design
WTransportation is very
common

Comparison
Protaper Hand Files

SS Files

WLess debris is extruded

apically

WDebris extrusion apically is

high

WCan be used in abrupt

curvature with prebent
instrument WHEN pathway
established by hand SS files

WCan be used in abrupt

curvature but final preparation
never smooth

WInstrument separation is low

due to good tactile feedback

WInstrument separation has not

been a historic problem

W Questions ?