PREPARASI SALURAN

AKAR
Epita Sarah Pane
Bagian Konservasi FKG USU
Inside the pulp area……
What we would like to have
?
Konsep preparasi
Koronal dan apikal.

A= Apex radiografik
B = Resistance form
C = Retention form
D = Convenience form
E = Outline form
What are we going to do?
Apical instrumentation
 Aims

Cleaning

Membersihkan saluran akar dari sisa-
sisa-sisa organik

Shaping

Membentuk saluran akar agar bisa diisi secara
optimal
 Cleaning
Membersihkan saluran akar dengan melakukan
debridemen.

Debridemen = mengeluarkan iritan yang ada

maupun yang mampu menjadi iritan dari

seluruh sistem saluran akar.

Iritan = bakteri, produk bakteri, jaringan
nektorik, debris organik, jaringan vital, produk
dari saliva, darah, dll.

Teknik debridemen

Menggunakan
instrumen dengan
menyentuh / menekan
/ menyusuri seluruh
dinding saluran akar
Access errors
Access errors = canal prep errors
Access errors = canal prep errors
Access error = canal prep error
Access errors = canal prep errors
Carefull of radiograph interpretation !!!
 Instrumentation
Teknik Dasar menggerakkan file
1. File
2. Ream
Teknik kombinasi file dan ream
1. Turn and pull
2. Watch--winding
Watch
3. Serial shaping
4. Balanced force
 Filing motion

Push-pull action with instruments ((Filing
Push- Filing
technique))
technique

With K-
K-file but capable of damaging the canal
very quickly

Effective with Hedstrom-
Hedstrom-type file

Limitation:

Easily cut the middle of a curvature and cause a
strip perforation
 Reaming motion

Reaming technique

Clockwise or right-
right-hand rotation of an
instrument.

Risk of rotating instruments: instrument
fracture

Effective with reamer (reamer’s use a more
axial orientation of their cutting edge)
 Turn and Pull motions

One quarter turn to the right (reaming)is
followed by a straight outward pull (filing).

Effective if the instrument is not forcefully
pushed toward the apex and subsequent
instruments are stepped-
stepped-back from the apical
terminus

Limitation: tendency towards “hourglass”
canal shape
 Watch – winding motions

Back and forth oscillation of a file (30 to 60
degrees) right and 30 to 60 degrees left as the
instruments is pushed forward into the canal

Effective with K-
K-file, can be used with reamer

The instrument is not to be pushed
aggressively into the canal
Watch--winding and pull motions
Watch

When used with Hedstrom files, watch-
watch-
winding motion cannot cut dentin.

Watch--winding is maintained while the file is
Watch
gently rocked right and left until meets
resistance, then it is time freed by a pull stroke.
 Serial shaping motions

With six unique motions of files and reamers:
follow, follow-
follow-withdraw, cart, carve, smooth
and patency.
 Balanced force motions

The most effective technique to cut dentin

The oscillation of the preparation instruments
right and left with a different arc in each
direction.

Light inward pressure, initiating ¼ turn to the
right, larger arc is used when the file is rotated
to the left to drill the canal open. Alternate
these two directions until the working depth is
reached.
 Steps in root canal preparation

Initial measurements

Tentative working length

Radiograph of Initial Apical File (IAF)

Setting instruments

Canal preparations
 Initial Apical File

File apikal awal

File pertama yang bisa dimasukkan ke dalam
saluran akar sepanjang kerja

File pertama bisa nomor berapa saja,
tergantung besar saluran akar. File tidak boleh
longgar, tidak boleh ketat.

Masukkan file ke saluran akar sesuai panjang
kerja estimasi dan ambil radiographnya.
Root canal preparation - Objectives

A continuously tapering preparation

Original anatomy maintained

Position of the foramen maintained

Foramen as small as is practical

TOTAL SPACE OBTURATION

 Root canal preparation-
preparation-technique

Standardized technique

Step back technique = serial technique

Starting at the apex

Step down technique = crown down

Starting at the orifice of the canal

Combination or hybrid technique = step down
– step back technique, modified double
double--flared
technique
Standardized technique
Round, tapperred, almost paralell
 Step back technique

Starting at the apex with fine instruments and
working one’s way back-
back-up or down with
progressively larger instruments.

Introduced by Mullaney.

Designed to avoid apical zipping in curved
canal

Still suitable in curved canals
A. Phase I – Apical preparation up to file
no.25 with recapitulation using prior size
file
B. Phase II – Stepping back
procedure in 1mm increments, nos
25 through 45. Recapitulation with
a no.25 file to full working length.
C. Refining phase IIA-gates glidden drill
nos 2, 3 and 4 used to create coronal and
midroot preparation
D. Refining Phase II-B – No.25 file,
circumferential filing smooths step-
back
E. Completed preparation – a continuos flowing
flared preparation from the
cementodentinoenamel junction to the crown.
In curved canals
Always curved files
Always use lubricant
 Step down technique

Advocated by Marshall and Pappin, called
Crown--down pressureless preparation
Crown

Using gates glidden and larger files in the
coronal third of the canals and progressively
smaller files are used from the ‘crown-
‘crown-down’
until the desired length is reached

Known as Step down = crown down
technique.

Primary purpose: to minimize or eliminate the
amount of necrotic debris that could be
extruded through the apical foramen during
instrumentation.

Will prevent post treatment discomfort,
incomplete cleansing and difficulty in
achieving a biocompatible seal at the apical
constriction.

Advantage: freedom from constraint of the
apical enlarging instruments by coronal
flaring.
 Hybrid technique

Step-down step back
Step-

K-file series step down technique
 Modified technique

Ruddle technique

Profile GT taper technique

Quantec instrument technique
 Stainless steel instrumentation
limitations

Too many instruments and steps needed

Each resultant shape is different

Canal transportation

Excessive dentin removal with rotary
instrument such as gates glidden burs
 Nickel titanium

Flexible

Fatigue and fail if overstressed, especially
during rotation - fracture
 Nickel titanium rotary
instrumentation

Profile system

Protaper system

Light speed system
Ultra--sonic Instrumentation
Ultra
File dibengkokkan