Managing the Apical Impediment

Six Primary Types of Impediments: • Impediments are identified by the tactile sense felt through the file handle
4. Blockage – Previously Treated of “loose resistance to apical file placement,” as the tip of the instrument
1. Straight Canal with Irregularity
2. Curved Canal with Irregularity 5. Ledging – Previously Treated bumps against the impediment. Only files bent to retain 70-90° at their tip
3. Abruptly Bent Canal 6. Separated Instrument – Previously Treated ends will negotiate around most impediments (see Chart 2). Tight
resistance to apical file placement indicates lateral binding of the file in a
canal region narrower than that instrument.
Procedural Flow
• If an un-bent #10 K-File “hangs up” on an impediment, rotary files cannot
Small Canals Medium and Large Canals be taken to that length or a ledge will result. Shorten the stop to the
reference point and measure. That is the distance to the impediment.
Patency Zone
• Subtract 1 mm (for safety) from that length, measure the initial GTX
Canal Terminus Rotary File (20-.06 in small canals, 30-.08 in medium & large canals) to this
shorter length, and cut a shape to that point.
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• Then use pre-bent stainless steel K-Files to accomplish Serial Step-back
Impediment routines to rough out the apical preparation to working length, beyond
the impediment.
• To complete the shape, an appropriate GT
15 Hand File is over-bent at least 180° with
10K File Test Fails Adjust Stop to Reference Point
10K File Test Fails Adjust Stop to Reference Point
Example Canal Length (mm)

EndoBender Pliers (SybronEndo) to

overcome its NiTi shape-memory, after
Rotary Shaping 1 mm Short of Impediment

which it will retain a residual bend of

30-45°. It is imperative that the bend is in
the last 2 flutes of the file for it to be
effective (see illustration).
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• Sometimes two or three attempts are required before a residual bend will
be imparted. Using a stop with a directional mark, align the mark toward
Orifice Level
the file bend and you are ready. A careful watch-winding motion is used
to direct the bent file tip away from and beyond the impediment. As soon
as the file tip is beyond the impediment, the direction of the pre-set bend
5 is no longer important.
• GT Hand Files are used with a Reverse Balanced Force cutting motion (the
Serial Step-Back Technique Use pre-bent Serial Step-Back Technique Use pre-bent rotational engagement stroke is counter-clockwise and the pushing,
pre-bent stainless steel files
rotary or hand file
to complete shape pre-bent stainless steel files
rotary or hand file
to complete shape
cutting stroke is clockwise). Because hand GT Files have .20 mm tip
diameters, it is often necessary to cut them 1-3 mm’s long in medium and
6% NaOCl large canals. Alternately, a pre-bent GTX rotary file can be used for this
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final shaping procedure. As they have a wider range of tip diameters,
cutting beyond the terminus is usually unnecessary.
• After the final GT Hand File or GTX Rotary File has finished the
20-.08 GT Hand
20-.06 GT Hand

preparation, an un-bent #10 K-File will often smoothly translate beyond

the impediment. Even when it doesn’t, gutta percha cones will usually
traverse around the impediment. If a gutta percha cone will not fit to
length, consider using a GTX Obturator since the filling material will move
D ENTAL E DUCATION L ABORATORIES
at least one millimeter ahead of the carrier. Chart
L . S TEPHEN B UCHANAN, DDS
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