0099-2399/84/1010- 0491/$02 00/0
JouRnAL OF ENOODONTICS
Copyright 9 1984 by The American Assooauon of Endodontists
An Evaluation of the Crown-down Pressureless
Technique
Evaluacion de la Tecnica de Instrumentacion hacia el
Tercio Cervical sin Ejercer Presion Apical
Leslie F. Morgan, DMO, and Steve Montgomery, DDS
Forty single-canal extracted human teeth with apical
curvature of 10 to 35 degrees were instrumented
using the crown-down pressureless technique and
the other half using a traditional filing technique.
~Five similar uninstrumented teeth served as con-
trois.
Xantopren Blue impression matedal was injected
under vacuum into the root canal systems of all of
the specimens, which were then cleared. The spec-
imens were evaluated by five independent evalua-
tors according to several desirable and undesirable
~instrumentation parameters, and an overall rating
was given.
Statistical analysis showed a significant differ-
ence only in the overall rating. The crown-down
pressureless technique received significantly more
excellent ratings, while the conventional method
received significantly more poor ratings. The crown-
down pressureless technique was shown to be an
effective method for instrumenting the curved root
canals in this study.
Cuarenta dientes humanos extraidos, de un solo
conducto, con curvatura apical de 10 a 35 ~ fueron
instrumentados en condiciones similares a la clinica.
La mitad fueron instrumentados usando la tecnica
de instrumentacion hacia el tercio cervical (crown-
down) sin ejercer presion apical y la otra mitad
usando la tecnica de Umado convencional. Cinco
dientes similares sin instrumentar sirvieron como
control. Se inyecto material de impresi6n Xantopren
azul al vacio dentro del sistema canalicular de todas
las piezas, y luego se los abdo y se despej6 el
matedal de impresi6n. Las piezas fueron evaluadas
Por cinco observadores independientes de acuerdo
Con varios parametros de instrumentacion desea-
hies e indeseables y se hizo una evaluacion total
de eficiencia. El analisis estadistico mostro una
diferencia significativa solo en la evaluacion final.
491
Printed In U.S A
Voc. 10, NO 10, OCTOBER 1984
Esta demostro que la tecnica de instrumentacion
hacia el tercio cervical sin ejercer presion apical fue
mucho mejor que las tecnicas convencionales. La
tecnica de instrumentacion hacia el tercio cervical
sin ejercer presion apical demostro set un metodo
efectivo para instrumentar conductos curvos.
REVIEW OF THE LITERATURE
General agreement exists regarding certain principles
of root canal instrumentation. The preparation should
have a continuously tapering conical shape with the
narrowest cross-section at its apex. The apical foramen
should remain in its original position. Instruments should
be used in sequential small to large sizes and should
be precurved before insertion into curved canals. In-
strumentation should occur in a wet canal and be
confined within the root canal space. The canal walls
should be free of irregularities and final dentin shavings
should be clean and white (1-3).
Studies have demonstrated that canal instrumenta-
tion adhering to the principles described above may still
leave irregularities that occur more frequently in the
coronal two-thirds of root canal systems (4-7).
A round apical preparation facilitates obturation. In-
struments used in a reaming motion achieve this type
of preparation (8, 9). Weine et al. (10) described the
tendency for precurved instruments to straighten within
the canal. This causes overpreparation of the outer
portion of a curve at the working length and a zipped,
hourglass apical preparation which is difficult to obtur-
ate. This effect is accentuated by using precurved files
in a reaming motion and by large files, which have
decreased flexibility. The final result is a very difficult
obturation problem. To minimize this problem some
authors advise that fine, curved canals not be enlarged
beyond size #25 (7, 10).
Walton (7) found that a stepback technique employ-
 492 Morganand Montgomery
ing straight files in a reaming motion was superior to
reaming or filing alone. This was especially true in
curved canals, and no problems were reported with
ledge or apical zip formation.
A stepback, serialized technique augmented by
Peeso or Gates Glidden drills was shown to be a
superior instrumentation technique when compared
with standard filing or to Giromatic preparations (11-
13). Several authors (11, 12, 14) espoused the use of
a #2 Gates Glidden deep in the canal followed by a #3
and #4 at successively shallower levels, This coronal
flaring facilitated irrigation and coronal tissue removal.
This technique may weaken the tooth due to excessive
dentin removal and may invite perforation (14).
Abou-Rass and Jastrab (13) and Abou-Rass et al.
(15) suggested using a #1 Peeso reamer to a depth of
about 4 mm to enlarge the cervical third of the canal
and facilitate instrumentation. This was intended to
reduce ledging and packing of debris apically. They felt
the use of larger rotary instruments would produce a
stepped preparation and increase the danger of perfo-
ration.
Extrusion of canal contents during instrumentation is
a concern in endodontics, as it can cause postoperative
discomfort and delayed hea~ing. This is a problem with
virtually all instrumentation techniques (12, 13, 16).
Chapman et al. (17) and Chapman (18) found files and
reamers equally guilty of debris extrusion, which oc-
curred in 90% of their specimens. Hession (16) reached
the following conclusions: (a) instrumentation tends to
force canal contents toward the apical foramen; (b) this
will occur most often when the size of the instrument
closely approximates that of the canal; (c) early canal
flaring provides a coronal escapeway that reduces this
"piston-in-cylinder" effect.
Recently, a new instrumentation technique was sug-
gested to minimize the extrusion of canal contents (F.
J. Marshall and J. B. Pappin, personal communication).
This "crown-down pressureless technique" involves
early canal flaring with Gates Glidden drills, followed by
the incremental removal of canal contents and dentin
proceeding from the canal orifice to the working length.
Straight files are used in a LARGER TO SMALLER
sequence with a reaming motion and no apical pressure
once the instrument begins to bind in the canal. Early
coronal flaring has recently been supported by Leeb
(19) who showed that instruments tend to bind first in
the coronal aspect of an unflared canal, making effec-
tive instrumentation difficult.
The crown-clown pressureless technique seems to
violate several long-standing endodontic axioms and
appears to be a recipe for perforation, ledge, and zipped
canal formation. Before this technique can be recom-
mended for routine use, it must be shown that it does
not cause deleterigus canal alterations.
The purpose of this study was to determine whether
ledging, zipping, and perforation occur more frequently
Journal of Endodontics
in curved canals using the crown-down pressureless
technique compared with a traditional filing method.
MATERIALS AND METHODS
Forty single-canal extracted human teeth with intact
crowns and apical curvature between 10 and 35 de-
grees were used. Five similar teeth served as uninstru.
mented controls. The teeth were numbered randomly
by engraving the crowns with a bur. They were radi.
ographed faciolingually and mesiodistally, and the de-
gree of apical curvature was determined using the
method of Jungmann et al. (8). The experimental spec.
imens were divided into two groups of 20 each. They
were paired according to the degree of canal curvature
and width as determined from the preoperative radi-
ographs. All specimens were stored in a solution of
equal volumes of glycerin and water until they were
cleared.
All experimental teeth were mounted in a typodont
(Columbia Dentoform Corp., New York, NY) with sticky
wax. The typodont was placed into a chair-mounted,
manikin. Rubber dam isolation was used and radi.
ographs were taken as necessary to determine working
length. K-Flex files (Sybron/Kerr Corp., Romulus, MI)
were used for all hand instrumentation. All irrigation
was accomplished by delivering 2 ml of tap water from
a plastic syringe through a 23-gauge endodontic in'i.
gating needle placed passively at the canal orifice. Upon
removal from the typodont, each specimen was root
planed with a periodontial curette to remove all remain-
ing wax and adherent periodontal ligament before being
returned to the storage medium.
Group A
Twenty teeth (Table 1) were instrumented using the
crown-down pressureless technique (CDPT) (F. J. Mar-
shall and J. B. Pappin, personal communication). Fol-
lowing coronal access, the radicular access preparation
began. Radicular access consisted of preparing the
coronal two-thirds of the root canal to remove the bulk
of the canal contents and to facilitate straight line
access to the apical third of the canal.
RADICULAR ACCESS
The canal was sounded by placing a straight #35 file
to the point of first resistance without using apical force
The depth of this penetration was measured and, if this
distance was 16 mm or more, the radicular access
preparation was completed to this depth. If the #35 file
penetrated less than 16 mm, the measured depth was
compared with the preoperative radiograph to deter
mine whether the resistance was due to canal curvature
or canal narrowing. If the resistance was due to a curve
this measured length was used as the radicular access
length. If the file was stopped by canal narrowing, the
Vol. 10, No. 10, October 1984 Crown-downPressurelessTechnique 493

TAaLE 1. Specimen data

Group Group 8 Group C

Tooth No. Degrees Curva- Final Apical File Tooth No. Degrees Curva- Final ApicalFile Tooth No. Degrees Curva-
ture ture ture
29 10 35 29 10 35 29 6
20 11 35 29 12 35 10 7
20 12 45 20 13 35 29 5
13 14 35 5 13 25 7 6
29 14 35 7 13 30 20 4
29 14 25 20 14 25 n--5
20 14 25 10 14 35
29 15 35 13 15 40
20 15 35 29 15 35
11 16 25 20 16 25
29 17 25 29 17 25
20 18 30 11 18 35
29 19 30 20 19 25
7 19 25 7 19 30
29 20 35 10 20 35
20 22 35 28 23 40
7 25 25 29 24 25
7 27 30 20 28 30
20 31 35 29 32 35
29 35 25 20 33 30
n = 20 368 n = 20 368

canal was enlarged with hand instruments (see "True

Working Length and Instrumentation Sequences") until
the #35 file penetrated 16 mm into the canal without
resistance or until a curve was encountered at a depth
tess than 16 mm. The radicular access length was then
recorded.
Radicular access was completed in a wet canal with
a #2 Gates Glidden drill followed by a #3, each taken

A
to the radicular access length without apical force (Fig.
1).

PROVISIONAL WORKING LENGTH

A provisional working length was established from

the preoperative radiograph at a point 3 mm short of F~G 1. Determination of radicular access length and radicular access
preparation.
the radiographic apex. A #30 file was then placed into
the wet canal until resistance was first encountered. It
was rotated clockwise two full revolutions without api-
cal pressure. Next a #25 file was placed in the canal
until resistance was met and rotated twice passively.
This sequence was repeated with successively
SMALLER files until the provisional working length was - Provisional
Working
reached (Fig. 2). The canal was then irrigated. [~ ~ Length
(PWL)
TRUE WORKING LENGTH AND INSTRUMENTATION
SEQUENCES

The file that reached provisional working length was

replaced in the canal to that depth and radiographed to
determine the true working length. For purposes of this
Study, true working length was located 1.0 mm short
of the radiographic apex. If this instrument was shown
to be 3 mm or less from the radiographic apex, the F~G 2. Determination of provisional working length during the first
next smaller file was introduced into the canal, rotated instrumentation sequence.
 494 Morgan and Montgomery
twice passively, and removed from the canal. This was
repeated with successively smaller files until true work-
ing length was reached. The canal was again irrigated.
This completed the first instrumentation sequence,
which began with a #30 file at the radicular access
length and concluded with the largest file that passively
reached the true working length (Fig. 3).
The second instrumentation sequence began with a
#35 file, which is one size larger than the file that began
the previous sequence. After the #35 file was inserted,
passively rotated twice, and removed, consecutively
smaller files were used similarly until a file reached true
working length. Generally, the instrument that reached
true working length was one size larger than the file
that reached the true working length in the preceding
instrumentation sequence.
The third instrumentation sequence began with a
#40 file and progressed similarly through consecutively
smaller instruments down to the true working length.
This was followed by a sequence beginning with a #45
file, then one beginning with a # 5 0 file, and so on until
a satisfactory apical preparation was obtained. This
was defined as that file size that was two sizes larger
than the one that first reached true working length or a
minimum of a #25, whichever was larger.
None of the instruments used in this technique were
precurved. Apical and torquing pressures were
avoided. Replacing and rotating an instrument of the
same size at the same depth was also avoided. These
actions tend to cause ledging, especially in curved
canals (F. J. Marshall and J. B. Pappin, personal com-
munication).
Group B
Twenty teeth (Table 1) were instrumented using a
circumferential filing technique with precurved files as
described by Weine (20). Irrigation occurred after the
use of each instrument. Instrumentation continued until
an apical preparation was completed at a file two sizes
I~NL I mm
True
Working
FIG 3. Determination of true working length during the first instrumen-
tation sequence.
Journal of Endodontic,,
larger than the first file to bind at the working lengtt
(1.0 mm short of the radiographic apex) or a #25
whichever was larger. Then successively larger file,,
were stepped back to depths incrementally 1 mm far
ther from the working length until at least a # 6 0 fit ir
the canal orifice.
Group C
Coronal access openings were made in the five con.
trol teeth (Table 1). As much soft tissue as possibl{
was removed from their root canal systems with barbec
broaches. No further instrumentation or irrigation wa,,
done.
Injection and Clearing
After instrumentation, all teeth in the study wet(
subjected to an injection and clearing process. The
canals were dried with paper points followed by inset
tion of a #10 file through the apical foramen to ensur~
patency. The teeth were then mounted in a vacuur~
manifold connected to a constant vacuum source of 27
mm Hg. Xantopren Blue (Unitek Corp., Monrovia, CAI
impression material was mixed according to the man.
ufacturer's directions and injected through the access
openings with an impression syringe. When the material
protruded from the apical foramen, the vacuum was
shut off. The material was allowed to set for 20 rain,
and the specimens were then rendered transparent
using the method of Robertson and Leeb (21). When
completely cleared, they were stored in enough Silicone
710 (Dow Coming Corp., Midland, MI) to cover them.
Each specimen was photographed at • using a
Zeiss stereomicroscopeSR (Carl Zeiss, D-7082 Ober-
kochen West Germany). Faciolingual and mesiodistal
views corresponding to the preoperative radiograph
were taken. Additionally, a third photograph showing
what was judged to be the best view of each canal
preparation was taken.
DATA COLLECTION AND STATISTICAL
ANALYSIS
The specimens were independently evaluated by four
endodontists and one general practitioner. None of the
evaluators had prior knowledge that different instru
mentation techniques were being compared or that
uninstrumented controls were included. The evaluators
went individually into a darkened room containing two
Caramates (Eastman Kodak Co., Rochester, NY)
placed side by side. A detailed set of instructions was
read before the viewing sessions, and a copy was als0
available in the room. Caramate One contained the
preoperative radiographs of each specimen, showing
the faciolingual and mesiodistal views on the same film
Caramate Two contained the postoperative specimen
photographs, each being encoded with a number co~
Vol. 10, No. 10, October 1984 Crown-down Pressuretess Technique 495

responding to that on the matching radiograph. The
three photographs of each specimen were presented
in the same order each time: faciolingual, mesiodistal,
and "best view." Before the photographs were shown
on Caramate Two, the evaluators were instructed to
draw their perception of the preoperative canal anat-
omy based on the radiograph showing on Caramate
One. This acted as the preoperative control. The eval-
uator then viewed the postoperative photographs of
the particular specimen at will and without time re-
straints. Each evaluator then answered the questions
on the evaluation form (Table 2) for each specimen.
Realizing that the evaluation was to be highly subjec-
tive, efforts were made to standardize evaluator re-
sponses as closely as possible. A preliminary evaluation
form and set of instructions were first tested on five
endodontic postdoctoral students. Their responses and
suggestions aided in the formulation of the final evalu-
ation form. These instructions consisted of a question
by question listing of operationa~ definitions, exclusions
necessitated by experimental execution, and photo-
graphs of anatomical and instrumentation features
which were addressed on the evaluation form. Only in
the final question, where the evaluator was asked for a
subjective overall rating of the canal preparation, were
no specific guidelines given.
A copy of the instructions was furnished to each
evaluator 1 wk before the actual evaluation took place
for familiarization purposes. It was hoped a common
initial viewpoint would help to standardize evaluator
responses. Their responses were analyzed for interra-
ter reliability using the alpha test. Aft questions with an
alpha score of 0.55 or better were analyzed using a
Mann-Whitney U test at a significance level of (~ = 0.05.
The evaluation form was designed so that the "A"
response to each question was either the ideal or
indicative of the particular parameter in question. Analy-
sis was done in terms of A responses compared with
total responses less those rated "uncertain" for com-
parisons between groups. The evaluators were in-
structed to use the uncertain response only as a last
resort. The overall rating in question 9 was analyzed
both in terms of "excellent" responses (response A)
and in terms of "poor" responses (response C) com-
pared with total responses.
RESULTS
The results are shown in Table 3. The evaluators
found a significant difference in the overall subjective
appearance of the preparations. The CDPT was rated
excellent significantly more often than the convention-
ally prepared and uninstrumented control teeth (p =
0.02) (Fig. 4). Conversely, the conventionally instru-
mented teeth were rated poor significantly more often
than those instrumented using the CDPT (p = 0.02) but
not more often than the controls (Fig. 5). There were
no statistically significant differences among the three
groups in terms of the specific preparation criteria.
Two questions that directly addressed the purpose
of the study, ledging and perforation, were excluded
from statistical evaluation due to poor rater agreement.

TAB": 2. Evaluation form

1. Sketch your radiographic perception of the root canal systems in both dimensions on the sheet provided, including the outline of the main
canal and your concept of the apical anatomy.
2. The root canal preparation is
A. reasonably smoothly tapered.
B. obviously hourglass or reverse hourglass shaped.
C. obviously stepped.
D. uncertain, inadequate information to tell.
3. The terminus of the canal preparation
A. ends in a definite, regularly shaped stop that is ideal for this tooth.
B. is obviously zipped or transported.
C. uncertain, inadequate information to tell.
THE FOLLOWING STATEMENTS ARE TO BE ANSWERED BY MARKING ONE OF THE FOLLOWING:
A. Yes
B. No
C. Uncertain, inadequate information to tell.
4. The root canal preparation was obviously ledged.
5. The tooth was obviously perforated by the root canal preparation at a point other than the canal terminus.
6. The maJn canal was reasonably well debrided (i.e. there was good canal wall adaptation of the contrast medium).
7. There were branches of the main cana~ (i.e. secondary canals without an orifice, an isthmus, etc.) that were generally untouched by the
instrumentation.
B. The Xantopren Blue was completely surrounded by debris in the apical third (i.e. no canal wall apposition apically, but adequate canal wall
apposition more coronally).
9. OVERALL RATING
A. Excellent
B. Satisfactory
C. Poor
496 Morgan and Montgomery Journal of Endodontics

TAeUE 3. Statistical evaluation of data No single evaluator or group of evaluators could have
Interrater Group A Group A Group B been excluded from the statistical analysis to signifi-
Question No. (from versus versus versus cantly improve rater agreement.
Table 2) Reliability Group B Group C Group C
(~=) (p=) (p=) (p=)
DISCUSSION
2 0.59 0.32 0.29 0.17
3 0.55 0.42 0.73 0.18 Xantopren Blue impression material has been shown
4 0.31 to produce very accurate three dimensional models of
5 -0.85
6 0.64 0.64 0.11 0.30
root canal systems when injected through the access
7 0.61 0.66 0.55 0.79 opening under vacuum (6, 13, 22, 23). This material is
8 0.65 0.11 0.51 0.59 dimensionally stable and inert to attack by acid, organic
9 (in terms of ex- 0.60 0.02 0.02 0.85 solvents, and sodium hypochlorite (22, 23). A pilot study
cellent re- also showed it to be inert to Silicone 710. It was also
sponses)
9 (in terms of poor 0.60 0.02 0.13 0.75
shown to fill all available space in the root canal systems
responses) of teeth used in this study.
9 Alpha scores Of 0 55 or greater received further statistic, at anatysLs.
Although extensive measures were taken to stand-
ardize evaluator responses, ingrained rater perceptions
were difficult to modify in this subjective evaluation.
The human element makes studies of this nature as
much a study in psychology as in endodontics. Al-
though the evaluators could tell a difference in the end
product, they were unable to detect any differences
among the component instrumentation parameters. Un-
fortunately, an accurate preoperative control of original
root canal anatomy does not exist for instrumentation
studies. Until one is available, we must rely on the
trained but tainted human eye. In this study, the eval-
uators' two dimensional drawings of canal configura-
tions from the preoperative radiographs acted as the
FiG 4. Preparations done with the CDPT that were rated excellent
(/eft), satisfactory (center), and poor (right). controls. Accuracy was dependent upon evaluator per-
ception, training, state of mind, and other factors. Per-
haps future research will furnish a more objective con-
trol and evaluation method.
It was surprising to find that the greatest rater disa-
greement occurred in the questions concerning ledging
and perforation. From previewing the photographs, nei-
ther author was expecting an affirmative response to
the occurrence of either of these mishaps. The evalu-
ators were told that the final instrument went to a level
1 mm short of the radiographic apex in all experimental
teeth. This fact should have suggested that ledge for-
mation was a rare occurrence. Some evaluators may
have confused ledging and apical zipping, although!
both terms were defined and were to be considered
independently.
FIG 5. Preparations done using the conventional filing technique that
The affirmative responses to perforation were more
were rated excellent (left), satisfactory (center), and poor (right). difficult to explain. Since the foramina were made patenl
after instrumentation in order to inject the Xantopren
Blue, perforations at the canal terminus were speci~
To gain more insight into these results, an analysis of cally excluded from consideration. Working radiographs
the raw data was done. Assuming a "worst case" and gross postoperative root examination revealed no
criteria, a tooth was considered to be ledged or perfo- obvious perforations. The injection and clearing method
rated if any two evaluators responded affirmatively or revealed a large number of accessory and lateral canalsJ
with uncertainty. Thirteen teeth were thus found to be in the specimens (Fig. 6). Perhaps these were calledl
ledged: five by the CDPT, seven by the conventional perforations by some evaluators.
method and one control. Similarly, 15 teeth were The uninstrumented control teeth fared unusuallyl
zipped: 8 by the CDPT, 5 by the conventional tech- well in the evaluation. This was probably due to thet
nique, and 2 controls. type of teeth selected. Most specimens were mandi-I
Vol. 10, No. 10, October 1984
FIG6. An example of unusual canal anatomy visible in a control tooth
using the injection and clearing method.
ibular second premolars and maxillary lateral incisors.
These teeth tend to have conical and relatively smoothly
tapered root canals. They were selected since they had
one root, which allowed for good circumferential eval-
uation photography, and they had curved canals. Xan-
topren Blue reached the canal terminus in all but one
control specimen. The control teeth were randomly
selected from specimens not meeting the apical cur-
vature requirements of the experimental teeth and so
tended to have straighter canals. Perhaps this was why
merely broaching the canals allowed for such good
Xantopren Blue penetration.
Also surprising was the final apical file size used in
some of the more severely curved specimens. The teeth
were instrumented randomly without knowledge of the
particular degree of curvature. The final file size was
two sizes larger than that file which first bound at the
Working length. As some relatively large final instrument
Sizes were reached in some of the more severely curved
Canals, it must be concluded that canal diameter rather
than degree of curvature governed the final instrument
Size in these specimens. It is reasonable to assume
this will occur clinically in these types of teeth unless a
COnscious effort is made to limit the size of the prepa-
ration to a certain instrument size. Clinically, it is wise
to limit instrumentation of severely curved canals to a
~25 or #30. The apical binding felt beyond these sizes
Crown-down Pressureless Technique 497
may be the result of the instrument cutting along the
outside curvature of the canal, creating an apical zip.
This occurred in several of the more curved specimens
prior to attaining final apical file size as defined, but
instrumentation progressed for standardization pur-
poses.
The injection and clearing method used in this study
is probably no better or worse than other subjective
tools used to evaluate canal instrumentation. It was
found to be an excellent method for the study of canal
anatomy. The frequency and clarity with which apical
deltas, accessory, and lateral canals were seen was
remarkable. They were often seen in surprising loca-
tions and configurations. This illustrates the difficulty of
complete debridement and obturation of root canal
systems, even in apparently simple cases. At the pres-
ent time, the best we can hope for is to create a
condition that the body finds biologically acceptable.
This study shows that the crown-down pressureless
technique is effective for instrumenting curved root
canals. Since the experimental teeth had relatively
thick, uniformly shaped dentin walls, the CDPT should
also be tested in molars. They tend to have canals with
dentin walls of variable thickness and roots that have
mesial and distal concavities. The use of large, aggres-
sive engine-driven instruments deep in molar root ca-
nals may weaken or perforate the canal wall, especially
on the furcal aspects of these roots. The CDPT appears
to be adaptable for safe use in all teeth, provided that
it is not abused. The decreased occurrence of canal
debris extrusion with the CDPT warrants further inves-
tigation.
The CDPT was much less fatiguing and seemed
faster than the conventional instrumentation method.
This probably resulted from the early mechanical prep-
aration of the coronal two-thirds of the canal, leaving
only the apical third to prepare by hand. Also, the use
of light rotational force on the instruments in the CDPT
was easier than the tight grasping and pulling of the
conventional technique.
The findings of this study are in agreement with those
of Leeb (19) and the contentions of Marshall and Pappin
(personal communication). The crown-down pressure-
less technique is an effective method of root canal
instrumentation that is easily mastered and adapted to
routine use. The technique or at least its principles of
early cervical canal flaring and straight-line access to
the apical third of the root canal, merit the consideration
of all who practice endodontics.
SUMMARY AND CONCLUSIONS
Two instrumentation techniques were compared in
curved canals using a simulated clinical environment.
Xantopren Blue impression material was injected into
the root canal systems and the teeth were cleared. Five
evaluators rated the effectiveness of canal instrumen-
tation and statistical comparisons were made.
498 Morgan and Montgomery
The following conclusions were made:
1. The crown-down pressureless technique received
significantly more excellent ratings than the con-
ventional filing method.
2. The occurrence of zipping was similar in both
techniques.
3. The occurrence of ledging and perforation was
questionable in either technique.
4. The injection and clearing method was satisfac-
tory for evaluating root canal instrumentation.
5. Less subjective methods for evaluating root canal
instrumentation are needed.
We wish to thank Drs. E. Steve Senia, Joel B. Alexander, and Carlos E. del
Rio for their contributions in editing this manuscript. Thanks also go to Mr.
John Schoolfield for his help with the statistical evaluation and to Ms. Sylvia
Gonzales for typing the manuscript.
References
1. Ingle JI. Endodontios. 2nd ed. Philadelphia: Lea & Febioer, 1976:182-
204.
2. Welne FS. Endodontic therapy. 3rd ed. St. Louis: CV Mosby, 1982:264-
7.
3. Cohen S, Burns RC (eds.). Pathways of the pulp. 3rd ed. St. Louis: CV
Mosby, 1984:181-4,
4. Haga CS. Microscopic measurements of root canal preparatK)ns follow-
ing instrumentation. J Br Endo Soc 1968;2:41-6.
5. Gutierrez JH, Garcia J. Microscop~ and macroscopic investigation on
results of mechan~7..alpreparation of root canals. Oral Surg 1968;25:108-16,
6. Davis SR, Braytoo SM, Goldman M. The morphology of the prepared
Journal of Endodontics
root canal: a study utilizing injectable silicone. Oral Surg 1972;34:642-48.
7. Walton RE. Histologic evaluation of different methods of enlarging the
pulp canal space. J Endodon 1976;2:304-11,
8. Jungmann CL, Uchin RA, Bucher JF. Effect of instrumentation on the
shape of the root canal, J Endodon 1975;1:66-9,
9. Vessey RA. The effect of filing versus reaming on the shape of the
prepared root canal. Oral Surg 1969;27:543-7,
10. Weine FS, Kelly RF, Lio PJ. The effect of preparation procedures on
original canal shape and on apical foramen shape. J Endodon 1975;1:255~62.
11, Coffae KP, Brilliant JD. The effect of sedal preparation versus nonserial
preparation on tissue removal in the root canals of extracted mandibular human
molars, J Endodon 1975; 1:211-4.
12. Klayman SM, Brilliant JD. A comparison of the efficacy of serial prepa.
ration versus Giromatic preparation. J Endodon 1975; 1:334-7.
13. Abou-Rass M, Jastrab RJ. The use of rotary instruments as auxUlary
aids to root canal preparation of molars. J Endodon 1982;8:78-82.
14. Brilliant JD, Christie WH A taste of endodontics. J Acad Gen Dent
1975;23:29-36,
15 Abou-Rass M, Frank AL, Glick DH, The anticurvature filing method to
prepare the curved root canal. J Am Dent Assec 1980; 101:792-4.
16. Hession RW. Endodontic morphology III, canal preparation. Oral Surg
1977;44:775-85.
17, Chapman CE, Collee JG, Beagde GS. A preliminary report on the
correlation between apical infection and instrumentation in endedontics. J Br
Endo Soc 1968:2:7-11,
18. Chapman CE. The correlat,~:)nbetween apical infection and instrurnem
tarpon in endodontics. J Br Endo Soc 1971;5:76-80.
19. Leeb JI. Canal orifice enlargement as related to biomechanical prepa.
ration, J Endodon 1983;9:463-70,
20. Weine FS Endodontic therapy. 3rd ed. St, Louis: CV Mosby, 1981 ;257-
9,264-7.
21. Robertson DC, Leeb JI. The evaluation of a transparent tooth model
system for the evaluation of endodontically filled teeth. J Endodon 1982;8:317-
21.
22. Sproles RA. An anatomical investigation of the coronal pulp chamber
of molar teeth utilizing a silicone injection technique [Thesis], Los Angeles:
University of Soothem California, 1975.
23. Mather TN. A comparison of endodontic instruments from three man.
ufacturers: The effect of these instruments on root canal anatomy [ThesisJ.
Minneapolis: University of Minnesota, 1976.