Cleaning and Shaping of the Root Canal System. Part II Edit by Hou Tiezhou 02988088507
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Cleaning and Shaping of the Root Canal System. Part IIEdit by Hou Tiezhou02988088507
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Root Canal InstrumentationEstimate working lengthVerify canal patencyEstimate canal sizeEstablish actual working length
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Root Canal InstrumentationCrown down preparationCoronal thirdMiddle thirdApical third
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Armamentarium
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Armamentarium
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ArmamentariumStainless steel size 10 K-filesUsed to explore canal patencyFiling or quarter turn pull motion Do not rotate through 360 degrees
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ArmamentariumStainless steel size 15 and 20 K filesUsed to establish actual working length
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Armamentarium
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ArmamentariumProfile orifice shapersUsed to prepare the coronal one third of the root canal
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Profile Orifice Shapers
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ArmamentariumProfile 0.06 taper rotary filesUsed to prepare the middle third
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Armamentarium
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ArmamentariumProfile 0.04 taper hand NiTi filesUsed to prepare the apical third of the root canal
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Armamentarium
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Estimated Working LengthEstimated working length is the distance from the reference point to the radiographic apex, as measured on a parallel preoperative radiograph
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Estimated working lengthTake a pre-operative parallel radiographClinically, use a XCP film holder
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Estimated working length Length from incisal edge to radiographic apexOnly an estimate because of radiograph distortion
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Estimate canal sizeRadiographic appearanceCrown/root morphologyStandardized sizes (See table in manual)
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Estimate canal size
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Explore Canal PatencyEnsure that canal can be negotiated to radiographic apexSelect #10 K filePrecurve file if necessary
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Explore Canal Patency
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Explore Canal Patency
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Establish Actual Working lengthInstrumentation should terminate at:The apical constriction1 mm short of radiographic apexActual WL = Estimated WL 1 mm
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Establish actual working lengthWL can be established using:RadiographsApex locator
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Establish Actual Working Length
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Establish Actual Working Length
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Establish Actual Working Length
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Establish Actual Working Length
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Crown Down Preparation
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Crown Down Preparation
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Crown-down preparationPlastic incisor with transparent root
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Crown-down preparationPlace SS K file into canal until the tip is just visible at the apex
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Actual Working LengthRemove file from canalSubtract 1 mmThis is the actual working lengthIn this case the WL is 20 mm
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Actual Working Length
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Preparation of Coronal Third
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Preparation of Coronal ThirdThe coronal third measurement is WL minus 8 mm, that is 12 mmProfile OS do not have rubber stops however the cutting flutes measure 10 mmThe goal is to work the largest OS to 12 mm
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Preparation of coronal third
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Preparation of coronal third
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Preparation of the coronal thirdRotate OS at 300 rpmNote: Orifice shaper should be rotating at 300 rpm before it is placed in the canalAdvance the OS in 1 mm incrementsWhen resistance is encountered retract OS while still rotating Never force any instrument apically
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Preparation of coronal thirdBlue (#60) OS extends to approx. 9 mm
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Preparation of coronal third
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Preparation of coronal third
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Preparation of coronal thirdGold (#50) OS reaches 12 mm
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Preparation of coronal thirdProgress from larger to smaller orifice shaperEach smaller OS will extend further into canalRepeat the sequence until the largest OS extends to 12 mm
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Preparation of coronal thirdBlue (#60) OS extend to WL 8 mm = 12 mm
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Preparation of Middle ThirdProfile 0.06 taper series 29 rotary files
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Preparation of Middle ThirdProfile 0.06 taper series 29 rotary filesThe middle third measurement is WL minus 4 mm, that is 16 mmThe aim is to work the brown (#7) file to 16 mm
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Preparation of Middle ThirdProceed from larger to smaller fileEach smaller file will extend further into the canalRepeat the sequence until the largest file extends to 16 mm
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Preparation of middle third
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Preparation of middle third
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Preparation of middle third
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Preparation of middle third
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Preparation of middle third
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Preparation of middle third
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Preparation of middle third
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Preparation of middle third
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Preparation of middle third
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Preparation of middle third
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Preparation of apical thirdProfile 0.04 taper nickel titanium hand files
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Preparation of apical thirdProfile 0.04 taper nickel titanium hand filesThe measurement is the full working length, that is 20 mm
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Preparation of apical thirdMeasure working length on #15 fileSet rubber stop at that lengthLubricate the canal with Prolube
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Preparation of apical thirdAdvance size 15 file to working lengthRotate file through 360 degreesIrrigate copiously with NaOCl after each file
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Preparation of the apical thirdAdvance size 20 file to working lengthContinue through sequence, seating each file to working length
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Preparation of apical thirdProgress from smaller to larger filesEach file is fully seated at working lengthSmall canals prepared to a minimum of ISO 35 or 40Large canals prepared to a minimum of ISO 40 50
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Preparation of apical third
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Preparation of apical third
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Preparation of apical third
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Preparation of apical third
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Preparation of apical third
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Preparation of apical third
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Preparation of apical third
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Preparation of apical third
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Preparation of apical third
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Preparation of apical third
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Preparation of apical third
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Preparation of apical third
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File kit on completion of instrumentation
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Master Apical File (MAF)The largest file that extends to working lengthMAF film is exposed to confirm length and placement
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Master Apical FileFor large canals minimum MAF #40 - 50For small canals minimum MAF #35 - 40
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Master Apical FileTake a radiograph with MAF in place. This confirms:LengthPlacement
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Mission Accomplished
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