Monday morning, the doctor walks into the clinic relaxed after the weekend and opens the

appointment register. Call on my first case he remarks, full of enthusiasm and vigor and then what does he see-the first case is Oh no! My God- M!. Good morning and welcome to today"s seminar on iomechanical preparation during endodontic therapy. #et"s delve deeper under the following su$headings% CO&'(&')
Introduction Definition and objectives Basic terms and motions of instrumentation General principles and Techniques of biomechanical preparation a) Hand Apical coronal Coronal apical b) Automated

 Curvatures and cleanin and shapin Advances in automated instrumentation and adjuvant techniques Conclusion and Biblio raph!

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*&'+O,-C'*O& #es$ the root canal s!stem is complicatedl! comple%& Accessor! and lateral canals$ isthmuses$ calcifications$ curvatures and 'hat not combine to form a dauntin challen e to the astute clinician& Achievin not just vertical access but true ( dimensional preparation is an issue that has and still ve%es a majorit! of clinicians as evidenced b! the m!riad techniques and instrumentation that have spa'ned in the quest for ideal cleanin and shapin & )ust as nothin is constant but chan e so too in the root canal nothin is predictable e%cept the unpredictable& Alon 'ith dili ent access preparation$ canal location and 'or*in len th determination onl! throu h biomechanical preparation$ 'ill ensure ood obturation and healin & +nderstandin that a denture is as ood as its initial impression$ an inla! as ood as the tooth preparation and an

obturation as ood as the biomechanical preparation$ let us e%plore the rationale and techniques to achieve that perfect canal preparation& ,(.*&*'*O& /&, O 0(C'*1()% ,childer introduced the concept of -Cleanin and ,hapin . almost (/0 decades a o&

Biomechanical preparation refers to the controlled removal of dentin and root canal contents b! manipulation of root canal instruments and materials& It consists of cleanin and shapin & Cleaning% 1efers to the removal of all contents of the root canal s!stem before and durin shapin includin substrates$ microflora$ bacterial products$

foods$ caries etc& )haping% 1efers to a specific root canal form 'ith particular desi n objectives& It involves the carvin and predetermined removal of root canal structure to achieve a uniform$ taperin homo eneous desi n& The final shape permits effective irri ation$ obturatin instrumentation and eneral h!draulics required to transform and capture a ma%imum cushion of utta/ percha and sealer into all foramina 'ith three dimensionalit! and no e%trusion bein achieved& The purpose of this seminar is to provide the rationale and techniques for proper cleanin and shapin of the root canal s!stem$ 'hich 'ill enable the clinician to obturate the s!stem&

As 'ith man! aspects of dental profession$ such as a denture bein no better than the initial impression$ or an inla! bein no better than the tooth preparation$ it follo's that canal obturation 'ill be no better than the cleanin and shapin of the entire s!stem& Generall! spea*in $ the " main objectives in canal cleanin and shapin are2 iological% Biolo icall!$ the oal of intracanal procedures is to remove all pulp tissue remnants and micro/or anisms and their substrates alon 'ith infected dentin& Mechanical% 3echanicall! (/D shapin of the canal is the objective 'hich must be accomplished to achieve biolo ic cleanin & iologic o$2ectives include% 1& Confine all instrumentation 'ithin the root canal space 4apical constriction) to maintain its spatial inte rit!& 1epeated

instrumentation e%tendin be!ond the constriction is un'arranted& It causes peri/radicular inflammation and often destro!s the normal biolo ic constriction of the root ape%& "& Avoid pushin contaminated debris past the confines of the apical constriction&

3an! instances of post treatment pain and s'ellin can be attributed to necrotic tissue and micro/or anisms and their to%ins bein inoculated into the peri/radicular tissues as a result of cleanin procedures& This induces a rapid

indiscriminate

immunolo ic response& (& 1emove all the potential irritants from the entire canal s!stem& This avoids recurrent peri/radicular inflammation and creates a condition that permits prompt$ uneventful healin & 0& 6stablish the e%act 7&8 and completel! clean and shape the canal s!stem& 5& Create sufficient 'idth in the coronal half of the canal s!stem to allo' for copious flushin and debridement& Mechanical O$2ectives include% 1& Develop a continuousl! taperin form in the root canal preparation& The final preparation of this s!stem should be an e%act replica of the ori inal canal confi uration in shape$ taper$ and flo' onl! lar er& 9nl! too often$ canals are simpl! -bored out. 'ith the clinician failin to consider the spatial relationship of the canal to the overall root anatom!&

"& ;repare a sound apical dentin matri% at the DC junction& This provides the resistance form to the intraradicular cavit! preparation& This also prevents the over/e%tension of instruments and controls the apical movement of obturation& (& ;repare the canal to taper apicall!$ 'ith the narro'est cross/ sectional diameter at the apical termination 4apical dentin matri%)& The apical third of the canal preparation must provide a taperin < parallel$ spatial confi uration in order to ensure a firm seatin of the utta/percha and sealer& The three/dimensional shape of the preparation$ especiall! of the apical 1<(rd$ must provide a retentive cavit! to enhance condensation procedures& 0& Confine cleanin and shapin procedures to the canal s!stem$ utta/percha sealer durin

thereb! maintainin the spatial inte rit! of the apical foramen& Adherence to this principle prevents violation of the peri/ radicular tissues& This principle is evident 'hen foramina are transported 4moved) 4=ip and elbo')durin e%cessive apical

instrumentation& This can be internal or e%ternal transportation&

>

5& 1emove all residue of cleanin and shapin procedures that could prevent patenc! of the apical foramen i&e& dentin shavin s and tissue debris& This 'ill help prevent complications li*e led es$ loss of canal len th$ development of false canals etc& 1ecapitulation is essential to all cleanin procedures as i norin this important step 'ill often lead to led es$ loss of canal len th$ dev of false canals etc& !rocedural terms% 1) MAF-Master apical file: It is the lar est file that binds sli htl! at correct 78 after strai ht line access& It is determined b! passivel! placin the successivel! lar er files at the C&7&8& until correct si=e is reached 'hich binds at the tip& The file bindin at first or smallest file to bind is initial apical file& 2) Pre curving of instruments ;recurvin of stainless steel instruments is mandator! 'hile

ne otiatin curved canals& It is a valuable tool for feelin canal passa es and for movin around calcifications$ led es and around curved foramina& It helps to prevent procedural problems and perform adequate shapin in curvatures& ;recurvin can be done either 'ith cotton or au=e or usin commercial! available devices utili=in the dia nostic %/ra!& ?

() 1ecapitulation 2 An essential step especiall! in apical coronal techniques @ it means the use of instruments in the correct si=e sequence smaller to lar er and returnin to smaller instruments from time to time before advancin to a lar er si=e& 6& & after 15 no& 1Amm them proceed to "A$ then use 1A and 15 and proceed to "5 and so on& This helps prevent pac*in of dentinal filin s and ensures patenc! of root canal throu h to the apical foramen& 0) Anticurvature filin /Bilin a'a! from curvatures and dan er areas

described in detail under curvatures& asic terms of Motions of instrumentation @ B3; is a d!namicall! delicate motion @ flo'in $ rh!thmic and ener etic& Carious motions involved are2 Methods of Cleaning and )haping Cleanin and shapin are d!namicall! delicate motions$

flo'in $ rh!thmic$ and ener etic& In order to use files and reamers efficientl!$ the movements require distinction& There are : distinctive motions of files and reamers& A) Follow:

+suall! performed 'ith files& Are used initiall! durin cleanin and shapin or an! time an obstruction bloc*s the foramen&

Irri atin $ precurvin different *inds of curves$ curvin all the 'a! to the tip of the instrument and multiple curves in multiple directions of the instrument are all part of follo'& A) Follow-withdraw Biles are used& This motion is used once the foramen has been reached and the ne%t step is to create the path from access cavit! to foramen& The motion is follo'$ then 'ithdra' or -follo' and pull. or -follo' and remove.& It is simpl! an in @ and @ out passive motion that ma*es no attempt to shape the canal& B) Cart 1efers to the e%tension of a reamer to or near the radio raphic terminus& The reamer should entl! and randoml! touch the dentinal 'alls and -cart. a'a! debris& C) Carve 1eamers are used for shapin & The *e! is not to press the instrument apicall! but simpl! to touch the dentin 'ith a precurved reamer and shape on 'ithdra'al randoml!&

1A

D)

mooth Is accomplished 'ith files& In the past$ most endo procedures 'ere performed 'ith a smoothin or circumferential filin

motion& If the previous four motions are follo'ed smoothin is rarel! required& !) Patenc" Is achieved 'ith files< reamers& It means that the portal of e%it has been cleared of an! debris in the path& Also included are " other terms iven b! 1uddle/Gau in and Tunin & Gau in refers to the *no'in the cross sectional diameter of the foramen that is confirmed b! the si=e of the instrument that -snu s in. at 'or*in len th& Tunin is ensurin that each sequentiall! lar er instrument

uniforml! bac*s out of the canal b! A&5 mm&

11

Also included is scoutin

that refers to usin

instruments to

au e and estimate the root canal anatom!$ form and variations and is same as follo'& Motion of instrumentation 3 envelopes of motion% A) Filing: Indicates a push/pull motion of the instrument& The in'ard passa e is po'ered b! hand and file ri idit!& Cuttin is done durin 'ithdra'al or pull stro*e& Done usin files and usuall! in

circumferential manner& B) #eaming Indicates cloc*'ise < ri ht/hand rotation of an instrument& The instrument must be restrained from insertion to enerate a cuttin effect& Instrument E is increased 'hen this motion is emplo!ed& It is a rotatin /pushin motion limited to a quarter to half turn& C) $urn-and-pull%Com&ination) Is a combination of reamin and fillin $ the file is inserted 'ith a F turn cloc*'ise and in'ardl! directed hand pressure 4i&e& reamin ) positioned into the canal b! this action$ the file is subsequentl! 'ithdra'n 4i&e& fillin )&

1"

The rotation durin placement sets the cuttin ed es of the file into dentin and the non/rotatin dentin that has been en a ed& ,isadvantages% Hour lass canal shapes 'ere observed b! 7eine& 'ithdra'al brea*s local the

According to childer Cloc*'ise rotation of a half/revolution follo'ed b! 'ithdra'al& The file is not inserted to'ards the ape%$ rather$ he raduall! allo's the preparation to pro ress out of the canal& F turn to ri ht follo'ed b! strai ht pull out D) 'atch-winding Is the bac*/and/forth oscillation of a file 4(A/:AG) ri ht and left as the instrument is pushed into the canal& It is an e%panded use of the -Caiven. technique described b! In le& This bac* and forth motion can be combined 'ith a pull stro*e and effectivel! planes 'alls& It has various

advanta es li*e canal centerin $ not necessitatin precurvin

1(

and balancin mechanics&

tooth structure cuttin

'ith instrument

This bac*/and/forth movement causes the files and reamers to plane the 'alls efficientl!&

In a 'a!$ this is a predecessor to the balanced force technique$ as the (A/:AG of cloc*'ise rotation pushes the file tip and 'or*in ed es into the canal and the (A/:AG of

counter cloc*'ise motion partiall! cuts a'a! the en a ed dentin& !) 'atch-winding and pull 7hen used 'ith H/files$ 'atch 'indin cannot cut dentin 'ith the bac*stro*e& It can onl! 'i ti htl! into the 'all& 7ith each cloc*'ise turn$ the instrument moves apicall! until it meets resistance and must be freed 'ith a pull stro*e& F) Balanced force techni(ue This calls for oscillation of the preparation instruments ri ht and left 'ith different arcs in either direction& le and 'ed e the ed es

10

To insert an instrument$ it is rotated to the ri ht 4cloc*'ise) a quarter turn& This pulls the instrument into the canal and positions the cuttin ed es into the 'alls&

He%t$ it is rotated left 4countercloc*'ise) at least 1<( rd of the revolution to unthread the instrument and drive it from the canal&

/dvantages% ,imultaneous apical and counter/cloc*'ise rotation of file stri*es a balance bet'een the tooth structure and instrument elastic memor!& This balance locates the instrument ver! near the canal a%is$ even in severel! curved canals$ so this technique avoids transportation& It 'or*s effectivel! 'ithout pre/curvin &

General Guidelines for cleaning and shaping% 1& Direct strai ht line access should be obtained& "& rubber dam is a prerequisite and microscopes are an asset&

15

(& Accurate len th determination is a prerequisite& 1emember canal len th ma! shorten on

instrumentation of curved canals& 0& Instruments should be used sequentiall! 'ith recapitulation& 5& Instrument stops and reproducible reference points should be used& :& Do not force instruments and re ularl! inspect and debride instruments& >& +se copious irri ation and instrument in 'et canals& Carious chemical aids can be used to supplement preparation li*e 1C prep$ 6DTA$ Gl!de etc& ?& Confine instruments to root canal and do not force debris apicall!& D& Ho' much to enlar e is a priceless question/ Ho' lar e and ho' much to enlar e is dictated b! the anatomic structure$ accessibilit! of the canal and s*ill of the operator& Inadequate enlar ement limits cleanin $ debridement$ disinfection and obturation

1:

'hile over=ealous preparation leads to iatro enic problems$ unnecessar! 'ea*in susceptibilit! to fracture$ of tooth and spatial

perforations$

movement of apical foramen etc& 6arlier " uidelines 'ere considered sacrosanct/ enlar e a root canal at least ( si=es be!ond the si=e of the first instrument that binds and enlar e a canal until clean 'hite dentinal shavin s appear in the flutes& Ho'ever$ these are not considered valid criteria toda! b! an! researcher or clinician& ,tudies have sho'n that onl! enlar ement upto (A to 0A number permits effective irri ation thou h this ma! not be al'a!s possible& Thus enlar in the root canal should be done based on m!riad factors to achieve both biolo ical and mechanical objectives&

'echni4ues for preparing root canals% /pical coronal techni4ue Coronal-apical techni4ue

In 'hich the 78 is established and In 'hich the coronal portion of the the full len th of the canal is then canal is prepared before determinin 1>

prepared& e& & / / / ,tandardi=ed& ,tep/bac*& 1oane 4balanced force)

the 78 Advantages: Allo's earl! debridement of the coronal part of canal 'hich ma! contain bul* of or anic debris& 6nables better and deeper penetration of irri ant earl! in the preparation& Tends to shorten the effective 78 and determinin the 78 after such enlar ement 'ill reduce the problem of its alteration durin preparation& Allo's better control over apical instrumentation& 1educes the piston/in/ a/c!linder effect responsible for debris e%trusion Ho'ever$ there are ris*s of led in $ bloc*a e and perforation&

e& & 2 / / / / ,tep/do'n& Double/flare& Cro'n/do'n pressureless& Canal/master

1?

/pical coronal )) / tandardi*ed preparation: Done in narro' canals 'ith circular cross/sections& 78 determined& ,mallest instrument adjusted to 78& ,equentiall! enlar ed entire canal& 9bturation 'ith silver cone& ,isadvantages% / / / / 1is* of e%trusion of debris& Alteration of 78& Certical root E is overinstrumentation is carried out& +nli*el! to debride comple% canals

1D

;ossibilit! of canal deviation&

To overcome deficiencies a h!brid technique consistin of reamin the apical third and filin the coronal t'othird has been recommended 'ith coronal preparation obturated 'ith utta percha& tep &ac+ preparation: 78 determined& Instrument that fills to correct 78 is chosen& 6nlar e ( HoIs lar er at the ape%& 1educe the 78 len th b! 1mm and continue to enlar e canal < flarin & 1ecapitulate$ irri ate for patenc!& Coronal preparation done usin GGD&

"A

,isadvantages% / / / / 2) 6%trusion of debris& Apical bloc*a e& Alteration of 7&8& Tendenc! for canal deviations& #oane $echni(ue %Balanced Force)

Three of its main features are2 / Canals are prepared to predesi ned dimensions of 'hich ( are reco ni=ed and are 05$ :A and ?A accordin to the si=e of apical preparation& / These dimensions refer to the si=e of the file used at the third step bac*& / 6ach step/bac* from the master apical file at the ;D8 is A&5mm shorter than the previous one& This is termed as the -apical control =one.& / Ble% 1 files are used&

"1

78 determined to the radio raphic ape% 'ith the lar est file placed 'ithout force& This helps in determinin predesi ned preparation 405$ :A$ ?A)& the selection of

""

Coronal apical techni4ue )) / tep down techni(ue:%Marshall and Papus) Is a modification of the step/bac* technique& ;repare the coronal portion to 1:/1? mm <be innin of the curve 'ith anti/curvature fillin & GGDIs are used to refine the coronal part& Determine 78& +sin step/bac*$ complete the apical preparation& ,isadvantages% / / / 8ed e formation& Apical bloc*a e& ;erforation&

"(

Throu h this technique overcomes most of the disadvanta es of the step/bac* technique& 2) Dou&le Flared $echni(ue: Determine 7&8& ;repare till 10 mm < coronal to the curve& Irri ate and clean& Go 1mm deeper$ maintainin instrumentation coronal to the curve and file& A ain 1mm deeper& Continue till 78 is achieved& ;repare usin step/bac* *ndications% / / Bor strai ht canals or Bor strai ht portions of curved canals&

"0

Contra indications% / / In calcified canals& In !oun permanent teeth 'ith open apices&

,) Crown-down pressureless techni(ue: / Bor curved canals 'ithout causin deviations& 1otar! action is used to cut dentine 'ith the apical part of files& Determine 78 and prepare till E (5 till 1:mm 4'iden the canal 'ith smaller files first) 1educe si=e J o do'n and enlar e till ape%& Chan e to E0A J repeat& -) Canal master techni(ue: / Its aim is to aid the maintenance of curves usin a rotar! instrument desi ned so that onl! the apical 1/"mm is en a ed in dentine removal&

"5

/dvantages% / / Avoids the need for recapitulation& The apical A&>5mm of the hand instrument is safe/ended to facilitate maintenance of canal curvature& Determine 78 ;repare to the be innin of the curve +se canal master in step/bac* fashion& 5y$rid-techni4ue / An amal amation of various techniques can be used combin different desirable aspects and convenience to achieve thorou h biomechanical preparation&

":

)!(C*/# CO&)*,(+/'*O&) *& C-+1/'-+()-CO&1(&'*O&) /&, COM!#*C/'*O&) C-+1/'-+(-'5( (&G*&( O. COM!#*C/'*O&) / As an instrument is curved$ elastic forces develop internall!& These forces attempt to return the instrument to its ori inal shape and are responsible for strai htenin of the final canal shape and location& / These internal elastic forces 4i&e& restorin forces) act on the canal 'all durin preparation and influence the amount of dentin

removed& The! are particularl! influential at the junction of the instrument tip and its cuttin ed es& This re ion is the most efficient cuttin restorin surface alon an instrument$ and 'hen activated b! the

forces$ it removes more tissue& This phenomenon is

responsible for apical transportation and its consequences& 67 !re-curving of instruments. 87 /nti-curvature filing / Is the controlled and directed preparation into the bul*!<safet! =ones and a'a! from the thinner portions or dan er =ones of the root structure$ 'here perforation or strippin occur& of the canal 'alls can

">

.eed: / It is a method of appl!in instrument pressure so that shapin 'ill occur a'a! from the inside of the root curvature in the coronal and middle 1<(rd of a canal& / 7as described b! Abou/1ose$ Bran* and Glic*& The! emphasi=ed that durin shapin procedures$ files should be pulled from canals as pressure is applied to the outside canal 'all& This dimensionall! applied pressure$ prevents dan erous midcurvature strai htenin in curved canals& /dvantages% / It maintains the inte rit! of canal 'alls at their thin portion and reduces the possibilit! of root perforation < strippin & / 3aintains di ital control over the instrument and the preparation of the curved canal is used& 9 +adicular access / 7as first promoted b! ,childer&

"?

This creates space in the more coronal re ions of the canal 'hich enhances placin and manipulatin subsequent files as it increases the depth and effectiveness of irri ation&

3a! be accompanied b! rotar! instrument < circumferential filin & : +everse .laring 3 !re-flaring

Is the presentl! preferred development of flarin

'hereb! the

coronal portion of the preparation is flared before the completion of the apical portion& / In the standard flarin technique$ the apical portion of the tooth is completed before an! fillin is performed& / / In the reverse flarin and aspects of preparations are carried out& 3inimal fillin at the tip enlar ement of the coronal part ape% is completed apical flarin & /dvantages% / Irri ants are allo'ed to et do'n the canal earlier and farther to produce cleanin & / In curved canals$ more effective preparation of the apical area is provided 'hen the file has fe'er obstructions in the coronal part&

"D

Biles$ plu

ers$ fillin material can penetrate to the ape% more easil!

three a lar er orifice& *nstruments used for +everse .laring / / A&0 taper instruments 4Hi/Ti)& 3eKI3 Available in 5 instruments @ "5&A&"5 at Do 4A&A($ A&A0$ A&A05$ A&A5$ A&A55 <mm @ tapers)& +sed in ear reduction handpieces at (0A rpm& 3ade from Hi/Ti in H/st!le& Desi ned b! 3ac,padden& 1itano Biles& Hand instrument 'ith H/confi uration 'ith several tapers& 3ade in len ths shorter than "1mm& 5 Also for curved canals copious irri ation is mandator!& : ,afe sided instruments and files dulled on one side can be emplo!ed or HiTi instruments can be used& (A

> 6%tremel! narro' canals require the use of smaller instruments and mid si=e Golden 3edium files alon 'ith chemical chelators etc& ? Double curved or ba!onet shaped canals/Here after the apical foramen has been cleaned and shaped the middle third curve is eliminated 'ith H/files ta*in care not to strip and perforate and then re ular instrumentation carried out& This is done b! introducin a small H/file at the junction of middle an apical third and filin a'a! inner portion of the curve& D Dilacerated roots require coronal flarin usin fle%ible and safe sided instruments& and then

!reparation using /utomated ,evices or Mechanical *nstrumentation The lure of faster$ easier and more efficient cleanin and shapin has spa'ned various t!pes of automated devices& There is literall! a revolution oin on in automated devices 'ith ne' brands and techniques introduced ever!da!&

(1

,isadvantages% / 8oss of tactile sense and lac* of control of 'here and ho' much dentine is removed from the root canal 'all& Classification% / #otar" / +sed in slo' runnin standard handpiece e& &$ GGD$ ;eeso$ Canal master @ used onl! in the structure part& / 8atest addition is the ne' 1:21 ear reduction handpiece HiTi matic at (AArpm& / / / Hi/Ti files are used& +sed for preparation of severel! curved canals& Biles are manufactured 'ith an off/centre tip that facilitates ne otiatin around curvatures and led es& / 3!riad nic*el titanium eneration of instruments and devices li*e ;roBile$ ;roTaper$ Luantec$ 8i ht ,peed$ 9, etc have been introduced& **7 #eciprocal (uarter turn:

("

This uses a special handpiece that contrarotates the instrument three DAG&

/ / /

6& & Giromatic 41D:0)& 6ndocursor& 6ndolift @ has a vertical component in addition to the rotation&

,isadvantages of /utomated / / Hand instrument requires the same amount of time as automated& Blare preparation 'ith hand instrument tends to remove debris from 'ithin the canal s!stem than automated& / Automated is difficult to use in the most post re ions of the oral cavit!& / There is reater propensit! for the automated s!stem to produce =ipped canals$ led es etc& / A controlled po'er/assisted s!stem desi ned to eliminate the ori inal problems encountered b! Giromatic appeared in 1D?1& / D!natra*

((

+ses stainless steel instruments 'ith increased fle%ibilit! consist flute depth and curved canals and rounded tip to minimi=e and control led es$ =ips$ etc&

***7 / / / / /

0ertical Canal finder& Has a vertical movement of (/1 mm and free rotational movement& Instrument used is canal master 4H/file 'ith a safe ended tip)& Canal 8ender& Certical movement of A&0/A&? mm

( instrument M/file 'ith a safe ended tip& H/file& +niversal file 4fle%ible H/file 'ith a safe/ended tip)& There are fe' basic uidelines for rotar! shapin 2 ") ,trai ht line access& () 6stimatin the cross/sectional diameter& 0) Bamilari=in 'ith specific root canal anatom! and seatin &

(0

5) ,peed and sequencin 'ith ear reduction and electric motor and usin lar e to small files& :) 8ubrication and a li ht or feather touch equivalent to usin sharp lead pencil& *17 / / / 17 / / 6ndostar 5 6ndosonic Air (AAA #andom 6& & 6%calibur& M/files& "A$AAA/"5$AAArpm& onics

/dvantages% / 1*7 1educes fati ue and stress durin preparation& 1ltrasonics !ie;oelectric / 3ost common / Ho H"9 coolin

Magnetostrictive / 1equires H"9 coolin

(5

/ 3a! produce apical 'idenin and led es in curved canals& /dvantages% / Cleanin effect is b! acoustic streamin &

I) 3icrobrushes2 Advancement in small 'ire technolo !$ injection moldin $ bristle materials and bristle attachment have enabled the creation of endodontic microbrushes& These can be activated b! rotar! or ultrasonics and are primaril! intended for finishin root canals& The! contain 1:mm bristle 'ith DA diameter of A&0$ A&5$ A&: and A&?& 1otar! brushes are run at about (AA rpm 'hile ultrasonic ones are run 'ith Ha9Cl and 1>N 6DTA& II) 8asers2 In 1D>1$ 7eichman and )ohnson 'ere probabl! the first to su of laser in endodontics& Initiall! Hd2#AG and C9" lasers 'ere used& The! are mainl! advocated as a coadjunct for microbial reduction and to readil! root surface& 1ecentl!$ ar on lasers$ e%cimer laser$ holmium2#AG laser$ diode laser and erbium 2 #AG laser 'ith various 'avelen th have been investi ated& These est the use

(:

can be delivered usin a optical fibre "AA/0AAOm diameter equivalent to E "A/0A file coolin s!stems 'ith air 'ater spra!s ma! accessor! this& 8ev! compared the laser technique 'ith a step bac* procedure findin the form better& The technique 'as2 1& 6nlar e apical re ion 'ith E 15 file J copious irri ation& "& ;reparation be ins 'ith the laser ener ! level set at 15Amilli joules& (& Bibre optic is inserted to 728 and enlar ement done circumferentiall! first apicall! tehn movin

coronall! to enlar es upto E:A instrument& The av & time to complete the preparation 'as 1 minute& Althou h hand instruments left some 'alls untouched and smear la!er 'as found coverin 'alls$ laser preparation sho'ed remar*able cleanliness& Ho'ever 8ev! also found meltin of dentin and closin off of tubules and meltin of silicon fiber optic& ,imilarl! various other lasers have been e%perimented 'ith&

(>

Currentl! 'avelen th at +C plaster appears promisin & The ArB e%cimer laser at 1D(nm and KeCl 4(A?nm) laser appear 'ell suited& ,econd harmonic ale%andrite laser 4(>>nm) also sho's promise& 3ainl! toda! lasers are advocated for cleanin or sterili=in the root canal and shapin is a modalit! under investi ation& The laser is e%cellent at satisf!in the root canal& Buture promises of efficient preparation$ sterile canals$ shorter treatment time and minimum effort 'ith ma%imum result are fuellin laser research at brea* nec* speed& ;otential disadvanta es of cost$ safet!$ coolants$ effective control etc have to be overcome& 8asers have a definitive future in endodontics onl! the direction has to be delineated& &on instrumented root canal cleansing% 8ussi et al introduced devices to cleanse the root canal 'ithout instrumentation& The 1st device reported in 1DD( consisted of a PpumpI that inserted an irri ant 4li*e Ha9Cl) creatin bubbles and cavitation that

loosened debris& This process 'as follo'ed b! ne ative pressure 4suction) that removed debris& 3ore recentl! a smaller ne' improved machine 'as introduced& Also o=one pumps li*e heali=ae have been veritified in cleansin root canal s!stems&

(?

.inali;ing the preparation% After cleanin and shapin b! an! of the mind ba lin variet! of

techniques it is necessar! to fina lin the preparation and mana e the smear la!er& Throu h a controversial topic$ if divided to be removed$ smear la!er removal and final finishin is accomplished cutter 'ith 6DTA and ultrasonics$ 6DTA and microbrushes 'ith Ha9Cl or other ne'l! available chemicals for its mana ement to provide a root canal no' read! for obstruction&

(D

CO&C#-)*O&% -Tr! cleanin a house after a 'ild part!&. Cleanin and shapin root canals is just more difficult& The comple% anatom!$ convoluted curvatures$ non/ne otiable interconnections and hard to reach noo*s and crevices ma*e for a challen in and dauntin tas*& -;urit! is considered the

hallmar* of sanctit!.& 9btainin clean and sterile root canals is the secret of ood healin & Also the revolution of automated endodontic combined 'ith advances in hand instrumentation have chan ed the lon 'e shape and clean canals& Thus combinin the art of proper shapin and the science of immaculate cleanin 'ill culminate in ideal biomechanical preparation that 'ill la! the foundation for ideal obturation and healin therap!& and ultimatel! successful

0A

i$liography% 1& 6ndodontics @ ,toc*$ Gulabivala$ 7al*er$ Goodman& "& 6ndodontics @ In le and Ba*eland& (& 6ndodontic practice @ Grossman$ 9liet$ 1io& 0& 6ndodontics @ Cohen and Burn&
5& DCHA&

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