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 preparation during endodontic therapy. Lets delve deeper under the following subheadings: iomechanical

CONTENTS
#ntroduction $efinition and o%&ectives asic terms and motions of instrumentation

General principles and 'echni(ues of %iomechanical preparation a) *and +pical coronal Coronal apical %) +utomated Curvatures and cleaning and shaping +dvances in automated instrumentation and ad&uvant techni(ues Conclusion and i%liography

INTRODUCTION -es, the root canal system is complicatedly complex. +ccessory and lateral canals, isthmuses, calcifications, curvatures and what not com%ine to form a daunting challenge to the astute clinician. +chieving not &ust vertical access %ut true . dimensional preparation is an issue that has and still vexes a ma&ority of clinicians as evidenced %y the myriad techni(ues and instrumentation that have spawned in the (uest for ideal cleaning and shaping. /ust as nothing is constant %ut change so too in the root canal nothing is predicta%le except the unpredicta%le. +long with diligent access preparation, canal location and working length determination only through %iomechanical preparation, will ensure good o%turation and healing. 0nderstanding that a denture is as good as its initial impression, an inlay as good as the tooth preparation and an o%turation as good as the %iomechanical preparation, let us explore the rationale and techni(ues to achieve that perfect canal preparation. DEFINITION AND OBJECTIVES: 1childer introduced the concept of 2Cleaning and 1haping3 almost .-4 decades ago.

iomechanical preparation refers to the controlled removal of dentin and root canal contents %y manipulation of root canal instruments and materials. #t consists of cleaning and shaping. Cleaning: 6efers to the removal of all contents of the root canal system %efore and during shaping including su%strates, microflora, %acterial products, foods, caries etc. Shaping: 6efers to a specific root canal form with particular design o%&ectives. #t involves the carving and predetermined removal of root canal structure to achieve a uniform, tapering homogeneous design. 'he final shape permits effective irrigation, o%turating instrumentation and general hydraulics re(uired to transform and capture a maximum cushion of guttapercha and sealer into all foramina with three dimensionality and no extrusion %eing achieved. 'he purpose of this seminar is to provide the rationale and techni(ues for proper cleaning and shaping of the root canal system, which will ena%le the clinician to o%turate the system.

+s with many aspects of dental profession, such as a denture %eing no %etter than the initial impression, or an inlay %eing no %etter than the tooth preparation, it follows that canal o%turation will %e no %etter than the cleaning and shaping of the entire system. Generally speaking, the 5 main o%&ectives in canal cleaning and shaping are7 Biological: iologically, the goal of intracanal procedures is to remove all pulp tissue remnants and micro-organisms and their su%strates along with infected dentin. Mechanical: Mechanically .-$ shaping of the canal is the o%&ective which must %e accomplished to achieve %iologic cleaning. Biologic objecti e! incl"#e: ,. Confine all instrumentation within the root canal space 8apical constriction) to maintain its spatial integrity. 6epeated

instrumentation extending %eyond the constriction is unwarranted. #t causes peri-radicular inflammation and often destroys the normal %iologic constriction of the root apex. 5. +void pushing contaminated de%ris past the confines of the apical constriction.

Many instances of post treatment pain and swelling can %e attri%uted to necrotic tissue and micro-organisms and their toxins %eing inoculated into the peri-radicular tissues as a result of indiscriminate cleaning procedures. 'his induces a rapid

immunologic response. .. 6emove all the potential irritants from the entire canal system. 'his avoids recurrent peri-radicular inflammation and creates a condition that permits prompt, uneventful healing. 4. 9sta%lish the exact :.; and completely clean and shape the canal system. <. Create sufficient width in the coronal half of the canal system to allow for copious flushing and de%ridement. Mechanical Objecti e! incl"#e: ,. $evelop a continuously tapering form in the root canal preparation. 'he final preparation of this system should %e an exact replica of the original canal configuration in shape, taper, and flow only larger. Only too often, canals are simply 2%ored out3 with the clinician failing to consider the spatial relationship of the canal to the overall root anatomy.

<

5. !repare a sound apical dentin matrix at the $C &unction. 'his provides the resistance form to the intraradicular cavity preparation. 'his also prevents the over-extension of instruments and controls the apical movement of gutta-percha sealer during o%turation. .. !repare the canal to taper apically, with the narrowest crosssectional diameter at the apical termination 8apical dentin matrix). 'he apical third of the canal preparation must provide a tapering = parallel, spatial configuration in order to ensure a firm seating of the gutta-percha and sealer. 'he three-dimensional shape of the preparation, especially of the apical ,=.rd, must provide a retentive cavity to enhance condensation procedures. 4. Confine cleaning and shaping procedures to the canal system, there%y maintaining the spatial integrity of the apical foramen. +dherence to this principle prevents violation of the periradicular tissues. 'his principle is evident when foramina are transported 8moved) 8>ip and el%ow)during excessive apical instrumentation. 'his can %e internal or external transportation.

<. 6emove all residue of cleaning and shaping procedures that could prevent patency of the apical foramen i.e. dentin shavings and tissue de%ris. 'his will help prevent complications like ledges, loss of canal length, development of false canals etc. 6ecapitulation is essential to all cleaning procedures as ignoring this important step will often lead to ledges, loss of canal length, dev of false canals etc. $%oce#"%al te%&!: ,) MAF-Master apical file: #t is the largest file that %inds slightly at correct :; after straight line access. #t is determined %y passively placing the successively larger files at the C.:.;. until correct si>e is reached which %inds at the tip. 'he file %inding at first or smallest file to %ind is initial apical file. 2) Pre curving of instruments !recurving of stainless steel instruments is mandatory while negotiating curved canals. #t is a valua%le tool for feeling canal passages and for moving around calcifications, ledges and around curved foramina. #t helps to prevent procedural pro%lems and perform ade(uate shaping in curvatures. !recurving can %e done either with cotton or gau>e or using commercialy availa%le devices utili>ing the diagnostic x-ray. @

.) 6ecapitulation 7 +n essential step especially in apical coronal techni(ues A it means the use of instruments in the correct si>e se(uence smaller to larger and returning to smaller instruments from time to time %efore advancing to a larger si>e. 9.g. after ,< no. ,Bmm them proceed to 5B, then use ,B and ,< and proceed to 5< and so on. 'his helps prevent packing of dentinal filings and ensures patency of root canal through to the apical foramen. 4) +nticurvature filing-Ciling away from curvatures and danger areas descri%ed in detail under curvatures. Ba!ic te%&! o' Motion! o' in!t%"&entation A M! is a dynamically

delicate motion A flowing, rhythmic and energetic. Darious motions involved are7 Metho#! o' Cleaning an# Shaping Cleaning and shaping are dynamically delicate motions, flowing, rhythmic, and energetic. #n order to use files and reamers efficiently, the movements re(uire distinction. 'here are ? distinctive motions of files and reamers.

A)

Follow: 0sually performed with files. +re used initially during cleaning and shaping or any time an o%struction %locks the foramen. #rrigating, precurving different kinds of curves, curving all the way to the tip of the instrument and multiple curves in multiple directions of the instrument are all part of follow. A) Follow-withdraw Ciles are used. 'his motion is used once the foramen has %een

reached and the next step is to create the path from access cavity to foramen. 'he motion is follow, then withdraw or 2follow and pull3 or 2follow and remove3. #t is simply an in A and A out passive motion that makes no attempt to shape the canal. ) !art 6efers to the extension of a reamer to or near the radiographic terminus. 'he reamer should gently and randomly touch the dentinal walls and 2cart3 away de%ris.

!)

!arve 6eamers are used for shaping. 'he key is not to press the instrument apically %ut simply to touch the dentin with a precurved reamer and shape on withdrawal randomly.

")

#mooth #s accomplished with files. #n the past, most endo procedures were performed with a smoothing or circumferential filing motion. #f the previous four motions are followed smoothing is rarely re(uired.

$)

Patenc% #s achieved with files= reamers. #t means that the portal of exit has %een cleared of any de%ris in the path. +lso included are 5 other terms given %y 6uddle-Gauging and 'uning. Gauging refers to the knowing the cross sectional diameter of the foramen that is confirmed %y the si>e of the instrument that 2snugs in3 at working length.

,B

'uning is ensuring that each se(uentially larger instrument uniformly %acks out of the canal %y B.< mm. +lso included is scouting that refers to using instruments to gauge and estimate the root canal anatomy, form and variations and is same as follow. Motion o' in!t%"&entation ( en elope! o' &otion: +) Filing: #ndicates a push-pull motion of the instrument. 'he inward passage is powered %y hand and file rigidity. Cutting is done during withdrawal or pull stroke. circumferential manner. ) &eaming #ndicates clockwise = right-hand rotation of an instrument. 'he instrument must %e restrained from insertion to generate a cutting effect. #nstrument G is increased when this motion is employed. #t is a rotating-pushing motion limited to a (uarter to half turn. !) 'urn-and-pull(!ombination) #s a com%ination of reaming and filling, the file is inserted with a H turn clockwise and inwardly directed hand pressure $one using files and usually in

,,

8i.e. reaming) positioned into the canal %y this action, the file is su%se(uently withdrawn 8i.e. filling). 'he rotation during placement sets the cutting edges of the file into dentin and the non-rotating withdrawal %reaks local the dentin that has %een engaged. Di!a# antage!: *ourglass canal shapes were o%served %y :eine.

According to #childer Clockwise rotation of a half-revolution followed %y withdrawal. 'he file is not inserted towards the apex, rather, he gradually allows the preparation to progress out of the canal. H turn to right followed %y straight pull out ") )atch-winding #s the %ack-and-forth oscillation of a file 8.B-?BI) right and left as the instrument is pushed into the canal. #t is an expanded use of the 2Daiven3 techni(ue descri%ed %y #ngle. 'his %ack and forth motion can %e com%ined with a

,5

pull stroke and effectively planes walls.

#t has various

advantages like canal centering, not necessitating precurving and %alancing tooth structure cutting with instrument mechanics. 'his %ack-and-forth movement causes the files and reamers to plane the walls efficiently. #n a way, this is a predecessor to the %alanced force techni(ue, as the .B-?BI of clockwise rotation pushes the file tip and working edges into the canal and the .B-?BI of counter clockwise motion partially cuts away the engaged dentin. $) )atch-winding and pull :hen used with *-files, watch winding cannot cut dentin with the %ackstroke. #t can only wiggle and wedge the edges tightly into the wall. :ith each clockwise turn, the instrument moves apically until it meets resistance and must %e freed with a pull stroke.

,.

F)

alanced force techni*ue 'his calls for oscillation of the preparation instruments right and left with different arcs in either direction. 'o insert an instrument, it is rotated to the right 8clockwise) a (uarter turn. 'his pulls the instrument into the canal and positions the cutting edges into the walls. Jext, it is rotated left 8counterclockwise) at least ,=. rd of the revolution to unthread the instrument and drive it from the canal.

A# antage!: 1imultaneous apical and counter-clockwise rotation of file strikes a %alance %etween the tooth structure and instrument elastic memory. 'his %alance locates the instrument very near the canal axis, even in severely curved canals, so this techni(ue avoids transportation. #t works effectively without pre-curving.

,4

)ene%al )"i#eline! 'o% cleaning an# !haping: ,. 5. asset. .. +ccurate length determination is a prere(uisite. 6emem%er canal length may shorten on instrumentation of curved canals. 4. recapitulation. <. should %e used. ?. $o not force instruments and regularly inspect and de%ride instruments. @. 0se copious irrigation and instrument in wet canals. Darious chemical aids can %e used to supplement preparation like 6C prep, 9$'+, Glyde etc. E. de%ris apically. Confine instruments to root canal and do not force #nstrument stops and reproduci%le reference points #nstruments should %e used se(uentially with $irect straight line access should %e o%tained. ru%%er dam is a prere(uisite and microscopes are an

,<

F.

*ow much to enlarge is a priceless (uestion- *ow large and how much to enlarge is dictated %y the anatomic structure, accessi%ility of the canal and skill of the operator. enlargement limits cleaning, de%ridement, #nade(uate and

disinfection

o%turation while over>ealous preparation leads to iatrogenic pro%lems, unnecessary weaking of tooth and suscepti%ility to fracture, perforations, spatial movement of apical foramen etc. 9arlier 5 guidelines were considered sacrosanct- enlarge a root canal at least . si>es %eyond the si>e of the first instrument that %inds and enlarge a canal until clean white dentinal shavings appear in the flutes. *owever, these are not considered valid criteria today %y any researcher or clinician. 1tudies have shown that only enlargement upto .B to 4B num%er permits effective irrigation though this may not %e always possi%le. 'hus enlarging the root canal should %e done %ased on myriad factors to achieve %oth %iological and mechanical o%&ectives. Techni*"e! 'o% p%epa%ing %oot canal!: Apical co%onal techni*"e Co%onal+apical techni*"e

#n which the :; is esta%lished #n which the coronal portion of the canal and the full length of the canal is is prepared %efore determining the :; then prepared. e.g. Advantages: ,?

1tandardi>ed. 1tep-%ack. 6oane 8%alanced force) +llows early de%ridement of the coronal part of canal which may contain %ulk of organic de%ris. 9na%les %etter and deeper penetration of irrigant early in the preparation. 'ends to shorten the effective :; and determining the :; after such enlargement will reduce the pro%lem of its alteration during preparation. +llows %etter control over apical instrumentation. 6educes the piston-in-acylinder effect responsi%le for de%ris extrusion *owever, there are risks of ledging, %lockage and perforation.

e.g. 7 Apical co%onal +) #tandardi,ed preparation: $one in narrow canals with circular cross-sections. ,@ 1tep-down. $ou%le-flare. Crown-down pressureless. Canal-master

:; determined. 1mallest instrument ad&usted to :;. 1e(uentially enlarged entire canal. O%turation with silver cone. Di!a# antage!: 6isk of extrusion of de%ris. +lteration of :;. Dertical root G is overinstrumentation is carried out. 0nlikely to de%ride complex canals !ossi%ility of canal deviation.

'o overcome deficiencies a hy%rid techni(ue consisting of reaming the apical third and filing the coronal twothird has %een recommended with coronal preparation o%turated with gutta percha. #tep bac- preparation: :; determined. #nstrument that fills to correct :; is chosen.

,E

9nlarge . Jo"s larger at the apex. 6educe the :; length %y ,mm and continue to enlarge canal = flaring. 6ecapitulate, irrigate for patency. Coronal preparation done using GG$. Di!a# antage!: 2) 9xtrusion of de%ris. +pical %lockage. +lteration of :.;. 'endency for canal deviations. &oane 'echni*ue ( alanced Force)

'hree of its main features are7 Canals are prepared to predesigned dimensions of which . are recogni>ed and are 4<, ?B and EB according to the si>e of apical preparation. 'hese dimensions refer to the si>e of the file used at the third step %ack. ,F

9ach step-%ack from the master apical file at the !$; is B.<mm shorter than the previous one. 'his is termed as the 2apical control >one3.

Clex 6 files are used. :; determined to the radiographic apex with the largest file placed without force. 'his helps in determining the selection of predesigned preparation 84<, ?B, EB).

Co%onal apical techni*"e +) #tep down techni*ue:(Marshall and Papus) #s a modification of the step-%ack techni(ue. !repare the coronal portion to ,?-,E mm =%eginning of the curve with anti-curvature filling. GG$"s are used to refine the coronal part. $etermine :;. 0sing step-%ack, complete the apical preparation. Di!a# antage!:

5B

;edge formation. +pical %lockage. !erforation. 'hrough this techni(ue overcomes most of the disadvantages of the

step-%ack techni(ue. 2) "ouble Flared 'echni*ue: $etermine :.;. !repare till ,4 mm = coronal to the curve. #rrigate and clean. Go ,mm deeper, maintaining instrumentation coronal to the curve and file. +gain ,mm deeper. Continue till :; is achieved. !repare using step-%ack In#ication!:

5,

Cor straight canals or Cor straight portions of curved canals.

55

Cont%a in#ication!: #n calcified canals. #n young permanent teeth with open apices.

.) !rown-down pressureless techni*ue: Cor curved canals without causing deviations. 6otary action is used to cut dentine with the apical part of files. $etermine :; and prepare till G .< till ,?mm 8widen the canal with smaller files first) 6educe si>e K go down and enlarge till apex. Change to G4B K repeat. /) !anal master techni*ue: #ts aim is to aid the maintenance of curves using a rotary instrument designed so that only the apical ,-5mm is engaged in dentine removal. A# antage!: +voids the need for recapitulation.

5.

'he apical B.@<mm of the hand instrument is safe-ended to facilitate maintenance of canal curvature. $etermine :; !repare to the %eginning of the curve 0se canal master in step-%ack fashion.

,-b%i#+techni*"e +n amalgamation of various techni(ues can %e used com%ing different desira%le aspects and convenience to achieve thorough %iomechanical preparation. S$ECIA. CONSIDERATIONS IN CURVATURES+CONVENTIONS AND COM$.ICATIONS C"% at"%e+The Engine O' Co&plication! +s an instrument is curved, elastic forces develop internally. 'hese forces attempt to return the instrument to its original shape and are responsi%le for straightening of the final canal shape and location. 'hese internal elastic forces 8i.e. restoring forces) act on the canal wall during preparation and influence the amount of dentin

54

removed. 'hey are particularly influential at the &unction of the instrument tip and its cutting edges. 'his region is the most efficient cutting surface along an instrument, and when activated %y the restoring forces, it removes more tissue. 'his phenomenon is responsi%le for apical transportation and its conse(uences. /0 $%e+c"% ing o' in!t%"&ent!1 20 Anti+c"% at"%e 'iling #s the controlled and directed preparation into the %ulky=safety >ones and away from the thinner portions or danger >ones of the root structure, where perforation or stripping of the canal walls can occur. 0eed: #t is a method of applying instrument pressure so that shaping will occur away from the inside of the root curvature in the coronal and middle ,=.rd of a canal. :as descri%ed %y +%ou-6ose, Crank and Glick. 'hey emphasi>ed that during shaping procedures, files should %e pulled from canals as pressure is applied to the outside canal wall. 'his dimensionally

5<

applied pressure, prevents dangerous midcurvature straightening in curved canals. A# antage!: #t maintains the integrity of canal walls at their thin portion and reduces the possi%ility of root perforation = stripping. Maintains digital control over the instrument and the preparation of the curved canal is used. a1 Ra#ic"la% acce!! :as first promoted %y 1childer. 'his creates space in the more coronal regions of the canal which enhances placing and manipulating su%se(uent files as it increases the depth and effectiveness of irrigation. b1 May %e accompanied %y rotary instrument = circumferential filing. Re e%!e Fla%ing ( $%e+'la%ing #s the presently preferred development of flaring where%y the coronal portion of the preparation is flared %efore the completion of the apical portion.

5?

#n the standard flaring techni(ue, the apical portion of the tooth is completed %efore any filling is performed.

#n the reverse flaring and aspects of preparations are carried out. Minimal filling at the tip enlargement of the coronal part apex is completed apical flaring.

A# antage!: #rrigants are allowed to get down the canal earlier and farther to produce cleaning. #n curved canals, more effective preparation of the apical area is provided when the file has fewer o%structions in the coronal part. Ciles, pluggers, filling material can penetrate to the apex more easily three a larger orifice. In!t%"&ent! "!e# 'o% Re e%!e Fla%ing B.4 taper instruments 8Ji-'i). MeL#M +vaila%le in < instruments A 5<.B.5< at $o 8B.B., B.B4, B.B4<, B.B<, B.B<< =mm A tapers).

5@

0sed in gear reduction handpieces at .4B rpm. Made from Ji-'i in *-style. $esigned %y Mac1padden. 6itano Ciles. *and instrument with *-configuration with several tapers. Made in lengths shorter than 5,mm. +lso for curved canals copious irrigation is

mandatory. < 1afe sided instruments and files dulled on one side can %e employed or Ji'i instruments can %e used. ? 9xtremely narrow canals re(uire the use of smaller instruments and mid si>e Golden Medium files along with chemical chelators etc. @ $ou%le curved or %ayonet shaped canals-*ere after the apical foramen has %een cleaned and shaped the middle third curve is eliminated with *-files taking care not to strip and perforate and then regular instrumentation carried out. 'his is done %y introducing a small

5E

*-file at the &unction of middle an apical third and filing away inner portion of the curve. E $ilacerated roots re(uire coronal flaring and then using flexi%le and safe sided instruments. $%epa%ation "!ing A"to&ate# De ice! o% Mechanical In!t%"&entation 'he lure of faster, easier and more efficient cleaning and shaping has spawned various types of automated devices. 'here is literally a revolution going on in automated devices with new %rands and techni(ues introduced everyday. Di!a# antage!: ;oss of tactile sense and lack of control of where and how much dentine is removed from the root canal wall. Cla!!i'ication: 1) &otar% 0sed in slow running standard handpiece e.g., GG$, !eeso, Canal master A used only in the structure part. ;atest addition is the new ,?7, gear reduction handpiece Ji'i matic at .BBrpm.

5F

Ji-'i files are used. 0sed for preparation of severely curved canals. Ciles are manufactured with an off-centre tip that facilitates negotiating around curvatures and ledges.

Myriad nickel titanium generation of instruments and devices like !roCile, !ro'aper, Muantec, ;ight 1peed, O1 etc have %een introduced.

II0 -

&eciprocal *uarter turn: 'his uses a special handpiece that contrarotates the instrument three FBI. 9.g. Giromatic 8,F?4). 9ndocursor. 9ndolift A has a vertical component in addition to the rotation.

Di!a# antage! o' A"to&ate# *and instrument re(uires the same amount of time as automated. Clare preparation with hand instrument tends to remove de%ris from within the canal system than automated.

.B

+utomated is difficult to use in the most post regions of the oral cavity.

'here is greater propensity for the automated system to produce >ipped canals, ledges etc.

+ controlled power-assisted system designed to eliminate the original pro%lems encountered %y Giromatic appeared in ,FE,.

$ynatrak 0ses stainless steel instruments with increased flexi%ility consist flute depth and curved canals and rounded tip to minimi>e and control ledges, >ips, etc.

III0 -

2ertical Canal finder. *as a vertical movement of .-, mm and free rotational movement. #nstrument used is canal master 8*-file with a safe ended tip). Canal ;ender. Dertical movement of B.4-B.E mm

. instrument N-file with a safe ended tip.

.,

*-file. 0niversal file 8flexi%le *-file with a safe-ended tip). 'here are few %asic guidelines for rotary shaping7 5) 1traight line access. .) 9stimating the cross-sectional diameter. 4) Camilari>ing with specific root canal anatomy and seating. <) 1peed and se(uencing with gear reduction and electric motor and using large to small files. ?) ;u%rication and a light or feather touch e(uivalent to using sharp lead pencil. IV0 V0 &andom 9.g. 9xcali%ur. N-files. 5B,BBB-5<,BBBrpm. #onics 9ndostar <

.5

9ndosonic +ir .BBB

..

A# antage!: VI0 6educes fatigue and stress during preparation. 3ltrasonics $ie3oelect%ic - Most common - Jo *5O cooling - May produce apical widening and ledges in curved canals. A# antage!: Cleaning effect is %y acoustic streaming.

Magneto!t%icti e - 6e(uires *5O cooling

I0 Mic%ob%"!he!: +dvancement in small wire technology, in&ection molding, %ristle materials and %ristle attachment have ena%led the creation of endodontic micro%rushes. 'hese can %e activated %y rotary or ultrasonics and are primarily intended for finishing root canals. 'hey contain ,?mm %ristle with $B diameter of B.4, B.<, B.? and B.E. 6otary %rushes are run at a%out .BB rpm while ultrasonic ones are run with JaOCl and ,@O 9$'+.

.4

II0 .a!e%!: #n ,F@,, :eichman and /ohnson were pro%a%ly the first to suggest the use of laser in endodontics. #nitially Jd7-+G and CO5 lasers were used. 'hey are mainly advocated as a coad&unct for micro%ial reduction and to readily root surface. 6ecently, argon lasers, excimer laser, holmium7-+G laser, diode laser and er%ium 7 -+G laser with various wavelength have %een investigated. 'hese can %e delivered using a optical fi%re 5BB-4BBPm diameter e(uivalent to G 5B-4B file cooling systems with air water sprays may accessory this. ;evy compared the laser techni(ue with a step %ack procedure finding the form %etter. 'he techni(ue was7 ,. irrigation. 5. ,<Bmilli &oules. .. Ci%re optic is inserted to :7; and enlargement done circumferentially first apically tehn moving coronally to enlarges upto G?B instrument. !reparation %egins with the laser energy level set at 9nlarge apical region with G ,< file K copious

.<

'he avg. time to complete the preparation was , minute. +lthough hand instruments left some walls untouched and smear layer was found covering walls, laser preparation showed remarka%le cleanliness. *owever ;evy also found melting of dentin and closing off of tu%ules and melting of silicon fi%er optic. 1imilarly various other lasers have %een experimented with. Currently wavelength at 0D plaster appears promising. 'he +rC excimer laser at ,F.nm and LeCl 8.BEnm) laser appear well suited. 1econd harmonic alexandrite laser 8.@@nm) also shows promise. Mainly today lasers are advocated for cleaning or sterili>ing the root canal and shaping is a modality under investigation. 'he laser is excellent at satisfying the root canal. Cuture promises of efficient preparation, sterile canals, shorter treatment time and minimum effort with maximum result are fuelling laser research at %reak neck speed. !otential disadvantages of cost, safety, coolants, effective control etc have to %e overcome. ;asers have a definitive future in endodontics only the direction has to %e delineated. Non in!t%"&ente# %oot canal clean!ing:

.?

;ussi et al introduced devices to cleanse the root canal without instrumentation. 'he ,st device reported in ,FF. consisted of a Qpump" that inserted an irrigant 8like JaOCl) creating %u%%les and cavitation that loosened de%ris. 'his process was followed %y negative pressure 8suction) that removed de%ris. More recently a smaller new improved machine was introduced. +lso o>one pumps like heali>ae have %een veritified in cleansing root canal systems. Finali3ing the p%epa%ation: +fter cleaning and shaping %y any of the mind %aggling variety of techni(ues it is necessary to finagling the preparation and manage the smear layer. 'hrough a controversial topic, if divided to %e removed, smear layer removal and final finishing is accomplished cutter with 9$'+ and ultrasonics, 9$'+ and micro%rushes with JaOCl or other newly availa%le chemicals for its management to provide a root canal now ready for o%struction.

.@

CONC.USION: 2'ry cleaning a house after a wild party.3 Cleaning and shaping root canals is &ust more difficult. 'he complex anatomy, convoluted curvatures, non-negotia%le interconnections and hard to reach nooks and crevices make for a challenging and daunting task. 2!urity is considered the hallmark of sanctity3. O%taining clean and sterile root canals is the secret of good healing. +lso the revolution of automated endodontic com%ined with advances in hand instrumentation have changed the long we shape and clean canals. 'hus com%ining the art of proper shaping and the science of immaculate cleaning will culminate in ideal %iomechanical preparation that will lay the foundation for ideal o%turation and healing and ultimately successful therapy.

.E

Bibliog%aph-: ,. 9ndodontics A 1tock, Gula%ivala, :alker, Goodman. 5. 9ndodontics A #ngle and akeland. .. 9ndodontic practice A Grossman, Oliet, 6io. 4. 9ndodontics A Cohen and urn.
<. $CJ+.

.F