Cleaningg and Shaping

p g

PER 811/812

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 Cleaning and Shaping

What is this?

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 Cleaning
The removal of all inorganic debris,
organic substrates and related
microorganisms from the root canal
system

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 Shaping
The development of a suitable shape in
each root canal to facilitate
disinfection irrigation and
disinfection,
placement of a permanent three-
three-
di
dimensional
i l filling
filli

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 Cleaning and Shaping
Objectives
Remove infected soft and hard tissue

Give disinfectingg irrigants

g access to the
apical canal space

Develop a continuously tapering conical

form in the root canal preparation
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 Cleaning and Shaping
Objectives::
Objectives

Make the canal narrower apically,

with the narrowest cross-
cross-sectional
diameter at its terminus

Never transport the foramen

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 Two Types of Cleaning

Mechanical
Hand files
Engine--driven files
Engine

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 Two Types of Cleaning

Chemical
Irrigation solutions
e.g. Sodium hypochlorite (NaOCl
(NaOCl))
EDTA

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 Chemo-mechanical
Chemo-
instrumentation

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 Principle of Cleaning
Instruments contact and plane the wall
loosen debris

Chemical action of irrigants further dissolves

organic remnants and destroys
microorganisms

Irrigants then flush the loosened and

suspended
d dddebris
b i ffrom th
the canall space
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 Irrigation Essential!
Canals cleaned using
instrumentation only
left 35% or more of the
canals surface area
canals
unchanged

Peters, et al 2004
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 Techniques of Shaping

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 Two Major Concepts
Step Back
Create taper working
from apex to
coronal 1/3

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 Two Major Concepts
Crown Down
Create taper working
from coronal to
apical 1/3

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 Basic Technique (UB)
Establish estimated length
Negotiate the canal and establish
patency
t
Establish workingg length
g (WL)
( )
Instrument at WL to size 20 or 25
Fl
Flare coronall portion
i with
i h Gates
G
Glidden burs (GG)

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 Basic Technique (cont
(contd)
d)
Enlarge the body of the canal with
sequential filing

**Enlarge
Enlarge the apical third (step-
(step-back)

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 Cleaning and Shaping -Detail
Estimated working length

Determined from pre-pre-operative

radiograph
g p
Endodontic ruler
Pl
Place file
fil (with
( i h stopper)) against
i film
fil
((Digital
g use ruler function))
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 Measuring length

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 Establishing Working Length
(WL)

Pre--Op
Pre WL
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 Establishing Working Length

Adjusted working length film

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 Steps for Cleaning and Shaping
Access
Appropriate to tooth you are
working
ki on

(Stock,Christopher.Endodontics,3rdEdition.MosbyLtd.,122004.).

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 Negotiating the Canal

Flood access cavity

with irrigating
solution

VERY
IMPORTANT!

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 NEVER WORK IN A DRY
CANAL!!!

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 Negotiating the Canal

"Slip
Slip and slide
slide" the
instrument
Never
N fforce the
h
instrument

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 Pathfinder Instrument

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 Negotiating the Canal
Use the path
path--
finding file to
the estimated
working length
andd just
j past to
establish
patency

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 Patency
Patent
Patent
def: open, as a doorway or a
passage.

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 Negotiating the Canal
Place the path
path--
finding file to
the estimated
working length

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 Initial Preparation
Filing Reaming

Use 0.5 to 2 mm Quarter turn

fili strokes
filing k and
d pull
ll

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 Initial Preparation

Do not screw the file

y
in the canal. They
may break!

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 Initial Preparation
p

Repeat procedure with next

size files
Enlarge sequentially to #20
or #25 file to WL
Check patency with #10

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 Initial Preparation
p

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 Initial Preparation

Cl
Clean each
h
instrument after
use

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 T h i
Technique Summary
S
Working Length
Initial preparation
1st Recapitulation
Gates-glidden
Gates glidden
Preparation of body
2 dR
2nd Recapitulation
it l ti
Final apical preparation

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 What is Recapitulation?
The sequential reentry and reuse of
each previous instrument.
R
Recapitulation
it l ti does
d nott only
l confirm
fi
patency; it is the careful, rhythmic
sequencing of the series of files and
reamers to create the shape p that
achieves the mechanical objectives

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 Recapitulation
Also removes debris built up ON THE
WALLS

Patencyy only
y ggives yyou a channel
through the debris

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 Technique Summary
Working Length
Initial preparation
1st Recapitulation
Gates--glidden
Gates
Preparation of body
2nd Recapitulation
Final apical preparation
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 Gates Glidden
Start with #2 GG
Cut on outstroke only
Do not force bur
Never more than halfway into
canal
Cannot use past curve
Irrigate
g and check p
patency
y
Repeat sequentially with #3GG
then #4GG stepping back 1-
1 -2
mm
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 Gates Glidden Sizes
GG #2 = Size 70 file

GG #3 = Size 90 file

GG #4 = Size 110 file

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 Gates Glidden

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 Technique Summary
1. Working Length
2. Initial preparation
3. 1st Recapitulation
4
4. Gates--glidden
Gates
5. Preparation of body
6. 2nd Recapitulation
7
7. Final apical preparation
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 Preparation
p of the Body
y of the Canal

Serial stepp back ppreparation

p
From last instrument, (the #20 or #25
file) set stops short in -1 mm
increments from file sizes #30 to # 80
Example :
WL = 24mm
File # 25 --->
---> 24 mm
File # 30 --->
---> 23 mm
File # 35 --->
---> 22 mm

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 Preparation of the Body of the Canal

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 Summary
Technique Summary
1. Working Length
2. Initial preparation
3. 1st Recapitulation
4
4. Gates--glidden
Gates
5. Preparation of body
6. 2nd Recapitulation
7
7. Final apical preparation
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 Technique Summary
1. Working Length
2. Initial preparation
3. 1st Recapitulation
4
4. Gates--glidden
Gates
5. Preparation of body
6. 2nd Recapitulation
7
7. Final apical preparation
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 Final Apical Preparation
Enlarge the apical
preparation to a size
appropriate for the canal.
Each canal is different
There are NO pre-
pre-set sizes!
The Master Apical
p File
(MAF) is the largest file
that easily goes to and
stops at the WL when
only gentle pressure is
used

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 Final Apical
p Preparation
p

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 Summary
-Access
-Patency with # 10
-Apical enlargement #15
#15--#25
-Coronal /middle flaring with gates
-Body prep #30-
#30-#80
-Final apical prep #30 -#40

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UB School of Dental Medicine