Faculty of Dentistry

Endodontic Department
ENDODONTIC CLINIC MANUAL

NAME:
NUMBER:
ACADEMIC YEAR:
 ENDODONTIC CLINIC MANUAL

Description:
This clinic manual contains a brief review of treatment techniques along
with a detailed description of procedural guidelines. All students should
review the sections before initiating treatment.
Rationale:
Providing patient treatment in a new clinical discipline is quiet challenging.
Although the stress associated with your first few experiences cannot be
completely eliminated, it can be greatly reduced if you are familiar with the
procedures that you will be expected to follow.
 
Intended learning outcomes:
The student should be able to complete the following tasks:
I. Diagnose endodontic pathosis (both pulpal & periapical).
II. Assess case difficulty.
III. Set up the appropriate treatment plan for each endodontic disease
entity.
IV. Arrange instruments and materials in such a manner that efficient,
aseptic Endodontic treatment can be provided.
V. Control pain & / or swelling before, during or after treatment.
VI. Isolate any tooth that requires Endodontic treatment.
VII. Prepare an access preparation that allows free passage of instruments
to the apical 1/3 of the root canal.
VIII. Prepare the appropriate roots to the appropriate preparation sizes.
IX. Obturate instrumented canals with three-dimensional fills.
X. Expose and document accurate, useful radiographs of treated and
completed cases.
XI. Complete and submit the necessary documented clinical requirements
in the allocated time.

 
 
 
 
 
 

 
 INFECTION CONTROL GUIDELINES

Before Treatment

Hand washing:

§ Before and after treating each patient, after handling contaminated

items, after blowing your nose or using the toilet, and before handling
food.

§ Remove all jewelry from hands and forearms (rings, watches,

bracelets).

§ Fingernails should be kept short and cleaned regularly.

§ Nail polish & artificial fingernails harbor microorganisms and may

not be worn.

§ Wash hands with cleanser for 3 minutes using anatomic scrub

technique.

§ End with a cold-water rinse to close the pores & dry with paper
towels.

§ Cuts and sores on hands must always be covered.

§ Apply clean plastic barriers to pull-handles, light handles, control

switches, evacuation hoses and holders, air/water syringes and holders

§ Open sterile trays and instrument packages immediately prior to use

and bring only those items necessary for treatment into the operatory.

During Treatment

§ Exam gloves: always wear gloves when touching blood, saliva or

mucous membranes, and when examining all oral lesions.

§ Over gloves: are to be worn over contaminated gloves when it is

necessary to handle equipment or supplies.

§ Masks: Surgical masks must be worn to protect from spatter of blood

and saliva.

§ Protective Eyewear: Safety glasses with side shields or face shields

 
 are to be used when splashing or spattering of blood and saliva is
likely.

§ Clinic Jackets: long sleeve, cuffed clinic jackets are worn to protect
the user from injury and the spatter of body fluids & change daily or
more often if visibly soiled.

§ Handling of sharp instruments and needles: DO NOT recap, bend,

break or manipulate used needles by hand. Dispose of used needles,
scalpel blades, and other sharp items in puncture-resistant container.

§ Avoid touching unprotected switches, handles or other equipment

with contaminated gloves.

§ Prepare in advance for the procedure by obtaining all necessary

supplies and equipment.

After Treatment

§ Remove contaminated attire (gloves, mask, and eyewear) & clean

hands.

§ Discard disposables (suction tips, air–water syringe tips, plastic

wrappings) along with other patient contaminated waste.

§ Use a hemostat to place used sutures, blades and needles into sharps
container.

§ Remove gross debris (i.e., dental materials, gauze, cotton rolls,

sharps) from instruments trays, instruments, and replace tray cover.

§ All heat tolerant items (instruments & hand pieces) are cleaned &
packed for sterilization.

 
 SELECTION OF CASES

Case difficulty assessment is to be done before treatment starts. In general,

the categories are:

Easy cases: The case is an anterior or premolar tooth that has no

pathological or anatomical characteristics likely to result in compromised
treatment or prognosis. Dental students can treat these cases.

Moderate cases: The case has pathological or anatomical characteristics,

which require intermediate operator skills in Endodontics in order to avoid a
compromised treatment or prognosis. Included are all molar teeth, any
calcified tooth or one with moderate canal curvatures and medically
compromised patients. Competent dental students under close faculty
supervision can treat these cases.

Difficult cases: The case has pathological and anatomical characteristics,

which require specialist level operator skills and extensive clinical
knowledge. These cases will not be treated by dental students, and should be
referred to experienced endodontic specialists.

A STEP-BY-STEP DIAGNOSTIC GUIDE

CASE HISTORY

• Medical History: The medical history is brief, but very important.

Any systemic disease(s) present must be noted. Any allergies must be
noted, and medications taken must be listed with dosage and
frequency. The need for premedication with antibiotics & / or
analgesics should be also determined.

• Dental History: should include any pertinent information related to

the tooth that might indicate why root canal treatment may be
necessary. Any previous restorations should be listed. This includes:
crowns, amalgams, bridges, RCT, composites, and temporaries. If an
exposure, pulp cap, pulpotomy or pulpectomy has been accomplished,
it should be noted.

• History of chief complaint: should include data on the previous

history of pain, including duration, intensity, spontaneous or

 
 provoked, and when it occurred. Any history of trauma and the
approximate date of occurrence should be noted. If the tooth is
discolored, indicate and describe the discoloration and possible cause.

CLINICAL EXAM

• The clinical exam will consist of several steps. It starts with an extra-
oral exam and proceeds to specific tests, which determine possible
Endodontic origin of a specific problem.
• Initially, the patient's face should be inspected for signs of asymmetry
due to swelling. The lymph nodes associated with drainage from the
oral cavity should be palpated to identify enlarged or tender nodes.
• Intra-orally, the area in question should be observed for vestibular,
palatal, and/or lingual swelling. Presence of swelling, as well as the
presence of a sinus tract, is to be noted.
• Percussion and palpation tests will be done for all teeth in question.
• The depth of the gingival sulcus on the mesial, facial, distal, and
lingual/palatal aspects of the tooth is to be measured and recorded, as
well as the degree of tooth mobility.
• When appropriate, an electric pulp test and thermal test are done.
• The tooth should be examined for presence of discoloration and
transmission of light. A discoloration or darkness to transmitted light
should be noted.

RADIOGRAPHIC EXAMINATION

• All Endodontic x-rays must be taken on number 2 periapical films.

The apex and crown of the tooth in question and the two adjacent
periapical areas (mesial and distal) should be clearly defined. The
tooth to be treated should be centered on the film. 
• Pre-op / Diagnostic and Final x-rays should be taken with a film
holder to insure consistent positioning and angulations. 
• If a periapical lesion is associated with the tooth requiring root canal
therapy, the entire outline of the periapical lesion should be defined on
the film.
• All x-rays should be saved; however, the pre-treatment, working
length, fitted G.P., and one final x-ray are mandatory for case
recording.

 
• Manual film processing guidelines
When hand processing in the quick developing boxes, using the
following minimum times
- Developing: at least 30 seconds, 45-60 seconds is best.
- Water rinse
- Quick Fixing: fixing at least 1 minute is needed before viewing the
image (a poorly quick fixed x-ray film will appear green or
clouded).
- Complete Fixing requires approximately 10 minutes.
- Final water rinse: when films are taken chair-side they should be
placed in a cup of water to complete the final wash. This also
requires a minimum of 10 minutes (a poorly washed film will turn
brown and opaque over time)

RADIOGRAPHIC INTERPRETATION

• The Coronal findings should describe existing caries, restorations,

fractures, pulp chamber status, visible pulpotomy, sclerotic tracts,
deep bases, etc. A pulp exposure is usually not visible on a
radiograph, but if suspected, list as deep caries with possible pulp
exposure.
• The Radicular findings should give your interpretation of the status
of the canals. Straight, visible canals; sclerotic, moderately curved,
severely curved in apical third; visible canals half way to apex; and,
canals not visible in apical half are examples of possible findings.
• The Periradicular (osseous) findings will include apical lesions with
a brief description. Examples are: apical thickening of PDL, Changes
in the osseous structure, other than apically, should also be noted. This
may include periodontal bone loss, lateral lesions associated with
lateral canals, changes around root fractures.

PULPAL DIAGNOSIS

• Reversible pulpitis implies that the pulp tissue will heal and that RCT
will not be necessary.
• Irreversible pulpitis means that the pulp is vital but is damaged to
the extent that it will not heal.
• Necrosis means that only necrotic tissue will be found throughout
most of the root canal system.

 
• Devitalization implies a normal pulp that is being extirpated for
restorative reasons.

PERIAPICAL DIAGNOSIS

• If facial swelling occurs, the patient has a cellulitis.

• The presence of pus or cellulitis associated with radiolucency is
pathognomonic for a Phoenix abscess.
• Percussion sensitivity relates to apical periodontitis, even when there
is an absence of radiographic apical changes.
• An acute periapical abscess has acute symptoms associated with it
and pus is released through the canal or from the apex when the tooth
is opened.
• A draining fistula or sinus tract is pathognomonic for chronic apical
periodontitis.

RESTORATIVE EVALUATION

• Each case should be evaluated carefully for its potential restorability.

• Crown lengthening and surgical exposure of margins should be done
prior to endodontic treatment.
• To facilitate tooth isolation, badly broken down teeth can be
reinforced with bands or built up using the appropriate restoration.

 
 RUBBER DAM ISOLATION

All Endodontic procedures must be completed using adequate isolation

methods in order to provide aseptic treatment, prevent leakage of irrigating
solutions into the patient's mouth and avoid ingestion of foreign materials.

Rubber Dam materials

• Latex.
• Non-latex: made from silicone, for patients allergic to latex.

Colors

• Light colors enable the vision of radiographic films.

• Dark colors provide better contrast for the eyes.

Thickness

• Light / medium / heavy / extra heavy.

• Proportional to tear strength.

Frames

• Plastic
• Metal: can interfere with radiographic interpretation.

Clamps

The following examples of clamps can used for effective isolation of

Endodontic cases, unless circumstances dictate otherwise:

For Incisors For canines / premolars

 
 For large molars For small molars

Rubber Dam Punch

• For creating a hole in the rubber dam sheet.

• Use the largest hole on the punch for molars, a medium size hole for
premolars and a small one for anterior teeth.

Rubber Dam Forceps

For application and removal of the clamp

PLACEMENT TECHNIQUES

• As a single unit
• Clamp first
• Sheet first
• Bow technique

 
 ACCESS CAVITY PREPARATIONS

PURPOSE OF ACCESS PREPARATION

• An appropriate, adequate and sufficient Endodontic Access is the

"Key to Endodontics." Errors in access preparation will result in
errors in preparation and obturation.
• The goal should be to provide straight-line access to the canal
orifice(s) with minimum required removal of tooth structure.
• The access must remove all remnants of the pulp tissue in the pulp
horn area to prevent staining of dentin.
• All caries and stained dentin must be removed for a proper access.
Softened areas provide routes of entry under temporary closure that
can permit recontamination of the internal spaces between visits.

STAGES OF ACCESS PREPARATIONS

• Coronal access: cavity cut in the crown to provide access to root

canal orifice(s).
• Radicular access: flaring the straight portion (coronal 2/3 or 1/2) of
the root to provide access to the point where the canal starts to curve.
Usually done with Gates Glidden drills.

Maxillary Central Incisors

The morphology of the chamber is triangular in design with high pulp horns
on mesial and distal aspects of the chamber. The access opening is triangular
in shape. The outline form of the access cavity changes to a more oval shape
as the tooth matures and the pulp horns recede because the mesial and distal
pulp horns are less prominent. A lingual ledge or lingual bulge is often
present (Figure A).

Maxillary Lateral Incisors

The chamber is similar to central incisors but proportionately smaller. The

access opening is triangular, similar to maxillary central incisors, and
proportionately smaller in the middle third of the lingual surface of the tooth.
A lingual ledge may also be present but is usually not clinically significant.
If a lingual shoulder of dentin is present, it must be removed before
instruments can be used to explore the canal (Figure B).

 
 Maxillary Canine

The chamber shape is usually elliptical or oval. The access opening is oval
on the lingual surface and should be in the middle third of the tooth, both
mesiodistally and incisal-apically. Because of its shape, the clinician must
take care to circumferentially file the access opening labially and palatally to
shape and clean the canal properly. A lingual edge may be present but is
usually not clinically significant (Figure C).

Maxillary First Premolar

The chamber is usually oval and maintains a similar width from the occlusal
level to the floor, which is located just apical to the cervical line. The palatal
orifice is slightly larger than the buccal orifice. In cross section at the CEJ,
the palatal orifice is wider buccolingually and kidney-shaped because of its
mesial concavity. The access opening is oval on the occlusal surface and
should be in the middle third of the tooth, both mesiodistally and
buccolingually. Buccal and lingual cusps should not be undermined during
access opening preparation. The buccal pulp horn usually is larger. There are
often ledges of calcification on the buccal and/or lingual walls just coronal
to the orifice that may inhibit straight-line access to the canal system (Figure
D).

Maxillary Second Premolar

The chamber morphology is usually oval. A buccal and a palatal pulp horn
are present; the buccal pulp horn is larger. The access opening is oval on the
occlusal surface and should be in the middle third of the tooth, both
mesiodistally and buccolingually. The buccal and lingual cusps should not
be undermined during access opening preparation. The single root is oval

 
and wider buccolingually than mesiodistally, so the canal(s) remains oval
from the pulp chamber floor and tapers rapidly to the apex (Figure E).

Maxillary First Molar

The chamber is usually triangular or square, and the access opening is

triangular to slightly square on the occlusal surface. Preparation of the
access should be distal to the mesial marginal ridge, within the middle one-
third buccolingually, and mesial to the transverse ridge. Care should be
taken not to undermine the transverse ridge during preparation or to extend
the access opening so far mesially as to undermine the mesial marginal
ridge. The palatal canal orifice is centered palatally, the distobuccal orifice is
near the obtuse angle of the pulp chamber floor, and the main mesiobuccal
canal orifice (MB-1) is buccal and mesial to the distobuccal orifice
positioned with- in the acute angle of the pulp chamber. The second
mesiobuccal canal orifice (MB-2) is located palatal and mesial to the MB-1.
A line drawn to connect the three main canal orifices—MB orifice,
distobuccal (DB) orifice, and palatal (P) orifice—forms a triangle known as
the molar triangle (Figure F).

Maxillary Second Molar

This shape of this chamber is usually less triangular and more oval than the
maxillary first molar. The access opening is triangular, but becomes more
straightened in a mesiobuccal- palatal direction. Preparation of the access
should be distal to the mesial marginal ridge, within the middle one- third
buccolingually, and mesial to the transverse ridge. Care should be taken not
to undermine the transverse ridge during preparation. The opening begins
slightly more distally than in the first molar because of the location of the
canal and root structure. When four canals are present, the access cavity

 
preparation of the maxillary second molar has a rhomboid shape and is a
smaller version of the access cavity for the maxillary first molar. If only
three canals are present, the access cavity is a rounded triangle with the base
to the buccal. As with the maxillary first molar, the mesial marginal ridge
need not be invaded. Because the tendency in maxillary second molars is for
the distobuccal orifice to move closer to a line connecting the MB and P
orifices, the triangle becomes more obtuse and the oblique ridge is normally
not invaded. If only two canals are present, the access outline form is oval
and widest in the buccolingual dimension. Its width corresponds to the
mesiodistal width of the pulp chamber, and the oval usually is centered
between the mesial pit and the mesial edge of the oblique ridge (Figure G).

Maxillary Third Molar

The chamber is usually less triangular and more oval in shape than the
maxillary second molar. The access opening is somewhat triangular, but
tends to rotate as the DB canal orifice becomes more aligned with the palatal
canal. Preparation can begin in the central fossae and proceed in a
buccopalatal direction. The access cavity form for the third molar can vary
greatly, because the tooth typically has one to three canals that would require
the access preparation to be anything from an oval that is widest in the
buccolingual dimension to a rounded triangle similar to that used for the
maxillary second molar. The MB, DB, and P orifices often lie nearly in a
straight line. The resultant access cavity is an oval or a very obtuse triangle
(Figure H).

 
 Mandibular Central and Lateral Incisors

The chamber shape is triangular to oval in design, with high pulp horns on
mesial and distal aspects of the chamber in younger patients. A lingual ledge
or lingual bulge may be present, which restricts visualization of the canal
orifice and prevents straight-line access of the canal system. Often, the
access opening must be extended more lingually in order to obtain straight-
line access to the lingual orifice and the canal system. In addition, all
working length films taken of mandibular incisors should be exposed at a
slight mesial or distal angle to confirm the presence or absence of a second
canal. Due to their small size and internal anatomy, the mandibular incisors
may be the most difficult access cavities to prepare. The external outline
form may be triangular or oval, depending on the prominence of the mesial
and distal pulp horns. When the form is triangular, the incisal base is short
and the mesial and distal legs are long incisogingivally, creating a long,
compressed triangle. Without prominent mesial and distal pulp horns, the
oval external outline form also is narrow mesiodistally and long
incisogingivally. Complete removal of the lingual shoulder is critical,
because this tooth often has two canals that are buccolingually oriented, and
the lingual canal is most often missed. To avoid this, the clinician should
extend the access preparation well into the cingulum gingivally. Because the
lingual surface of this tooth is not involved with occlusal function, butt joint
junctions between the internal walls and the lingual surface are not required
(Figure I).

Mandibular Canine

The morphology of the chamber is usually elliptical or oval, and a lingual

ledge may be present. The access opening is oval on the lingual surface and
should be in the middle one-third of the tooth, both mesiodistally and
incisal-apically. Preparation of the access cavity for the mandibular canine is
oval or slot-shaped. The mesiodistal width corresponds to the mesiodistal
width of the pulp chamber. The incisal extension can approach the incisal
edge of the tooth for straight-line access, and the gingival extension must
penetrate the cingulum to allow a search for a possible lingual canal. As with
the mandibular incisors, butt joint relationships between internal walls and
the lingual surface are not necessary (Figure J).

 
 Mandibular First Premolar

The chamber shape is usually oval or rounded, as is the access opening on

the occlusal surface. As in many other circumstances, above, the access
opening should be in the middle third of the tooth, both mesiodistally and
buccolingually. Whenever possible, the buccal cusp should be preserved
without being undermined during access opening preparation. The oval
external outline form of the mandibular first premolar is typically wider
mesiodistally than its maxillary counterpart, making it more oval and less
slot-shaped. Because of the lingual inclination of the crown, buccal
extension can nearly approach the tip of the buccal cusp to achieve straight-
line access. Lingual extension barely invades the poorly developed lingual
cusp incline. Mesiodistally, the access preparation is centered between the
cusp tips. Often the preparation must be modified to allow access to the
complex root canal anatomy frequently seen in the apical half of the tooth
root (Figure K).

Mandibular Second Premolar

As with the mandibular first premolar, the chamber morphology is usually

oval or rounded, as is the access opening on the occlusal surface.
Additionally, the access opening should be in the middle third of the tooth,
both mesiodistally and buccolingually, and the buccal and lingual cusps
should not be under- mined during access opening preparation. There are at
least two variations in the external anatomy that affect the access cavity
form of the mandibular second premolar. First, because the crown typically
has a smaller lingual inclination, less extension up the buccal cusp incline is
required to achieve straight-line access. Second, the lingual half of the tooth
is more fully developed. Consequently, the lingual access extension is
typically halfway up the lingual cusp incline. The mandibular second
premolar can have two lingual cusps, sometimes of equal size. When this
occurs, the access preparation is centered mesiodistally on a line connecting
the buccal cusp and the lingual groove between the lingual cusp tips. When

 
the mesiolingual cusp is larger than the distolingual cusp, the lingual
extension of the oval outline form is just distal to the tip of the mesiolingual
cusp (Figure L).

Mandibular First Molar

The chamber is usually triangular to square in shape. The access opening is

triangular to slightly square on the occlusal surface, and its preparation
should be distal to the mesial marginal ridge and primarily within the mesial
half of the occlusal surface, keeping in mind that the distal extension of the
access opening should extend into the distal half of the tooth. The access
cavity for the mandibular first molar is typically trapezoid or rhomboid
regardless of the number of canals present. When four or more canals are
present, the corners of the trapezoid or rhombus should correspond to the
positions of the main orifices. Mesially, the access need not invade the
marginal ridge. Distal extension must allow straight-line access to the distal
canal(s). The buccal wall forms a straight connection between the MB and
DB orifices, and the lingual wall connects the ML and DL orifices without
bowing (Figure M).

Mandibular Second Molar

The chamber morphology is usually triangular. The opening of the access is

triangular, but tends to straighten in a mesiodistal direction if two separate
orifices are not present in the mesial root. Preparation should be distal to the
mesial marginal ridge and primarily within the mesial half of the occlusal
surface, although the distal extension of the access opening should extend
into the distal half of the tooth. When three canals are present, the access
cavity is very similar to that for the mandibular first molar, although perhaps
a bit more triangular and less rhomboid. The distal orifice is less often
ribbon-shaped buccolingually; therefore, the buccal and lingual walls
converge more aggressively distally to form a triangle. The second molar
may have only two canals, one mesial and one distal, in which case the
orifices are nearly equal in size and line up in the buccolingual center of the
tooth. The access cavity for a two-canal second molar is rectangular, wide
mesiodistally and narrow buccolingually. The access cavity for a single-
canal mandibular second molar is oval and is lined up in the center of the
occlusal surface (Figure N).

 
 Mandibular Third Molar

The morphology of the chamber is usually less triangular and more oval than
the mandibular second molar. The access opening is also triangular to oval,
with a pulp chamber that tends to be very large and very deep. The anatomy
of the mandibular third molar is very unpredictable, and the access cavity
can take any of several shapes.

 
 WORKING LENGTH DETERMINATION

• The working length determines how far into the canal the instruments
can be placed and worked.
• It affects the degree of pain and discomfort which the patient
experience following appointment by the virtue of over or under
instrumentation.
• If placed within correct limits, it plays an important role in
determining the success of treatment.
• When working length is short, it leads to apical leakage. Moreover,
there is continued existence of viable bacteria that contributes to
periradicular lesion and thus poor success rate.

RADIOGRAPHIC METHOD (INGLE’S METHOD)

Step by step procedure for Ingles method

• Measure the tooth on the properly aligned pre- operative radiograph. 
• Subtract at least 1 mm, which is for safety factor for possible image
distortion or magnification. 
• Set the instrument stopper at this tentative working length. 
• Place the instrument in the canal until the stopper reach the sound
reference point.
• Expose the radiograph.
• On the radiograph estimate the difference between the end of the
instrument and the end of the root (radiographic apex), which ideally
should be 0.5-1 mm.
• If the instrument is over or under extended from this value, adjust
accordingly.
• Set the endodontic ruler at this new corrected length and readjust the
stop on the exploring instrument. 
• A confirmatory radiograph of the new adjusted W.L. is highly
desirable because of the possibility of radiographic distortion, sharply
curving roots and operator measuring errors.
• CONFIRMATORY RADIOGRAPHS SHOUD BE DONE IF
WORKING LENGTH IS CORRECTED BY MORE THAN 1 MM.

 
 CLEANING & SHAPING

• After finishing the access cavity preparation, the pulp chamber should
be irrigated with an adequate volume of sodium hypochlorite diluted
with water in the ratio 1:1.
• Achieve good dryness, and under adequate illumination, locate the
root canal orifice(s) using an endodontic explorer.
• A pathfile file number 10 or 15 adjusted at the provisional working
length (length of tooth at the pre-operative radiograph -1 mm) is used
to confirm the patency of the canal(s).
• The coronal third of the canal is flared with Gates Glidden drills size 2
or 3 or 4 (according to canal diameter).
• Preferably a larger file (number 20 or 25) is inserted in the canal at the
provisional working length (PWL) and a radiograph is taken.
• Working length is (WL) adjusted accordingly to be within 1 mm from
the radiographic apex.
• Apical preparation is done using flexible k-files at the correct WL in a
watch winding motion (30-60 degrees clockwise and counter
clockwise).
• Start with the initial file, which is the largest file that reaches WL and
binds (does not rotate easily).
• Work with successive files using the same motion until you reach the
master apical file (MAF).
• The file is changed when it rotate freely in the canal.
• Size of MAF depends on canals initial diameter, anatomy and whether
the case is a vital (inflamed) or a non-vital (infected) one.
• Minimum MAF sizes:
- Maxillary incisor & canines & single canalled premolars is 55.
- Maxillary lateral incisor and mandibular incisors is 45.
- Maxillary premolars with two canals are 35.
- Buccal canals of maxillary molars and mesial and distal canals of
mandibular molars are 35.
- Palatal canals of maxillary molars and distal canal of mandibular
molars (if it is a single canal) are 50.
• MAF is used in a circumferential filling motion to blend the
preparation of the apical part with that of the coronal part.
• Irrigation with 3 ml sodium hypochlorite coupled with canal patency
check using the patency file (number15) is done at each change of file.

 
 OBTURATION

• The tooth must be free of symptoms, not tender to percussion or

palpation. This is obviously tested before use of local anesthesia. As
stated above, the canals must be clean and dry.
• A gutta-percha masterpoint of same dimensions as the master apical
file is selected. Mark working length by pinching the point with pliers,
place it in the canal.
• Expose a radiograph (masterpoint radiograph) to verify the correct
placement of the gutta-percha-point. If the point goes to working
length, obturation procedures are permissible.
• Cover the masterpoint with sealer, and place it in the canal. A finger
spreader is inserted along the point to make space for accessory points
that are also covered with sealer prior to insertion.
• If doubts exist to the homogeneity of the fill, expose a new radiograph
for verification.
• After filling, sear off the excess gutta-percha with a canal plugger
heated in alcohol flame, and progressively remove 1-2mm of gutta-
percha from the top of each canal orifice.

 
 CHECKLIST FOR STUDENT SELF-EVALUATION

PRE-TREATMENT

• All infection control guidelines

• Complete and ordered set of instruments
• Correct rubber dam placement
• Build-up of mutilated teeth if necessary

ACCESS CAVITY PREPARATION

• Proper access location

• Correct outline form
• Complete deroofing of pulp chamber
• Canal orifice(s) located
• Smooth walls with proper flare

CLEANING & SHAPING

• MAF reach WL without binding

• Sound apical stop
• Canal(s) free of debris
• Smooth walls with proper flare
• Gradual flaring from apex to orifice

OBTURATION

• Master cone fits with resistance to WL (tug back)

• Gutta percha properly extended to WL
• Absence of voids in the filling
• Gutta percha removed 1 mm below the level of the root canal orifice
• Access cavity clean from sealer

 
 ENDODONTIC REQUIRMENT SHEET
STUDENT NAME:
NUMBER:
CASE NUMBER:

PATEINT NAME AGE

ADDRESS TEL
CHIEF COMPLAIN

MEDICAL HISTORY DRUG

HISTORY

CLINICAL FINDINGS
SYMPTOMATIC ASYMPTOMATIC
LOCATION LOCALIZED DIFFUSE REFERRED
CHRONOLOGY CONSTANT MOMENTARY INTERMITTENT LINGERING
QUALITY SHARP DULL SPONTANEOUS OCCAJONAL
AFFECTED BY COLD HOT BITING PERCUSSION PALPATION POSTURE
RELEIVED BY COLD HOT ANALGESCICS NOT RELIEVED
EXTRA ORAL LYMPHADEN- INTRA ORAL SWELLING SINUS TRACT
SWELLING OPATHY LOCALIZED / DIFFUSE

RADIOGRAPHIC FINDINGS
PDL PDL BONE APICAL LATERAL OSTEOSCLEROSIS
NORMAL THICKENED NORMAL BONE BONE
RESORPTION RESORPTION

DIAGNOSIS
PULPAL PERIAPICAL
• WNL • WNL
• REVERSIBLE PULPITIS • ACUTE APICAL PERIODONTITIS
• IRREVERSIBLE PULPITIS • ACUTE APICAL ABSCESS
• PULP NECROSIS • CHRONIC APICAL PERIODONTITIS
• PRIOR RCT • PHOENIX ABSCESS
• CONDENSING OSTIETIS

PROGNOSIS
PULPAL PERIODONTAL RESTORATIVE
• FAVORABLE • FAVORABLE • FAVORABLE
• QUESTIONABLE • QUESTIONABLE • QUESTIONABLE
• POOR • POOR • POOR
• HOPELESS • HOPELESS • HOPELESS

 
 ACCESS PREPARATION

GEOMETRIC OUTLINE:
• PROPERLY EXTENEDED • COMPLETE DEROOFING • ADEQUATE
• INCOMPLETE DEROOFING FLARING
• UNDER EXTENDED • INADEQUATE
• OVER EXTENDED FLARING

DATE SIGNATURE

CLEANING AND SHAPING

CANAL CANAL CANAL CANAL

REFRRENCE POINT
PROVISIONAL WL
FINAL WL
FLARING
MAF

DATE SIGNATURE

OBTURATION

CANAL CANAL CANAL CANAL

MASTER CONE
SPREADER
AUXILLARIES

DATE SIGNATURE

 
 ENDODONTIC REQUIRMENT SHEET
STUDENT NAME:
NUMBER:
CASE NUMBER:

PATEINT NAME AGE

ADDRESS TEL
CHIEF COMPLAIN

MEDICAL HISTORY DRUG

HISTORY

CLINICAL FINDINGS
SYMPTOMATIC ASYMPTOMATIC
LOCATION LOCALIZED DIFFUSE REFERRED
CHRONOLOGY CONSTANT MOMENTARY INTERMITTENT LINGERING
QUALITY SHARP DULL SPONTANEOUS OCCAJONAL
AFFECTED BY COLD HOT BITING PERCUSSION PALPATION POSTURE
RELEIVED BY COLD HOT ANALGESCICS NOT RELIEVED
EXTRA ORAL LYMPHADEN- INTRA ORAL SWELLING SINUS TRACT
SWELLING OPATHY LOCALIZED / DIFFUSE

RADIOGRAPHIC FINDINGS
PDL PDL BONE APICAL LATERAL OSTEOSCLEROSIS
NORMAL THICKENED NORMAL BONE BONE
RESORPTION RESORPTION

DIAGNOSIS
PULPAL PERIAPICAL
• WNL • WNL
• REVERSIBLE PULPITIS • ACUTE APICAL PERIODONTITIS
• IRREVERSIBLE PULPITIS • ACUTE APICAL ABSCESS
• PULP NECROSIS • CHRONIC APICAL PERIODONTITIS
• PRIOR RCT • PHOENIX ABSCESS
• CONDENSING OSTIETIS

PROGNOSIS
PULPAL PERIODONTAL RESTORATIVE
• FAVORABLE • FAVORABLE • FAVORABLE
• QUESTIONABLE • QUESTIONABLE • QUESTIONABLE
• POOR • POOR • POOR
• HOPELESS • HOPELESS • HOPELESS

 
 ACCESS PREPARATION

GEOMETRIC OUTLINE:
• PROPERLY EXTENEDED • COMPLETE DEROOFING • ADEQUATE
• INCOMPLETE DEROOFING FLARING
• UNDER EXTENDED • INADEQUATE
• OVER EXTENDED FLARING

DATE SIGNATURE

CLEANING AND SHAPING

CANAL CANAL CANAL CANAL

REFRRENCE POINT
PROVISIONAL WL
FINAL WL
FLARING
MAF

DATE SIGNATURE

OBTURATION

CANAL CANAL CANAL CANAL

MASTER CONE
SPREADER
AUXILLARIES

DATE SIGNATURE

 
 ENDODONTIC REQUIRMENT SHEET
STUDENT NAME:
NUMBER:
CASE NUMBER:

PATEINT NAME AGE

ADDRESS TEL
CHIEF COMPLAIN

MEDICAL HISTORY DRUG

HISTORY

CLINICAL FINDINGS
SYMPTOMATIC ASYMPTOMATIC
LOCATION LOCALIZED DIFFUSE REFERRED
CHRONOLOGY CONSTANT MOMENTARY INTERMITTENT LINGERING
QUALITY SHARP DULL SPONTANEOUS OCCAJONAL
AFFECTED BY COLD HOT BITING PERCUSSION PALPATION POSTURE
RELEIVED BY COLD HOT ANALGESCICS NOT RELIEVED
EXTRA ORAL LYMPHADEN- INTRA ORAL SWELLING SINUS TRACT
SWELLING OPATHY LOCALIZED / DIFFUSE

RADIOGRAPHIC FINDINGS
PDL PDL BONE APICAL LATERAL OSTEOSCLEROSIS
NORMAL THICKENED NORMAL BONE BONE
RESORPTION RESORPTION

DIAGNOSIS
PULPAL PERIAPICAL
• WNL • WNL
• REVERSIBLE PULPITIS • ACUTE APICAL PERIODONTITIS
• IRREVERSIBLE PULPITIS • ACUTE APICAL ABSCESS
• PULP NECROSIS • CHRONIC APICAL PERIODONTITIS
• PRIOR RCT • PHOENIX ABSCESS
• CONDENSING OSTIETIS

PROGNOSIS
PULPAL PERIODONTAL RESTORATIVE
• FAVORABLE • FAVORABLE • FAVORABLE
• QUESTIONABLE • QUESTIONABLE • QUESTIONABLE
• POOR • POOR • POOR
• HOPELESS • HOPELESS • HOPELESS

 
 ACCESS PREPARATION

GEOMETRIC OUTLINE:
• PROPERLY EXTENEDED • COMPLETE DEROOFING • ADEQUATE
• INCOMPLETE DEROOFING FLARING
• UNDER EXTENDED • INADEQUATE
• OVER EXTENDED FLARING

DATE SIGNATURE

CLEANING AND SHAPING

CANAL CANAL CANAL CANAL

REFRRENCE POINT
PROVISIONAL WL
FINAL WL
FLARING
MAF

DATE SIGNATURE

OBTURATION

CANAL CANAL CANAL CANAL

MASTER CONE
SPREADER
AUXILLARIES

DATE SIGNATURE

 
 ENDODONTIC REQUIRMENT SHEET
STUDENT NAME:
NUMBER:
CASE NUMBER:

PATEINT NAME AGE

ADDRESS TEL
CHIEF COMPLAIN

MEDICAL HISTORY DRUG

HISTORY

CLINICAL FINDINGS
SYMPTOMATIC ASYMPTOMATIC
LOCATION LOCALIZED DIFFUSE REFERRED
CHRONOLOGY CONSTANT MOMENTARY INTERMITTENT LINGERING
QUALITY SHARP DULL SPONTANEOUS OCCAJONAL
AFFECTED BY COLD HOT BITING PERCUSSION PALPATION POSTURE
RELEIVED BY COLD HOT ANALGESCICS NOT RELIEVED
EXTRA ORAL LYMPHADEN- INTRA ORAL SWELLING SINUS TRACT
SWELLING OPATHY LOCALIZED / DIFFUSE

RADIOGRAPHIC FINDINGS
PDL PDL BONE APICAL LATERAL OSTEOSCLEROSIS
NORMAL THICKENED NORMAL BONE BONE
RESORPTION RESORPTION

DIAGNOSIS
PULPAL PERIAPICAL
• WNL • WNL
• REVERSIBLE PULPITIS • ACUTE APICAL PERIODONTITIS
• IRREVERSIBLE PULPITIS • ACUTE APICAL ABSCESS
• PULP NECROSIS • CHRONIC APICAL PERIODONTITIS
• PRIOR RCT • PHOENIX ABSCESS
• CONDENSING OSTIETIS

PROGNOSIS
PULPAL PERIODONTAL RESTORATIVE
• FAVORABLE • FAVORABLE • FAVORABLE
• QUESTIONABLE • QUESTIONABLE • QUESTIONABLE
• POOR • POOR • POOR
• HOPELESS • HOPELESS • HOPELESS

 
 ACCESS PREPARATION

GEOMETRIC OUTLINE:
• PROPERLY EXTENEDED • COMPLETE DEROOFING • ADEQUATE
• INCOMPLETE DEROOFING FLARING
• UNDER EXTENDED • INADEQUATE
• OVER EXTENDED FLARING

DATE SIGNATURE

CLEANING AND SHAPING

CANAL CANAL CANAL CANAL

REFRRENCE POINT
PROVISIONAL WL
FINAL WL
FLARING
MAF

DATE SIGNATURE

OBTURATION

CANAL CANAL CANAL CANAL

MASTER CONE
SPREADER
AUXILLARIES

DATE SIGNATURE

 
 ENDODONTIC REQUIRMENT SHEET
STUDENT NAME:
NUMBER:
CASE NUMBER:

PATEINT NAME AGE

ADDRESS TEL
CHIEF COMPLAIN

MEDICAL HISTORY DRUG

HISTORY

CLINICAL FINDINGS
SYMPTOMATIC ASYMPTOMATIC
LOCATION LOCALIZED DIFFUSE REFERRED
CHRONOLOGY CONSTANT MOMENTARY INTERMITTENT LINGERING
QUALITY SHARP DULL SPONTANEOUS OCCAJONAL
AFFECTED BY COLD HOT BITING PERCUSSION PALPATION POSTURE
RELEIVED BY COLD HOT ANALGESCICS NOT RELIEVED
EXTRA ORAL LYMPHADEN- INTRA ORAL SWELLING SINUS TRACT
SWELLING OPATHY LOCALIZED / DIFFUSE

RADIOGRAPHIC FINDINGS
PDL PDL BONE APICAL LATERAL OSTEOSCLEROSIS
NORMAL THICKENED NORMAL BONE BONE
RESORPTION RESORPTION

DIAGNOSIS
PULPAL PERIAPICAL
• WNL • WNL
• REVERSIBLE PULPITIS • ACUTE APICAL PERIODONTITIS
• IRREVERSIBLE PULPITIS • ACUTE APICAL ABSCESS
• PULP NECROSIS • CHRONIC APICAL PERIODONTITIS
• PRIOR RCT • PHOENIX ABSCESS
• CONDENSING OSTIETIS

PROGNOSIS
PULPAL PERIODONTAL RESTORATIVE
• FAVORABLE • FAVORABLE • FAVORABLE
• QUESTIONABLE • QUESTIONABLE • QUESTIONABLE
• POOR • POOR • POOR
• HOPELESS • HOPELESS • HOPELESS

 
 ACCESS PREPARATION

GEOMETRIC OUTLINE:
• PROPERLY EXTENEDED • COMPLETE DEROOFING • ADEQUATE
• INCOMPLETE DEROOFING FLARING
• UNDER EXTENDED • INADEQUATE
• OVER EXTENDED FLARING

DATE SIGNATURE

CLEANING AND SHAPING

CANAL CANAL CANAL CANAL

REFRRENCE POINT
PROVISIONAL WL
FINAL WL
FLARING
MAF

DATE SIGNATURE

OBTURATION

CANAL CANAL CANAL CANAL

MASTER CONE
SPREADER
AUXILLARIES

DATE SIGNATURE