E n d o d o n t i c s L e c t u r e 7 |1

ROOT CANAL PREPARATION - What is used to remove the pulp  Nerve broach
Objectives or files
- Describe the objectives for both cleaning and - Nerve broach: Metal with small spikes  Insert in
shaping, explain how to determine when these have narrow canal  Tendency for it to break 
been achieved - Narrow canals  Use small sized files (Size
- Diagram the shapes of the flared (step back) the 6,8,10)
standardized (serial shaping) and crown down - Bigger canals  Bigger files
preparations - What to base which files to use in the canal 
- Describe the various techniques in canal radiograph, knowledge in canal anatomy
preparation (step by step)
- Distinguish between apical stop, apical seat, and 3. Debridement
open apex, and how they affect canal preparation - Removal of end products of inflammation
and obturation - Diagnosis for debridement
- Describe the techniques of pulp removal o Acute Apical Abscess / Chronic Apical
- Characterize the difficulties of preparation of Abscess (Medyo maingay nung part na to)
anatomic aberrations that make complete
debridement difficult 4. Disinfection
- Enumerate possible procedural errors which can - Removal/ destruction of pathogenic microorganism
happen and how to avoid and manage them
- Describe alternative techniques in canal preparation Canal Cleaning
- Removal of all contents of the root canal system
Topic Outline o Pulp tissues, infected material, organic
- Definition of terms substrates, microflora, bacterial by-
- Biologic objectives of canal preparation products, caries, food, tissue remnants,
- Mechanical objectives pulp stones, filling materials
- Anatomical considerations in RC prep
- Motions of instrumentations Canal Shaping
- Terminologies - Creates a continuously tapering cone
- Technique for RC prep - Preserving the natural or original configuration of
- Features of ideal root canal preparation the root canal
- Guidelines of root canal preparation o Not following  Weaken the remaining
- Intracanal medication tooth, curved area was not reached 
- Post operative guidelines Bacteria will multiply; therefore will go
- Conclusion out of canal causing periapical infection
o End 0.5 from tip of the apex
Canal Preparation - Make the apical terminus the narrowest cross
- Systematic procedure of removing pulp tissue, section providing an apical stop
debris, and microorganism with the use of files, o How  MAF
irrigants (Sodium Hypochlorite), and chemicals - Prepare the canal in multiple planes
(EDTA) while shaping to facilitate filling of the o Entire circumference and entire canal
root canal system walls is cleaned  Circumferential Filing
- Facilitate cleaning by removing restrictive dentin,
Location of Orifices allows greater volume of irrigant to work deeper
- Orifices may be better and safely opened up with and into all aspects of the root canal system thus
ultrasonics eliminating the pulp, bacteria, and their endotoxins
- Situations wherein it is difficult to locate the canal o What do we do to make the volume of
orifices irrigant is in greater amount?  Enlarge
o Not accessed well opening  Cervical  Middle
o Pulp stones o Enlarge the canal not only for easier
o Calcification/Thinning of chamber and insertion of the file but also to increase the
canal volume of irrigant inside the canal 
- Advantage: does not have a head, easier to see Better irrigation
- For cases that it is difficult to located the orifices - Carves away restrictive dentin and sculpt a
preparation that is thoroughly cleaned and prepared
Biologic Objectives for obturation …  DURING FILING
1. Canal Cleaning - How do you attain shaping?
- To free the root canal system of pulp, bacteria, and o Files
their endotoxins
- How do we attain cleaning? Anatomical Considerations Before Starting Root Canal
o Irrigate Preparation—Root Canal System is Complex
- May divide, rejoin, and possess lateral
2. Extirpation ramifications
- Removal of vital pulp - Apical foramen lies several mms away from the
- Extirpate with vital pulp  expect to see a red end of roots (Apex locator)
color due to bleeding - Roots may possess an additional canal
(Radiograph, SLOB)

o If not able to locate, clean, shape
additional canal  Fail root canal
treatment
- All canals are curved especially in the apical third
- In flattened, and curved roots, canal may lie closer
to the bifurcation side of the root
o When is the time you cannot see a curve
on the radiograph? Curved toward the
lingual/palatal, labial, buccal
o Teeth with curvature toward the palatal 
Palatal root of Max. 1st Molar, for lower C
shaped canal (buccal or lingual)
o In c shaped canals, how would you know
where it would curve  Remove the file
and don’t move it check where it curves
Motions of Instrumentation
1. Turn and Pull
- Quarter turn rotation (engage to tooth) and pull
2. Filing
- Push and pull motion (up and down)
- When file is loose in the canal
3. Watch Winding
- About 30-60 degrees clockwise (CW) and
counterclockwise (CCW) movement of the
instrument
4. Balanced Force
- About 90 degrees clockwise rotation of the
instrument and about 270 degrees counterclockwise
rotation with slight apical pressure
Terminologies
- Reference Point
o Usually a cusp or incisal edge
o Reference point of Mbu Canal  Depends
where the file will go
o Make sure your stopper is not lose and
perpendicular to file, and your length is
correct
- Radiographic tooth image
o Distance from a reference point up to the
root apex
- Apical Constriction
o Located 0.5 to 1mm from the radiographic
root apex where you can find the
cementodentinal junction (CDJ)
o Can go as far as 2 mm
o Clinic 
- Working Length (WL)
o Distance from a reference point to the
apical end to the canal constriction
- Actual Wire Length (AWL)
o The actual length of the IAF inserted
inside the canal for working length
determination
o WL = AWL (+-) discrepancy between the
file and the tip of the apex – 1 Safety
Factor (SF)
E n d o d o n t i c s L e c t u r e 7 |2
o Note: If the discrepancy is more than 2mm
please repeat the working length
computation
o Pre-op is straight (discrepancy is minimal)
 Subtract 0.5  In clinic, pre-op is
taken from the mouth  Tendency to
distort  Subtract 2 mm safety factor (to
not exceed)
o Short radiograph  Apex locator says
you’re out  Maintain the length
Canal Preparation Technique
1. Coronal Preparation
- Orifice opening and enlargement
- Establish tentative working length
2. Patency/ Canal Patency/ Glide Path
- File handle is moved gently in a push and pull
motion, and this action is repeated until the #10 file
moves easily to pre-established length
- To find out if the file can be inserted
- Canal Patency
- Apical Patency – file can get out of apical foramen
3. Scouting
- Procedure which involves insertion of small
diameter files to evaluate cross sectional diameter
of a canal and provide information as to whether
the canal is open, partially restricted, or calcified,
also if they merge, curve, recurve, dilacerate, or
divide
- Checks presence of a straight line access through
the position of the file if it is parallel to long axis or
skewed off
- To feel the shape and conformity of the file to the
canal
- Learning every curve
4. Radicular Preparation
- Procedure which involves flaring of the coronal 2/3
prior to apical preparation with the serial use of
larger to smaller [files]
- Enlarge opening so that
o it is easier for the file to get in
o increase the volume of irrigant
o easier to enter the apex
*** CROWN DOWN (Coronal preparation to radicular
preparation = CROWN DOWN)
- Dividing of tooth to cervical and middle thirds
- Start of cleaning
- Objective
o For easier irrigation
o To enlarge canal
 Clean cervical third first
 Clean middle third
- Crown down computation
o TLI – RL = CL
o RL/3
- Measure crown length and root length  when
size 35 cannot get in, do crown down
- No exact size you should be ending with
crown down  as long as you enlarge the
cervical and middle third whatever the size that
reached that level
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- After, check if the file can get in - Compute the WL

Size WL Reference o If the file passed out of the apex
Point o If the file is short of the apex
25 21.5mm Incisal Edge
30 21.5mm Incisal Edge o If the file is flushed at the radiographic
35 21.5mm Incisal Edge apex
40 21.5mm Incisal Edge
(MAF) 6. Apical Preparation/ Serial Filing
- Enlarge the apical constriction
o CL + 1/3RL = Cervical Third - Sequential use of files from IAF to MAF (is the file
o CL + 2/3RL = Middle Third three sizes larger than the IAF) at WL with
- Done to increase diameter of cervical third recapitulation
then middle third, easer to clean the apical - Motion of instrumentation: Watch-winding and
third pull
- Good tunnel results to easier entering and - Example
existing of irrigant Size WL Reference
- For big canals Point
o No need for a crown down IAF 25 22 mm Incisal
o If the size 35 can enter up to the apical Edge
third, then good 30 22 mm Incisal
- If you do not irrigate, dentinal shavings will go Edge
to the apical third and form DENTIN MUD 35 22 mm Incisal
- Always put the patency file. Must reach up to Edge
the end MAF 40 22 mm Incisal
- Size of patency file depends up to when it can Edge
be inserted - Recapitulation
o Reinsertion/reuse of an instrument
5. Working Length Determination previously used to renegotiate the original
- Selection of IAF WL
o To enlarge the apical third o Not doing this can cause breakage of file
o End cleaning at apical constriction o Example
o Located 0.5 mm before the apical foramen  IAF size #20, WL=22mm  If
o Requirement of file #25 cannot be accommodated, go
 File that is inserted up to apical back to size 20 at 22 mm
constriction that has snug fit (to o RIMMING  Continuous clockwise
remove dentin) direction  To avoid breakage, do
 Measure the diameter of apical counterclockwise rotation
constriction - MAF
 Must only be enlarged three o Biggest file used up to the WL
times (AC must be as small as o Minimum size of MAF is 25 for narrow
possible) canals
 Note: Enlargement is for o Example
preparation of GP insertion  MAF=Size 40, WL= 22  Take
 How to select tooth length a radiograph with the MAF
 From incisal edge to apex inserted into the canal to verify
 Ex. TLI = 22mm = 22 – 0.5 = again the length
21.5 (snug fit) o Objectives
o How to choose file  Must have snug fit
 Must have binding and reach the  Create apical stop  No matter
tentative working length how much you push, it stops
 If you push it and the file goes
- Methods of establishing WL out  Loose  Change to a
a. Tactile sensation – feel the apical foramen bigger file
b. Paper point evaluation – bleeding on the o Why need to xray?
tip means you have already exceeded  To make sure that we are
c. Electronic apex locator cleaning and shaping the canal up
d. Use of radiograph to the apical constriction (0.5mm
from apical) to make sure you are
- Measure the length of the tooth form the pre- at the correct length
operative radiograph. Subtract 2mm from this  Too large: hard to control length
length to compensate for the distortions and too much obturation
- Select initial apical file o How to know if an apical stop is created?
o Should reach the estimated trial WL
o Biggest file that should reach the apical 7. Step-Back Preparation (for Lateral compaction)
resistance/snug fit the end of the canal - Body of the canal is prepared using subsequent
- Take a radiograph larger files 1-2 mm short of the working length
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- Instrumentation progresses coronally then 4. Always keep debris suspended in irrigant. Irrigate
recapitulate copiously.
- Sequential use of successively smaller to larger o Not following may create DENTIN MUD
sizes of instruments to prepare the canal at … 5. Use instruments in proper sequence without
- Enlarge apical third skipping sizes
- Use larger size of the file then reduce length every o Skipping files may cause breakage of files
1mm because you tend to push to hard
- Example 6. Establish a straight line access
Size WL Reference Point o Importance: Cannot file entire canal well
40 21.5mm Incisal Edge 7. Have a vision of the shape of the canal and work
45 20.5mm Incisal Edge towards shaping it with the 5 mechanical objectives
40 21.5mm Incisal Edge in mind
50 19.5mm Incisal Edge 8. Always recapitulate to ensure canal patency
40 21.5mm Incisal Edge 9. Never force down instruments. Stop at resistance
55 18.5mm Incisal Edge 10. Verify working length at all times
40 21.5mm Incisal Edge 11. Be patient. Try to do it once but well.

8. Circumferential Filing Intracanal Medication

- Use of MAF to smoothen all the canal walls
- Clean the whole circumferential to smoothen canal
wall especially files when used to enlarge canal
- In and out throughout the entire canal
- You want to achieve a Glassy appearance
o Example
 MAF = size 40, Working length
22mm
9. Spreader Reach Test
- Insert the MAF together with the spreader inside
the canal. The length of the spreader should be at
least 1 to 2 mm short of the WL
- This is done to verify if the canal has been properly
flared
- Use sizes 30 of spreader for larger canals and sized
25 for smaller canals
- Pointed spreader while plugger is blunt
- To check if properly shaped canal
- Spreader sizes: 15-40
- Narrow: 25-30s
o Maxillary first pm and molars
o Mandibular incisors and MB, ML molar
- Large: 30-35s
o Mandibular canine, pm, distal canal
- WL= 21.5-1mm (must be 1mm or 2mm short of
WL – spreader requirement)
- No need to take radiograph because you’re already
enlarged canal
Features of an Ideal Preparation
- Minimal enlargement of the apical foramen
- Creation of an even, progressive taper form the
apical stop to the pulp chamber following the
natural curvature of the canal
- Provision for an apical stop at the end of the canal
- Adequate cleaning of the canal at optimum
working length
Guidelines in Instrumentation
1. Check instruments prior to use for any sign of
instrument strain or metal fatigue
2. Precurve files if stainless steal. If curved, use
directional stoppers (limitations of ss and Niti
(Nickel Titanium)
3. Select proper instruments depending on their use
and properties
- Placement of intracanal medication is for cases
which cannot be finished in one appointment
- In between appointment, calcium hydroxide is the
recommended medicament. This required direct
contact
- Coronal seal has to be maintained between
appointments with the use of durable cements
- Cannot remove all the bacteria in the canal  Must
disinfect  Fill in with CaOH  Prevent … of
bacteria in the canal
Examples of intracanal Irrigant
- Sodium Hypochlorite 5.2%
o Characteristics: Low surface tension,
organic tissue solvent, lubricant, anti-
microbial, economical, toxic
o Cleans the root canal system after shaping,
and it penetrates deep into the dentinal
tubules when used at the correct
temperature and concentration for
appropriate amount of time
o Mix with 9 parts water and 1 part Clorox
 0.05%
o Still a gold standard because it is the only
one that can dissolve the pulp and dissolve
the organic structures
- Chlorhexidine Glutamate 2% without alcohol
o Broad antimicrobial spectrum
- Hydrogen Peroxide 3%
o Nose used alone
- Normal Saline
- Sterile Water
- Chelating Agents (calcium removers) 17% EDTA
(Ethylene diaminetetraacetic acid) for smear layer
removal – acqueous
o The use of viscous (paste) chelator
(EDTA) facilitates the insertion of the first
file and the aqueous (watery) chelator
removes the smear layer prior to
obturation
o Viscous  insertion and lubrication of file
o Aqueous  irrigation
o Opens up the dentinal tubules
Guidelines in Irrigation
- Irrigate copiously after each file
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- Insert needle halfway into the canal - Dry (using paper points same size and length
- Needle top should not bind into the canal walls as MAF)
- Remove air bubbles form syringe before depositing - Place cotton
- Deposit slowly - TF (4 mm Cavity Fermin)
- Remove rubber dam
Objectives of Irrigation - No premature contact
- Gross debridement
- Removal of microbes
- Lubrication
- Dissolution of pulp tissue remnants
- Removal of smear layer (organic and inorganic)
o Inorganic use EDTA

Recommendations
- Use needle gauge 25 or 27
- Dilute sodium hypochlorite with distilled water 1:9
- Deposit at least 2 mL at one time

Different Kinds of Files

- Manual
- Rotary

Problems of Canal Preparation

- Blockage
- Formation of dentin mud
- Separated files
- Canal Transportation
- Broken Bur
- Zipping
- Apical Perforation
- Strip Perforation– perforation on the side of the
canal  inner side of curvature on the inner side 
Anti curvature filing

Post-operative Guidelines
- Put the tooth out of contact if possible even prior to
WL determination if possible
- Although with better technique there is less post-
operative pain, sometimes, there is still need for
mild anti-inflammatory analgesics to manage
transient anti-inflammatory…

Conclusion
- The different methods of root canal preparation are
working with high predictability of success.
Excellent clinical results are obtainable with these
methods. However, we should not overlook the
possibility that different techniques may one day
prove to be superior. It is a challenge, therefore, for
students and dentists to continually aspire to refine
these

BIOMECHANICAL PREPARATION
- Cleaning (irrigant) and shaping (file) of canal
 Scouting and Patency
 Crown Down
 Initial Apical File
 Working Length Computation
 Serial Filing
 Master Apical File
 Step Back
 Circumferential Filing
 Spreader Reach Test
 Temporary Filling
- Irrigate
- Aspirate