Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
What we remove from the pulp space is far more The objectives of cleaning and shaping are twofold:
important than what we replace it with To debride and disinfect the root canal system;
Endodontic treatment can be divided into three main phases: proper To shape /contour the root canal walls and apical constriction,
access preparation into the pulp cavity, cleaning and shaping of for the purpose of sealing the root canal completely with a
the root canal and obturation. The initial step for cleaning and condensed, inert filling material.
shaping the root canal is proper access to the chamber that leads To help achieve these objectives, each individual root canal should
to straight-line penetration of the root canal orifices. The next step be examined radio-graphically and explored with endodontic
is exploration of the root canal, extirpation of the remaining pulp instruments. The examination should include an assessment of
tissue or gross debridement of necrotic tissue and verification of canal length, shape, size, curvature, entrance orifice, location of
the instrument working length. This step is followed by proper foramina, canal ramifications and presence of calcifications or
instrumentation, irrigation and debridement and disinfection of the obstructions.
root canal. Obturation completes the procedure. According to Schilder, the cleaning and shaping of a root canal
The importance of adequate canal cleaning and shaping, rather should fulfill the following mechanical objectives: (Table I)
than reliance on antiseptics, cannot be overemphasized. Histologic Should have a continuous tapering conical shape, with the
examination of pulpless teeth in which root canal therapy has failed narrowest cross-sectional diameter apically and the widest diameter
often shows that the canals were not completely cleaned. Obturation coronally.
of an improperly cleaned canal would still lead to an endodontic The walls should taper evenly toward the apex and should be
failure (Fig. 1). confluent with the access cavity,
To give the prepared root canal the quality of flow, that is, a shape
that permits plasticized gutta-percha to flow against the walls without
impedance.
Should keep the apical foramen as small as practical.
Should clean and shape the canal without transporting the apical
foramen.
Table I : Schilders Objectives for cleaning and shaping
Instrument
Cross-sectional design Tip design Taper Other features
System
ProFile (Dentsply Fixed taper. 2%, 4% and 20-degree helix angle and
Non Cutting
Maillefer) 6%. constant pitch.
Triple-U shape with radial lands. Neutral
rake angle planes dentine walls.
GT Files (Dentsply Fixed taper. 4%, Files have a short cutting portion.
Non Cutting
Maillefer) 6%, 8%, 10% and 12%. Variable pitch.
Triple-U shape with radial lands.
Decreased helical angle,
Variable width lands (lands at the tip &
increased pitch. Heat treatment
GT Series X shank region of the file are narrower No 10% or 12% taper.
aims to improve cyclic fatigue
than mid-file lands)
resistance.
Cutting (SC). Fixed taper. 2%, 3%, 4%, Flute space becomes
Quantec SC,
Non-cutting 5%, 6%, 8%, 10% and progressively larger distal to
LX (Sybron Endo) S-shape design with double-helical flute, (LX). 12%. thecutting blade.
positive rake angle and two wide
radial lands.
Convex Triangular
into clinical success. For this to happen, we need two important the apical constriction due to the complexity in canal curvature and
parameters: canal configuration.
i. Shaping the canal in order to physically remove the With the advent of rotary ni-ti instruments came the newer feature
inflamed / infected contents. of taper wherein both MAF size and taper play an important role
ii. Cleaning the canal with appropriate irrigants, which in root canal cleaning and shaping dynamics. A careful review of
would clean and disinfect the pulp space. endodontic literature reveals that the following combination of MAF
In the end, the ultimate success of root canal therapy lies in the and taper have shown superior cleanliness in the crucial apical third
ability of the irrigant to reach the critical apical third and the isthmus of the canal:
region. The role of an instrument thereby lies primarily in creating a i. Master Apical File size #40 with a taper of 4%
shape or channel for the irrigant to be able to access the inaccessible ii. Master Apical File size #30 with a taper of 6%
regions of the root canal. The critical clinical question that arises is iii. Master Apical File size #20 with a taper of 10%
then What is the ideal size of canal enlargement? The apical three mm of the root canal system is the most crucial area
A careful review of endodontic literature shows that over the past to be cleaned in order to achieve clinical success. It is interesting to
40 years various clinicians and researchers have recommended compare the size of enlargement in each of the above-mentioned
different sizes of MAF (Master Apical File) enlargement (Table 4) three systems at the critical 3 mm level short of apex. (Fig. 3)
Glickman
.04 .06 .10
Tooth Grossman Tronstad and Weine
Dumsha
Maxillary
Centrals 80-90 70-90 35-60 3 sizes
Laterals 70-80 60-80 25-40 3 sizes
Canines 60-60 50-70 25-40 3 sizes 3 mm 3 mm 3 mm
First Premolars 30-40 35-90 25-40 3 sizes 0.52 0.48 0.50
0.48 0.42 0.40
Second Premolars 50-55 35-90 25-40 3 sizes
0.44 0.36 0.30
Molars 30-55-50 3 sizes
MB/DB 35-60 25-40 3 sizes
MAF # 40 MAF # 30 MAF # 20
P 80-100 25-50 3 sizes
Fig 3: Different effective combinations of MAF and Taper
Mandibular
From the above figure you can realize that all the three systems
Centrals 40-50 35-70 25-40 3 sizes
are enlarging the canal to a size of around #50 at the level 3 mm
Laterals 40-50 35-70 25-40 3 sizes
short of working length. This observation made me wonder whether
Canines 50-55 50-70 30-50 3 sizes
this could be a critical parameter, which a clinician should keep
First Premolars 30-40 35-70 30-50 3 sizes
in mind while doing cleaning and shaping. Thereby I conducted a
Second Premolars 50-55 35-70 30-50 3 sizes
study comparing the four common combinations of MAF and Taper
Molars 30-55-90 3 sizes
advocated by manufacturers. The study groups assessed were: (Fig.
MB/ML 35-45 25-40 3 sizes
4)
D 40-80 25-50 3 sizes
Group I MAF #25 with TAPER 8% Waveone (Dentsply)
Table 4 Recommendations of MAF size
Group II MAF #30 with TAPER 6% K3 (Sybron)
The most commonly advocated concept is the three sizes Group III MAF #35 with TAPER 5% M Two (VDW)
enlargement rule wherein after manually gauging the size of the Group IV MAF #40 with TAPER 4% HYFLEX (Coltene)
apical constriction; the clinician increases the apical third to three The study protocol consisted of instrumenting root canals with either
sizes more from the first file that binds at the apex. This concept has one of the four test groups. The irrigation regime consisted using
now been disproved, as it is impossible to accurately clinically gauge 5.25% NaOCl in between each instrument change and a final rinse
Statistical analysis of the results revealed no difference in the MAF X TAPER Size of enlargement at
cleaning ability of the tested four groups. 3 mm short of Working length