1- Rational for treatment:

• Pulpal injury frequently leads to irreversible inflammatory

conditions that proceed from ischemia to infarction to
necrosis & ultimately periradicular extension of disease
process endodontic ttt can approach 100% success if the
content of the root canal system one completely removed,
because they are the source of irritation to the attachment
apparatus
2- Objectives of cleaning & shaping:
A. Clinical objectives
B. Biological objectives
C. Mechanical objectives
A. Clinical objectives :
( Start with the end in mind )
Endodontic performance is enhanced when clinicians view
preoperative Radiographs
* Pretreatment :
• Before endodontic treatment, pulpally involved
must be evaluated to ensure they are restorable
• it is advantageous to build up a tooth to
Facilitate Subsequent Endodontic Procedure
* Access for success :
• Access preparation are essential elements to
successful endodontics.
 • Preparing well designed endodontic access
cavity is a critical first step in a series of procedures that leads to
the 3Dahturatier of the root canal system.
* Shaping Facilitates cleaning :
- By removing restrictive dentin which allow on
effective volume of irrigant to work deeper & more
quickly to circulate all aspects of root canal.
- By serving to eliminate the pulp Bacteria & their
endotoxins
N.B. : It is important to appreciate that files produce shape, but it is
essential to understand that irrigants clean a root canal system.
* Shaping facilitates obturation :
• Facilitates three dimensional obturation by removing restrictive
dentin.
• Allow instruments to work deeply , unrestricted by dentinal
walls.
• Allow gutta percha & sealer to be moved into all aspects of
prepared root canal system.

N.B. : The shape is critical, not only for effective cleaning but also for
3D obturation.

i.e.: Shaping & cleaning is intended to emphasize that canals are

generally shaped first and then cleaned if irrigation protocols are
followed.
* Restoration & Recall :
- Evidence of success of Endodontically treated tooth
is application of well designed, marginally sealed &
esthetically pleasing restoration
- Recall Examination should be conducted periodically until
healing is noted
B- Biological objectives :
Biological objectives of cleaning & shaping procedures one to remove
all the pulp tissue, bacteria & their endotoxins from the root canal
system.
1- Avoid aggressive instrumentation
2- Assume curvature in all canals
3- Avoid apical blockage
4- Assume curvature
C- Mechanical objectives :
1- Irrigation :
To eliminate as much debris as possible before introducing the
enlarging instrument inside the canal
2- Resistance form :
By enlarging the apical terminus of canal while preserving apical
constriction, violating the apical constriction by over
instrumentation leads to irritation of the periapical tissue by
instrument & filling material, in addition, abscence of an apical
 stop due to violation of the apical constriction results in inability
to compact root canal filling material.
3- Retention form :
This is achieved by enlarging the apical terminus while retaining
its round cross section. This shape provide an intimate contact
between the apical dentin walls & the gutta percha prevent further
leakage.
4- Extension for prevention :
Keep the apical foramen as small as practical & Never transport
apical foramen.

I V . Traditional ( step back )

1- T.L. Determination
A- Radiograph
B- Tactile Sense
C- Apical Periodontal Sensitivity
D- Paper Point Measurement
E- Electronic Apex Locator
F- New Radiograph Technology

1- T.L. Determination
Definition of working length (acc. To glossary) :
Distance From a Coronal reference point to the point at which
preparation and olituation Should be Terminated.

Anatomic apex: TIP or end of the root determined morphologically.

Radiographic Apex: TIP on end of the root determined radio-
graphically.
Apical Foramen: main apical opening of the root canal eccentrically
located away from anatomic or radiographic apex.
Apical constriction: apical portion of the root canal having the
narrowest diameter.
This position may very but usually 0.5 - 1.0 mm short of the center of
apical foramen.

A- Radiograph Method:
Known as Ingles Method,
Items essential to perform this procedure:
1- Goods undistorted , preoperative radiographs Showing the total
length and all roots of the involved tooth.
2- Adequate canal access.
3- An Endodontic ruler.
4- Knowledge of average length of all teeth.
5- Definite, repeatable reference to an anatomic land marks.
- To establish the length of the tooth , stainless steel reamers or file
with an instrument stop on the shaft is needed.
- The exploring instrument size must be Small enough negotiate
the total length of canal but large enough not to be lose in the
canal.
Determining length of cured canals:
A. Initial measurement:
The tooth is measured an a good pre-operative radiograph using long
cone technique tooth appears to be 23 mm long on radiograph .
B- Tentative working length :
As a safety factor allowing for image distortion an magnification
subtract 1mm from initial measument for a tentative was king length
of 22 mm.
C- Final working length :
The instrument is inserted into the tooth to this length radiograph is
taken. Radiograph shows that the image of the instrument appears to
be 1.5mm from the radiographic end of the root, this added to
tentative working length giving total 23.5 mm from this sulutract
1.0mm as adjustment for apical termination short of the
cementodentinal junction. The Final working length is 22.5mm used
to enlarge the root canal.
Variation:
When two canals of maxillary First premolars appear to be
superimposed much confusion least time may be saved by :
o Take individual Radiograph of each canal.
o Preferable method to expose the radiograph from mesial
horizontal Angle.
o M L M (Clarks fule ):
Mesial , the lingual canal appear mesial on the film.
Mesial , the Buccal appear Distal on the film.
3- Digital tactile Sense :
o If the coronal position of the canal is not constricted or if it is
preflared ,an experienced clinician may detect an increase in
resistance as the file approaches the apical to 3mm.
o This method is inaccurate if the canal is constricted throughout
its entire length on if the canal has excessive curvature ,this
method should be considered as supplementary to radiograph or
apex locator.
C- Determination of working length by paper point measurements:
In root canal with an immature apex (wide open) , by gently
passing the blunt end of a paper point into the canal after profound
anesthesia the moisture or blood on the potion of paper point that
passes apex may be an estimation of working length.
D- Determination of working length by apical periodontal
sensitivity:
If an instrument is advanced in the canal toward in flamed tissue
the by hydrostatic pressure developed inside the canal may cause
moderate to series , instantaneous pair ,at the onset of pain , the
instrument tip may still be several millimeters shot of the apical
constriction. If canal contents are totally necrotic or these is
periradicular lesion is present because the tissues is not richly
innervated. Also, Vital pulp tissue with nerves and vessels may
remain in the most apical part of the main canal even in the
presence of large periapical lesion, this suggests that a painful
 response may be obtained inside the canal even though the canal
contents are necrotic and there is a periapical lesion.
E- Determination of working length by electronics :
Apex locator is commonly used to locate the apical constriction, the
cementodentinal junction or the apical foramen.
All apex locators function by using the human body to complete an
electrical circuit, one side of the apex locator is connected to an
endodontic instrument and the other side is connected to the pt.’s body
either by contact to lip or held in hand.
Another important point in accuracy studies is the error tolerance that
is accepted in experimental design.
There appear to be growing concern that either +0.5 or –0.5 , error
may give rise to clinical problems & that the ± 0.5 tolerance may be
unacceptable.
- The classification of apex locations presented here is a
modification of classification presented by McDonald, this
classification is based on the type of current flow & the
opposition to the current flow.
- First generation.
- Second generation.
- Third generation.
Also, there are other 2 types :
- Fourth generation.
- Fifth generation.
- Other uses of Apex locator :
• Sunada suggested the possibility of using apex locators to
detect root perforations.
• It was later reported that the electronic Apex locators (EALs)
could determine the location of root or pulpal floor
perforation.
• The method also aided in diagnosis of external root resorption
that had invaded dental pulp space or internal root resorption
that had perforated to external root surface.
Contraindications :
Use of Apex locators & other electrical devices such as pulp testers,
electro-surgical instruments is contraindicated for patients who have
cardiac pacemakers.
F- New Radiograph Technology :
1- Xero-Radiography :
Can produce high quality diagnostic film at 1/3 of the
exposure time of the conventional radiograph, this system
include :
- conventional X-Ray machine.
- Special intra-oral film cassette.
- Photo processor.
2- Digital image processing :
It enables the radiograph to be digitized & manipulated
electronically, Radiographs are taken using conventional
techniques & processing. They are then backed & digitized &
the image areas or pixels are converted to 256 gray levels. A
subtraction image can be manipulated electronically. By this
method, it is possible to remove bone trabeculae & enhance
the remaining image, typically tooth.
3- Radi-Visio-Graphy (RVG) :
This system provides an image on a video monitor while reducing
the total radiation by 75%. This system consists of 3 componants :
a- Radio Component : which consists of hypersensitive intra-oral
sensor & a conventional X-Ray machine, the sensor translates
 the image produced into electric signals that is transmitted to the
display processing unit.
b- Visio Component : which consists of a visio monitor &
processing unit. The processing unit magnifies the image 4-times
for display an video monitor.
c- Graphy Component : which is a high resolution video printer.

* Chelating Agents :
- Containing ethylenediamintetracitic acid (EDTA).
* Purpose :
- Lubrication.
- Emulsification.
- Holding debris in suspension.
* RC prep (premier Dental products) viscous chelator, its principle
ingredients are EDTA, urea peroxide & propylene glycol.
* Glycol is lubricants that coats instrument & facilitate movement in
open canal containing calcific material or in restricted canals.
* Using RC prep & Naocl produce significant effervescence
creating an elevator action to evaluate debris in root canal system
rinsing or irrigation with EDTA 17% solution for 1 minute
eliminate smear layer, opens up dentinal tubules & provide cleaner
surface against which gutta-percha & sealer will adapt.
 Cleaning And Shaping Techniques
I- Hand Driver Techniques

Apical coronal Hybrid Coronal Apical

1- Step back tech ( tech by Cohen) 1- Step down
2- Standardized tech 2- Double flare
3- Roane ( balanced force ) 3-Crown–down pressures tech.
(apical conlial zero)
Rotary driven tech.
1- Profile
2- Profile greater taper
3- Light speed
4- Light speed-x
5- Quantec
6- Mcyimseus
7- Hero 642
8- Hero shaper
9- Endosequance
10- Liberators
11- NRT files
12- K3 Instrumentation
13- Flex- matser
14- Root S – apex ( reveisd laper )
15- Pow – R& RBS
16- Ez – fill safe
17- Race
Root canal preparation :
1- Scouting the coronal two thirds :
Stainless steel hand files no. 10 &15 used to scour the coronal two
thirds. They are not just reassuring wires, they provide the following
important information :
(1) They reveal the sass – sectional diameter of the canal & provide
information whether the canal is open, partially restricted or
calcified.
(2) They confirm the presence or absence of straight line access.
Clinicians can observe the handle position of the instrument to
see is it is upright & parallel to long axis of tooth or not, When
the handle of the scouting instrument is old the long axis of
tooth, then pre – enlargement procedures should be directed
toward up righting the file handle by refining & expanding the
access preparation & removing the restrictive dentin from
coronal third of the canal. This procedure simplifies all
subsequent instrumentation & eliminates many cleaning &
shaping frustrations. Fig 8- 58 p.264.
(3) They provide information about root canal system anatomy.
( canals that merge , curve , recurve , dilacerate or divide).

* The Balanced force technique (Roane)

- it uses instruments in a step-beak manner to initiate pre-
enlargement procedure & to rapidly gain access to the apical
third. So the apical preparation is called ( apical control zone )
 - The flex R- files used are not precurved &used in a controlled
rotary motion.

Step by Step :
1- Phase I (file insertion) : File is inserted into the canal a bock &
forth motion until it feels snug. The file is rotated cloak wise
rotation 45 – 90 to move the instrument deep to the canal, move its
cutting blades deeper into the canal & engage dentin. (fig. 8– 62,
A p : cohen).
2- Phase II (file cutting) : The clinician applies two simultaneous
balancing forces on the file handle. The instrument is rotated CCW
with slight apical pressure. The CCW movement tends to move the
file out of the canal so that it is balanced by the force of file being
pushed into the canal.
After this cutting cycle the instrument is extended deeper into the
canal by CW rotation as in phase I & than phase II is repeated, ( Fig:
8-62, B-P : 268 cohen).
Phase I- Flute loading ….The dentin cut in phaseII Lies partially in
the interblade spaces of the file & partially in the canal apical to
instrument carnally. ( Fig : 8-62,C-p:268 ).
When flute loading is performed properly, the position of file tip never
goes apically, because the tendency of the file to move apically is
balanced by the force of the file being lifted out of the canal. After
two or three rotations, the file removed from canal & its apical flutes
loaded with dentin mud.
Step by step :
1- The canal is irrigated with NaOCL & Flex – R file no. 15 is
inserted to the estimated length by CW & CCW rotation. This
action is repeated to move the file to the estimated length .
2- A no. 20 & 25 files are inserted by 0.5 mm short of full canal
length in a balanced force section as in phase II.
3- Before completion the hand enlargement ( beyond no. 25 ) the
body of the canal is shaped with GG- drills.
4- The best sequence is to being with no.6 GG – drill & cut into the
canal opining a distance no more than 2 mm . then irrigation
with NaOCL.
5- Then proceed with no.5 GG- drill & extend the depth to another
2 mm & irrigation.
6- Continue this process until no.2 GG – drill which is entered the
canal to 10 mm depth or a curvature prevents its penetration
N.B: do not force a GG- drill through a curvature or breakage or a
ledge will result.
7- Irrigate the canal & reinsert no. 25 in a clock Wise rotational
movement with slight coronals pressure ( phase III ) to remove
debris that block the canal .
8- Irrigate the canal & move to no. 30 file, use balanced force
nations, & continue to file no.45.
9- Receiving the control zone & establishing apical potency.
-: Advantages
1- No measurable apical canal transportation as it is remain
centered in the canal.
 2- Effective instrumentation of curved roof canal.
3- less derris extruded through apex.

Disadvantage :-
Instrument breakage so that the tactile sense is important in this
technique during handling the files.
10- Return no. 15 file and pass it through the full canal length.
11- Ingrate, fit the no. 25 file with its length 0.5 short of the full canal
length, rotate and then remove.
12- Ingrate and insert no. 35 to depth 1mm short, rotate
and then remove.
13- Ingrate and do the same with no. 45 (1.5 short).
14- Ingrate and now pass no.20 to the full length and carefully rotate it
though the foramen, irrigate, dry the canal.
15- Fit a gutta-percha point to the canal, when it fits to full
canal length, preparation is completed.

“Step down technique”

It is the technique in which Gates. Glidden drills & lager files are first
used in the coronal two-thirds of the canal & then smaller files are
used from the crown down until the desired length is reached.

Benefits of crown down technique:

1- Minimize or eliminate the amount of necrotic debris that could
be extruded though the apical foramen during instrumentation.
This would prevent pretreatment discomfort, incomplete
cleansing of difficulty in achieving a biocompatible seal at
apical constriction.
2- Allows deeper of earlier penetration of irrigants.
3- The freedom from constraint of the apical enlargement
interments. By first flaring the coronal two-thirds of the canal,
the final apical incitements. Well have easy access down the
canal. This increased allows greater control of less chance of
zipping near the apical constriction (gives better tactile control
in apical third).
4- Reduce the problem of losing working length during
preparation.
Step down. Step by step: fig 10-80 (Ingle) p:537.
1- The access cavity is filled with sodium hypo chlorite & the
first instrument (curved instrument) introduced into the canal.
Page (3)
2- Establishing the working length by the initial penetrating K –
file . to ensure this penetration the coronal third many
enlarged by smaller Gates – Gliden drills.
3- With the use of sodium hypochlorite, K. flex, Triple flex or
safety headstream instrument we used Starting with a No.50
instrument ( for example ) & working down the canal to a sire
No.15.
 - The instrument are used in a watch winding motion
( clockwise then anticlockwise motion ) until the
working length is reached.
- When there is a resistance the next smallest sire is
use.
4- Irrigation should follow the use of each instrument &
recapitulation after each instrument by using the initial
scouting file No.10 or 15 to the working length of the canal.
Fig .8.59 p.265 cohen.
5- A reverse order of instrument are used by starting by smaller
instrument as No.20 & progressively larger ones to a sire
No.40 or 50 ( Step – back technique ). This improves the
tapered shape of the canal, properly enlarge the apical third &
round out the lateral canal orifices.
* Modified technique:
• Following the complete access, the clinician uses the proper
sire of Gates Gliden drills. Which creates a smooth guide path
facilitates the placement of subsequent instrument.
• If the plup in vital a broach is used to extirpate it.
• At this stage the coronal two thirds should be scouted by a
No.10 or 15 curved stainless steal K. file in presence of
lubricant & sodium hypochlorite.
• Exploration of this portion of the canal will confirm straight
line access, cross sectional diameter & root canal system
anatomy. Files are used serially to flow the canal until
 sufficient space is generated to safely introduce Gates Gliden
drills or Ni –Ti rotary shaping files.
• Irrigation with sodium hypochlorite & recapitulation with a
No.10 file decrease canal blockage & move debris into the
solution where it can be removed from root canal system
anatomy.
• Then the preenlargement of the canal done with Gates Glidden
drills that used as a brush to remove restrictive dentin. Initially
start with a Gates – Gliden drill No. 1& then with larger
instrument to promote smooth, flowing tapered preparation.
• Following the pre-enlargement the optical third is finished so
that there is smooth uniform taper from the orifice to the
radiographic terminus.

1. Hand driven techniques:

a) Apical-coronal techniques:
1. Standardized technique:
This is the classic technique initially described as the referred method
of cleaning and shaping. The desired and, result of this technique is to
create a preparation that has the same size, shape and taper as a
standardized instrument.
Step-by-step:
1. Determine the working length.
2. Introduce the smallest reamer into the canal and rotate it clockwise
to engage dentine and then withdraw.
3. Wipe clean and reinsert; repeat until the working length is
reached.
4. Repeat with successively larger reamers until the required size is
reached apically.
5. A canal shape should be produced which matches the last reamer
used and which may be obturated with a matching silver point.
This technique had several disadvantages:
1. Files and reamers are round in cross section while canals are
elliptical. The canals were thus insufficiently cleaned; pulp
debris and infected dentin remained in the canal system and
caused problems.
2. Creating a true standardized tapered preparation is difficult in
ideal situations and impossible in curved canals.
3. This technique was used to prepare the canal to receive silver
point filling. When silver point filling was substituted by gutta-
percha, due to deleterious products from breakdown of silver
points, and their removal due to endodontic failures, many
problems arise, particularly in curved canals. Of these
problems, ledging was the most common.
2.Step back technique:
Also called telescopic or serial root canal preparation. This
technique was designed to overcome instrument transportation in the
apical-third of the canal. Serial or step-back technique; starting at
the apex with fine instruments and working one's way back up the
canal with progressively larger instruments.
Mullaney divided the step-back preparation into two phases: phase
I; apical preparation starting at the apical constriction and phase II;
preparation of the remainder of the canal, gradually stepping back
while increasing in size. The completion of the preparation is the
refining phase, to produce a Continuous taper from
apex to cervical.
Curving the file to match the canal is paramount to success in the
step-back maneuver. Because all root canal have some curvature.
Even apparently straight canals are usually curved to some degree
and canals that appear to curve in one direction often curve in other
directions as well.
Step-by-Step:
a) Phase I: (Apical preparation):
To start phase I, the canal must have been explored with a fine
pathfinder or instrument and that the working length of the tooth has
been established, that is the apical constriction identified.
The first active instrument to be inserted should be a fine K-file,
curved and coated with a lubricant (such as Gly-oxide, RC Prep,
File-Eze, K-Y jelly or liquid soap) until it reaches the full working
length. The motion of the instrument is watch winding. Upon
removal, the instrument is wiped clean, recurved, relubricated, and
repositioned. Watch winding is then repeated. This procedure is
repeated until the instrument is loose in position. The next size K-
file is used, length established, precurved, lubricated and positioned.
Watch winding or very short filing strokes can be used. It is
important to use a lubricant to aid the instrument tip to macerate and
remove the fibrous pulp stumps, which are always compacted into
the constricture and leads to
apical blockage.
By the time size 25 K-file has been used to full length, phase I is
completed. The 1-2 mm span back from the apical constriction
should be clean of debris, unless this area of the canal was large to
begin with, as in youngster, then a larger instruments are used to
start with. Past size 25 lies danger, as instruments become larger,
they become stiffer. Metal "memory" plus stress on the instruments
starts its straightening. It will no longer stay curved and starts to
dig, to zip the outside convex wall of the canal.
Irrigation between each instrument use is now in order, as well as
recapitulation with the previous smaller instrument carried to the
full length and watch wound. This breaks up the apical debris so it
may be washed away by NaOCl. All of these maneuvers (curved
instruments, lubrication, cleaning debris from the used instrument,
copious irrigation and recapitulation) will ensure patency of the
canal of the apical constriction.
b) Phase II: (Stepping back):
In a fine canal, the step back process begins with size 30 K-
file. Its working length is set 1-mm short of working length. It is
precurved, lubricated, carried down the canal to the new shortened
length, watch-wound and retracted. The same process is repeated
until size 30 becomes loose at this adjusted length. Recapitulation
to full length with size 25 file follows to assure patency to
constriction. This is followed by copious irrigation before the next
curved instrument is introduced. In this case, it is size 35, again
shortened by 1-mm from that of size 30. It is curved, lubricated,
inserted, watch wound and retracted followed by recapitulation and
irrigation.
Thus the preparation step back up the canal 1-mm and one
larger instrument at a time. When that portion of the canal is
reached, usually the straight mid-canal, where the instruments no
longer fit tightly, then circumferential filing may begin, along with
plenty of irrigation. H-file or Gates Glidden drills could be used in
preparing this portion of the canal. Care must be taken to
recapitulate between each instrument with the original size 25 file
along with ample irrigation.
Refining is then performed, which is a return to size 25
instrument, smoothening all around the walls with vertical push-
pull strokes, to perfect the taper from the apical constriction to the
cervical canal orifice. In this case, a safe-ended, non-cutting tip H-
file is the most efficient in performing this refining.
Modifications of the step back technique:
1. The preparation is completed in the apical area and then
the step back procedure begins 2-3 mm up the canal. This gives a
short, almost parallel retention form to receive the primary.
2.Double-flared technique:
This technique was devised with the fundamental principles of the
coronal-apical approach in mind.
Ste-by-step:
1. Irrigate the pulp chamber and introduce a small file into the
canal using only gentle push-pull movements to a working
length estimated from radiographs. The aim of this is to
introduce irrigant into the canal.
2. Take a further radiograph to check the working length.
3. Re-irrigate and introduce a larger instrument into the canal to
a depth of about 14 mm or in any case coronal to the curve.
This should be loose inside the canal, but is used to file the
canal walls.
4. Re-irrigate and introduce the next size down 1-mm deeper
into the canal, maintaining instrumentation coronal to the
curve, and file the walls gently. The instrument should not
bind in the canal.
5. Repeat stage(4) with the next size down.
6. Continue until the working length is reached, taking another
radiograph if necessary to establish definitive working length.
Once the working length is reached the full length of the
canal is prepared to the appropriate size.
7. The canal is now prepared using the step-back technique as
described before, except that much less filing is necessary to
establish the final taper. Once again, the use of recapitulation
is stressed.
 This technique was originally recommended for straight
canals and in straight portions of curved canals. It is contra-
indicated in calcified canals, young permanent teeth and in those
with open apices. The principles of the approach, to neutralize
canal contents and minimize their extrusion, may be applied to
most teeth.

3) Crown-down pressure less technique:

The aim of this technique is to facilitate preparation of curved
canals without causing deviation. In this method the working
length of tooth is not first established.
Step-by-step:
1. The access cavity is filled with NaQCl.
2. Determine radicular access length (the length to which a #35
file penetrates to its point of resistance). If this is more than
16 mm, the coronal portion of the canal should be prepared to
this length. If the file penetrates less than 16 mm, a
radiograph should be used to determine whether it is because
of canal curvature or narrowing of the canal. If it is due to
beginning of a curve, the canal is prepared to the point of first
resistance; if not, the canal is widened with smaller files until
the #35 file penetrates to 16 mm (pre-Gates preparation).
Radicular access is now prepared up to this point, taking care
not to ledge the wall if a, curvature begins here.
 3. Then #2 followed by #3 G.G. drills are used without apical
force to flare out the radicular access and copious irrigation
follows.
4. At this point, a provisional working length 3 mm short of the
radiographic apex is established. A file #30 is placed in the
canal until resistance is encountered and is rotated twice in a
clockwise passive penetrating movement. Then smaller files
are used until the provisional working length is reached.
5. True working length must be established then.
6. Repeat the sequence of placing a file and rotating twice
without apical pressure until the working length is reached,
starting with a #40.
7. To make sure the apical area is thoroughly cleaned-
successively larger files are used to reach "the constriction
until a #25 at least, is used to full working length. Final
smoothing of the walls and perfection of the continuing
flaring shape are accomplished with #30 to 35 H-files used
circumferentially.
4) Canal master technique:
Its aim is to aid the maintenance of curves using a rotary
instrument designed so that only the apical 1-2 mm is engaged
in dentin removal.
Step-by-step:
1. Determine the working length.
 2. Prepare the beginning of the curve using the mechanized
rotary instruments.
3. Use the canal, master instruments in step-back fashion to
prepare the curve.
VI- Rotary using NiTi :
Problems associated with hand & rotary instrumentation with stainless
steel :
1- Too many steps to generate desired shapes.
2- Canal transportation naturally results from instruments increase
in diameter & stiffness.
3- Use of traditional canal enlargement such as Gates-Giddier drills
can cause excessive dentin removal.
Types of rotary :
(1) Profile.
(2) Profile GT
(3) Protaper
(4) K3
(5) Light speed.
(6) Quantec
(7) Race
(8) Heroshaper
(9) Light speed x
(10) Endo sequence
(11) Root s-apex
(12) Pow-R & RBS
(13) Flex master
(14) EZ-Fill space
(15) Librator
(16) NRT Files
(17) Hero 642
1- Profile file 0.04 & 0.06 taper rotary

• Designed for use in a controlled slow-speed, high torque, rotary

hand piece.
• Orifice shape in 0.06 & 0.07 mm/mm taper are designed to
replace Gates-Glidden drills for shaping the coronal portion of
the canal, these instruments remain centered in the canal while
creating a tapering preparation this preflaring allows for
effective cleaning & shaping of apical half of the canal with
profile series 0.04 tape.
• Profile are available in either 0.04 (double taper) or 0.06 (Triple
taper).
• No significance difference between 0.04 & 0.06.
• Use of 0.06 improve canal shape.
 • 0.04 is more suitable in small canals.
• 0.06 is more suitable in mid. root portion of most canals as distal
of mandibular molars.
3- Technique of Protaper rotary system :
With a smooth, reproducible glide path end on accurate working
length, the apical one-third can be optimally finished with Pro Taper
files. pulp chamber is filled brimful with NoOCl. S1 is selected and is
always the first ProTaper file carried to the full working length. When
there is a smooth, reproducible glide path, the S1 file will float down
the canal and move length (Figure 10).
In the event the apical movement of the S1 stalls out prior lo
achieving length, then remove S1 and irrigate, recapitulate with the 10
file lo confirm the glide path, and re-irrigate. Generally, only one or
two passes are required lo easily, move S1 lo length. Following the
use of S1, irrigate, recapitulate and re-irrigate.
Shaping File No. 2, termed S2, is the next instrument used and has a
write identification ring on its handle, a DO diameter of 0.20 mm, and
nine [9] increasingly larger percentage tapers over its 14 mm of
culling blades. 52 will typically move passively to the desired working
length on the first pass (Figure 11). The S2 file is used in the same
manner as S1 and when it reaches the terminus of the canal, it should
be immediately withdrawn. The 52 file will easily fallow the
improved SI glide path and will progressively carry another shaping
wave deeper towards the apical extent of the canal. When the 51 and
S2 files are carried to full length, they will have optimally shaped the
coronal two-thirds of virtually all canals as their progressively tapered
designs ensure that each instrument performs its own "crown-down"
work S1 and S2 should he carried to me full working length only one
time and for no longer than one second. Following the use of 52,
irrigate, recapitulate and re-irrigate In more tortuous canals and
especially during the learning curve it is wise to re-confirm working
length following the use of S1 and S2 as a more direct path to the
terminus has been created
At this stage of treatment, the preparation can be finished. The
preparation goal is to produce a fully tapered canal that exhibits
uniform shape over length. To fulfill this objective there are three
finishing files tanned Fl, F2 and F3 which have yellow, red and blue
identification rings on their handles corresponding to DO diameters of
0.20, 0.25 and 0 30 mm, respectively. In addition, the-apical one-
thirds of F1H F2 and F3 have fixed tapers of 7%, B% and 9%,
respectively. The first finishing file selected is the Fl which is
introduced info the canal and passively allowed to move to just short
of the previously recorded working length (Figure 12) When the Fl
achieves this depth, it is immediately withdrawn and its apical flutes
inspected for debris to appreciate the precise location where it is
cutting within the canal. ProTaper files are never used in a pumping
motion or allowed to linger at the working length
Following the use of Fl, flood the canal with irrigant, recapitulate and
confirm patency, then re-irrigate to liberate the debris from the canal.
It is important lo completely understand and fully appreciate that files
shape a root canal but irrigants clean a root canal system. As such, the
potential for an irrigant to work is maximized when it is healed,
flooded into shaped canals and given ample time to work. 3,14

IMPORTANCE OF ACCESS
Preparing a root canal can commence after
completing straightline access la me orifice(s).9
In teeth exhibiting calcification, dentin can be
precisely sanded away and orifices more readily
identified by utilizing contra-angled, parallel-
walled and abrasively cooled ultrasonic
instruments (ProUltra Endo Tips,Dentsply
Maillfer Ballaigues, Switzerland} 10 In combination, microscopes and
ultrasonic have driven "microsonic" technique* that have dramatically
improved successfully locating receded orifices Once any orifice ha$
been located, it can be advantageously flared with one or more gates
glidden drills [Dentsply Maillefer; Ballaigues, Switzerland). Attention
to detail when finishing the access cavity facilitates the subsequent
shaping of a root canal. A "finished" access cavity is confirmed when
hand files can be conveniently passed through an access cavity, easily
slide dawn smooth axial walls that seemlessly transition into a flared
orifice, and effortlessly inserted into me underlying root canal system.
 Light Speed LSX
[

Access, Flaring, Working Length, Canal Potency

Make access and flare the coronal 4 to 5 mm with Gates-Glidden
Drills or Orifice Openers (see our Straight Line Access Technique
Guide). Determine working length (WL) with an electronic foramen
locator (recommended). Ensure canal potency to WL with a #15 or 20
K- file.

Step 1: Instrument the Apical Part of the Canal and Determine the
Final Apical Size
Begin with the LSX #20 and continue with sequentially larger sizes
until the apical part of the canal is prepared to the correct Final Apical
Size (FAS*).
This is the size that requires a firm push in at least the apical 5 mm to
advance it to WL. Determining the FAS will become intuitive with
experience. See Figure A for Average Final Apical Sizes.
The FAS defines the Working Width (WW). It is the instrument size
that is slightly larger than the original apical canal diameter. The FAS
mechanically cleans the apical canal walls. See Figure B, Apical
Cross-Section.
*Also called the Master Apical File (MAF) or Master Apical Rotary
(MAR).
Instrumentation Guideline
With the handpiece rotating, enter the canal
and slowly advance the LSX apically. If there
is no resistance (common with smaller sizes)
keep advancing to WL. If there is resistance
(blade engages walls), pause there for a
moment, and then advance to WL with a slow,
continuous pushing motion. Sometimes a LSX will not advance to
WL because of a sharp curve (usually at the very end of the canal).
Instead of using force, smooth out the curve with a #20 K-file. In very
rare instances, a #25 Kfile is required.

Irrigation Sequence
Irrigate after each instrument that cuts dentin (applying suction while
irrigating enhances debris removal). Flush with NaOCL (or irrigant of
your choice) until the solution is clear. Fill the canal and chamber with
liquid EDTA (do not suction it out).
Technique Guide
Step 2: Complete Apical Shaping
Instrument 4 mm short of WL with the next larger
instrument (than the FAS). This shapes the apical 5
mm to accept the 5 mm SimpliFill Apical Plug
used for obturation.
Note: If obturating with a Standardized cone (.02
taper) instead of SimpliFill, step-back from WL in
2 mm increments with sequentially larger instruments until reaching
an instrument size that is 25 larger than the FAS. For example, if the
FAS is a # 45, instrument 2 mm short of WL with a # 50, 4 mm short
of WL with a # 55, 6 mm short of WL with a # 60, 8 mm short of WL
with a # 65 and 10 mm short of WL with a # 70. This provides canal
shape for the Standardized Master cone.

Step 3: Instrument Mid-Root

Instrument the remaining 4 to 5 mm of the mid-
root with sequentially larger instruments. Advance
to resistance, pause, then push 2 mm apically. BE
CAREFUL NOT to advance any instrument to
within 5 mm of WL as this may result in a loose
fitting SimpliFill Plug. Repeat this step until
reaching a size that will not easily advance past
the coronal third of the canal. Mid-root
instrumentation usually requires 3 instruments.
Step 4: Recapitulate
Using the FAS rotating in the handpiece, recapitulate to WL and:
1) Confirm that the canal is prepared so that the FAS goes
easily to WL without encountering any obstructions.
2) Confirm that the WL was maintained.
3) Then stop the handpiece rotation and confirm the existence
of an apical stop by attempting to push the FAS past the
WL. The FAS should not advance past WL.

Step 5: Final Irrigation*

1) Irrigate with NaOCL (or irrigant of your choice), suction
and dry.
2) Rinse with EDTA, suction and dry Once you have
confirmed that the canal is clean and free of debris the
canal is ready for obturation.
* Follow the obturation system manufacturer’s recommendations
for final irrigation procedure.
Do Not
• Do not push hard or force LightSpeed instruments.
• Do not instrument in a dry or semi-dry canal. Instead, instrument
with liquid EDTA in the canal.
• Do not exceed 3000 RPM or go below 2000 RPM.
• Do not overuse LightSpeed instruments.
• Do not use LightSpeed without rubber dam.
NOTE: When overstressed, LSX instruments are designed to
twist-up or pull loose from the handle. This may
occur when they:
• become dull from overuse
• are pushed too rapidly
• encounter unusual anatomy
• encounter inadequate coronal flaring
If fracture occurs the fragment usually is easily removed. If the
fragment cannot be removed, try bypassing it with K-type files.

Smear Layer
Debries compacted into the surface of dentinal tubules by the action of
instruments.
Composed :
- Organic , inorganic calcific tissues
- Neuritis tissues
 - Micro organisms

Described by scanning election microscope (SEM):

- as amorphous substance with an irregular surface covering
anatomical structures of the root canal.
- Consist of 2 layers :
1- surface layer : cover orifice of dentinal tubules
2- inner layer : penetrate into dentinal tubule so occlude them,
provide natural barrier against fluid movement.

Has variable thickness :

- Is fluenced by type of root, instrument used & amount and
composition of irngant employed.
There are different opinions whether to remove or preserve
smear layer.

Positive effects of preserved smear layer :

1- Influence movement of fluids in dentinal tubules.
2- Prevent penetration of microorganism into dentinal tubules.
3- Reduce permeability of dentin for toxins.
4- Prevent dentin surface from being wetted by an exudates.
Negative influence of preserved smear layer:
1- Prevent contact between root canal wall and filling material.
2- Make penetration of filling material and disinfectant, irrigant
into dentinal tubules more difficult.
3- Bacteria present in smear layer may cause delayed pathological
conditions.
 Laser
- Laser stands for light amplifications by stimulated Emission of
Radiation. It is characterized by monochromatic (one color /
one wavelength).
- The laser light can be used in endodontics in three main areas:
1- the periapex, 2- the root canal system, 3- hard tissue mainly
dentist
- Unlike the carbon dioxide laser, the Nd : YAG (Neoolyminum
: YUrium Aluminum Garnet), argon, excimer, holmium &
erbium laser beams can be delivered through a fiber obtic that
allows better accessibility to root canals.
- Technique :
o The apical region is widened by no. 15 K-file with
irrigation.
o The fiber diameter used inside the canal ranges from 200
to 400µm equivalent to no. 20 – 40 file.
o Preparation begins with laser energy level set at 150
milli-joules. The plasma effect could be observed at the
end of the fiber when contacted with dentin. It appears as
a bright spark. It transforms the dentin into ionized gas
leaving no debris on canal wall.
 o The fiber optic inserted to working length & enlargement
is performed circumferentially starting in the apical third
upward to cervical portion to a size no. 60 instruments.
o The dentin appears crusty, many aspects with open
tubules & no apparent smear layer.
o Another Phenomenon noted was melting, recrystalization,
glazed surfaces & deposit of silicon fiber optic.
o Levy has suggested that the fiber optic is made of
hydroxyapatite so the deposit that plug the tubules would
be inorganic tooth substance.
- He also speculated that fused hydroxyapatite can be used to
send the root apex or repair a crack.
- Laser also can be used to vaporize broken instruments in
canals.
Hazards :
1- The best produced from irridacted root surface by laser may
cause damage to surrounding tissues.
2- Studies found that when a fiber optic placed 1 mm from the
apical foramen for 2-3 seconds, infilteration of inflammatory
cells observed in all groups in 2 weeks.
Disadvantages :
1- Difficult access to severely curved.
2- Expensive equipments.
 Irrigation
Root canal should be washed out or irrigated before , during coarse of
cleaning and shaping.
Benefits of Irrigation
1- Gross debridement
2- Elimination of microbes
3- Dissolution of pulp remnants
4- Removal of smear layer
5- Lubricant
Types
1- Isotonic saline
2- Sodium hypochlorite
3- Hydrogen peroxide
4- Chelating agent
5- Lubricants
6- Quaternary ammonium compound
7- Chlorohexidine gluconate
1- Sotonic saline
- Produce no recognized tissue damage
- Gross debridement
- Lubricant
2- Sodium hypochlorite
Most commonly used irrigant
- Gross debridement
- Lubricant
 - Destruction of microbes
- Dissolution of tissue
- In full concentration (5.25%) toxic to surrounding tissues so
must be equal to water (2.69%) to decrease its toxicity while
retain its action.

Combining:
Naocl with hydrogen peroxide cause foaming action for better
removal of debris.
But is : inhibit antibacterial action of both irrigant
Alternate use : of Naocl and EDTA is capable of removing smear
layer.

3- Hydrogen peroxide
- Popula due its effervescences action able of removing debris from
inside the canal.
- Release nascent oxygen that work against anaerobic microorganism

4- Chelating agent

Ethelyene dianine tetra acetic acid (EDTA)

- used as supplement of Naocl
- remove smear layer
- soften dentin
- facilities removal of calcific obstructions.
Not used for all situations but has specific indication
As it can soften dentin through out canal
If they are sealed into canal between visits or for extended period
during cleaning , shaping.

5- Lubricants
Rc- prep, surgical Jell :
- Used during initial canal negotiation procedure
- Has lubricant action
- Facilitate instrument movement with in the canal

Recommended :
During early stages of preparation to eliminate soft tissue blockage

6- Quaternary ammonium compound

- Antiseptic
- Low toxicity
- No tissue solvent action

7- Chlor hexidine gluconate Co.2%

- Antibacterial action compared to Naocl
- No tissue solvent action
 Techniques of Irrigations
1- Syringe irrigation.
2- Uhrasonic irrigation.

1- Plastic Syringe irrigation:

Use plastic syringe by bending needle to allow easier insertion inside
canal.
Is recommended that :
Needle lie passively inside canal as forceful irrigation can puss into
periapical tissues causing severe complications.
2- Ultra sonic irrigation
used with small loosely fit file in the canal with the irrigant.
The vibrational motion of file inside canal :
- Move irrigant in vortex like motion so cleaning areas can't be
reached by files.
- Cause warming irrigates so increase it's action.