Safa - lecture 6

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Questions and Answers

What is the role of the apex locator in endodontics?

  • It locates the apex of the root and its depth. (correct)
  • It provides imaging for root canal assessments.
  • It measures the patient's tooth sensitivity.
  • It indicates the correct file size for treatment.

Why is it important to measure the working length accurately in root canal treatment?

  • To facilitate easier posterior restorations after treatment.
  • To ensure that the treatment does not exceed the apex of the tooth. (correct)
  • To guarantee the complete elimination of bacteria from the canal.
  • To prevent injury to surrounding tissues by keeping instruments within safe limits. (correct)

When considering the anatomy of the apex, which point should the treatment ideally end?

  • The apical constriction. (correct)
  • The radiographic apex.
  • The apical foramen.
  • The root canal cementum.

What is defined as the working length in endodontics?

<p>The maximum length where root canal preparation and irrigation should terminate. (B)</p> Signup and view all the answers

How is the estimated working length typically determined?

<p>From pre-operative radiographs or average tooth length. (C)</p> Signup and view all the answers

What common mistake can occur when interpreting the working length in extracted teeth?

<p>Misjudging the radiographic apex as the apical constriction. (C)</p> Signup and view all the answers

Which of the following is NOT a component of the working length determination process in endodontics?

<p>Confirmation from the patient about pain levels. (D)</p> Signup and view all the answers

What is the primary reason for removing the smear layer before obturation?

<p>It enhances the bond strength of the root canal sealer. (D)</p> Signup and view all the answers

Which of the following statements about canal preparation is true?

<p>Irrigation is the primary method to address areas inaccessible to instruments. (B)</p> Signup and view all the answers

What role do antimicrobial irritants play in root canal treatment?

<p>They assist in the chemical cleaning of the canal. (A)</p> Signup and view all the answers

Why can't canal preparation simply be viewed as a mechanical function?

<p>The procedures must be performed together for effective treatment. (C)</p> Signup and view all the answers

What is a significant drawback of the smear layer within the canal system?

<p>It can interfere with the action of irrigants. (A)</p> Signup and view all the answers

What is the primary purpose of the lip clip in the apex locator system?

<p>To complete the electrical circuit (D)</p> Signup and view all the answers

Why is tactile sensation not a reliable method for determining working length in root canal treatment?

<p>It can cause unnecessary discomfort to the patient (C)</p> Signup and view all the answers

In which condition can an apex locator still function effectively for determining working length?

<p>In a dry pulp chamber (D)</p> Signup and view all the answers

What characteristic of an apex locator allows it to measure the distance to the apex?

<p>It assesses resistance or impedance changes (C)</p> Signup and view all the answers

What should be done if the file is over-extended beyond the apex by more than 2 mm?

<p>Take another radiograph to assess (A)</p> Signup and view all the answers

Which of the following is a limitation of using an apex locator?

<p>Heavy amalgam restorations (C)</p> Signup and view all the answers

How does an apex locator indicate that the file is at the correct working length?

<p>The display reads zero and a beeping sound occurs (C)</p> Signup and view all the answers

What is the function of the paper point in historical methods of determining working length?

<p>To check for bleeding at the apex (A)</p> Signup and view all the answers

What procedure should be followed if the file is found to be under-extended by 7 mm during a radiographic check?

<p>Take a new radiograph and adjust the file accordingly (D)</p> Signup and view all the answers

What is the primary purpose of shaping the root canal system during endodontic treatment?

<p>To facilitate the placement of irrigants and fillings (C)</p> Signup and view all the answers

What is the consequence of failing to properly obturate the root canal?

<p>Possible reinfection and discomfort for the patient (B)</p> Signup and view all the answers

Which of the following statements regarding root canal treatment is incorrect?

<p>Canals must always be shaped to a wider diameter. (D)</p> Signup and view all the answers

What does the principle of 'cleaning' in endodontics entail?

<p>Removing all pathogenic contents from the root canal system (A)</p> Signup and view all the answers

According to Dr. Herbert Schilder, what is a consequence of having unshaped canals?

<p>Inability to effectively clean and fill the canals (B)</p> Signup and view all the answers

What is the role of gutta percha in endodontic treatment?

<p>To fill the shaped canal system effectively (B)</p> Signup and view all the answers

During endodontic treatment, what should be done after performing chemo-mechanical treatment?

<p>Canals must be filled with a suitable material (C)</p> Signup and view all the answers

What is the desired outcome of thorough endodontic treatment?

<p>To eliminate all bacteria and their byproducts (B)</p> Signup and view all the answers

What can happen if the temporary restoration falls out after endodontic treatment?

<p>The patient may experience renewed infection (B)</p> Signup and view all the answers

What does the term 'timely' imply in relation to coronal restoration?

<p>The restoration should be performed promptly after treatment (A)</p> Signup and view all the answers

What is the maximum enlargement recommended for the canal when placing rubber stops on Gates-Glidden drills?

<p>2/3 of the canal (D)</p> Signup and view all the answers

What should be done with the #4 Gates-Glidden drill after the rubber stop is set?

<p>Activate the handpiece and plane the canal walls (C)</p> Signup and view all the answers

How is the distance set for the #3 Gates-Glidden drill in relation to the #4 Gates-Glidden drill?

<p>2mm longer than for #4 (A)</p> Signup and view all the answers

What is the primary direction of shaping the root canal in the crown-down technique?

<p>Coronal-to-apical (B)</p> Signup and view all the answers

What is one of the advantages of the crown-down instrumentation technique?

<p>It prevents apical extrusion of debris (C)</p> Signup and view all the answers

What should be done before entering the apical part of the canal in the crown-down technique?

<p>Irrigate to remove infected coronal tissues (A)</p> Signup and view all the answers

Which morphological factor can complicate root canal preparation?

<p>Canal wall irregularities (B)</p> Signup and view all the answers

During the procedure with Gates-Glidden drills, what must instruments do in relation to the canal walls?

<p>Contact and plane the canal walls (C)</p> Signup and view all the answers

What is the purpose of setting the rubber stop on the Gates-Glidden drills at different distances?

<p>To achieve a gradual tapering of the canal (B)</p> Signup and view all the answers

What is a key reason for combining step back and crown down techniques?

<p>To enhance the contact of irrigation solution with microorganisms (B)</p> Signup and view all the answers

The apex locator is primarily used to measure the width of the root canal.

<p>False (B)</p> Signup and view all the answers

Working length in endodontics refers to the precise location where root canal preparation should not exceed 3 mm beyond the apical foramen.

<p>False (B)</p> Signup and view all the answers

The estimated working length is solely based on the actual measurement of the root canal using a K file.

<p>False (B)</p> Signup and view all the answers

File placement within the root canal should ideally reach up to the apex of the root for optimal treatment.

<p>False (B)</p> Signup and view all the answers

During root canal treatment, if the file is seen to be exiting the tooth, it indicates proper working length.

<p>False (B)</p> Signup and view all the answers

Working length measurement is considered a critical step in root canal preparation.

<p>True (A)</p> Signup and view all the answers

A periapical radiograph is taken only after the access cavity has been created in order to measure working length.

<p>False (B)</p> Signup and view all the answers

Watch winding involves a continuous clockwise rotation of the instrument.

<p>False (B)</p> Signup and view all the answers

Reaming can be safely performed by rotating the instrument 360º to enlarge the canal space.

<p>False (B)</p> Signup and view all the answers

Circumferential filing is only appropriate for canals that are round and smaller in size.

<p>False (B)</p> Signup and view all the answers

The Balanced Force technique involves rotating flexible K files with cutting tips a quarter-turn counterclockwise.

<p>False (B)</p> Signup and view all the answers

Anti-curvature filing aims to remove more dentine from the inner curve than the outer curve of a root canal.

<p>False (B)</p> Signup and view all the answers

Gutta percha is used to fill unshaped canals effectively.

<p>False (B)</p> Signup and view all the answers

Mechanical instrumentation in the canal is done after cavity preparation to remove tissues and microorganisms.

<p>True (A)</p> Signup and view all the answers

The term 'timely' in relation to coronal restoration means the restoration should be done as quickly as possible to avoid complications.

<p>True (A)</p> Signup and view all the answers

All bacteria can be completely eliminated from the root canal system during treatment.

<p>False (B)</p> Signup and view all the answers

Obturating an open canal can lead to bacterial growth and patient discomfort.

<p>True (A)</p> Signup and view all the answers

Widening the root canal only makes it easier to deliver irrigation and obturation instruments.

<p>False (B)</p> Signup and view all the answers

Ensuring that all tissues and microorganisms are removed is a critical biologic objective of root canal treatment.

<p>True (A)</p> Signup and view all the answers

Dr. Herbert Schilder believes that unshaped canals can be effectively cleaned during treatment.

<p>False (B)</p> Signup and view all the answers

Success in endodontic treatment relies solely on mechanical instrumentation.

<p>False (B)</p> Signup and view all the answers

After obtaining a good seal with gutta percha, the temporary restoration does not need to be replaced immediately.

<p>False (B)</p> Signup and view all the answers

An apex locator can be accurately used in wet pulp chambers.

<p>False (B)</p> Signup and view all the answers

If the file length is over-extended by up to 2 mm, a radiograph is always required to confirm the working length.

<p>False (B)</p> Signup and view all the answers

The lip clip of the apex locator is placed on the same side as the rubber dam during a procedure.

<p>False (B)</p> Signup and view all the answers

Tactile sensation was used historically for determining working length with anesthesia administered.

<p>False (B)</p> Signup and view all the answers

Apex locators measure resistance or impedance change between hard and soft tissues.

<p>True (A)</p> Signup and view all the answers

Confirmational radiographs must be taken before using the apex locator to ensure accurate readings.

<p>False (B)</p> Signup and view all the answers

Apex locators have an accuracy ranging from 70% to 100% depending on the distance from the apex.

<p>False (B)</p> Signup and view all the answers

Paper points were historically used for checking working length, and they are still in common use today.

<p>False (B)</p> Signup and view all the answers

The visual display of an apex locator reaches zero when the file touches the periapical tissues.

<p>True (A)</p> Signup and view all the answers

The canal shaping process should maintain a cross-sectional diameter that is wider at every point apically.

<p>False (B)</p> Signup and view all the answers

The master cone is the largest file that reaches the apical constriction without damaging the canal anatomy.

<p>False (B)</p> Signup and view all the answers

The primary goal of canal shaping is to facilitate cleaning and provide space for filling materials.

<p>True (A)</p> Signup and view all the answers

The shaping of the canal should flow against the natural shape of the original canal.

<p>False (B)</p> Signup and view all the answers

Training your fingers for tactile sensation is unnecessary during the root canal treatment process.

<p>False (B)</p> Signup and view all the answers

In order to maintain proper canal shaping, one should increase the size of files as they move coronally from the access cavity.

<p>True (A)</p> Signup and view all the answers

The foramen position in the canal shaping process should be as wide as practical.

<p>False (B)</p> Signup and view all the answers

The process of shaping a canal will result in a structure resembling an upright Eiffel Tower.

<p>False (B)</p> Signup and view all the answers

Regular cleaning of the file flutes is essential for efficient root canal treatment.

<p>True (A)</p> Signup and view all the answers

The shaping technique does not require pre-curving files near the tip for effectiveness.

<p>False (B)</p> Signup and view all the answers

Flashcards

Working Length (Endodontics)

The maximum length (in millimeters) of the root where root canal preparation and irrigation should end. It's crucial for optimal treatment.

Apex Locater

A device used to locate the apex (tip) of a tooth root and its depth.

Apical Constriction

The narrowest part of the root, typically where root canal treatment should end.

Apical Foramen

The opening at the apex of the root canal.

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Estimated Working Length

An initial guess of the root canal length taken from existing radiographs or average tooth length.

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Periapical Radiograph

An X-ray taken to view the area around the apex of a tooth, often used in Endodontics.

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Root Canal Preparation

The process of cleaning and shaping the root canal to prepare for filling.

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Working Length (WL)

The maximum length (measured in millimeters) of the root canal that should be prepared and cleaned during treatment.

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Tactile Sensation

An outdated method of determining WL by physically feeling the file touch the apex. It's no longer used due to patient discomfort.

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File Over-Extension in WL

When the file goes beyond the ideal working length, exceeding the apex of the root canal.

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File Under-Extension in WL

When the file is placed too short within the root canal, failing to reach the ideal working length.

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Confirmation Radiographs

X-ray images taken after using an apex locator to confirm the accuracy of the determined working length.

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Paper Point (WL)

An outdated method of estimating working length by checking for bleeding at the file's tip.

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Radiographic Apex (WL)

The visible end or tip of the root canal in a radiograph image.

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Chemo-mechanical Treatment

The process of cleaning and shaping the root canal using instruments and irrigants to remove infected tissue and debris.

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Obturation

The process of sealing the root canal with gutta percha, a rubber-like material, to prevent bacteria from re-entering.

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Why is obturation important?

Obturation prevents bacteria from re-entering the cleaned canal, reducing the risk of infection and pain.

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Coronal Restoration

The final step of endodontic treatment where the tooth is restored to its original form and function, using crowns or fillings.

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Biologic Objectives of Endodontic Treatment

These objectives aim to eliminate infection, shape the canal for cleaning and filling, and restore the tooth.

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Removal of Tissues and Microorganisms

The first objective removes all infected tissue and bacteria from the root canal system.

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Shaping the Root Canal

The second objective involves shaping the canal to allow for proper cleaning, medication placement, and filling.

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Filling the Shaped Canal

The third objective ensures proper filling and restoration of the tooth to prevent future infections.

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Timely Coronal Restoration

A timely final restoration is crucial to prevent bacteria from entering the treated canal and causing reinfection.

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Unshaped canals cannot be cleaned and unshaped canals cannot be filled

This quote emphasizes the importance of properly shaping the root canal for effective cleaning and filling.

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Smear Layer

A thin layer of debris on the root canal wall made of organic and inorganic matter. It can harbor bacteria and prevent proper sealing.

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Debridement

The process of thoroughly cleaning out the root canal by removing debris, bacteria, and infected tissue.

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Paradigm Shift

A significant change in the way we think about and approach root canal preparation. From focusing on physical cleaning to preparing for irrigation and filling.

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Why remove the smear layer?

Because it can prevent proper sealing, allow bacteria to grow, and interfere with the effectiveness of disinfectants.

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Chemo-mechanical Preparation

The process of cleaning and shaping the root canal using both mechanical instruments and chemical disinfectants.

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Coronal flaring

Enlarging the coronal portion of the root canal to provide better access for cleaning and shaping.

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Gates-Glidden drills

Specialized drills used for coronal flaring, gradually shaping the canal from the crown towards the apex.

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Rubber stops

Devices placed on Gates-Glidden drills to control their depth of penetration and prevent over-enlargement of the canal.

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Crown-down technique

A root canal shaping technique where instruments are used progressively from the crown towards the apex, gradually cleaning and shaping the canal.

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Advantages of crown-down technique

Reduces risk of debris being forced into the apex, allows for better irrigation, facilitates canal obturation.

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Challenges in canal preparation

Morphologic factors such as curved canals, lateral canals, fins, and isthmuses can make shaping difficult.

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Paradigm shift in Endodontics

The focus has shifted from just physically cleaning to preparing for effective irrigation and obturation.

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Working Length

The maximum safe length of the root canal where treatment should stop. It's measured in millimeters.

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Pre-operative Radiograph

An X-ray taken before starting root canal treatment.

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File Over-Extension

When the file used for root canal cleaning goes beyond the apex of the root canal, potentially damaging tissues.

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File Under-Extension

When the file used for root canal cleaning does not reach the apex of the root canal, leaving debris and infection.

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Radiographic Apex

The visible point where the end of the root canal appears in an X-ray image.

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Lip Clip

A part of the apex locator that helps complete the electrical circuit by attaching to the patient's lip, allowing measurement of resistance.

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Watch Winding

A reciprocating back-and-forth motion of the endodontic file. Used to negotiate canals and place files with minimal damage.

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Reaming

Clockwise rotation of the endodontic file to enlarge the canal space. It planes the canal walls and removes tissue.

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Filing

A linear push and pull motion of the file to scrape the canal walls and remove tissue.

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Circumferential Filing

A directional filing motion on the mesial, distal, buccal, and lingual sides of the canal. Used for wider, non-round canals.

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Anti-curvature Filing

A technique for curved canals where more dentin is removed from the outer (safety) surface compared to the inner (danger) curve.

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Canal Shaping

Creating a properly shaped cavity within the root canal, allowing access for cleaning and filling.

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Continuous Tapering

The canal gets gradually narrower from the opening to the tip, forming a cone shape.

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Master Cone

The largest file that can reach the canal's tip without causing damage. It determines the final shape of the canal.

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File Movements

Specific techniques used to move files inside the canal to prevent breakage or damage.

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Pre-curving Files

Slightly bending files before use to match the canal's shape.

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Cleaning Flutes

Regularly cleaning the grooves on files to remove debris.

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What's the main goal of endodontic treatment?

To remove infection, shape the canal for filling, and restore the tooth to function.

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What's a timely coronal restoration?

The final restoration done quickly to prevent bacteria re-entry and reinfection.

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Why is it important to shape the canal?

Shaping allows for proper cleaning, medication placement, and filling, ensuring effective treatment.

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What's the smear layer?

A thin layer of debris on the canal wall that can harbor bacteria and hinder sealing.

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What are the advantages of the crown-down technique?

Reduces debris being pushed towards the apex, facilitates irrigation, and makes obturation easier.

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What's the paradigm shift in endodontics?

The focus has moved from just physical cleaning to preparing the canal for effective irrigation and sealing.

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Study Notes

Endodontics Study Notes

  • Working Length Determination:

    • Apex locator used to measure root apex depth.
    • Working length is the maximum root length for canal preparation/irrigation.
    • Measured with K-files inside the canal and periapical radiographs.
    • Pre-operative radiographs are taken before access cavity, followed by periapical radiographs.
    • Critical to end treatment at apical constriction.
    • Working length is measured in millimeters.
    • File should be within 1-2mm of radiographic apex for accurate measurements.
  • Radiographs:

    • Essential for working length determination.
    • Files should be within 0.5-1mm of estimated working length.
    • Working length often estimated using apex locator, pre-operative radiographs, and average tooth length.
    • Necessary to confirm working length with a radiograph.
    • Radiograph length measurement is not accurate for in-mouth measurements.
  • Multi-rooted Teeth:

    • Radiographs must be taken in mesial or distal direction.
    • Buccal and palatal roots must be differentiated for accurate treatment.
  • Apex Locator:

    • Electric device for accurate working length measurement.
    • Accuracy is 90-100% when file is 0.5-0.1 mm from the apex.
    • Used by completing the circuit with the PDL (periodontal ligament).
    • Displays zero and beeps when touching the periapical tissues.
  • Historical Determination of Working Length:

    • Tactile sensation, using the file to feel tissue contact.
    • Paper point method for checking working length. (less common)
    • Blood staining of the tip can be used to check if apex is bleeding.
  • Trouble Shooting in Working Length Radiographs:

    • File too long: correct the length and retake radiographs.
    • File too short: adjust in canal without radiograph.
  • Step-by-step Endodontic Treatment:

    • Diagnosis of pulpal and periapical diseases.
    • Mechanical and chemical instrumentation.
    • Chemo-mechanical debridement.
    • Obturation (canal filling).
    • Interim and definitive coronal restoration.
    • Review and follow up.
  • Step-back Technique:

    • Access preparation, canal scouting, estimated working length.
    • Initial binding file (at least size 15 K-File).
    • Radiographic confirmation of WL.
    • Apical preparation (enlargement).
  • Crown-Down Technique:

    • Coronal shaping (e.g. gates-glidden).
    • Use of progressively smaller files.
    • Aim is to shape the canal in a coronal to apical direction.
  • Irrigation and Recapitulation:

    • NaOCl (sodium hypochlorite) is frequently used as an irrigant for dissolving organic debris.
    • EDTA (ethylenediamine tetraacetic acid) can remove smear layer effectively.
    • Recapitulation involves preparing the canals in a manner that clears debris.
    • 1-2 ml of irrigant is used for this.
  • Chlorhexidine Digluconate (CHX):

    • Bactericidal agent effective against bacteria for up to 12 weeks.
    • Not for dissolving organic tissue, but maintains antibacterial action.
    • 0.2% for bacteriostatic effect; 2% for bactericidal effect.
    • Less commonly used, as it does not remove the smear layer.
  • Passively Ultrasonic Irrigation: - A technique for thoroughly cleaning canal walls.

  • Accidental NaOCl injection: - Causes pain, bleeding, edema, and delayed complications. - Side vented needls are used in order to reduce injection risks. - Treat with saline or sterile water during treatment and inform patient of potential risk factors.

  • Biological Objectives of Root Canal Treatment: - Removing all tissue, microorganisms, byproducts and substrates from root canal system. - Shaping the root canal system to facilitate irrigant/medicaments placement and obturation.

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