Podcast
Questions and Answers
What is the primary goal of the step-back technique in root canal preparation?
What is the primary goal of the step-back technique in root canal preparation?
- To ensure staying within the confines of the canal (correct)
- To widen the canal significantly
- To create multiple openings in the canal
- To use larger instruments only
The step-down technique involves starting with larger instruments and progressing toward smaller instruments.
The step-down technique involves starting with larger instruments and progressing toward smaller instruments.
True (A)
Name the two phases of the step-back preparation technique.
Name the two phases of the step-back preparation technique.
Phase I and Phase II
Prior to the introduction of nickel-titanium files, a crucial rule in endodontics was to always use a __________ instrument in a curved canal.
Prior to the introduction of nickel-titanium files, a crucial rule in endodontics was to always use a __________ instrument in a curved canal.
Match the following terms with their corresponding descriptions:
Match the following terms with their corresponding descriptions:
Which of the following problems can the step-back technique help avoid?
Which of the following problems can the step-back technique help avoid?
All root canals are straight and do not have any curvature.
All root canals are straight and do not have any curvature.
What does the term 'apical constriction' refer to in the context of root canal preparation?
What does the term 'apical constriction' refer to in the context of root canal preparation?
What is the purpose of enlarging canals beyond size 25 at the apical constriction?
What is the purpose of enlarging canals beyond size 25 at the apical constriction?
Files larger than size 25 are suitable for use in curved canals.
Files larger than size 25 are suitable for use in curved canals.
What is used to break up apical debris during canal preparation?
What is used to break up apical debris during canal preparation?
In fine canals, the step-back process begins with a No. ___ K-style file.
In fine canals, the step-back process begins with a No. ___ K-style file.
Match the following instruments with their descriptions:
Match the following instruments with their descriptions:
Why should irrigation be performed between each instrument use?
Why should irrigation be performed between each instrument use?
Curved instruments should not be lubricated before use.
Curved instruments should not be lubricated before use.
What is the recommended procedure after introducing each curved instrument?
What is the recommended procedure after introducing each curved instrument?
What is the primary purpose of using Hedstroem files during canal preparation?
What is the primary purpose of using Hedstroem files during canal preparation?
Gates-Glidden drills should be run in reverse to prevent binding.
Gates-Glidden drills should be run in reverse to prevent binding.
What should be done between each instrument during canal preparation?
What should be done between each instrument during canal preparation?
The __________ is the area where reshaping can be done using power-driven instruments.
The __________ is the area where reshaping can be done using power-driven instruments.
Match the following instruments with their primary uses:
Match the following instruments with their primary uses:
What is recommended to lubricate Gates-Glidden drills?
What is recommended to lubricate Gates-Glidden drills?
Used Gates-Glidden drills are more aggressive than new ones.
Used Gates-Glidden drills are more aggressive than new ones.
What motion is recommended when using power-driven instruments to decrease binding?
What motion is recommended when using power-driven instruments to decrease binding?
What is the first active instrument that should be inserted during Phase I?
What is the first active instrument that should be inserted during Phase I?
The watch winding motion during instrument insertion requires more than three quarter-turns.
The watch winding motion during instrument insertion requires more than three quarter-turns.
At what distance from the apical constriction should the canal be clean of debris?
At what distance from the apical constriction should the canal be clean of debris?
The instrument must always be to full depth when the cutting action is made during _______.
The instrument must always be to full depth when the cutting action is made during _______.
Why is lubrication important in the canal during Phase I?
Why is lubrication important in the canal during Phase I?
The apical constriction is typically located about _____ mm from the anatomic end of the root.
The apical constriction is typically located about _____ mm from the anatomic end of the root.
Phase I is complete after a size 25 K file has been used to full working length.
Phase I is complete after a size 25 K file has been used to full working length.
Flashcards
Step-Back Technique
Step-Back Technique
A technique for shaping the root canal that starts at the apex with fine instruments and progresses towards the cervical orifice with progressively larger instruments.
Step-Down Technique
Step-Down Technique
The opposite of the step-back technique, where shaping starts at the cervical orifice with larger instruments and progresses towards the apex with progressively smaller instruments.
Apical Constriction
Apical Constriction
The apical constriction is the narrowest point of the root canal, located near the apex.
Phase I (Step-Back)
Phase I (Step-Back)
The first phase in the step-back technique, where the canal is initially shaped at the apical constriction.
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Phase II (Step-Back)
Phase II (Step-Back)
The second phase in the step-back technique, where the canal is shaped from the apical constriction towards the cervical orifice, gradually increasing instrument size.
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Refining Phase IIA & IIB
Refining Phase IIA & IIB
A phase within Phase II of the step-back technique, where the canal is refined to ensure a continuous taper from the apex to the cervical orifice.
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Curved Instruments in Curved Canals
Curved Instruments in Curved Canals
The use of curved instruments to match the curvature of the root canal, especially important with curved canals. This is critical to avoid damaging the canal walls.
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Canal Shadow in Radiograph
Canal Shadow in Radiograph
The shadow of the canal in a radiograph, which can help determine the curvature of the root canal.
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K-style File
K-style File
A type of file used in root canal shaping, known for its flexibility and ability to navigate curved canals effectively.
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Recapitulation
Recapitulation
The process of using a smaller instrument to confirm the patency of the canal after using a larger instrument, ensuring the canal is not blocked, and cleaning debris.
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Copious Irrigation
Copious Irrigation
The repeated flushing of the canal with a disinfectant solution like sodium hypochlorite, ensuring proper cleaning and removal of debris.
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Phase I of Canal Preparation
Phase I of Canal Preparation
The initial step in canal preparation where the apical constriction is located and a fine file is used to gently explore the canal.
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K File
K File
A thin, flexible instrument used to explore and shape root canals. Its size is indicated by a number, with smaller numbers representing finer instruments.
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Watch Winding Motion
Watch Winding Motion
A gentle, twisting motion used to navigate and shape the root canal using a K file.
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Lubricant
Lubricant
A specialized solution used to lubricate instruments during canal preparation, facilitating easier passage and removing debris.
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Irrigation
Irrigation
The process of using an irrigant to flush debris and bacteria out of the canal.
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Debridement
Debridement
The process of removing pulp tissue and debris from the canal using instruments and irrigation.
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Size 25 K File
Size 25 K File
The final size reached during Phase I of canal preparation, allowing for the use of larger instruments in the next phase.
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What is the apical constriction?
What is the apical constriction?
The narrowing of the canal located close to the apex of the root.
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What is the 'continuous taper' in root canal prep?
What is the 'continuous taper' in root canal prep?
The canal is shaped to create a smooth, gradual narrowing from the apex to the opening of the root.
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What are Hedstroem files used for?
What are Hedstroem files used for?
These files are designed to remove material from the canal walls, but they can be aggressive and prone to breaking.
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Why is lubricating essential when using Hedstroem files?
Why is lubricating essential when using Hedstroem files?
This is the key to prevent Hedstroem files from getting stuck and breaking. Lubrication helps the file move smoothly and avoid binding.
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What are Gates-Glidden drills used for, and why are they delicate?
What are Gates-Glidden drills used for, and why are they delicate?
These drills are used to enlarge the canal, creating a larger pathway, but they can easily break if not used carefully.
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Why is 'copious irrigation' essential in root canal preparation?
Why is 'copious irrigation' essential in root canal preparation?
This ensures that the canal is clear and ready for filling by removing debris, preventing it from sticking to the inside of the canal.
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What's the purpose of Phase IIB in root preparation?
What's the purpose of Phase IIB in root preparation?
The shaping of the canal is refined to ensure a smooth flow from the apex to the opening of the root, making it easier to fill.
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What is 'recapitulation' in root canal prep?
What is 'recapitulation' in root canal prep?
This involves using a smaller file to check if the canal is open and clear after using a larger file. Helps avoid blockages.
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Instrumentation Technique: Step-Back or Step-Down
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Two approaches to shaping canals:
- Step-back: Starts at the apex, using progressively larger instruments.
- Step-down (crown-down): Starts at the cervical orifice, using progressively smaller instruments.
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Both methods aim for a continuous taper.
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The step-back method is divided into two phases:
- Phase I: Apical preparation, starting at the apical constriction.
- Phase II: Preparation of the remainder of the canal, gradually working towards the cervical orifice, increasing in size.
- Refining Phase II: Further shaping to create a continuous taper from apex to the cervix.
Step-by-Step Hand Instrumentation (Phase I)
- Initial exploration with a fine pathfinder to identify the apical constriction.
- Using a fine, precurved, lubricated instrument (e.g., file No. 08, 10, or 15).
- Employing the "watch winding" motion (clockwise-counterclockwise).
- Repeating the process with progressively larger instruments.
Additional Considerations
- Curved instruments are necessary for curved canals.
- Irrigation is crucial between instrument changes to remove debris.
- Sodium hypochlorite is used for irrigation.
- Lubrication (e.g., Gly-Oxide, R.C. Prep, File-Eze) is important.
- Working length should be established and maintained throughout.
- Correcting instruments and proper motions should be followed meticulously.
Phase II
- Beginning with a No. 30 K-file, working 1mm short of the full working length.
- Pre-curving and lubricate the file.
- Recapitulating with a No. 25 instrument to ensure patency.
- Using Hedstroem files for larger canals.
- Employing copious irrigation and recapitulation.
Instrument Selection (Phase IIA and IIB)
- Gates-Glidden drills are used for shaping the mid-canal.
- Starting with smaller drills, increasing in size gradually.
- Proper lubrication and reverse direction use to prevent binding.
- Smoothing instrument walls in IIB with recapitulation using a No. 25 instrument.
- Use of hand-powered Gates Glidden instruments (in lieu of newer power-driven instruments), and Orifice Openers.
- "Coke-bottle" shapes are avoided due to potential issues.
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