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?
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
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.
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Match the following terms with their corresponding descriptions:
Match the following terms with their corresponding descriptions:
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Which of the following problems can the step-back technique help avoid?
Which of the following problems can the step-back technique help avoid?
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All root canals are straight and do not have any curvature.
All root canals are straight and do not have any curvature.
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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?
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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?
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Files larger than size 25 are suitable for use in curved canals.
Files larger than size 25 are suitable for use in curved canals.
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What is used to break up apical debris during canal preparation?
What is used to break up apical debris during canal preparation?
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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.
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Match the following instruments with their descriptions:
Match the following instruments with their descriptions:
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Why should irrigation be performed between each instrument use?
Why should irrigation be performed between each instrument use?
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Curved instruments should not be lubricated before use.
Curved instruments should not be lubricated before use.
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What is the recommended procedure after introducing each curved instrument?
What is the recommended procedure after introducing each curved instrument?
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What is the primary purpose of using Hedstroem files during canal preparation?
What is the primary purpose of using Hedstroem files during canal preparation?
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Gates-Glidden drills should be run in reverse to prevent binding.
Gates-Glidden drills should be run in reverse to prevent binding.
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What should be done between each instrument during canal preparation?
What should be done between each instrument during canal preparation?
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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.
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Match the following instruments with their primary uses:
Match the following instruments with their primary uses:
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What is recommended to lubricate Gates-Glidden drills?
What is recommended to lubricate Gates-Glidden drills?
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Used Gates-Glidden drills are more aggressive than new ones.
Used Gates-Glidden drills are more aggressive than new ones.
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What motion is recommended when using power-driven instruments to decrease binding?
What motion is recommended when using power-driven instruments to decrease binding?
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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?
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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.
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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?
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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 _______.
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Why is lubrication important in the canal during Phase I?
Why is lubrication important in the canal during Phase I?
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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.
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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.
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Study Notes
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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Description
This quiz covers the key instrumentation techniques used in endodontics, specifically focusing on the step-back and step-down methods of canal shaping. You'll learn how these approaches are executed and their phases, providing a solid foundation for successful root canal treatment.
