Step-Back Technique in Endodontics

Step-Back Technique in Endodontics

• Emphasizes keeping the apical preparation small in its original position and producing a gradual taper coronally.
• Involves preparation of the apical third initially, followed by the middle and coronal third of the canal using larger instruments.

Phases of Step-Back Technique

• Phase I: Apical preparation starting at the apical constriction.
• Phase II: Preparation of the remainder of the root canal, gradually stepping back while increasing in size.

Phase I Procedure

• Evaluate the carious tooth before initiating endodontic treatment.
• Prepare the access cavity and locate the canal orifices.
• Establish the working length of the tooth using a pathfinder.
• Insert the first instrument into the canal with a watch winding motion.
• Irrigate the canal and lubricate the instrument for use in the apical area.
• Recapitulate the canal with previous smaller number instruments.

Phase II Procedure

• Insert the instrument into the canal with a watch winding motion, remove it after circumferential filing, and irrigate.
• Recapitulate with previous smaller number instruments.
• Use Gates Glidden to prepare the coronal root area.
• Refine the root canal with a master apical file with push-pull strokes to achieve a smooth taper form.

Procedures and Reminders

• Set rubber stops on files #15, 20, 25, 30, and 35 at the working length.
• Insert files in a sequential order, into the root canal until the rubber stop contacts the occlusal reference point.
• Always work in a wet field and irrigate often.
• Recapitulate often to break up apical debris.

Advantages and Disadvantages

• Advantages: Better tactile awareness, keeps apical preparation small, gradual taper, and ability to prepare a proper apical stop.
• Disadvantages: Chances of pushing debris into periradicular tissues, tendency to straighten the curved canal, and time-consuming.

Modified and Passive Step-Back Techniques

• Modified Step-Back Technique: Completion of preparation in the apical third of the canal, started 2-3 mm short of the minor diameter/apical constriction.
• Passive Step-Back Technique: Combination of hand and rotary instruments to obtain an adequate coronal flare and preparation of the apical part.