Endo

Working length
estimation and
intracanal preparation
technique
By : Muntaha Ali
Manar mustafa
Manar hussien
Manar Basim
Working length determination
• Determination of an accurate working length is one of the most critical steps of
.endodontic therapy
The cleaning, shaping and obturation of the root canal system cannot be. accomplished
accurately unless working length is determined precisely
working length
The distance from a coronal reference
point to a point at which canal
preparation and obturation should
terminate
Objectives of WL
• To establish the length of the tooth at which the canal preparation ansubseque
.obturation are to be completed
The apical end of the root canal is the .

CDJ, which is usually 0.5-1mm short of
.the radiographic apex
Sometimes the apical foramen is .

laterally positioned, so it would be
more than 1mm from the radiographic
.apex
Anatomic consideration:
Anatomic apex is the “tip or end of root determined
morphologically”.
_Radiographic apex is the “tip or end of root determined
radiographically
-Apical foramen a funnel shape, main apical opening of the root
canal which may be
.located away from the anatomic or radiographic apex
Apical constriction (minor apical diameter) is the apical portion of
the root canal having
the narrowest diameter. It is usually 0.5-1mm short of the apical
foramen. The minor
diameter widens apically to foramen, i.e. major diameter
Cementodentinal junction is the region where cementum and dentin
are united, the point
at which the cemental surface terminates at or near the apex of the
tooth. It is not always
- necessary that CDJ coincide with apical constriction. Location of
CDJ ranges from 0.5
.3mm short of anatomic apex
Reference point:
It is the site on the incisal edge or occlusal surface from which
measurements are made. Usually, it’s the highest point on the incisal edge in
anterior teeth & the tip of the cusp in posterior teeth. It should:
_Stable
_Easily visualized
during preparation
_Not changing during
or between appointments
Consequences of over-extended
working length
_Perforation through apical construction
_Over instrumentation
_ Overfilling of root canal
_Increased incidence of postoperative pain
_ Prolonged healing period
_ Lower success rate due to incomplete regeneration of cementum, periodontal •

Overfilling
Consequences of working short of actual working
length
• Incomplete cleaning and instrumentation of the canal
Persistent discomfort due to presence of pulpal remnants .
Underfilling of the root canal .

Incomplete apical seal .
Apical leakage which supports the existence of viable bacteria, further leads to poor .
healing and periradicular lesion

Underfilling
Methods in determining Wl
1.Radiographic method of working length determination
_Examine preoperative radiograph & estimate the length of the tooth
_Know the average length of each tooth
Place the file selected to be the correct initial width into the canal with its rubber
_stopper set at the estimated working length
_Radiograph the tooth to verify the position of the instrument

One should take the following steps:
a. Take two individual radiographs with the instrument placed in each canal.
b. Take radiograph at different angulations, usually 20° to 40° at horizontal angulation.
c. Insert two different instruments, e.g. K file in one canal, H file/reamer in other canal and
take radiograph at different angulations.

2. Electronic apex locator
Radiographs are often misinterpreted because of difficulty in distinguishing the
radicular anatomy and pathosis from normal structures. Electronic apex locators
are used for determining working length as an adjunct to radiography. They )EAL(
are basically used to locate the apical constriction or cementodentinal junction or
the apical foramen, and not the radiographic apex.

3.Step-down technique:
This technique was developed to shape the coronal part of the
canal before instrumentation of the apical part.

The objectives of this technique is:-
1- To permit straight access to the apical region of the canal .
2- To remove the bulk of necrotic tissue and microorganisms before apical shaping
3- To allow deeper penetration of irrigant deeply into the apical part of the canal.
4- The WL is less likely to change with less chance of zipping near the apical
constriction.
4. Balanced force technique
This technique was introduced after the development
of new file ‘Flex-R file’.

⚬ This file has “safe tip design” with a guiding land area behind
the tip which allows the file to follow the canal curvature without binding in the
outside wall of the curved cana text
⚬ While the old K-type files have pyramidal tips with
cutting angles which can be quite aggressive with clockwise rotation.

Advantages of balanced force technique:-
Lesser chances of creating a ledge, blockage or canal
transportation.
5.Crown-down (pressure-less) technique
The crown-down instrumentation concept based on the canal shaping

technique
moving from the crown toward the apical portion of the canal.
Advantages of crown down technique:-
1. Removal of tissue debris coronally
2. Reduction of postoperative sensitivity which could result from

periapical extrusion
of debris.
3.Better dissolution of tissue with increased penetration of the

irrigants.

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Working length

The apical end of the root canal is the .

Sometimes the apical foramen is .

_Perforation through apical construction

_ Overfilling of root canal

_Increased incidence of postoperative pain

_ Prolonged healing period

_ Lower success rate due to incomplete regeneration of cementum, periodontal •

• Incomplete cleaning and instrumentation of the canal

Persistent discomfort due to presence of pulpal remnants .

Underfilling of the root canal .

healing and periradicular lesion

_Examine preoperative radiograph & estimate the length of the tooth

_Know the average length of each tooth

_stopper set at the estimated working length

_Radiograph the tooth to verify the position of the instrument

b. Take radiograph at different angulations, usually 20° to 40° at horizontal angulation.

take radiograph at different angulations.

are basically used to locate the apical constriction or cementodentinal junction or

the apical foramen, and not the radiographic apex.

This technique was developed to shape the coronal part of the

canal before instrumentation of the apical part.

This technique was introduced after the development

of new ﬁle ‘Flex-R ﬁle’.

⚬ While the old K-type ﬁles have pyramidal tips with

cutting angles which can be quite aggressive with clockwise rotation.

5.Crown-down (pressure-less) technique

The crown-down instrumentation concept based on the canal shaping

2. Reduction of postoperative sensitivity which could result from

3.Better dissolution of tissue with increased penetration of the

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