Tips and Tricks in Root Canal New-4

Dr Nia Mariam Joseph Dr Dithykumari K K
1. PRE- ENDODONTIC
MANAGEMENT
• Rubber dam isolation.
• Irrigation
• Inter-appointment temporization
• Prevents fractures of the weakened tooth structure
• Improves aesthetics
• Facilitates post-endodontic restoration.
Gavriil D, Kakka A, Myers P, O´ Connor CJ. Pre-endodontic
restoration of structurally compromised teeth: current concepts.
British Dental Journal. 2021 Sep;231(6):343-9.

2. Isolation
Doomed if you don’t dam
• enhances visibility
• reduces the risk swallowing instruments
• reduces the risk of contamination of oral microorganisms in the blood and/or saliva
• provides a clean and dry operating field
• reduces aerosol splatters in the oral cavity from dental procedures
• protects dentists, hygienists, and patients from possible exposure to HIV,
hepatitis, and other infectious diseases
Cleary P. Five steps for success in endodontics .

3. Selection of burs
4. Pulp stone
In less than 20 % 0f cases
Jannati R, Afshari M, Moosazadeh M, Allahgholipour SZ, Eidy M, Hajihoseini

M. Prevalence of pulp stones: A systematic review and meta ‐analysis. Journal of
Evidence‐Based Medicine. 2019 May;12(2):133-9.
Ultrasonic
C+ files
Jain P, Patni P, Hiremath H, Jain N. Successful
removal of a 16 mm long pulp stone using ultrasonic
tips from maxillary left first molar and its endodontic
management. Journal of Conservative Dentistry: JCD.
2014 Jan;17(1):92.
5. Use of pulp devitalizing paste
Used only if pulp is vital Available as both gel and paste form
• It contains paraformaldehyde which is
highly toxic.
• Avoid contact with tissues
When to avoid?
• Perforations
• Non vital tooth
• Delayed appointments
6. Perforations
How to avoid?
Factors affecting prognosis
• Time
• Size
• Location
Fuss Z, Trope M. Root perforations: classification and treatment choices based on

prognostic factors. Dental Traumatology. 1996 Dec;12(6):255-64.
How to manage?
• MTA
• BIODENTIN
• GIC
Immediate placement required.

7.Uncontrolled bleeding
Causes
Inflamed pulp Over instrumentation Perforations

8. Location of orifice
9. Lateral condensation
10. Placement of calcium hydroxide
• Navy tips and plastic tips
11. Access through crowns
Tips for Access cavity preparation
12. Locating calcified canal in
maxillary Incisors
13.Locating MB2 canals in Maxillary
Molars
• MB2 canal was found in 53.78% of the cases.
• When MB2 canal present, a single apical foramen was observed in 66.28% of
the cases, two apical foramina were present in 33.72% of the cases.
Faraj BM. The frequency of the second mesiobuccal canal in maxillary first molars
among a sample of the Kurdistan Region-Iraq population-A retrospective cone-beam
computed tomography evaluation. Journal of Dental Sciences. 2021 Jan 1;16(1):91-5.
14. Have I located All canals ?
Mandibular incisors
Rahimi S, Milani AS, Shahi S, Sergiz Y, Nezafati S, Lotfi M. Prevalence

of two root canals in human mandibular anterior teeth. Indian Journal of
dental research. 2013 Mar 1;24(2):234.
Maxillary First premolar
de Lima CO, de Souza LC, Devito KL, do Prado M, Campos CN. Evaluation of root canal
morphology of maxillary premolars: a cone ‐beam computed tomography study. Australian
Endodontic Journal. 2019 Aug;45(2):196-201.
Maxillary second premolars
 If only canal it will be on Centre ,oval shape and wide bucco lingually
 Occasionally single canal will split in to two and it will exit in to two orifices..
Mandibular molar
• In 40 % of time there will be two canals in the distal root of mandibular first
molars.
• 64% of the cases had three root canals (mesiobuccal, mesiolingual and distal)
• 36% had four root canals. (mesiobuccal, mesiolingual, distobuccal and
distolingual
Chourasia HR, Meshram GK, Warhadpande M, Dakshindas D. Root

canal morphology of mandibular first permanent molars in an Indian
population. International journal of dentistry. 2012 Jan 1;2012
15.What file to use for canal negotiation ?
16.What is Glide path?
 The glide path is defined as a regular opening from the orifice of the root canal to the
apical foramen; any glide path instrument should follow smooth canal walls uninterrupted
.
Different types of motion
 The first type of motion is the following motion.

 The second type of motion is the smoothing motion
 The third type of motion is the envelope motion.
 The fourth type of motion is the balanced force or the Roane technique.
 Flexible hand file
 Smooth gentle pathway is created.
17. Watch Winding Motion
 Clock Wise and counter clockwise rotation around a quarter turn of the file.
 Chance of ledge formation reduced.
 File breakage reduced and enables easier canal location.
18.Use of EDTA in canal negotiation
• Curved ,narrow and calcified canal.

• EDTA will soften the root canal Dentin.
• While canal negotiation EDTA should be avoided
19 Orifice Enlargement
Inadequate straight line access resulting in the tip of
the file attempting to straighten itself .
• H files
• GG Drills of size2 or 3
• Orifice shapers
20. Closed Dressing Or Open
Dressing?
Intentional RCT
 Tooth is vital and normal pulp

Irreversible Pulpitis
 Patient has severe pain and pain aggravated during sleeping.

Long standing Nonvital teeth
 On radiographic examination there is a well described periapical lesion but

patient is asymptomatic.
ASYMPTOMATIC TOOTH
Painful Teeth
 After access opening heavy discharge and pus present.

 On radiographic examination no periapical radiolucency .
Periapical lesion, pus discharge and
sinus tract
• when the access was left open, more appointments were required to complete
treatment and recurrent acute exacerbations were more frequent than if the
tooth had been kept closed.
Weine FS, Healey HJ, Theiss EP. Endodontic emergency dilemma: leave
tooth open or keep it closed?. Oral Surgery, Oral Medicine, Oral
Pathology. 1975 Oct 1;40(4):531-6.
• Pulpal disease can become established periapical disease if we are giving an open
dressing.
• Patient may get an immediate relief but long term success rate may be compromised.
21. Occlusal Reduction?
 Tooth will extrude and compromise the longevity of the teeth.

 Occlusal surface reduction did not provide any further reduction in postoperative
pain for teeth with irreversible pulpitis and mild tenderness to percussion
compared with no occlusal reduction.
Parirokh M, Rekabi AR, Ashouri R, Nakhaee N, Abbott PV, Gorjestani H. Effect of
occlusal reduction on postoperative pain in teeth with irreversible pulpitis and mild
tenderness to percussion. Journal of endodontics. 2013 Jan 1;39(1):1-5.
 occlusal reduction was effective in reducing the intensity of postoperative
pain 12 h and 24 h after root canal instrumentation in the first visit in patients
with symptomatic irreversible pulpitis with sensitivity to percussion.
 Occlusal reduction lowered the risk of moderate-to-severe pain by about 40%
12 h post-instrumentation and the overall risk of pain by 25% 24 h post-
instrumentation
Ahmed YE, Emara RS, Sarhan SM, El Boghdadi RM, El‐Bayoumi

MA, El‐Far HM, Sabet NE, Abou El‐Nasr HM, Gawdat SI, Amin
SA. Post‐treatment endodontic pain following occlusal reduction in
mandibular posterior teeth with symptomatic irreversible pulpitis
and sensitivity to percussion: a single‐centre randomized
controlled trial. International Endodontic Journal. 2020
Sep;53(9):1170-80.

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Dr Nia Mariam Joseph Dr Dithykumari K K

restoration of structurally compromised teeth: current concepts.

British Dental Journal. 2021 Sep;231(6):343-9.

Cleary P. Five steps for success in endodontics .

Jannati R, Afshari M, Moosazadeh M, Allahgholipour SZ, Eidy M, Hajihoseini

Fuss Z, Trope M. Root perforations: classification and treatment choices based on

Immediate placement required.

Inflamed pulp Over instrumentation Perforations

Rahimi S, Milani AS, Shahi S, Sergiz Y, Nezafati S, Lotfi M. Prevalence

Chourasia HR, Meshram GK, Warhadpande M, Dakshindas D. Root

 The first type of motion is the following motion.

• Curved ,narrow and calcified canal.

 Tooth is vital and normal pulp

 Patient has severe pain and pain aggravated during sleeping.

 On radiographic examination there is a well described periapical lesion but

 After access opening heavy discharge and pus present.

 Tooth will extrude and compromise the longevity of the teeth.

Ahmed YE, Emara RS, Sarhan SM, El Boghdadi RM, El‐Bayoumi

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