Cleaning & Shaping Presented by: Josef Ma. Karlos S. Bringas, D.M.D., D.D.S., M.S. Department of Endodontics

Endo Guards

Prerequisites 1. Record the following information: Length of root in mm = PATENCY LENGTH b. Working length (WL) = (Length of root) – 1.0 mm c. Master Apical Rotary (MAR) length = WL – 1.0 mm = (Length of root) – 2.0 mm

Lengths Record the following: Tooth length WL MAR length

Lengths Record the following: Tooth length WL MAR length

Lengths 23 mm Record the following: Tooth length: 23mm WL MAR length

Lengths Record the following: Tooth length: 23mm WL: 22mm MAR length

Lengths Record the following: Tooth length: 23mm WL: 22mm MAR length: 21mm

Prerequisites 1. Record the following information: 2. Patency. a. Length of root in mm = PATENCY LENGTH b. Working length (WL) = (Length of root) – 1.0 mm c. Master Apical Rotary (MAR) length = WL – 1.0 mm = (Length of root) – 2.0 mm 2. Patency.

Patency Set the stops to Patency Length. #10 #15

Patency 23 mm Set the stops to Patency Length. #10 #15

Patency Determine if a #10 or #15 hand file can be inserted to the apical terminus. Always use RC Prep. #10 #15

Patency Determine if a #10 or #15 hand file can be inserted to the apical terminus. Always use RC Prep. #15 #10

Patency Determine if a #10 or #15 hand file can be inserted to the apical terminus. Always use RC Prep. #10 #15

Patency 23 mm Determine if a #10 or #15 hand file can be inserted to the apical terminus. Always use RC Prep. #10 #15

Patency 23 mm Determine if a #10 or #15 hand file can be inserted to the apical terminus. Always use RC Prep. #10 #15

Patency 23 mm Determine if a #10 or #15 hand file can be inserted to the apical terminus. Always use RC Prep. #10 #15

Patency 23 mm Determine if a #10 or #15 hand file can be inserted to the apical terminus. Always use RC Prep. #10 #15

Patency 23 mm Determine if a #10 or #15 hand file can be inserted to the apical terminus. Always use RC Prep. #15 #10

Patency 23 mm Determine if a #10 or #15 hand file can be inserted to the apical terminus. Always use RC Prep. #10 #15

Steps of C&S ( Technique) Rotary file cleaning and shaping. 2. Apical preparation.

Steps of C&S ( Technique) Rotary file cleaning and shaping. 35/.12 20 series 30 series 2. Apical preparation.

Coronal Preparation Use the ProFile GT .35/.12, 17mm file. The color band denotes size. Green band means a size 35.

Coronal Preparation Use the ProFile GT .35/.12, 17mm file. The color band denotes size. Green band means a size 35. Each band denotes 0.02mm of taper, thus 6 x (0.02) = 0.12mm taper.

Use of Rotary Handpiece Use 8:1 gear reduction attachment. Run at constant speed: 35 0.12 (500 rpm’s) 20 series & 30 series (300 rpm’s) USE LIGHT PRESSURE.

Use of Rotary Handpiece Start the handpiece before entry into the canal and maintain at a constant rpm’s. The file should not be in contact with canal walls for more than 5 seconds. Advance the file slowly and carefully in 0.5 -1.0 mm increments using constant light pressure. NEVER FORCE A FILE IN A CANAL.

35/.12 Hand fit file to binding point.

35/.12 Hand fit file to binding point. Back-up stopper by 1-2mm.

35/.12 Hand fit file to binding point. Back-up stopper by 1-2mm.

35/.12 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 1mm increments.

35/.12 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 1mm increments.

35/.12 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 1mm increments.

35/.12 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 1mm increments.

35/.12 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 1mm increments.

35/.12 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 1mm increments.

2mm advancement accomplished 35/.12 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 1mm increments. 2mm advancement accomplished

Recap Irrigate with NaOCl Recapitulate with #15 file. Length should reach to entire length of the tooth. Ex. 23mm

Recap Irrigate with NaOCl 23 mm Irrigate with NaOCl Recapitulate with #15 file. Length should reach to entire length of the tooth. Ex. 23mm

Rotary File Instrumentation Use of 20 series Profile GT

20/.10 Hand fit file to binding point.

20/.10 Hand fit file to binding point.

20/.10 Hand fit file to binding point. Back-up stopper by 1-2mm.

20/.10 Hand fit file to binding point. Back-up stopper by 1-2mm.

20/.10 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 0.5 - 1mm increments.

Stop usage of file after: 21 mm 2mm advancement. File stalls twice. File advancement to MAR length. Ex: MAR = 21mm

Stop usage of file after: 21 mm 2mm advancement. File stalls twice. File advancement to MAR length. Ex: MAR = 21mm

20/.10 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 0.5 - 1mm increments.

20/.10 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 0.5 - 1mm increments.

20/.10 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 0.5 - 1mm increments.

20/.10 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 0.5 - 1mm increments.

20/.10 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 0.5 - 1mm increments.

20/.10 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 0.5 - 1mm increments.

20/.10 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 0.5 - 1mm increments.

2mm advancement accomplished 20/.10 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 0.5 - 1mm increments. Stop! Change file. 2mm advancement accomplished

Recap Irrigate with NaOCl 23 mm Irrigate with NaOCl Recapitulate with #15 file. Length should reach to entire length of the tooth. Ex. 23mm

Rotary File Instrumentation After using the 20/.10 file, irrigation and recapitulation, the next file in the series, 20/.08, is used. The sequence is: 20/.10, 20/.08, 20/.06, 20/.04 This is done until MAR is reached.

20/.08 Hand fit file to binding point.

20/.08 Hand fit file to binding point. Back-up stopper by 1-2mm.

20/.08 Hand fit file to binding point. Back-up stopper by 1-2mm.

20/.08 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 0.5 - 1mm increments.

20/.08 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 0.5 - 1mm increments.

20/.08 Hand fit file to binding point. Back-up stopper by 1-2mm.

20/.08 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 0.5 - 1mm increments. File stalls once.

20/.08 Hand fit file to binding point. Back-up stopper by 1-2mm.

20/.08 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 0.5 - 1mm increments.

20/.08 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 0.5 - 1mm increments. STOP! Change file. File stalls 2x

Recap Irrigate with NaOCl 23 mm Irrigate with NaOCl Recapitulate with #15 file. Length should reach to entire length of the tooth. Ex. 23mm

20/.06 Hand fit file to binding point.

20/.06 Hand fit file to binding point. Back-up stopper by 1-2mm.

20/.06 Hand fit file to binding point. Back-up stopper by 1-2mm.

20/.06 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 0.5 - 1mm increments.

20/.06 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 0.5 - 1mm increments.

2mm advancement accomplished 20/.06 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 0.5 - 1mm increments. Stop! Change file. 2mm advancement accomplished

Recap Irrigate with NaOCl 23 mm Irrigate with NaOCl Recapitulate with #15 file. Length should reach to entire length of the tooth. Ex. 23mm

20/.04 Hand fit file to binding point.

20/.04 Hand fit file to binding point. Back-up stopper by 1-2mm.

20/.04 Hand fit file to binding point. Back-up stopper by 1-2mm.

20/.04 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 0.5 - 1mm increments.

20/.04 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 0.5 - 1mm increments. MAR reached

20/.04 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 0.5 - 1mm increments. Stop! MAR reached

20/.04 Hand fit file to binding point. Back-up stopper by 1-2mm. Attach file to handpiece and advance apically in 0.5 - 1mm increments. Stop! Recapitulate.

Recap Irrigate with NaOCl 23 mm Irrigate with NaOCl Recapitulate with #15 file. Length should reach to entire length of the tooth. Ex. 23mm

Recap Irrigate with NaOCl 23 mm Irrigate with NaOCl Recapitulate with #15 file. Length should reach to entire length of the tooth. Ex. 23mm

FAQ #1 “I reached MAR with a 20/.06 file, do I still use a 20/.04?” Answer: This is usually common with larger canals. There is no need to use the 20/.04 file, it is ok to move to the 30 series.

FAQ #2 “I am done using the 20/.04 file but I have not reached MAR length yet… what do I do?” Answer: This is true for narrower canals. If this scenario happens, cycle through the files again until you reach MAR.

FAQ #2 “I am using the 20/.04 file but the file stalled twice. I have not reached MAR yet… what do I do?” .10 .08 .06 .04

Rotary File Instrumentation Use of 30 series Profile GT

30/.04 21 mm After the 20 series, the 30/.04 file is used.

30/.04 After the 20 series, the 30/.04 file is used. 21 mm After the 20 series, the 30/.04 file is used. Stopper length is set at 21mm which is the MAR length.

30/.04 After the 20 series, the 30/.04 file is used. 21 mm After the 20 series, the 30/.04 file is used. Stopper length is set at 21mm which is the MAR length.

30/.04 After the 20 series, the 30/.04 file is used. 21 mm After the 20 series, the 30/.04 file is used. Stopper length is set at 21mm which is the MAR length. The file is used until MAR length.

30/.04 After the 20 series, the 30/.04 file is used. 21 mm After the 20 series, the 30/.04 file is used. Stopper length is set at 21mm which is the MAR length. The file is used until MAR length. MAR reached

30/.04 After the 20 series, the 30/.04 file is used. 21 mm After the 20 series, the 30/.04 file is used. Stopper length is set at 21mm which is the MAR length. The file is used until MAR length. STOP! Recapitulate. Change to 30/.06. MAR reached

30/.06 21 mm Stopper length is set at 21mm which is the MAR length.

30/.06 21 mm Stopper length is set at 21mm which is the MAR length.

30/.06 Stopper length is set at 21mm which is the MAR length. The file is used until MAR length is reached.

30/.06 Stopper length is set at 21mm which is the MAR length. The file is used until MAR length is reached.

30/.06 Stopper length is set at 21mm which is the MAR length. The file is used until MAR length is reached. STOP! Recapitulate. Proceed to Apical Preparation. MAR reached

Steps of C&S ( Technique) Rotary file cleaning and shaping. 2. Apical preparation.

Apical Preparation Apical Gauging Master Apical File (MAF) determination

Apical Gauging To determine the apical terminus diameter.

Apical Gauging To determine the apical terminus diameter.

Apical Gauging

Apical Gauging Use handfiles starting with the 20/.02

Apical Gauging Use handfiles starting with the 20/.02 Stopper length is set at Patency Length. (ex. 23mm)

Apical Gauging Use handfiles starting with the 20/.02 Stopper length is set at Patency Length. (ex. 23mm) Insert file passively until apical resistance is encountered. The 1st file that resists apical movement is the apical gauging file.

Apical Gauging Use handfiles starting with the 20/.02 Stopper length is set at Patency Length. (ex. 23mm) Insert file passively until apical resistance is encountered. The 1st file that resists apical movement is the apical gauging file.

Apical Gauging Use handfiles starting with the 20/.02 Stopper length is set at Patency Length. (ex. 23mm) Insert file passively until apical resistance is encountered. The 1st file that resists apical movement is the apical gauging file.

Apical Gauging Use handfiles starting with the 20/.02 Stopper length is set at Patency Length. (ex. 23mm) Insert file passively until apical resistance is encountered. The 1st file that resists apical movement is the apical gauging file.

Apical Gauging Use handfiles starting with the 20/.02 Stopper length is set at Patency Length. (ex. 23mm) Insert file passively until apical resistance is encountered. The 1st file that resists apical movement is the apical gauging file.

Apical Gauging Use handfiles starting with the 20/.02 Stopper length is set at Patency Length. (ex. 23mm) Insert file passively until apical resistance is encountered. The 1st file that resists apical movement is the apical gauging file.

Apical Gauging Use handfiles starting with the 20/.02 Stopper length is set at Patency Length. (ex. 23mm) Insert file passively until apical resistance is encountered. The 1st file that resists apical movement is the apical gauging file.

Apical Gauging Use handfiles starting with the 20/.02 Stopper length is set at Patency Length. (ex. 23mm) Insert file passively until apical resistance is encountered. The 1st file that resists apical movement is the apical gauging file.

Apical Gauging Use handfiles starting with the 20/.02 Stopper length is set at Patency Length. (ex. 23mm) Insert file passively until apical resistance is encountered. The 1st file that resists apical movement is the apical gauging file. (ex. 25 is apical gauging file)

Apical Gauging Use handfiles starting with the 20/.02 Stopper length is set at Patency Length. (ex. 23mm) Insert file passively until apical resistance is encountered. The 1st file that resists apical movement is the apical gauging file. (ex. 25 is apical gauging file)

Apical Gauging Use handfiles starting with the 20/.02 Stopper length is set at Patency Length. (ex. 23mm) Insert file passively until apical resistance is encountered. The 1st file that resists apical movement is the apical gauging file. (ex. 25 is apical gauging file)

Apical Gauging Use handfiles starting with the 20/.02 Stopper length is set at Patency Length. (ex. 23mm) Insert file passively until apical resistance is encountered. The 1st file that resists apical movement is the apical gauging file. (ex. 25 is apical gauging file)

Apical Gauging Use handfiles starting with the 20/.02 Stopper length is set at Patency Length. (ex. 23mm) Insert file passively until apical resistance is encountered. The 1st file that resists apical movement is the apical gauging file. (ex. 25 is apical gauging file)

MAF 22 mm MAF is 1-2 sizes larger than the apical gauging file.(ex. Since apical gauging file is size 25, then a size 35 MAF is chosen.)

MAF 22 mm MAF is 1-2 sizes larger than the apical gauging file.(ex. Since apical gauging file is size 25, then a size 35 MAF is chosen.) Record MAF on your tx record.

Treatment Record

MAF 22 mm MAF is 1-2 sizes larger than the apical gauging file.(ex. Since apical gauging file is size 25, then a size 35 MAF is chosen.) Record MAF on your tx record. The canal should be cleaned and shaped to MAF at Working Length.

MAF 22 mm Set length of files to the Working Length.

MAF 22 mm Set length of files to the Working Length.

MAF Set length of files to the Working Length. 22 mm Set length of files to the Working Length. Use reaming motion or watch winding motion to clean and shape the canal.

MAF Set length of files to the Working Length. 22 mm Set length of files to the Working Length. Use reaming motion or watch winding motion to clean and shape the canal.

MAF Set length of files to the Working Length. 22 mm Set length of files to the Working Length. Use reaming motion or watch winding motion to clean and shape the canal.

MAF Set length of files to the Working Length. 22 mm Set length of files to the Working Length. Use reaming motion or watch winding motion to clean and shape the canal. Irrigate. Recapitulate after each file. Place MAF to Final Working Length and take a radiograph.

Steps of C&S ( Technique) Rotary file cleaning and shaping. 35/.12 20 series 30 series Apical preparation. Apical Gauging MAF MAR Patency length WL