Evaluation in the Modifications in Canal Anatomy of Curved Canals Following Glide Path Preparation using Path Files, G-Files and Hyflex Glide Path Files
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2018, Vol 3, Issue 1
Abstract
The instrumentation and preparation of the root canal system is regarded as being a most important stage of endodontic treatment for this has an influence on the efficacy of subsequent procedures in endodontic therapy. Root canal instrumentation was originally aimed at facilitating the placement of medicaments in the root canal and little attempt was made to clear the organic contents from the root canal system. The focus of instrumentation then shifted to preparing the root canal space to facilitate the placement of root canal fillings but the methods employed were mostly unrelated to the anatomy of the canal system or to the properties of the obturation materials. In 1974, Schilder altered endodontic protocols forever with his innovative and revolutionary concepts that defined the design and biological objectives for optimally shaping canal spaces and for debriding root canal systems. There were several primary objectives – shaping the root canal system to have a smooth taper from orifice to apex; keeping the apical foramen as small as was practical and in its original position; and ensuring that the preparation flowed with the original anatomy of the root canal system. Other objectives were to confine preparation to the canal space, facilitate the removal of all tissue without forcing necrotic debris through the apical foramen, and ensuring that the final shape facilitated the placement of medicaments and exchange of irrigants. However, the journey from orifice to apex can be perilous and proper root canal preparation remains one of the most difficult tasks in endodontic therapy. Canal scouting and preflaring are the first phases of canal instrumentation and it has also been noted that during these phases the clinician might more frequently encounter procedural difficulties. Instrumentation of canals with multi-planar curvatures and long, thin curved canals is fraught with possible procedural errors during either hand-file instrumentation or rotary nickel titanium (Ni-Ti) instrumentation. During preparation, especially when preparing curved canals, iatrogenic errors, such as ledges, zips, perforations, and root canal transportation, can occur. Technological advancements in rotary nickel-titanium (Ni-Ti) instruments have led to new design concepts and easier and faster techniques that preserve the original canal shape with considerably less iatrogenic error. Most of the procedural problems associated with achieving ideal shaping of curved canals were due to the stiffness of stainless steel instruments. Nickel-titanium (Ni-Ti) rotary instruments were introduced to improve root canal preparation. Ni-Ti rotary instruments revolutionised endodontics as they have a lower modulus of elasticity than stainless steel instruments; and therefore exert fewer lateral forces on the dentine walls in curved canals. Even though Ni-Ti instruments are stronger and more flexible than their stainless steel counterparts fractures may still occur within their elastic limit. Fracture of rotary Ni-Ti instruments may occur as a result of cyclic flexural fatigue (bending stress) or through torsion (shear stress). John West in 2006 defined the glide path as a smooth, though possibly narrow, tunnel or passage from the coronal orifice of the canal to the radiographic terminus or electronically determined portal of exit. The endodontic glidepath is a smooth radicular tunnel from canal orifice to physiologic terminus (foraminal constriction) of the root canal. The glidepath must be discovered if already present in the endodontic anatomy or prepared if it is not present. The glidepath can be short or long, narrow or wide, essentially straight or curved. Its minimal size should be a “super loose No. 10” endodontic file. What the rationale of endodontics requires is the entire length of the root canal system be cleaned and shaped. Glide Path is pre requisite to this mechanical objective. A glide path is achieved when the file forming it can enter from the orifice and follow the smooth canal walls uninterrupted to the terminus.The lack of glide path establishment may result in ledge formation, blockage of root canals, transportation, zip formation and perforation.Glide path helps prevent torque failure and cyclic fatigue.Glidepath is the secret to radicular rotary safety and marks the path of modern endodontics. By creating a glide path we can maintain the original canal anatomy with less modification of canal curvature and fewer canal aberrations. Cone Beam Computed Tomography (CBCT) provides a significantly faster image acquisition and reconstruction scheme and aids in the diagnosis of canal morphology. As compared with conventional periapical radiography, CBCT eliminate superimposition of surrounding structures, providing additional clinically relevant information. Even though resolution is not as high as that of conventional radiographs, the availability of 3-Dimensional information, a relatively higher resolution and a significantly lower dose than medical-grade Computed Tomography makes CBCT the imaging modality of choice in challenging situations demanding localization and characterization of root canals The aim of this study is to compare the changes in the root canal anatomy after creation of glide three different NiTi rotary instruments.
Authors and Affiliations
Dr Annil Dhingra
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