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Preparation of RC System---9780723610892

Preparation of RC

6 Preparation of the root canal system J. D. Regan and J. L. Gutmann Introduction 77 Preoperative assessment 78 Preparation of the clinical crown 80 Access cavity 81 Root canal orifices 83 Working length determination 84 Root canal irrigation 85 Instrumentation techniques 86 Crowndown technique 87 Stepback technique 88 Calcified canals 89 Nickel-titanium instruments 90 Controversies in root canal cleaning and shaping 90 Where should the preparation end? 90 When should the preparation end? 90 Should apical patency filing be performed? 91 Should treatment be completed in one or multiple visits? 91 References 91 elective treatment, the removal of healthy tissue. Retreatment of failing cases is addressed in Chapter 13. Historically, a mechanistic approach to root canal treatment was frequently adopted, but in recent years a greater awareness of the complexities of the root canal system (Fig. 6.1) has led to the development of newer techniques, instruments and materials. These new developments have greatly enhanced the clinician’s ability to achieve the biologically-based objectives of root canal treatment, which include: 1. Removal of all tissue, bacteria and bacterial products and substrates from the root canal system. INTRODUCTION The key factor in the development of pulpal inflammation and apical periodontitis is the presence of bacteria [42]. It has been widely accepted that bacteria and/or their products are the main aetiological factors in the initiation and progress of these diseases [10]. Consequently, the central focus of root canal treatment has been directed towards the elimination of bacteria and their substrates from the pulp canal system. This may involve removal of necrotic pulp and tissue debris, removal of an inflamed pulp or, in Figure 6.1 A root end which has been made transparent showing two lateral canals. 77

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