LOMA LINDA UNIVERSITY

SCHOOL OF DENTISTRY

DEPARTMENT OF ENDODONTICS

LABORATORY MANUAL
ENDN 832-1 ENDODONTICS I
SPRING QUARTER 2013

COURSE DIRECTORS
Bonnie Retamozo, DDS, MSD
INTRODUCTION:

The purpose of this technique manual is to aid the student in developing the skills which are
necessary to perform basic clinical endodontic procedures. Endodontic techniques are described,
instruments and their use are explained and the performance criteria for each laboratory
procedure are stated.

Successful completion of the pre-clinical technique course and the Endodontic Clinic orientation
will qualify you to treat patients in the Endodontic Clinic.
Successful endodontics requires attention to detail; this is true both in the pre-clinical laboratory
setting and in clinic.

COURSE GOAL: To provide the student with foundational knowledge and skills needed to
treat patients in the endodontic clinic.

COURSE LEARNING OUTCOMES:

At the completion of this course the student should be able to:

1. Be familiar with endodontic instruments and supplies.

2. Interpret radiographs as used in endodontics to evaluate pulpal anatomy, estimate root

canal length and determine adequacy of obturation.

3. Properly access maxillary and mandibular teeth.

4. Accurately determine canal length and working length.

5. Adequately clean and shape the root canal system.

6. Properly mix root canal sealer.

7. Properly obturate an instrumented root canal system, including fitting of the master cone,
placement of the root canal sealer and lateral condensation of gutta percha.

8. Discuss the principles involved in each of the above procedures.

9. Describe the basis for evaluation of each procedure.

10. Provide adequate inter-appointment temporization.

PREREQUISITE:

A supply of extracted teeth is needed to complete some of the projects and the competency tests.
1
INSTRUMENT ISSUE / TOOTH SELECTION / RADIOLOGY

GOAL: To Identify and Describe the Use of Endodontic Instruments.

CLASS LEARNING OUTCOMES:

1. Recognize an endodontic explorer and state its use.

2. Recognize an endodontic spreader and state its use.

3. Recognize an endodontic plugger and state its use.

4. Recognize an endodontic excavator and state its use.

5. State the use of an endodontic ruler (root canal gauge).

6. Recognize locking cotton pliers and state their use.

7. Recognize a Woodson no. 2 instrument and state its use.

8. Recognize Gates-Glidden burs and state their use and describe how their size is
designated.

9. Recognize root canal files and explain their use, size and length designation and their
color coding system.

10. Recognize rubber stops and state their use and proper placement.

Endodontic explorer. One endodontic explorer is included in the issue (Fig. 1). It is a double-
ended instrument numbered DG16 and is used for locating coronal root canal orifices.
IT SHOULD NOT BE USED AS A SPREADER.

FIG. 1

2
Endodontic excavator. The issue has two double-ended long shank spoon excavators (Fig. 2),
numbered #31, #33L. They are longer than conventional excavators to allow curettage of the
pulp chamber. THESE INSTRUMENTS SHOULD NOT BE HEATED.

FIG. 2

Locking cotton pliers. The locking cotton pliers (Fig. 3) are designed specifically for
endodontics. They are to hold gutta percha points and paper points at fixed lengths; if needed
you may add a standard type of pliers from your regular issue.

FIG. 3

Endodontic ruler. One endodontic ruler (Fig. 4) located on your mirror handle is included in
the issue. It is graduated in 1 mm increments and is used for measuring endodontic files, gutta
percha points, paper points, etc.

FIG.4

3
File organizer. The file organizer (Fig. 5) is used to hold and organize intracanal instruments
(files) during root canal preparation.

FIG. 5

Burs and Gates Gliddens. The issue has a variety of long shank round burs for use in the slow
speed contra-angle handpiece. They are numbered 2, 4, 6, 8 and are designed for use in
completing access preparations. Also included are regular high speed burs (#2, 4, 6, 1558)
which are used in preparing the coronal access. Further, the issue has one vial of Gates Glidden
burs (Fig. 6). These are numbered 1 to 5 and are distinguished by bands on the shanks denoting
their numbers. These burs are designed to widen the coronal orifice of root canals and to aid in
developing a funnel shaped canal preparation.

FIG. 6

4
Intracanal hand instruments. The following “K-type” files are in the issue: #10 through #70 in
the 25 mm length. The files have colored handles which correspond to the file sizes (Table 1).
Files are used to clean and shape the root canal(s). Included also are rubber stops. These are
placed on the files (Fig. 7) to make the files conform to specific lengths needed. Files and rubber
stops may be autoclaved. Size of the file is determined by the formula X/100 = tip size in mm
(e.g. #20 file = 0.2 mm at 1 mm from the tip).

FIG. 7

TABLE 1
Instrument Color Instrument Color Instrument Color
Size Size Size
08 Gray 40 Black 90 White
10 Purple 45 White 100 Yellow
15 White 50 Yellow 110 Red
20 Yellow 55 Red 120 Blue
25 Red 60 Blue 130 Green
30 Blue 70 Green 140 Black
35 Green 80 Black

Film clip hangers. Six single clip film hangers are issued for use in the Preclinical Laboratory.
Always clip the film on the edge closest to the dimple. (Fig. 8)

FIG. 8

5
Irrigation. In the laboratory water is used to avoid contact with clothing and prevent accidental
spills. In the clinic, sodium hypochlorite (2.0%) is used for irrigation and extreme care must be
used to avoid contact with clothing due to its bleaching action.

Irrigation syringe. A Luer-Loc type, plastic 5 cc syringe with a specially designed needle is
used for irrigating the root canal system during cleaning and shaping. Fill the syringe, without
the needle attached, and squeeze out any water bubbles, attach the needle and you are ready to
irrigate the root canal.

Temporization Materials

Cavit. The tube of Cavit contains ready-mixed temporary filling material for the access cavity.
It can also be used for other purposes such as sealing leaky rubber dam margins around teeth and
other areas that need temporary seals against salivary contamination. This is an interim treatment
for teeth in the process of root canal therapy.

Woodson No. 2 instrument. The Woodson No. 2 instrument (Fig. 9) has a blade at one end and
a plugger at the opposite end. The blade is used to carry, place, and carve temporary filling
materials. The plugger is used for condensing filling materials into access preparations.

FIG. 9

6
Instruments for Obturation.

Endodontic spreaders. Two spreaders (Fig. 10) are issued. These are single-ended instruments
with tapered tips and identified as #D-11T and #D-11 S. These instruments are for lateral
condensation of the root canal filling material. CAUTION: DO NOT HEAT THESE
INSTRUMENTS

FIG. 10

Endodontic pluggers. Three flat ended pluggers (Fig. 11) identified as #1-3, 5-7, 9-11 are
issued. #1 is the smallest and #11 is the largest end. These are double-ended instruments used
for vertical condensation of endodontic filling materials. THEY MAY BE HEATED FOR
REMOVAL AND SOFTENING OF GUTTA PERCHA.

FIG. 11

7
Scissors. The pair of scissors (Fig. 12) issued are intended for cutting gutta percha points and
paper points to desired lengths. DO NOT USE for opening Cavit tubes and other heavy duty
chores.

FIG. 12

Root Canal Filling Materials

Root canal sealer. The type used in our laboratory and clinic is referred to as
Grossman’s/Roth’s sealer and is a zinc oxide and eugenol cement.

Gutta percha. Root canal fillings consist mainly of gutta percha, which is supplied in
two types: standardized ones for master cones (Fig. 13) and conventional for accessory
points (Fig. 14). More detailed information about gutta percha points will follow in
sections on obturation.

FIG. 13

8
 FIG. 14

Mounting teeth in acrylic model

A. Prior to mounting the tooth should be cleaned of all adherent patient material.

B. Using a small ball of rope wax secure the crown of the tooth/teeth to a tongue depressor.
Also place a ball of wax at the apex of the tooth/teeth.

C. Mix acrylic in a plastic medicine cup

D. Insert tooth / teeth into the acrylic up to the CEJ of the tooth.

E. Once the acrylic has hardened the tooth model can be removed from the plastic cup and
stored in water to prevent drying of the tooth.

9
TOOTH SELECTION AND RADIOGRAPHIC TECHNIQUE FOR ALL PROJECTS

GOAL: To select the appropriate teeth to be used for the

laboratory exercises.

CLASS LEARNING OUTCOMES:

1. Select the required teeth for the course projects:

2. Learn to expose radiographs using the laboratory radiographic units.

3. Learn to process analog radiographs using the portable chair side processing box.

4. Demonstrate correct relationship between tooth and film.

MATERIALS:

1. Extracted teeth
2. X-Ray film
3. Film clip hangers

10
PROCEDURES:

1. Properly selected teeth fulfill the following visual

criteria:

A. Crown - Free of caries or broken

restorations (Fig. 15).
B. Fully formed root apices (Fig. 16).
C. Minimal root curvatures (<30º) (Fig. 17).

NOTE: Teeth need to meet all criteria listed

above.

2. Take two radiographs (1 facial; 1 proximal - Fig.

18) of all teeth using the laboratory radiograph
machines. Use wax to stabilize teeth. (Exposure
times are posted on radiograph machine).

3. Develop the film using the portable chair side

radiograph processing box (Fig. 19). The visual
method of developing is used.

11
3.1. Raise the light filter cover.

3.2. There are four containers inside (Fig. 19). The developing solution is always
placed in the container farthest to the left. Going from left to right, the next
container is water, followed by the fixing solution, and the last container to the
right is water. They are placed from left to right in the order they are going to be
used.

3.3. Place the exposed x-ray film and a film clip in the box.

3.4. Close the light filter cover.

3.5. Insert hands in holes. DO NOT WEAR GLOVES!

3.6. Remove x-ray film from wrapper and place on film clip. Attach the film clip to
the edge of the x-ray film adjacent to the identifying dot (Fig. 20).

3.7. Immerse film in the developing solution (container #1) and slightly agitate several
times. Developing is complete when a definite visual image of the tooth appears
on the film (approximately 20 seconds).

12
 3.8. Rinse film in water (container #2) for a few
seconds to remove the developing solution.

3.9. Immerse film in the fixing solution (container

#3). You may now remove the light filter
cover.

3.10. While the x-ray film is in the fixer, remove the

lead from the film wrapper and place it in the
recessed well in the front of the processing
box. Place the plastic film wrapper in the
trash. The film should remain in the fixer
solution until it is “clear” rendering the image
translucent ( a minimum of 1 minute).

3.11. Rinse the film in water (container #4) for a

few seconds to remove the fixing solution.

3.12. The radiograph is now ready for preliminary

viewing.

3.13. After viewing, the film should be returned to

fixing solution for at least 3 minutes. This
should be done in fixer provided in
containers furnished outside of the
developing box. The film should be rinsed
in running water for a minimum of 1
minute to remove residual fixer from the
emulsion.

3.14. After rinsing, the x-rays are air dried and

placed in radiographic mounts provided. An
electric hair dryer may facilitate this
process.

4. Upon study of the radiographs teeth should have:

4.1. Clearly visible pulp chamber (Fig.21)

4.2. Patent, visible canal(s) (Fig. 22). This

allows for complete instrumentation to the
apical foramen for proper cleaning and
shaping.

13
 4.3. Roots and canals should have a curvature of
0-30º (Fig. 23). Excess curvature adds a
degree of difficulty not intended for this
course.

5. Storage of Teeth - When the necessary teeth have

been selected and approved, store them in a container
of water with a small amount of disinfectant added.
Failure to store teeth properly between lab sessions
may result in dehydration and fracture during
endodontic procedures.

NOTE: The tooth should be placed on the film so that

the incisal or occlusal aspect of the tooth is located
toward the locating dimple. All incisor radiographs
should be taken in a vertical position and all posterior
(premolars and molars) radiographs in a horizontal
position.

EVALUATION CRITERIA:

The student’s performance will be evaluated for:

1. Proper tooth selection based on visual and

radiographic criteria (See #1 and #4 in “Procedures”).

2. Quality of radiographs.

2.1. Tooth image is centered on the radiograph.

2.2. The incisal or occlusal of the tooth is toward

the side of the radiograph with the locating
dimple.

2.3. Radiographs for anterior teeth in vertical

position (Fig. 18, page 12).

2.4. Radiographs for posterior teeth in horizontal

position.

2.5. Radiographs are properly processed.

14
PROJECT 1: ACCESS PREPARATION
1 Plastic Anterior Tooth
1 Maxillary Incisor - Mounted
1 Mandibular Incisor - Mounted
1 Canine - Mounted

PROJECT 2: ACCESS PREPARATION

1 Plastic Mandibular Molar
1 Maxillary Premolar – Mounted
1 Mandibular Premolar - Mounted
1 Mandibular Molar - Mounted

READING ASSIGNMENT: Principles and Practice of

Endodontics 4th Ed. (Torabinejad
and Walton, 2008) pp. 230-257

GOAL: To learn the principles of access cavity preparations.

CLASS LEARNING OUTCOMES: The student will be able to:

1. Identify the instruments used for access cavity preparation.

2. Demonstrate the proper use of these instruments.

3. Interpret radiographs as a guide in access cavity

preparation.

4. Recognize the relationship of the size and shape of the pulp

chamber to the size and shape of the access preparation.

5. Identify the initial point of penetration in the enamel

surface.

6. Describe the angle of penetration through the enamel and

dentin to reach the pulp chamber.

7. Describe the mechanism for removal of the pulp chamber

roof.

8. Identify the root canal orifice(s).

9. Create straight line access to the root canal system.

10. Create the proper outline form for access preparations.

15
16
INSTRUMENTS AND MATERIALS REQUIRED:

The following instruments and materials must be set up prior to

starting the project.

1. Basic Endodontic Instrument set-up (Fig. 24).

1.1. Endodontic Explorer (#DG16)

1.2. Endodontic Excavators (#31,33)
1.3. Locking Cotton Pliers
1.4. Endodontic Mirror with Ruler
1.5. Irrigating Syringe and Needle
1.6. Irrigant(s)
1.7. Friction Grip Burs (#2, 4, 6, 1558, Small Tapered
Diamond)
1.8. Latch Burs (Long Shank #2, 4, 6, 8)
1.9. Paper Points
1.10. Sure-Stop Rubber Stops
1.11. File Organizer and Files
1.12. 2x2 Gauze and Cotton Pellets

FIG. 24

2. Teeth needed for these projects include Plastic anterior and

posterior teeth, maxillary and mandibular incisors, canine,
maxillary premolar and maxillary and mandibular molars.

3. Obtain 2 initial, diagnostic radiographic views (M-D), (F-L)

of all the teeth to be accessed.

17
ACCESS PREPARATION MAXILLARY CENTRAL OR
LATERAL INCISOR

The external outline form of the access cavity is determined by

the internal anatomy of the pulp space. The purpose of the
access cavity is not only to gain entrance into the pulp chamber,
but to also gain unobstructed access to the apical foramen.

PROCEDURES:

1. Study the radiographs of the project tooth to determine

the size, shape and coronal extension of the pulp chamber
(Fig. 25).

2. Draw a triangle shaped access outline on the lingual

surface with a sharp pencil (Fig. 26).

3. Contact the instructor for evaluation of the preliminary

access outline drawing.

4. Using a No.2 round bur in the high speed handpiece,

penetrate through the enamel to the dentin and remove
the enamel within the outline form drawing (Fig. 27).

5. Contact the instructor for evaluation of the preliminary

access.

6. After removal of the enamel, direct the bur nearly parallel

to the long axis of the tooth and remove dentin in the
direction of the pulp chamber (Fig. 28).

7. If the tooth has a small pulp chamber, you may not be

able to reach it with the high speed bur. In that case, use
the No. 2 long shank bur in the slow handpiece.

8. Once the pulp chamber has been reached, remove the

overhanging dentin from the lingual roof of the pulp
chamber. This is accomplished by working from the
inside to the outside removing dentin and enamel on the
outward stroke only. Following the internal anatomy
(Fig. 29).

NOTE: BE SURE TO REMOVE THE PULP HORNS!

18
9. After locating the canal orifice, the lingual shoulder
should be removed by carefully inserting a #2 long shank
slow speed bur into the canal and with pressure to the
lingual, work the bur from within the canal to the outside
(Fig. 30).

10. The walls of the access cavity may be flared and made
smooth by using a diamond finger bur or a #1558 bur.
REMEMBER, the flare is from the inside to the
outside like an inlay preparation (Fig. 31).

11. Direct straight line access can be checked by placing

an endodontic explorer into the canal orifice. The
explorer should follow the path of the canal without
binding on the walls of the access preparation (Fig.
32).

12. Irrigate and remove all debris from the pulp chamber,
locate the canal orifice with the endodontic explorer,
check the walls of the access cavity for smoothness
and lack of overhangs, particularly in the pulp horn
areas. Use the evaluation criteria to evaluate your
work before asking the instructor to evaluate it.

13. Have your laboratory instructor evaluate your

performance using the Endodontic Laboratory
Evaluation form provided for this project.

EVALUATION CRITERIA

13.1. Proper location of access

13.2. Correct outline form
13.3. Pulp horns removed
13.4. Lingual shoulder removed
13.5. Smooth walls with proper flare
13.6. Overextension and gouging avoided
13.7. Access cavity free of debris
13.8. Canal orifice located

19
20
ACCESS PREPARATION: MANDIBULAR CENTRAL OR
LATERAL INCISOR AND CANINES

The first step in the mechanical preparation of a root canal is

the preparation of an access cavity. REMEMBER: The
external outline form of the access cavity is determined by
the internal anatomy of the pulp space.

PROCEDURES:

1. Study the radiographs of the mandibular incisor to

determine the size, shape and coronal extension of the
pulp chamber (Fig. 33).

2. Draw an outline of the access cavity on the lingual surface

of the crown with a sharp pencil. Since mandibular incisors
many times have two root canals, the access cavity will
often involve the incisal edge (Fig. 34).

3. Contact the instructor for evaluation of the preliminary

access outline drawing.

4. Using a No. 2 round bur in the high speed handpiece,

make the initial penetration through the enamel into the
dentin. Enter through the center of the outline drawing.

5. Remove the enamel within the preliminary outline form

drawing (Fig. 35).

6. Contact the instructor for evaluation of the preliminary

access.

7. After removal of the enamel, direct the bur nearly parallel

to the long axis of the tooth and remove dentin in the
direction of the pulp chamber (Fig. 36).

8. Once the pulp chamber has been reached, remove the

overhanging dentin from the lingual roof. This is
accomplished by working from the inside to the outside
following the internal anatomy. This must also include
the pulp horns (Fig. 37).

21
9. The lingual constriction should be removed by carefully
inserting a No. 2 slow speed round bur into the canal.
While applying lingual pressure to the bur, work it from
the inside to the outside (Fig. 38). This will accomplish
unobstructed access to the apical area of the root canal.

10. REMEMBER, MANDIBULAR INCISORS

OFTEN HAVE TWO ROOT CANALS.
EXTENSION OF THE ACCESS TOWARD THE
INCISAL EDGE AND REMOVAL OF THE
LINGUAL SHOULDER WILL ASSIST IN
LOCATING BOTH CANALS WHEN THEY
EXIST (FIG. 39).

11. The walls of the access cavity should be flared and

made smooth by using a diamond finger bur or a No.
1558 bur. Remember, the flare is from the inside to
the outside (Fig. 40).

12. Have your laboratory instructor evaluate your

performance using the Endodontic Laboratory
Evaluation form provided for this project.

EVALUATION CRITERIA

12.1. Proper location of access

12.2. Correct outline form
12.3. Pulp horns removed
12.4. Lingual shoulder removed
12.5. Smooth walls with flare out
12.6. Access cavity free of debris
12.7. Canal orifice(s) located

22
ACCESS PREPARATION: MAXILLARY AND
MANDIBULAR PREMOLARS

PROCEDURES:

1. Study the radiographs of the project tooth to

determine the size, shape, and coronal
extension of the pulp chamber (Fig. 42).

2. Draw an oval shaped access outline on the

occlusal surface with a sharp pencil.
Due to the shape of the pulp chamber, the
outline will be wider bucco-lingually than
mesio-distally. Note that the mandibular first
premolar has a lingual tilt of the crown to the
long axis of the root. In order to achieve
straight line access to the apex of this tooth, the
access needs to be positioned toward the buccal
cusp (Fig. 43).

3. Contact the instructor for evaluation of the

preliminary access outline drawing.

4. Using a No. 2 round bur in the high speed

handpiece, penetrate through the enamel into the
dentin and remove the enamel within the outline
drawing (Fig. 44).

5. Contact the instructor for evaluation of the

preliminary access.

23
6. After the preliminary access has been
completed, use the same No.2 round bur to
penetrate through the dentin into the pulp
chamber. The penetration point should be in the
center of the access outline (Fig. 45).

7. Once the pulp chamber has been reached,

remove the roof by working from the inside to
the outside following the internal anatomy of
the pulp chamber (Fig. 46).

8. Remove the pulp chamber contents with an

endodontic spoon excavator. Irrigate the
chamber with water and locate
the canal orifice(s). Usually there is only one,
but occasionally two may be found.

9. The walls of the access cavity should be flared

and made smooth by using a diamond finger
bur or a No. 1558 bur (Fig. 47).

10. Irrigate with sodium hypochlorite and remove

all debris from the pulp chamber. Use the
evaluation criteria to self evaluate your work
before asking the instructor to evaluate it.

11. Have your laboratory instructor evaluate your

performance using the Endodontic Laboratory
Evaluation form provided for this project.

EVALUATION CRITERIA
11.1. Proper location of access
11.2. Correct outline form
11.3. Smooth walls with proper flare
11.4. Canal orifice(s) located
11.5. Access cavity free of debris

The access preparation is similar for the

mandibular and maxillary premolar. Follow
the same steps for both teeth.

24
ACCESS PREPARATION: MAXILLARY AND
MANDIBULAR MOLARS

The outline form for the access cavity preparation

on maxillary and mandibular molars is very similar.
The major difference is the position of the access
cavity as it relates to the crown of the tooth. The
outline form for both is basically triangular in
shape. For maxillary molars, the base of the
triangle is directed toward the buccal (Fig. 48). For
mandibular molars, the base of the triangle is
directed toward the mesial (Fig. 49). Remember
what you learned about pulp space morphology in
dental anatomy class. The angles of the triangle are
formed by the location of the root canal orifices on
the floor of the pulp chamber. By visually
projecting the location of the root canal orifices
onto the occlusal surface of the tooth, you will be
able to determine the outline form of the access
cavity (Fig. 50).

PROCEDURES:

1. Study the radiographs of the project tooth to

determine the size, shape and coronal
extension of the pulp chamber (Fig. 51 and
Fig. 52).

2. Draw a triangular shaped access outline on

the occlusal surface with a sharp pencil. On maxillary
molars the base of the triangle is toward the buccal. On
mandibular molars the base of the triangle is
toward the mesial (Fig. 48 and Fig. 49).

3. Contact the instructor for evaluation of the

preliminary access drawing.

4. Using a No. 2 round bur in the high speed

handpiece, penetrate through the enamel (or
restorative material) into the dentin and remove
the material within the outline drawing (Fig.
53).

25
 11.3 Smooth walls with
proper flare
5. Contact the instructor for evaluation of the 11.4 Canal orifices
preliminary access. located
11.5 Access cavity free of
6. After the preliminary access has been debris
completed, use the same No. 2 round bur to
penetrate through the dentin into the pulp
chamber. The penetration point should be in the
center of the access outline (Fig. 55).

7. Once the pulp chamber has been reached,

remove the roof by working from the inside to
the outside removing tooth structure on the
outward stroke. Continue to unroof the pulp
chamber following the internal anatomy (Fig.
56).

8. Remove the pulp chamber contents with an

endodontic spoon excavator. Irrigate the
chamber with sodium hypochlorite and locate
the canal orifices.

NOTE: Usually molar teeth have 3 or 4

canals. 1st molars, 50% of the time, will have
4 canals (Fig. 57). Occasionally molars will
have only 1 or 2 canals, but this is rare.

9. The walls of the access cavity should be flared

and made smooth by using a diamond finger
bur or a No. 1558 bur (Fig. 58).

11. Irrigate with water and remove

all debris from the pulp chamber. Use the
evaluation criteria to self evaluate your work
before asking the instructor to evaluate it.

12. Have your laboratory instructor evaluate

your performance using the Endodontic
Laboratory Evaluation form provided for
this project.

EVALUATION CRITERIA
11.1 Proper location of access
11.2 Correct outline form
26
PROJECT 3: ROOT CANAL PREPARATION
3 Canals – Clean and Shape

READING ASSIGNMENT: Endodontics, Principles and

Practice 4th Ed. pg 258-286

GOAL: To learn the principles of root canal preparation

(cleaning and shaping) as they apply to straight
or slightly curved canals.

CLASS LEARNING OUTCOMES:

1. Determine working length.

2. To learn proper use of root canal files.

3. To learn proper use of Gates-Glidden burs.

4. To learn proper use of intracanal irrigation.

5. To develop a gradually tapering root canal preparation

from apex to canal orifice.

6. To avoid ledging and transportation.

INSTRUMENTS AND MATERIALS REQUIRED:

The student will set up and have available the following

instruments and materials prior to starting the project.

1. Basic endodontic instrument set up

2. Root canal files No 10 - 70 (stainless steel)
3. Sure Stop rubber stops
4. File organizer
5. Gates-Glidden burs

27
PROCEDURES: .

After the proper coronal access has been achieved, the next
step in endodontic therapy is to clean the root canal and to
properly shape it to receive the filling material.

1. Place rubber stops on one of each root canal file #15

through #70 and place them in the file organizer (Fig.
59).

2. Pre-curve files #10 through #25 (Fig. 60).

3. Place the #10 file into the canal until the tip of the file
contacts the end of the root canal system.

4. Using a pair of cotton pliers, move the rubber stop

down until it contacts the reference point / incisal edge.

5. Remove the file from the tooth and measure the

distance from the rubber stop to the tip of the file with
the endodontic ruler (Fig. 62). This measurement
represents the total root canal length.

28
6. Next you need to establish the working length. This is
done by subtracting 1 mm from the total length.
Document the working length in your portfolio
under the correct tooth.

After establishing the working length you will use

Gates-Glidden drills.

7. Place rubber stops on Gates-Glidden drills #2, 3, and 4

(Fig. 64).

8. Insert the non rotating #4 Gates-Glidden drill into the

access until it meets resistance. Set the rubber stop 2
mm higher/above the reference point.

9. With the root canal filled with sodium hypochlorite,

activate the slow speed handpiece and insert the #4
Gates-Glidden drill into the canal until the rubber stop
contacts the reference point.

10. Using an in-and-out stroke, plane all root canal walls

with a circumferential motion. Irrigate with sodium
hypochlorite to remove debris.

11. Next, set the rubber stop on the #3 Gates-Glidden drill

at a distance 2mm longer than it was for the #4. Repeat
the same procedure as above. Remember to irrigate
following the use of the Gates-Glidden drill.

12. Now set the rubber stop on the #2 Gates-Glidden drill at

a distance 2mm longer than it was for the #3. Repeat
the same procedure as above. This will result in a
gradual tapering of the occlusal ½ of the root canal
(Fig. 67).

The next and final step in root canal preparation

involves cleaning and shaping of the apical ½ of the
root canal.

13. Set the rubber stops on files #15, 20, 25, 30 and 35 at
the working length.

29
14. With the root canal filled with sodium hypochlorite,
insert the file into the root canal until the rubber stop
contacts the occlusal/incisal reference point using a
slight clockwise rotation and a push-pull stroke with a
circumferential motion. Begin with the #15 file and
work up in sequence to the #30 or #35 file depending
on the size of the canal.

15. Now, set the rubber stop on file #40 ½mm shorter than
the working length, #45 1mm shorter, #50 1.5mm
shorter, etc., up through file #70 (Fig. 68). Using the
same filing motion as above, insert the files in a
sequential order, into the root canal until the rubber stop
contacts the occlusal reference point.

REMEMBER:

* ALWAYS WORK IN A WET FIELD

* IRRIGATE OFTEN
* RECAPITULATE OFTEN

This step-back preparation will blend the occlusal ½

and the apical ½ of the root canal into a smooth
gradually tapering preparation. Irrigate to remove all
debris and dry the canal with paper points. Use the self
evaluation criteria to evaluate your work before asking
an instructor to evaluate it.

16. Have your laboratory instructor evaluate your

performance using the Endodontic Laboratory
Evaluation form provided for this project.

EVALUATION CRITERIA

16.1. Preparation should flare gradually from apex to

canal orifice
16.2. Walls should be smooth
16.3. Largest working length file should fit easily to
working length without binding
16.4. Canal should be free of debris
16.5. Apical transportation avoided

30
COMPETENCY TEST I:

ACCESS: Mounted:
1 Maxillary Anterior
1 Mandibular Anterior
1 Posterior Multi-Canal molar of student’s choice.

GOAL: To evaluate your ability to apply the principles of

endodontic access cavity preparation.

INSTRUMENTS AND MATERIALS REQUIRED:

1. Basic endodontic instrument set-up

2. Radiographic film clips
3. Examination tooth mounted in an acrylic block according
to the tooth selection and mounting instructions
4. Two radiographs of mounted examination tooth (facial-
lingual and mesial-distal)
5. Radiograph film mount (provided at time of examination)
6. Examination evaluation form (provided at time of
examination)

PROCEDURE FOR TOOTH SELECTION AND

MOUNTING INSTRUCTIONS

1. TOOTH SELECTION: Any single canal anterior tooth

may be used except a tooth with the crown not intact or
with open apices. Intact means that the crown cannot
display any fractures that obviously involve the pulp
chamber. Craze lines, restorations which do not cover the
entire lingual or occlusal surface, and enamel fractures
are acceptable. Teeth with existing restorations are
acceptable as long as the restoration is intact with good
margins. Teeth with caries are not acceptable.

2. PREPARTION TO COMPLETE BEFORE THE

TEST The tooth should be cleaned of adherent patient
material by scrubbing with detergent and water or using
an ultrasonic cleaner. The tooth should be thoroughly
clean and rinsed.

31
3. The teeth should be mounted in acrylic:

A. Mount as described on page 9.

B. Place a ball of soft pink base - plate wax at the

apex of the roots. The wax ball should measure 4
mm or more and must be clearly visible on the
radiograph after the tooth has been mounted in
acrylic.

C. Cut a small horizontal notch in the coronal third

of the tooth root on the facial or lingual surface
with a bur. This notch will lock the tooth into the
acrylic and prevent removal or displacement of
the tooth. Be careful not to enter the root canal
space.

D. Place the tooth in the model, centering it in the

acrylic and embedding it to just below the
cemento-enamel junction. Make sure that the wax
at the root apex is not touching the bottom of the
mold.

E. After the acrylic has hardened, remove from

plastic cup. The tooth root and ball of wax must
be completely covered in the solid acrylic block

F. INSCRIBE YOUR BOX NUMBER ON THE

SIDE OF THE MODEL WITH A BUR.

G. Expose and develop radiographs of the mounted

tooth from a straight on and from a mesial or
distal direction. The developed radiographs must
clearly show the radiolucency (minimum 4 mm)
of the wax at the root apex. The pulp chamber
and root canal should be clearly visible on the
radiograph.

H. Store the mounted teeth in liquid until the time of

the competency test.

32
 EXAMINATION PROCEDURE

1. Before you ask your instructor to evaluate the

examination, be sure that you perform a self-evaluation
by checking the evaluation criteria for that section to
make sure that you have done everything required.

2. Pretreatment check: Ask your instructor for a start check.

They will evaluate the tooth selection and mounting
section at the same time.

3. Access:

3.1. Access the tooth appropriately (should look like a

text book access).

4. General performance:

4.1. The radiographs for this examination must be

properly mounted in the mount provided (see
example below) and labeled with your box
number and the project number.

4.2. Do not place wet radiographs in the plastic mount.

The radiographs should be thoroughly dried
before mounting.

5. Turn in the evaluation forms for recording your grade

to the ladies at the supply table.

Example of mounted radiographs.

Name Box # Comp #

Pretreat Final F-L
F-L
Pretreat Final M-D
M-D

33
PROJECT 4: OBTURATION - LATERAL
CONDENSATION
Obturate 3 prepared canals

After proper cleaning and shaping of the root canal system, the
next step in endodontic therapy is the obturation of the root
canal(s).

READING ASSIGNMENT: Endodontics, Principles and

Practice 4th Ed. pg 298-321

GOAL: To learn the principles of root canal obturation with

gutta percha and lateral condensation.

CLASS LEARNING OUTCOMES:

The student should be able to:

1. Select the proper master cone.

2. Properly fit the master cone.
3. Select the proper condensing instruments.
4. Select the proper accessory gutta percha points.
5. Properly mix the root canal sealer.
6. Completely obturate the root canal in all dimensions.

INSTRUMENTS AND MATERIALS REQUIRED:

The student should set up and have available the following

instruments and materials before starting the project.

1. Basic endodontic set up

2. Teeth previously cleaned and shaped
3. Cement spatula
4. Small glass slab with Roth’s R.C. sealer powder and
liquid (Eugenol).
5. Root canal spreaders (2)
6. Root canal pluggers (2)
7. Accessory gutta percha cones (MF & F)
8. Bunsen burner

34
PROCEDURES:

1. Check to make sure the canal is dry and free of debris.

1.1. Dry canal with paper points

1.2. Set rubber stop on largest working length file to
the working length.
1.3. Return this file to the canal and insert it to the
working length to determine canal is smooth
and clean.
1.4. If file does not extend easily to the working
length, re-irrigate the canal, recapitulate and
repeat steps 1-3.

2. Select the proper master cone

2.1. The master cone (gutta percha point) is selected

on the basis of the size of the largest working
length file.
2.2. Select a STANDARDIZED gutta percha point
corresponding in size to the largest working
length file used during the cleaning and shaping
procedures.

NOTE: Standardized gutta percha points

are obtained from the laboratory supply
table.

3. Contact the instructor to evaluate master cone

selection.

4. Now you are ready to fit the master cone.

4.1. Using the locking cotton pliers, measure and

crimp the master cone you selected with the
endodontic ruler and lock the pliers at a length
corresponding to the working length (Fig. 81).
4.2. Insert the master cone into the canal and
release from cotton pliers. Lightly tap your
finger on the cone to seat firmly. It should fit
completely to or within 1 mm of the working
length (Fig. 82).
4.3. Check for the feeling of resistance when you
place and remove the master cone from the
root canal.
35
 4.4. One of the following will occur during the
fitting of the master cone:

The master cone extends to the proper length

with the sensation of resistance (Fig. 82). If this
is the case, proceed to step #7.

The master cone will not extend to the working

length (Fig. 83). If this is the case, check the
root canal for patency and the presence of debris
(step #1 above) and refit the master cone.
MAKE SURE YOU HAVE SELECTED
THE PROPER SIZE MASTER CONE.

The master cone extends to the proper length

but fits without resistance (Fig. 84). If this is
the case, shorten the master by cutting 1 mm
from the apical tip with a pair of fine sharp
scissors (Fig. 85). Return master cone to the
canal and check the fit. If the master cone still
fits loosely, shorten it by 1mm again and
recheck the fit. If still loose, use the next larger
master cone and repeat fitting procedure.

5. Contact the instructor to evaluate the master cone fit.

6. Now you need to select the proper root canal

spreader.

6.1. Use the #D11 (smaller) spreader if the largest

working length file was a #60 or smaller.

6.2. Use the #3 spreader if the largest working length

file was a #70 or larger.

7. Check the spreader for proper fit.

7.1. Place a rubber stop on the spreader and position

it 2mm short of the working length (Fig. 86).

7.2. Insert the spreader into the canal. To insure that

it will fit without binding on the root canal walls
(Fig. 87). If the spreader binds, you need to
flare the preparation more.

36
37
8. Contact the instructor to evaluate the spreader selection and fit.

9. Select the proper accessory gutta percha points.

9.1. If you use the #D11 spreader, you should use the size medium-fine accessory
points.

10. Mixing the root canal sealer.

10.1. Place the root canal sealer and liquid on the small glass slab (Fig. 88).

NOTE: The root canal sealer powder and liquid are provided from the laboratory
supply cart. The assistant will pass it out to you.

10.2. Spatulate small portions of the powder into the liquid using a wide circular stroke
until a smooth homogenous thick creamy consistency is obtained

10.3. The proper consistency has been achieved when the spatula is slowly raised one
inch from the mass of sealer and the “string” of sealer holds (“strings outs”) for 4 to
5 seconds before breaking. (Fig. 89).

11. Contact the instructor to evaluate your selection of accessory gutta percha points and
your sealer mix.

38
12. Coating the root canal walls with sealer.

12.1. Place a rubber stop on the next to largest working length file and set it at the
working length.

12.2. Coat the apical ½ of the file with sealer (Fig. 90).

12.3. Insert the file into the root canal to the working length.

12.4. Slowly rotate the file counter clockwise while at the same time withdrawing
the file from the canal. To ensure that the canal walls are entirely coated with
sealer, it may be necessary to repeat this procedure two or three times.

13. Placing the master cone into the prepared root canal.

13.1. Hold the master cone with the locking cotton pliers at the previously
determined working length.

13.2. Coat the apical ½ of the master cone with sealer (Fig. 91).

13.3. Slowly insert the master cone into the canal until it is completely seated to
place (Fig. 92).

Fig. 90 Fig. 91 Fig. 92

39
14. Lateral condensation of gutta percha

14.1. The extruding portion of the master cone usually fits eccentrically in the canal,
leaving one side with more space. Lateral condensation can best be achieved
in this space along side of the master cone (Fig. 93).

14.2. Insert the spreader in the chosen side between the master cone and the wall of
the root canal and exert apical pressure until resistance is met.

14.3. Do not penetrate beyond the length indicated by the rubber stop (Fig. 94).

14.4. Rotate the spreader handle 180º several times to disengage the spreader point
from the gutta percha and slowly remove the spreader from the canal.

14.5. Repeat the spreader insertion, rotation and withdrawal three or four times, always
reinserting the spreader in the same position. This will condense the gutta percha
laterally.

14.6. Coat the apical 2-3 mm of an accessory cone with sealer and insert it into the
space created by the spreader (Fig. 91 and Fig. 96).

14.7. Reinsert the spreader in the same position, between the canal wall and the gutta
percha, and continue the lateral condensation process adding accessory cones
until the root canal space is completely obturated (Fig. 97 and Fig. 98).

Fig. 93

Fig. 94 Fig. 96

Fig. 97 Fig. 98

40
15. Contact the instructor to evaluate the lateral condensation.

16. Remove excess gutta percha.

16.1. Heat one end of the #9-11 gutta percha plugger in a Bunsen burner flame.

16.2. Remove the excess gutta percha 1 mm below the facial CEJ.

16.3. With the cold end of the gutta percha plugger, vertically condense the gutta
percha in the root canal space by applying firm apical pressure with the plugger
(Fig. 100).

Fig. 99 Fig. 100

41
Remove the excess sealer from the access with a cotton pellet saturated with alcohol (Fig. 101).

NOTE: WHEN FINISHED, THE GUTTA PERCHA SHOULD BE AT OR

1MM BELOW THE FACIAL CEJ AND THE ACCESS SHOULD BE
CLEAN AND FREE OF ANY EXCESS SEALER (Fig. 102).

16.4. Take a radiograph of the finished obturation to evaluate the density of the gutta
percha filling.

Use the evaluation criteria to self evaluate your work.

17. Have your laboratory instructor evaluate your performance using the Endodontic
Laboratory Evaluation form provided for this project.

EVALUATION CRITERIA

17.1. Proper selection of the master cone

17.2. Master cone fits with resistance to within 1mm of working length
17.3. Proper selection of spreader
17.4. Spreader fits in canal to proper length without binding
17.5. Proper selection of accessory cones for use with spreader
17.6. Root canal sealer mixed to proper consistency
17.7. Lateral condensation of gutta percha completed
17.7.1. Gutta percha extends to working length
17.7.2. No void in gutta percha
17.8. Gutta percha removed 1mm below facial CEJ
17.9. All excess sealer removed from access

Fig. 102

Fig. 101

42
PROJECT 5: ROOT CANAL THERAPY
1 Anterior Tooth

PROJECT 6: ROOT CANAL THERAPY

1 Multi-canal Premolar or 2 Single-rooted premolars

GOAL: To apply the principles of instrumentation & obturation in treating canals

CLASS LEARNING OUTCOMES:

The student should be able to:

1. Identify the instruments used for all technical phases of endodontic treatment.

2. Demonstrate the proper use of these instruments.

3. Demonstrate proper endodontic radiography techniques.

4. Demonstrate the ability to make an appropriate access preparation.

5. Establish the estimated working length from a pretreatment radiograph.

6. Determine working length.

7. Properly instrument & obturate the root canal space.

INSTRUMENTS AND MATERIALS REQUIRED:

The student will set up and have available the following instruments and materials prior to
starting the project.

1. Basic endodontic instrument set up

2. Previously accessed teeth
3. Radiographs of project canals (2)
4. X-ray film
5. X-ray film clips

MOUNT YOUR TOOTH IN ACRYLIC AND SAWDUST AS DESCRIBED ON PAGE 10

FOR THE NEXT 3 PROJECTS AND COMPETENCY II

43
PROCEDURES:

1. Study the radiographs of the project canal(s) to determine the size, shape and coronal
extension of the pulp chamber.

2. Contact the instructor for evaluation of the completed access cavity preparation.

3. Determine the estimated working length.

Using the endodontic ruler, measure the length of the image of the tooth on the
radiograph from the occlusal reference point to the radiographic root apex.

4. Negotiating the canal.

4.1. Position the rubber stop on the #10 SS file 1-2mm shorter than the estimated
length.

4.2. Pre-curve the file with a gentle apical curve.

4.3. Place water in the pulp chamber using the irrigating syringe.

4.4. Place the #10 file into the canal orifice and slowly. Advance it apically with a
slight back-and-forth or “watch winding” motion until the rubber stop touches the
reference point.

4.5. If you encounter resistance to the apical movement of the file, DO NOT FORCE
IT TOWARD THE APEX. Instead, pull the file back 1-2 mm, rotate the file
slightly while slowly and gently advancing it toward the apex again. By carefully
approaching, retreating and approaching - all the while rotating the file back-and-
forth, you will be able to bypass calcific deposits in the pulp tissue and negotiate
canal curvatures (Fig. 104).

4.6. Now examine the root apex. If the file has not exited through the apical foramen,
continue to advance it until it is visible (Fig. 105).

** NOTE THE LOCATION OF THE APICAL EXIT OF THE ROOT CANAL

(APICAL FORAMEN) IN RELATION TO THE ANATOMICAL ROOT
APEX.

5. Determine the working length.

5.1. Position the file so that the tip is flush with the root surface. Adjust the rubber
stop so that it contacts the coronal reference point you have chosen.

44
 5.2. Remove the file from the canal. If it is still curved, straighten it and measure the
distance from the rubber stop to the file tip. This measurement will be the total
root canal length or patency length.

DETERMINE THE WORKING LENGTH BY SUBTRACTING 1 MM

FROM THE TOTAL ROOT CANAL LENGTH.

5.3. Adjust the rubber stops on the #15-#35 files so that they are set at the working
length. Place them in the file organizer so that they are convenient and ready to
use (Fig. 106).

5.4. Place sodium hypochlorite into the pulp chamber using the irrigating syringe.
Starting with the #15 file, insert the file into the canal and slowly advance it
apically until the rubber stop reaches the coronal reference point.

5.5. Take a “working length” radiograph with the #15 file in place, position the tooth
on film and stabilize it with a small piece of soft wax. Expose and process
the film. The radiograph should demonstrate the file 1mm short of the total root
length (Fig. 107).

5.6. Contact your instructor to evaluate the working length determination.

6. Clean and shape the root canal system.

6.1. Follow the principles of the “Passive step-back technique” (Project #2)

6.2. After you have completed the root canal preparation, place the largest working
length file in the canal to the working length and expose a radiograph. Compare
the position of the tip of the file on this radiograph with the one taken with the
#15 file in place. They should be in the same place relative to the total root canal
length.

6.3. Contact your instructor to evaluate the root canal preparation.

7. Obturate following directions described in Project #4.

8. Mount all radiographs in the mount provided.

45
EVALUATION CRITERIA

The student’s performance will be evaluated for: (See project evaluation form)

1. Proper tooth selection

2. Access preparation
3. Length determination
4. Radicular preparation (cleaning and shaping)
5. Radicular obturation
6. Radiographs properly exposed and processed
7. Radiographs properly mounted
8. Proper instrument set up
9. Clean and organized work area

46
PROJECT 7: COMPLETE ROOT CANAL
TREATMENT OF A PLASTIC
MAXILLARY MOLAR #14

GOAL: To apply the principles of access,

instrumentation & obturation in treating
multi-canal teeth

CLASS LEARNING OUTCOMES:

The student should be able to:

1. Identify the instruments used for all technical phases of

endodontic treatment.

2. Demonstrate the proper use of these instruments.

3. Establish the estimated root canal length on all canals from

a pretreatment radiograph.

4. Determine total canal length and working length on all

canals.

5. Instrument & obturate the entire root canal system.

INSTRUMENTS AND MATERIALS REQUIRED:

The student will set up and have available the following

instruments and materials prior to starting the project.

1. Basic endodontic instrument set up

2. Project teeth
3. Radiographs of canals (2 views)
4. X-ray film
5. X-ray film clips
6. X-ray mounts

47
PROCEDURES:

1. Reduce the cusp tips with a diamond if necessary to get a

good reference point (Fig. 117.)

2. Study the radiographs of the project canal(s) to determine

the size, shape and coronal extension of the pulp chamber.

3. Complete the access cavity preparation following the

principles and procedures outlined in project #3 and 4 if
necessary

4. Contact the instructor for evaluation of the completed

access cavity preparation.

5. Determine the estimated working length of all canals.

5.1. Using the endodontic ruler, measure the length of

the image of the roots in the radiograph from the
occlusal reference point to the radiographic root
apex (Fig. 118). This measurement will be the
estimated length (E.L.)

6. Negotiating the canal(s).

6.1. Place a rubber stop on a size #10 file at a distance 1

mm shorter than the estimated length for this canal.

6.2. Pre-curve the file with a gentle apical curve.

6.3. Place sodium hypochlorite in the pulp chamber

using the irrigating syringe.

6.4. Place the #10 file into the canal orifice and slowly
advance it apically with a slight rotary back-and-
forth / “watch winding” motion until the rubber stop
touches the reference point (Fig. 119).

48
 6.5. If you
encounter
resistance
to the
apical
movement
of the file,
DO NOT
FORCE
IT
TOWAR
D THE
APEX.
Instead,
pull the
file back
1-2 mm,
rotate the
file
slightly
while
slowly and
gently
advancing
it toward
the apex
again. By
carefully
approachin
g,
retreating
and
approachin
g, all the
while
rotating
the file
back and
forth, you
will be
able to
bypass
calcific
deposits in
the pulp
49
 tissue and negotiate canal curvatures (Fig. 120).

6.6. Now examine the root apex. If the file has not
exited through the apical foramen, continue to
advance it until it is visible (Fig. 121).

** NOTE THE LOCATION OF THE APICAL

EXIT OF THE ROOT CANAL (APICAL
FORAMEN) IN RELATION TO THE
ANATOMICAL ROOT APEX.

7. Determine the working length.

7.1. Position the file so that the tip is flush with the root
surface at the apical foramen.

7.2. Adjust the rubber stop so that it contacts the coronal

reference point you have chosen (Fig. 119).
Remove the file from the canal. If it is still curved,
straighten it and measure the distance from the
rubber stop to the file tip. This measurement will
be the total root canal length. Determine the
working length by subtracting 1 mm from the total
root canal length.

7.3. Repeat this procedure for all canals and record the
appropriate data in your portfolio.

8. Take “working x-rays” for length determination as done for

the previous project.

9. Contact the instructor to evaluate the length determinations.

10. Clean and shape the root canal system.

10.1. After x-rays have been taken to verify the working

lengths of all canals, proceed with the radicular
preparation (cleaning and shaping).
10.2. Follow the
principles
for the
passive
step-back
technique
of root
50
 canal preparation as presented in project #2.

NOTE: Multiple rooted teeth often have a

combination of minimally and severely curved
roots. With your instructor’s assistance, evaluate
the degree of root curvature present in your tooth
and together determine the best method to be used
for each canal.

11. Working x-ray with largest working length files in place.

11.1. When you have completed cleaning and shaping all

of the canals, record the largest working length file
for each canal in your portfolio.

Take working x-rays with the largest working length files placed to
the working length. Repeat the same schedule of x-rays that you
took to verify the working length earlier in this project (see
procedure #8).Contact the instructor to evaluate the radicular
preparation.

12. Obturate following directions in Project #4.

13. Mount x-rays in the x-ray mount provided.

EVALUATION CRITERIA

The students’ performance will be evaluated for: (See project

evaluation form).

1. Access Preparation
2. Length Determination
3. Radicular Preparation (Cleaning and Shaping)
4. Radiographs Properly Exposed and Processed
5. Radiographs Properly Mounted

51
 [TBA]

COMPETENCY TEST II:

ACCESS & COMPLETE ENDODONTIC TREATMENT ANY ONE PRE-

DETERMINED CANAL

GOAL: To evaluate your ability to apply the principles of endodontic access cavity
preparation, radicular cavity preparation and obturation using lateral condensation of
gutta percha.

INSTRUMENTS AND MATERIALS REQUIRED:

1. Basic endodontic instrument set-up

2. Small glass slab and cement spatula
3. Accessory gutta percha points
4. Gutta percha spreaders
5. Gutta percha pluggers
6. Bunsen Burner
7. Radiographic film clips
8. Examination tooth mounted in an acrylic block according to the tooth selection and
mounting instructions
9. Two radiographs of mounted examination tooth (facial-lingual and mesial-distal)
10. Radiograph film mount (provided at time of examination)
11. Examination evaluation form (provided at time of examination)

PROCEDURE FOR TOOTH SELECTION AND MOUNTING INSTRUCTIONS

1. TOOTH SELECTION: Any multi-canaled posterior tooth may be used except a tooth
with the crown not intact. Intact means that the crown cannot display any fractures that
obviously involve the pulp chamber. Craze lines, restorations which do not cover the
entire lingual or occlusal surface, and enamel fractures are acceptable. Teeth with
existing restorations are acceptable as long as the restoration is intact with good margins.
Teeth with caries are not acceptable.

2. TOOTH MOUNTING: COMPLETE BEFORE THE TEST Prior to mounting, the

tooth should be cleaned of adherent patient material by scrubbing with detergent and
water or using an ultrasonic cleaner. The tooth should be thoroughly rinsed with tap
water before mounting.
The tooth should be mounted in acrylic:

A. Mount as described on page 9.

B. Place a ball of soft pink base - plate wax at the apex of the roots. The wax ball
should measure 4 mm or more and must be clearly visible on the radiograph after
the tooth has been mounted in acrylic.

C. Cut a small horizontal notch in the coronal third of the tooth root on the facial or
lingual surface with a bur. This notch will lock the tooth into the acrylic and
prevent removal or displacement of the tooth. Be careful not to enter the root
canal space.

D. Place the tooth in the model, centering it in the acrylic and embedding it to just
below the cemento-enamel junction. Make sure that the wax at the root apex is
not touching the bottom of the mold.

E. After the acrylic has hardened, remove from plastic cup. The tooth root and ball
of wax must be completely covered in the solid acrylic block

F. INSCRIBE YOUR BOX NUMBER ON THE SIDE OF THE MODEL WITH

A BUR.

G. Expose and develop radiographs of the mounted tooth from a straight on and from
a mesial or distal direction. The developed radiographs must clearly show the
radiolucency (minimum 4 mm) of the wax at the root apex. The pulp chamber
and root canal should be clearly visible on the radiograph.

H. Store the mounted tooth in liquid until the time of the competency test.

EXAMINATION PROCEDURE

1. Before you ask your instructor to evaluate the examination, be sure that you perform a
self-evaluation by checking the evaluation criteria for that section to make sure that you
have done everything required.

2. Pretreatment check: Ask your instructor for a start check. They will evaluate the tooth
selection and mounting section at the same time.

3. Access & Length determination:

3.1. Access the tooth appropriately (should look like a text book/DVD access).

3.2. Proceed with length determination.

53
 3.3. The radiograph for length determination should be taken from the facial-lingual
direction.

4. Instrumentation

4.1. Proceed with cleaning and shaping of the root canals using the technique and files
of your choice.

4.2. When you have completed the canal preparation, take a radiograph with the
largest working length file in place to the working length from the facial-lingual
direction.

5. Master cone selection and fit, spreader selection and fit, accessory cone selection and
sealer mix:

5.1. Select and fit the master cones.

5.2. Take a radiograph with the master cones in place from the facial-lingual direction.

5.3. Select and fit the gutta percha spreader(s).

5.4. Select and have the proper accessory cones ready for use.

5.5. Mix the root canal sealer.

6. Obturation:

6.1. Proceed with obturation of the root canal spaces with gutta percha and sealer
using lateral condensation.

6.2. The gutta percha should be removed internally from the pulp chamber to the level
of the facial-lingual cervical line.

6.3. The pulp chamber should be free of any sealer or debris.

6.4. Take two radiographs of the finished obturation, one from the facial-lingual and
the other from the mesial-distal direction.

7. General performance:

7.1. You will be evaluated during the examination for the availability of necessary
instruments and supplies, the neatness and organization of your work area and
your adherence to the proper laboratory dress code.

54
 7.2. The radiographs for this examination must be properly mounted in the mount
provided (see example below) and labeled with your box number and the project
number.

7.3. Do not place wet radiographs in the plastic mount. The radiographs should be
thoroughly dried before mounting.

8. Turn in the mounted tooth and the evaluation forms for grading in the boxes
provided at the supply table.

Example of mounted radiographs.

Name Box # Project # .

Pretreat Working Length Master Cone Final Obturation
F-L Determination Fit F-L
Pretreat LWL File Final Obturation
M-D M-D

55