THE ENDO RECIPE

Bottom of line?

• Instant succes !
• No variables
• No complications
• No risk
 The art of treating what you cant see

- If you cant see then you must feel

- Tactile sensation
The real recipe

The “ why ”
 What
The
Failure ?
The Basics
• Access
• Scouting and glidepath
• Coronal Flaring
• Irrigation
Remove • WL measurement
decay then •
•
Apical finish
Patency
• Recap Recap Recap
• Irrigation, Activation, Rinse
• Apical gauging
• Obturation
Access
Access

 Measure using Xray

 tooth tilt and orientation
 Sacrifice restorative material over dentine
 Use what carries provided as path of entry
 Endo Z bur overconfidence
 Straight line access, when?
Scouting

• The notion of “Available length”

• If it’s not pre-bent, it shouldnt be used
• Start small
• Watch wind
• Avoid great apical pressure and filling
Glidepath

• You can imagine it as a smooth reproducible

path all the way to the Apex

• Protip : when a file is placed in a canal and gently

pressed apically without watch winding, If it reaches the Apex smoothly
We can say we achieved glidepath

• Glidepath must be achieved before using any rotary instrument

Coronal Flaring

• Higher taper short instrument

• Pulp champer full of solution ( Water, NaOCl, EDTA)
• Brushing agaisnt outer walls only
• Clean your file flutes everytime you use one
• Let the instrument guide you down
• Pay attention to short roots

Your irrigation mission starts here

Coronal Flaring

So far what happened ?

• Coronal Interferences removed
• Change in WL
• It became easy to find canal orifice
Irrigation

WHY do we need irrigating solutions ?

 Irrigation
WHY do we need irrigating solutions ?
The main goal of an endodontic treatment is to enlarge and prepare
the canal for a chemical dissolution of inflamed and/or necrotic tissues

Most canal are not round

Irrigation
Irrigation

What irrigants do we use in endo

• NaOCl (Batman)
• EDTA solution ( Robin)
• Chlorhexidine 2% (Catwoman)
• Isopropyl Alcohol (Gordon?)

So you just put them in there and thats it ?

Irrigation

• CAVITATION

• AGITATION

• RECAPITULATION

What’s that ?
 Irrigatio
n
Nil: Negative control
CNI: Conventional needle irrigation
MDA: Manual dynamic activation
PUI: Passive ultrasonic irrigation
SI: Sonic irrigation

The influence of irrigant activation, concentration and contact time

on sodium hypochlorite penetration into root dentine: an ex vivo
experiment. S. S. Virdee et Al
WL measurement

• The device
• The mechanism
• The environment
• Where is the stop ?
• Why so late ?
• Point of reference

Well we can use Xray

 Apical finish

• Always look at your file flutes

• Where is the debris collecting
• Seriously ! Clean your flutes

• Recapitulate and check patency

 Patency

Pushing a small file (K10) a bit

beyond the apex after each file used.

Ensures debris is not collecting in

the apex
Apical gauging

You want to avoid this ?

Do apical gauging and use checked gutta percha

 Apical gauging

• Iso files only (2% taper)

• Take master file to WL

• Gently push apically

if it passes, move a one size
larger (for example 25 --> 30)

If it stops at WL, that’s your

GP Master cone size
Obturation

A root canal is a 3D structure, therefore Obturate in 3D

Think about coronal restoration

Type of sealer

Apical tug back

Gutta percha desinfection

Obturation

• Why bioceramics are the best

• Warm vertical condensation

 Conclusion

There is no recipe

There isn’t one way to do it

You have to do everything that needs to be done

THANKS
Questions?