Abstract
Shaping the canal system to promote disinfection and obturation is the cornerstone of molar endodontics. Clinical outcomes, both long and short term, hinge on the technical quality and attention to detail invested into this step. This chapter summarizes currently understood best practices, independent from specific instruments or technologies. A historically proved lead principle here, as in medicine in general, is “do not harm.”
Building on other chapters in this book, the rationale and literature supporting the must-haves and must-dos, techniques to fulfill the objectives for pertinent steps of shaping, cleaning, and filling during root canal treatment are described.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Ng Y-L, Mann V, Gulabivala K. A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health. Int Endod J. 2011;44:583–609.
Ricucci D, Russo J, Rutberg M, Burleson JA, Spångberg LS. A prospective cohort study of endodontic treatments of 1,369 root canals: results after 5 years. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112:825–42.
Karabucak B, Bunes A, Chehoud C, Kohli MR, Setzer F. Prevalence of apical periodontitis in endodontically treated premolars and molars with untreated canal: a cone-beam computed tomography study. J Endod. 2016;42:538–41.
Pettiette MT, Delano EO, Trope M. Evaluation of success rate of endodontic treatment performed by students with stainless-steel K-files and nickel-titanium hand files. J Endod. 2001;27:124–7.
Sjögren U, Hagglund B, Sundqvist G, Wing K. Factors affecting the long-term results of endodontic treatment. J Endod. 1990;16:498–504.
Kuttler S, McLean A, Dorn S, Fischzang A. The impact of post space preparation with Gates-Glidden drills on residual dentin thickness in distal roots of mandibular molars. J Am Dent Assoc. 2004;135:903–9.
Leeb J. Canal orifice enlargement as related to biomechanical preparation. J Endod. 1983;9:463–70.
Stabholz A, Rotstein I, Torabinejad M. Effect of preflaring on tactile detection of the apical constriction. J Endod. 1995;21:92–4.
Peters OA, Morgental RD, Schulze KA, Paqué F, Kooper PMP, Vier-Pelisser FV. Determining cutting efficiency of nickel-titanium coronal flaring instruments used in lateral action. Int Endod J. 2014;47:505–13.
Izu KH, Thomas SJ, Zhang P, Izu AE, Michalek S. Effectiveness of sodium hypochlorite in preventing inoculation of periapical tissues with contaminated patency files. J Endod. 2004;30:92–4.
Souza R. The importance of apical patency and cleaning of the apical foramen on root canal preparation. Brazil Dent J. 2006;17:6–9.
Arias A, Azabal M, Hidalgo JJ, la Macorra de JC. Relationship between postendodontic pain, tooth diagnostic factors, and apical patency. J Endod. 2009;35:189–92.
Zhu WC, Gyamfi J, Niu LN, Schoeffel GJ, Liu SY, Santarcangelo F, et al. Anatomy of sodium hypochlorite accidents involving facial ecchymosis - a review. J Dent. 2013;41:935–48.
Cailleteau JG, Mullaney TP. Prevalence of teaching apical patency and various instrumentation and obturation techniques in United States dental schools. J Endod. 1997;23:394–6.
Flanders DH. Endodontic patency. How to get it. How to keep it. Why it is so important? N Y State Dent J. 2002;68:30–2.
Buchanan LS. Management of the curved root canal. J Cal Dent Assoc. 1989;17:18–25. –7.
Sanchez JAG, Duran-Sindreu F, Matos MA, Carabaño TG, Bellido MM, Castro SM, et al. Apical transportation created using three different patency instruments. Int Endod J. 2010;43:560–4.
Vera J, Hernàndez EM, Romero M, Arias A, van der Sluis LWM. Effect of maintaining apical patency on irrigant penetration into the apical two millimeters of large root canals: an in vivo study. J Endod. 2012;38:1340–3.
Vera J, Arias A, Romero M. Effect of maintaining apical patency on irrigant penetration into the apical third of root canals when using passive ultrasonic irrigation: an in vivo study. J Endod. 2011;37:1276–8.
Vera J, Arias A, Romero M. Dynamic movement of intracanal gas bubbles during cleaning and shaping procedures: the effect of maintaining apical patency on their presence in the middle and cervical thirds of human root canals—an in vivo study. J Endod. 2012;38:200–3.
Haapasalo M, Endal U, Zandi H, Coil JM. Eradication of endodontic infection by instrumentation and irrigation solutions. Endod Topics. 2005;10:77–102.
West J. Endodontic update 2006. J Esthet Restor Dent. 2006;18:280–300.
American Association of Endodontists. Glossary of Endodontic Terms 2015 [accessed 2/27/2016]. Available from: http://www.nxtbook.com/nxtbooks/aae/endodonticglossary2015/.
Ricucci D, Langeland K. Apical limit of root canal instrumentation and obturation, part 2. A histological study. Int Endod J. 1998;31:394–409.
Wu MK, Wesslink PR, Walton RE. Apical terminus location of root canal treatment procedures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89:99–103.
Schaeffer MA, White RR, Walton RE. Determining the optimal obturation length: a meta-analysis of literature. J Endod. 2005;31:271–4.
Nair PNR. On the causes of persistent apical periodontitis: a review. Int Endod J. 2006;39:249–81.
Siqueira JF. Aetiology of root canal treatment failure: why well-treated teeth can fail. Int Endod J. 2001;34:1–10.
Wu MK, Dummer PMH, Wesselink PR. Consequences of and strategies to deal with residual post-treatment root canal infection. Int Endod J. 2006;39:343–56.
Friedman S. Management of post-treatment endodontic disease: a current concept of case selection. Aus Endod J. 2000;26:104–9.
Elayouti A, Weigner R, Löst C. The ability of root ZX apex locator to reduce the frequency of overestimated radiographic working length. J Endod. 2002;28:116–9.
Tan BT, Messer HH. The quality of apical canal preparation using hand and rotary instruments with specific criteria for enlargement based on initial apical file size. J Endod. 2002;28:658–64.
Patiño PV, Biedma BM, Liébana CR, Cantatore G, Bahillo JG. The influence of a manual glide path on the separation rate of NiTi rotary instruments. J Endod. 2005;31:114–6.
Blum JY, Machtou P, Micallef JP. Location of contact areas on rotary Profile instruments in relationship to the forces developed during mechanical preparation on extracted teeth. Int Endod J. 1999;32:108–14.
Paque F, Balmer M, Attin T, Peters OA. Preparation of oval-shaped root canals in mandibular molars using nickel-titanium rotary instruments: a micro-computed tomography study. J Endod. 2010;36:703–7.
Cheung GS, Liu CS. A retrospective study of endodontic treatment outcome between nickel-titanium rotary and stainless steel hand filing techniques. J Endod. 2009;35:938–43.
Bonessio N, Arias A, Lomiento G, Peters OA. Effect of root canal treatment procedures with a novel rotary nickel titanium instrument (TRUShape) on stress in mandibular molars: a comparative finite element analysis. Odontology. 2016. epub ahead of print.
Ng YL, Mann V, Gulabivala K. A prospective study of the factors affecting outcomes of non-surgical root canal treatment: part 2: tooth survival. Int Endod J. 2011;44:610–25.
Landys Boren D, Jonasson P, Kvist T. Long-term survival of endodontically treated teeth at a public dental specialist clinic. J Endod. 2015;41:176–81.
Di Fiore PM. A dozen ways to prevent nickel-titanium rotary instrument fracture. J Am Dent Assoc. 2007;138:196–201.
Peters OA. Current challenges and concepts in the preparation of root canal Systems: a review. J Endod. 2004;30:559–67.
Abou-Rass M, Piccinino MV. The effectiveness of four clinical irrigation methods on the removal of root canal debris. Oral Surg Oral Med Oral Pathol. 1982;54:323–8.
Boutsioukis C, Kishen A. Fluid dynamics of syringe-based irrigation to optimise anti-biofilm efficacy in root-canal disinfection. Roots. 2012;4:22–31.
Basrani B, Haapasalo M. Update on endodontic irrigating solutions. Endod Topics. 2012;27(1):74–102.
Zehnder M. Root canal Iirrigants. J Endod. 2006;32:389–98.
Rosenfeld EF, James GA, Burch BS. Vital pulp tissue response to sodium hypochlorite. J Endod. 1978;4:140–6.
Svec TA, Harrison JW. Chemomechanical removal of pulpal and dentinal debris with sodium hypochlorite and hydrogen peroxide vs normal saline solution. J Endod. 1977;3:49–53.
Waltimo T, Trope M, Haapasalo M, Ørstavik D. Clinical efficacy of treatment procedures in endodontic infection control and one year follow-up of periapical healing. J Endod. 2005;31:863–6.
Boessler C, Peters OA, Zehnder M. Impact of lubricant parameters on rotary instrument torque and force. J Endod. 2007;33:280–3.
Jungbluth H, Peters CI, Peters OA, Sener B, Zehnder M. Physicochemical and pulp tissue dissolution properties of some household bleach brands compared with a dental sodium hypochlorite solution. J Endod. 2012;38:372–5.
Basrani BR, Manek S, Sodhi RNS, Fillery E, Manzur A. Interaction between sodium hypochlorite and chlorhexidine gluconate. J Endod. 2007;33:966–9.
Retamozo B, Shabahang S, Johnson N, Aprecio RM, Torabinejad M. Minimum contact time and concentration of sodium hypochlorite required to eliminate Enterococcus faecalis. J Endod. 2010;36:520–3.
Gu L-S, Kim JR, Ling J, Choi KK, Pashley DH, Tay FR. Review of contemporary irrigant agitation techniques and devices. J Endod. 2009;35:791–804.
Boutsioukis C, Lambrianidis T, Kastrinakis E. Irrigant flow within a prepared root canal using various flow rates: a computational fluid dynamics study. Int Endod J. 2009;42:144–55.
Gutarts R, Nusstein J, Reader A, Beck M. In vivo debridement efficacy of ultrasonic irrigation following hand-rotary instrumentation in human mandibular molars. J Endod. 2005;31:166–70.
Peters OA, Bardsley S, Fong J, Pandher G, DiVito E. Disinfection of root canals with photon-initiated photoacoustic streaming. J Endod. 2011;37:1008–12.
DiVito E, Peters OA, Olivi G. Effectiveness of the erbium: YAG laser and new design radial and stripped tips in removing the smear layer after root canal instrumentation. Lasers Med Sci. 2012;27:273–80.
Peters OA, Paque F. Root canal preparation of maxillary molars with the self-adjusting file: a micro-computed tomography study. J Endod. 2011;37:53–7.
Haapasalo M, Wang Z, Shen Y, Curtis A, Patel P, Kakpour M. Tissue dissolution by a novel multisonic ultracleaning system and sodium hypochlorite. J Endod. 2014;40:1178–81.
Clark-Holke D, Drake D, Walton R, Rivera E. Bacterial penetration through canals of endodontically treated teeth in the presence or absence of the smear layer. J Dent. 2003;31:275–81.
Torabinejad M, Handysides R, Khademi AA, Bakland LK. Clinical implications of the smear layer in endodontics: a review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94:658–66.
Delivanis PD, Mattison GD, Mendel RW. The survivability of F43 strain of Streptococcus sanguis in root canals filled with gutta-percha and Procosol cement. J Endod. 1983;9:407–10.
Ørstavik D, Haapasalo M. Disinfection by endodontic irrigants and dressings of experimentally infected dentinal tubules. Endod Dent Traumatol. 1990;6:142–9.
Cobankara FK, Unlu N, Cetin AR, Ozkan HB. The effect of different restoration techniques on the fracture resistance of endodontically-treated molars. Oper Dent. 2008;33:526–33.
Okşan T, Aktener BO, Şen BH. The penetration of root canal sealers into dentinai tubules. A scanning electron microscopic study. Int Endod J. 1993;26:301–5.
Wennberg A, Ørstavik D. Adhesion of root canal sealers to bovine dentine and gutta-percha. Int Endod J. 1990;23:13–9.
Hülsmann M, Heckendorff M, Lennon A. Chelating agents in root canal treatment: mode of action and indications for their use. Int Endod J. 2003;36:810–30.
Paqué F, Luder HU, Sener B, Zehnder M. Tubular sclerosis rather than the smear layer impedes dye penetration into the dentine of endodontically instrumented root canals. Int Endod J. 2006;39:18–25.
Baumgartner JC, Mader CL. A scanning electron microscopic evaluation of four root canal irrigation regimens. J Endod. 1987;13:147–57.
Grawehr M, Sener B, Waltimo T, Zehnder M. Interactions of ethylenediamine tetraacetic acid with sodium hypochlorite in aqueous solutions. Int Endod J. 2003;36:411–7.
Peters OA, Boessler C, Zehnder M. Effect of liquid and paste-type lubricants on torque values during simulated rotary root canal instrumentation. Int Endod J. 2005;38:223–9.
Li GH, Niu LN, Zhang W, Olsen M, De-Deus G, Eid AA, et al. Ability of new obturation materials to improve the seal of the root canal system: a review. Acta Biomater. 2014;10:1050–63.
Ricucci D, Rocas IN, Alves FR, Loghin S, Siqueira Jr JF. Apically extruded sealers: fate and influence on treatment outcome. J Endod. 2016;42:243–9.
Wolcott JF, Hicks ML, Himel VT. Evaluation of pigmented intraorifice barriers in endodontically treated teeth. J Endod. 1999;25:589–92.
Yamauchi S, Shipper G, Buttke T, Yamauchi M, Trope M. Effect of orifice plugs on periapical inflammation in dogs. J Endod. 2006;32:524–6.
Ricucci D, Siqueira Jr JF. Fate of the tissue in lateral canals and apical ramifications in response to pathologic conditions and treatment procedures. J Endod. 2010;36:1–15.
Ruddle C. Shaping for success…everything old is new again. Dent Today. 2006;25:120–7.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Peters, O.A., Arias, A. (2017). Shaping, Disinfection, and Obturation for Molars. In: Peters, O. (eds) The Guidebook to Molar Endodontics. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-52901-0_6
Download citation
DOI: https://doi.org/10.1007/978-3-662-52901-0_6
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-52899-0
Online ISBN: 978-3-662-52901-0
eBook Packages: MedicineMedicine (R0)