Smart Endodontics


Step 1: Access Pulp Chamber Use the appropriate diamond or carbide burs to create a conservative access to the pulp chamber. Begin by cutting the outline, then penetrate deeper. Orifice locations generally follow the anatomy of the occlusal cusps on molars.
Step 2: Locate Canal Orifices Use hand files or an Endodontic Explorer to locate the orifices. Once you have found them, instrument with a #10 hand file to mid-root. Do not attempt to go to Working Length yet.
Step 3: Move Mesial Canal Orifices With Hedstrom files sizes 15, 20, and 25 move the mesial canal orifices and coronal third of the mesial canal walls away from the furcation by forcefully directing the Hedstrom blade mesially. The dentin at the orifices and walls is cut away with a pulling motion. This mesially directed filing is called “anticurvature filing”.
Step 4: Flare Coronally Using Gates Gliddens and light pecking motion, flare the coronal walls of the canal, no more than 4mm deep into the canal.
Step 5: Complete the StraightLine Access Remove any remaining projections of the chamber roof with a long, tapered, high speed diamond, leaving smooth, continuous access walls from chamber floor to the top of the crown. Then, make a “path” from each mesial canal orifice to the top of the crown by placing the tip of the diamond (not rotating) into the canal orifice, raising the tip just slightly above the orifice, activating the handpiece and tilting the diamond vertically. Do not move the tip. Use the diamond the same way for the distal (Mandibular) and palatal canals (Maxillary) except that the diamond is tilted parallel to the coronal part of the canal rather than vertically.
Step 6: Modify The Access for Rotary Instruments Modify the path to the orifices in order to make entry easier and reduce the possibility of a separation during instrumentation. Position the handpiece at each orifice as described in Step 5. The modification to Step 5 entails further tilting of the long tapered diamond beyond the vertical towards the mesio-lingual line angle. Modify the mesio-lingual “path” by tilting the diamond until the handpiece can be withdrawn without hitting the upper teeth. For the MB “path” tilt the diamond until the hand piece can be withdrawn without hitting the lower teeth. Your StraightLine access is now complete.