SciFed Dental & Oral Research Journal

Glide Path: Paving the Way for Safe and Sure Endodontics

SciFed Dental & Oral Research Journal

Glide Path: Paving the Way for Safe and Sure Endodontics

Review Article

Received on: January 16, 2017, Accepted on: January 24, 2017, Published on: March 27, 2017

Citation: Kalyan SS (2017) Glide path: Paving the way for safe and sure Endodontics. SF Dent Oral Res J 1:1.

Copyright: ©2017 Kalyan SS. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

  • Author

    S Sai Kalyan

    Department of Conservative Dentistry and Endodontics
    Pravara Institute of Medical Sciences
    Loni,Maharashtra
    India

Abstract


Fulltext

Introduction
         Last decade has seen unparalleled growth in the field of endodontic technology. Research studies into working length determination, Intra canal preparation, Culturing, Intracanal medicaments and root canal filling materials and techniques led us to incorporate and, In some cases, Totally alter our concepts concerning the clinical conduct of our practices in these areas. While focusing on technological innovations, we often tend to ignore or forget the basics behind the procedure. Canal curvatures present a unique challenge to dental clinicians. Negotiation and thorough instrumentation of tortuous and narrow root canals require special consideration on part of clinician and are an important step towards the goal of achieving endodontic success. It has been said that access is success. This holds true not only for coronal access but for radicular access as well. After a well done access cavity preparation, a definite path must be created into the root canal in which the successive instruments should glide without modifying the original curvature of the canal.
           The concept of Rotary Endodontics is not new. However, there is no single rotary system that advocates exclusive use of rotary files. Bergmanset al. [1] stated that during root canal preparation, no rotary instrument should gain access to any part of root canal, where a hand instrument has not been placed before. So, manual instrumentation to create a glide path remains to be an integral part of Endodontic treatment, whether the treatment is done with hand files or rotary files.
          If we go through the literature on glide path, lot has been mentioned about the importance of creating a glide path and the consequences or mishaps that follow is a reproducible glide path is not secured. But there is a relatively paucity of data as to how to secure a reproducible glide path. This article outlines various ways for glide path preparation and highlights the precautions to be followed while doing the same.

Glide Path- Demystified
                         The endodontic glide path has been defined by west [2] as a smooth radicular tunnel from canal orifice to physiologic terminus. The importance of obtaining a reproducible glide path lies in the fact that without it, the rationale of endodontics cannot be achieved and that it is necessary for quality control. [2
           Literature [3] reveals that successful outcomes are more likely and iatrogenic mishaps avoided when the instruments used for canal preparation follow a designated route, a reproducible glide path.

How to secure a reproducible glide path?
Manual creation of glide path with stainless steel K files
                    The oldest and commonest method to prepare a glide path is with stainless steel k files. Several authors [4,6] recommend its use as it not only lowers expense and precludes need of a separate handpiece, but provides a better tactile sensation5 and retains the impression of the canal after removal from a curved canal. [6,7
              They are stiff so that blockage and calcifications are negotiated easily [5,8] and are also less susceptible to separation in the canal. [5] West [2] recommends a minimum of a "super loose" size 10 K-file.
                     Ruddle [9] recommends the use of 0.02 tapered hand instruments to prepare and finish the apical one-third of a canal in cases where an irregular glide path exists, regardless of etiology or the size of the foramen, It has been suggested that instrument should be precurved before introducing the canal. As the curved file is with drawn from the canal, it creates an "envelope of motion" that scribes the side walls of the canal at random contact points,  eventually widening and conferring the root canal shape to allow larger files to follow. This procedure allows for the suspension of debris in the irrigation solution. [10]
                     Other hand instruments that can be safely used for creating a glide path include the Antaeos Stiff "C" file (Schwed, Kew Gardens, NY), C file (Dentsply /Tulsa Dental Specialities, Oklahoma, USA), C file (Roydent, Hoboken, NJ), C+ file (Dentsply /Maillefer Ballaigues, Switzerland), S finder (JS Dental, Sendoline, Ridgefeld, CT), D finder (Mani, Tochigi-ken, Japan), Stiff K file (Brasseler, Savannah, GA), Flexofile (Dentsply/Maillefer) and SenseusProFinder (Dentsply/ Maillefer), Hi-5 file (Miltex, York, PA), Pathfinder CS (Sybron Endo, Glendora, CA), Pathfinder SS (SybronEndo, Orange, California, USA). [11]

Hand files in a reciprocating hand piece
         Stainless steel K files can be more efficiently used with the M4 hand piece (Axis/Sybron Endo Coppel, TX), a contra angle that fits onto any E type slow speed hand piece as well as in the new TF Adaptive Motor, M4 Hand piece setting, (Axis/Sybron Endo Coppel, TX), and mimics the watch-winding motion normally used in hand filling, with a reciprocating motion, 30 degrees in each direction. Reciprocation is inherently safe in that if it is performed correctly, it is very unlikely to create an iatrogenic mishap. [12
              The main advantages of using the reciprocating hand piece are to reduce glide path preparation time and hand fatigue with narrow, multi-planar root canals compared to the conventional manual technique [13] and less chances of instrument separation when compared with rotary NiTi methods. [12]
   Figure .1
               
Newer Rotary NiTi files
          Path FileTM rotary instruments have been designed to create the glide path rapidly and safely, In place of stainless steel files. Available in 3 ISO sizes (013, 016 and 019) and 3 lengths (21, 25 and 31 mm) these files are flexible and resistant to cyclic fatigue, and offer many advantages compared to manual solutions. They are made up of NiTi alloy and have a very slight taper of .02 ensuring great resistance to cyclic fatigue.
                                                                                           Figure .2
                                              
                
X-PLORER Canal Navigation Series
          X-PLORER Canal Navigation Files, available as a hand or rotary file, help negotiate working length quickly and efficiently. Capable of negotiating tortuous anatomy, the durable 15/.01 file is more flexible than a #15 file - and half the taper, making initial instrumentation to the apex effortless. Follow with X-PLORER 20/.01, 20/.02, and if necessary 25/.02 for a reproducible glide path.
                                                                                           Figure .3
                                                                
 
ScoutRace
       Available in the lengths of 21, 25 and 31 mm, Scout Race is a sequence of three instruments with .02 taper and with ISO sizes of 10, 15 and 20. They are designed to mechanically prepare root canals with severe curvature. The files operate at a speed of 600-800 rotations per minute, and are used after determining the working length. The files have exclusively rounded safety tips for precise guiding and alternate cutting edges help eliminate screwing in effect.
                                                                                          Figure .4
                                               
 
Race ISO 10
       3 instruments make up the Race ISO 10 range, all with a size of ISO 10 and with .02, .04 and .06 taper. The Race ISO 10 are designed to reach working length in calcified or very narrow canals when manual K files of ISO 06 or 08 cannot progress further. They turn at a speed of 600-800 rotations per minute.
                                                                                         Figure .5    

                                             

G Files (Micromega)
      Available in lengths of 21, 29 and 25 mm, they have a taper of 0.03, they have superior flexibility due to small instrument diameters (n°12 and n°17). The cross-section varies throughout the length of the instrument. The 3 cutting edges are on 3 different radius's relative to the axis of the canal, which allows for more space for better elimination of debris and Excellent cutting action.
                                                                                         Figure .6
                                     
Lubricants and glide path 
    Lubricants such as the EDTA gel (Doloendogel Prevest Denpro) accelerates the process of glide path creation. Chelating lubricants effectively hold canal debris in suspension while lubricating the instrument being used. They facilitate a smooth passage of instruments and provides a reproducible glide path. These water based lubricants also reduce the cyclic fatigue of mechanized glide path instruments, thereby reducing the chance of file separation.

Conclusion
      The preparation of a glide path not only helps to reduce the risk of instrument separation but also conveys to the clinician an intimate knowledge of the tortuous anatomy of the canal from the orifice to the terminus.  Hence, it can be concluded that creating a reproducible glide path is a major determinant in endodontic success as it maintains original root canal anatomy and prevents iatrogenic mishaps. The dental clinicians should pay attention to this small but important step in endodontics to maintain original root canal anatomy, to enhance success rates in their endodontic cases. Mother nature, after all knows the best. 

References

  1. Bergmans L, Van Cleyenbreugel J, et al. (2001) Mechanical root canal preparation with NiTi rotary instruments: rationale, performance and safety. Status report for the American Journal of Dentistry Am J Dent 14: 324-333.
  2. West JD (2010) The endodontic Glidepath: "Secret to rotary safety." Dent Today 29: 86-93.
  3. Berutti E, Negro AR, et al. (2004) Influence of manual preparing and torque on the failure rate of Protaper instruments. J Endod 30: 228-230.
  4. Gambarini G (2005) The K3 rotary nickel titanium instrument system. Endod Topics 10: 179-182.
  5. Mounce RE (2005) Endodontic K-fles: invaluable endangered species or ready for the Smithsonian? Dent Today 24: 102-104.
  6. Ruddle CJ (2005) The ProTaper technique. Endod Topics 10: 187-190.
  7. Jerome CE, Hanlon RJ (2003) Identifying multiplanar root canal curvatures using stainless-steel instruments. J Endod 29: 356-358.
  8. Young GR, Parashos et al. (2007) The principles of techniques for cleaning root canals. Aust Dental Journal 52: S52-S63.
  9. Finishing the apical one third (2002) Endodontic considerations. Clifford J Ruddle. Dentistry today. May.1-10. 10. Schilder H (1974) Cleaning and shaping the root canal Dent Clin North Am 18: 269-296.
  10. Allen MJ, Glickman GN, et al. (2007) Comparative analysis of endodontic Pathfnders. J Endod 33: 723-726.
  11. Kinsey B, Mounce R (2008) Safe and effcient use of M4 safety handpiece in endodontics. Roots 4: 36-40.
  12. Cassim I, van der Vyver PJ (2013) The importance of glide path preparation in endodontics: a consideration of instruments and literature. SADJ 68: 322-327.

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