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Authors:Dr. Anil Dhingra

Dr. Herbert Schilder used the title, "Predictably Successful Endodontics," to describe In the most simple and direct way longterm treatment success that is not only possible, but attainable. In the current era of endodontic development, the mechanical steps to achieve predictably successful results include access preparation, glide path management, shaping canals, 3D disinfection, and filling root canal systems. Researchers agree that the most important factor that serves to influence clinical treatment success is to recognize the pulpal degeneration which occurs within an oftentimes complex anatomical space.

Pulpal breakdown and disease flow occur along the anatomical pathways and move in a coronal to apical direction. Secondary to pulpal breakdown, a lesion of endodontic origin forms in the bone adjacent to a portal of exit . One important factor influencing success is the often misunderstood concept of minimally invasive endodontics .In the modern era of technology available, this requires preparing well-shaped canals that, in turn, promote 3D cleaning and filling root canal systems .The goal of the endodontic cavity preparation is to gain access to the pulp chamber and the underlying root canal system. Endodontic access is the first mechanical step that will significantly influence a series of subsequent steps that serve to guide each case to a successful conclusion.

The mechanical objectives are to create straightline access to any given orifice and to create flared internal axial walls . All tantly, coronal interferences are removed to improve radicular access. An effective access preparation allows files to be easily placed into orifices directly , irrigants to effectively clean , and, obturation of root canals in three dimensions. In multirooted teeth, the access preparation is wide at the cavo surface of a tooth and continuously funnels toward the pulpal floor. All unsupported dentin and enamel is removed, as leaving this within the access preparation contributes to staining and discoloration of the clinical crown. Access cavities should not be restrictive or excessively large; the outline form and preparation should be confirmed when all the orifices in multirooted teeth can be visualized without moving the mouth mirror .

A micro small access cavity preparation compromises finding orifices and effectively treating root canal systems and makes difficult to place files and instruments. Working through a micro small access cavity preparation tends to compromise each and every subsequent step that comprises start-to-finish endodontics.

On the other side access cavities that are prepared too big structurally weaken natural or restoratively revised crowns and can lead to fractures and the premature loss of teeth. Over-prepared access cavities weaken tooth structure. Irregular access cavities compromise vision and make it difficult to place instruments into any given orifice because of an iatrogenic ledge within the access cavity, itself. When preparing the access cavity it should be remembered that it is not the type of bur that is most important.

What is most important is to understand the access concept, recognize the orientation between the crown and root, and appreciate the relative position of the pulp chamber from tooth to tooth . Restorative dentistry has identified the biological, mechanical, and esthetic guidelines required for any coronal preparation, which are based on the material utilized. The modern concept recognizes the importance of maximizing furcal side dentin, which protects against weakening roots, strip perforations, and longitudinal fractures. The mechanical necessity for preparing or shaping canals has long been recognized as an essential step in endodontic treatment.

The concepts concerning the role of canal preparation have been markedly based on the development of endodontics over a period of time. Over the past decades, root canal preparation has been described in different ways, including instrumentation, biomechanical instrumentation, and chemomechanical instrumentation. Each has something to offer, has been described in its own way, and is intended to forward the thinking and actual manner in which root canals are prepared. However, none of these instrumentation concepts conveys the actual objectives of root canal preparation. In 1974, Dr. Herb Schilder precisely described the mechanical objectives for preparing a canal that, when fulfilled, would ensure the biological goals for longterm success.

The confusion among the clinicians is whereas the Schilderian objectives have undergone rigorous scientific and clinical scrutiny for more than 40 years micro endodntics is a new concept that has yet to be defined, has no clinical guidelines, and is currently being exploited with virtually no published scientific evidence. Shaping refers to the conscious development of a preparation that is unique, specific, and appropriate for any given root canal and its corresponding root. Schilder used the expression, "the look," to describe any well-shaped canal that appropriately enlarges, mechanically reproduces, and flows with the original anatomy of the root canal. Shaping canals creates sufficient space to hold an effective reservoir of irrigant that, upon activation, can penetrate, circulate, and digest tissue from the uninstrumentable portions of a root canal system.

The underprepared canals harbor residual pulpal remnants bacteria and debris that continue to be a major cause of post-treatment disease. They rarely exhibit filled root canal systems. On the other hand overprepared canals violate both the mechanical objectives of canal preparation .Coronally overprepared canals weaken roots, which can lead to fractures, and strip perforations. Also there is a confusion among the clinicians regarding preparing a canal to a continuous taper.Almost all non-manipulated canals exhibit natural taper over their length.

As such, good shaping techniques reproduce this original anatomical form, emphasize deep shape, and more important focus on a more conservative tapered shape in the body of the root. A wrong concept is to over-enlarge the terminal extent of canals. Overpreparing the foramen leads to wet canals, post-treatment flare-ups. Literature is available that clearly defines that wellshaped canals that emphasize keeping the foramen as small as practical readily exchange irrigants throughout the root canal system. Predictably successful endodontics is therefore There is an old expression, "Model success. Success leaves clues." Longterm endodontic treatment success should integrate while fulfilling the mechanical and biological treatment objectives.

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