Glide Path Management - Preparation Sequence: Advanced Endodontics

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Glide path management is an exciting, hot topic. In this section, the concepts, strategies and techniques that will result in a smooth, reproducible glide path will be emphasized. We will look at comparing, going to length immediately and establishing a glide path versus performing a sequential glide path, especially in longer, narrower and more curved canals. Finally, working length, patency and how to consistently create a smooth, reproducible glide path in various anatomical configurations will be addressed. Major emphasis will be placed on the specific cutting action that will promote securing canals with small-sized hand files.
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welcome today I'm going to talk to you about glide path management out of all the things that I speak about in the course of a year I would say that the most important topic that you see on this menu is glide path management you can't begin to even have discussions about canal preparation three-dimensional disinfection and filling root canal systems if in fact we don't have glide path management so glide path management is a very interesting field and from my experiences as a teacher I can tell you it's usually where we have problems if you look at ledges blocks broken instruments all these things occur because we don't have a smooth reproducible glide path let's get started when we break glide path management out into its subsections you can see it's quite complicated in this specific section I will talk about glide path management and preparation sequence in subsequent sections I will speak about how to prepare canals and secure glide paths using mechanical instruments such as the path files then we'll talk about what we do in the instance where there is an irregular glide path well whether we're working in dye lacerations whether we're sliding instruments over a few millimeters all this guz is tell us that we need to be very cognizant of root canal system anatomy when we look at this spinning - that's a little bit sobering to see how complicated the internal anatomy really is if you look at the apical 1/3 of the mesial root this is very commonly what we encounter on an everyday basis clinically if we come in a little bit tighter week see a more formidable job as we begin to visualize more carefully the dye lacerations the deep by affinities the anastomosis in between systems lateral canals all these things are what we have to be aware of when we're sliding small sized hand files through curvature to length the goal of any practitioner doing endodontics is to get a small size hand file to length not once not twice but on a reproducible basis and once we can catheterize the canal and have a loose small size hand file at length everything begins to fall into place and all subsequent steps become much easier to fulfill let's look at an extracted tooth and you can see dial a serrated roots very very complicated and when you look right at them head-on you can see that they have apical bifida T both M B and D B notice how curved these roots are and they're multiplanar curvatures and we would imagine that the canals are more curved then the roots that actually hold them if we look at this maxillary first molar from the bottom up you're
looking right into that trifurcation notice the MB root large concavity on the Furka side look how broad that route is mesial to distal and when we're doing glidepath management you can begin to appreciate that there's going to be MB twos and MB ones in these roots over 90% of the time and that's because broad roots hold two systems frequently notice the bifida T on the Paolini cross-section based on the level that you would choose to look at it let's come in tighter if you look at that MB root you begin to start to notice that there are fir Aminah associated with the apical 1/3 let's come in tighter as we rotate the tooth there's one there's the second one there's the third one and we can rotate around see the fourth one and then up on top there's the fifth one so there's an example of a route with multiple apical portals of exit we see these cases clinically this is a beautiful case done my friend John West dr. John practices up in Tacoma Washington and these are pro taper shapes but the point of showing you these cases is they had to have been glide paths first you cannot use mechanical instruments when canals aren't secured notice the MB multiplanar curvature notice off the MB in the apical one-third there's some puffs on the external root surface and if you count carefully