Crown Down vs. Step Back, which is better?

In this video, Dr. Nasseh shares some of his ideas about the crown down vs. the step back technique during a recent trip to Vancouver CA. You can watch this and other videos on our website at: bit.ly/2DfGaZ7

[@MurtyCZ]

Exactly what I needed before my final state exam! Tutorials like this are awesome for students or fresh out of faculty dentists!

[@AANasseh]

Hope you did well on your exam and out practicing already! :)

[@serenaleigh8418]

I appreciate this session for long time that was my question and you explain the logic behind the 2 methods.

[@AANasseh]

I'm glad iI could help. Cheers! :)

[@saraluvcats6891]

What working length should I start with in Crown Down ? Lets assume I have a canal with working length = 22 mm ??

[@serenaleigh8418]

I Appreciate your session. for long time that was my question specially the difference and the logic behind.

[@MM-uj8fu]

Very insightful. Thank you

[@loz1610]

Does it cause ledge when starting with larger file trying to crown down

[@vikasdeep4428]

Good evening sir, nice video,my question is that what are drawbacks of crown down technique?

[@joshuatally2850]

I use a crown down technique rotary system. I am often able to get to the apex with the largest or second largest files fairly quickly. Should I still use the other files at that point or is it best to just irrigate at that point?

[@AANasseh]

No need for the smaller files beyond the "First File" that reaches apex. You can use one small file for occasional recapitulation but you have to decide whether you will go up in size or stop at that point. Generally, it's a good idea to go up at least one size from the first file that reaches apex. If there's remaining tissue (tissue found in the file's flutes and chip space) you may have to go up to even larger sizes. Hope this helps. : )

[@catmanjoe4312]

Dr Ali Thank you for wonderful presentations. Can you use Crown Down technique for a narrow and short MB2 canal/root on maxillary 1st molar? Thanks

[@cosmogang]

Recently saw data on the esx system showing bad statistics for cyclical fatigue and overall breakage. Has brassler addressed this and do you have any comments on the issue?

[@AANasseh]

Watch the video from a couple of weeks ago from Denver on the difference between cyclic fatigue and torque (lecture excerpt). You can't have it both in the same file. Either way, a new heat treated EndoSequence File is being released at this year's AAE and will be part of a Blend Technique I have developed. I will soon share more videos on that technique.

[@15bleach51]

Does it makes sense to perform crown-down using hand K-files? Which technique is better for traditional hand files?

[@AANasseh]

I should make a video about this! But the short answer is yes! :)

[@15bleach51]

@@AANasseh That would be fantastic! There are lot of dentists around the world who don’t have access to machine files and handpieces :(

[@dr.janneifar8897]

I need to know both of that

[@kavityphiller4891]

Another awesome presentation- thank you so much....very clear, very practical-

[@drtayyabfaraz_10]

Hello sir .which Technique do you use ?

[@rijamasood9927]

Which GP will be used with crown down then?30 or 15 ?As you mentioned that that by the end 30 # file should be able to go till the apex.How do we choose the final gp?

[@jameslingkianlun1285]

Heyy it's very informative and enlightening.In step back technique, does recapitulation help to reduce debris ? You also mention that you are likely going to get post operative problem in step back while removing debris...may I get the evidence on that... Btw I m on board with Ur explanation

[@oriappsinc7379]

I still don't understand about the idea of passive force for crown down technique, can anybody help me understand it? Like what and how did we actually do with the hand instrument while preparing root canal? Thank u in advance

[@sria8163]

When you go down to the apex in a clock wise direction in a crown down technique and subsequently think to get larger files say 25 or 30 to the apex , "a anti-clockwise rotation" should be more passive or less passive ?......reminds me driving down the roads that I should have been yesterday.... country roads- John Denver.

[@AANasseh]

I'm not sure I understand what you're trying to say. An counter clockwise motion on a file designed to cut in a clockwise direction does not cut! So, passive or active is not the point. The fact is that it won't cut and only pushes debris apically instead of pulling it coronally.

[@ahmedragah8956]

you are amazing

[@Sanytram77]

Isn't it more risky to form a ridge, using a crown down technique?

[@tedioable]

Thank you very much from brazil!!!

[@Ahuromazda]

Can you plz clarify something; in the crown down technique, lets assume you reach to WL with file 25 or 20, do you still have to continue filing down until.you reach 15 or can you just stop filing as soon as you reach desired WL?

[@drtayyabfaraz_10]

U made my life easy

[@maciejjabonski4855]

Is Crown Down technique possible with other rotary instruments, such as Protaper Gold from Dentsply Mallifier?

[@AANasseh]

It's possible but you would not be using the manufacturers' directions as they are designed for step back (if you take S1, S2, F1, etc. to apex sequentially)

[@maciejjabonski4855]

Real World Endo Great, thank you for quick answer. Always looking forward to your videos, learned much from them. Keep the great work up!

[@arunpaul8801]

Which technique has got less chances of ledge formation and canal transportation?

[@AANasseh]

Crown Down.

[@mohamedogeez4667]

Thanks for the brilliant detailed HQ video. I just have one question regarding the crown down technique; How do i know what size files to start with after using the orfice opener? Is it always 30? Different canals reach different sizes

[@AANasseh]

comes with experience. But starting lightly with a 30 or 25 is a good start. The key is to be passive and not push any file. It's about gentle movement down the canal with each file only doing part of the work. That's the basis of serial step-down. Good luck! :)

[@Thesvyatful]

Love your blog!

[@dollysamant9256]

Hello sir I m using K3XF rotary files... Can u tell me with those files how to do a crown down technique as they are all different tapers and are based on the colour coding...

[@AANasseh]

Sorry. Not familiar with that specific system.

[@dollysamant9256]

Can u please share which file system u use.. (brand name)

[@trickjacko8482]

Thanks for this valuable information Dr. Nasseh. How deep do you go into a canal with an orifice opener? Orifice openers are shorter than most canals so I've seen you can take them completely into a canal but I guess that will depend on the anatomy of the case and those risky areas that exist on walls near the furcation.

[@AANasseh]

Sorry. Only 3 years late in response! LOL! Better late than never! Anyway... I take the Orifice opener to almost half way down the root or to where it goes without significant resistance (early curves, thin canals, etc.) Key is not to be too aggressive with pushing. Cheers!

[@tonyblackops]

Doctor do you think the patency file is enough to prevent blockages in step back method?

[@AANasseh]

It certainly helps reduce it but can't eliminate it.

[@NeilSeaver]

When do you first use the apex locator in crown down?

[@AANasseh]

After coronal preferring (orifice opener and a mid-root shaper)

[@annacanta5659]

Yes after coronal pre-flaring, to establish working length. Then confirm working length with a radiograph (if in sim lab) 😅

[@Swaad172]

but at begaining.. if we use .. 25 or 30 to the coronal part .. it will engage to the dentinAL part n debris.. may be chances of broken instruments?😦...

[@md.ragibulislam6349]

Why? We SHOULD proceed increasing small amount of length.......

[@deep4100]

can u post lecture on niti metallurgy

[@AANasseh]

This might be a basic one on the topic: kzbin.info/www/bejne/hGemdpSdr5dqhrM

[@emadebrahim8826]

Good evning from ksa

[@Channel_976]

The Crown down of course 😂 dr plz talk about acute abscess management😅😅

[@JoonKimDMD]

Protaper system uses SX orifice opener, so it seems like a crown down technique, but it uses S1,S2, F1, F2 in step back fashion. Do you think the protaper is combing two techniques and uses the best of both worlds?

[@AANasseh]

Never been a fan of ProTapers even though I tested their original pre-release prototypes back in the mid 90’s. We actually developed their analogues in EndoSequemce Taper CM files for Brasseler that is currently popular among ProTaper users; but I personally don’t use them as I don’t believe it’s a proper crown down method and is inefficient. But if it works in your hands then by all means keep using it with whatever technique works for you. But to answer your question, no, it’s not the best of both worlds in my opinion.

[@TheiKurd]

What is the difference between the Crown down and Step Down technique? Thanks

[@AANasseh]

Fairly similar in concept. Step Down is the passive Step Down Technique originally described by Dr. Torabinejad. It's also a good technique.

[@aylaryousefbeigi8850]

👌🏻

[@sameharsanious1039]

Thank you so much Dr Nasseh for all your videos! You are teaching me what 4 years of dental school didn’t!

[@gatorboydomino]

is he married?

[@adibkashani7616]

Dear Nasseh. Your understanding of step back is wrong

[@AANasseh]

Enlighten us then.

[@adibkashani7616]

@@AANasseh Stepping back is primarily a technique for achieving a predictable taper using 02 taper hand files. Once you have decided what apical size you want to use and the WL, U prep the canal with progressively larger sizes each being 1/2 mm shorter than the next from the WL. You can also make that 1mm if you want a more conservative taper. BTW i am a big fan

[@AANasseh]

You’re just describing the taper preparation aspect of the step back technique. From an order of operations perspective regarding reaching apex, the difference between the two techniques is explained correctly in the video. In Step Back Technique you reach the Apex first and do your apical preparation first before preparing the final taper, and in Crown Down you reach the apex last after taper preparation and do your apical enlargement last. The Step-Back technique is the whole shaping technique, not just taper preparation part of the shaping. Cheers!

[@adibkashani7616]

@@AANasseh You are right , that is what i have described and you are right again, the philosophical difference between the 2 techniques has been explained in the presentation. I am not sure if the new generation is familiar with the tapering technique i described. Thanks again for all your presentations.

[@clementzheng8856]

For the crown down technique, after stepping down to the first file that goes to working length, what size we do want to go up to? Do we want to get the largest file we started with to working length or just 2-3 sizes larger? Thanks.

[@AANasseh]

Typically people say to go up 2-3 sizes; but ideally, after crown down, you want to find a file that fits 3mm short of working length and then drive that to length. This way you've gauged the apex to be cored out with that file to get apical clearing. But either way works, as long as it's not under prepared. Of course, apical curvatures and shapes can cause modifications since larger sizes will not flexible enough to get around short radius curvatures. Cheers!