Glide Path Management - Irregular Glide Path: Advanced Endodontics

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This show will identify the three causes that lead to an irregular glide path. Clinically, you will be shown exactly how to negotiate canals and then determine with 100% confidence, if you do or do not have a smooth, reproducible glide path. Importantly, how to pre-curve small-sized hand files and negotiate abruptly curved canals will be reviewed. Finally, you will be excited to see how to pre-curve NiTi shaping files so you can more safely prepare canals that exhibit an irregular glide path.
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in another segment I spoke to you about glidepath management but today I would like to expand that conversation to those instances where we do not flight paths let's take a look there are many times when we're working in the apical one thirds of routes and we realize there are irregularities or impediments in the retreatment situation which would prevent us from having a smooth reproducible glide path there are several factors that cause irregular glide path and let's take a look the first one is anatomical clearly we can all imagine in our mind as you're listening to me talk along about the anatomy you can remember perfectly cases you've treated where in fact there was a sharp dye laceration like in this distal buccal root that was treated brilliantly by my friend Elio Baroody but I think we all appreciate that trying to rotate an instrument around a 90-degree curvature is fraught with problems if you just think logically of a speed of 300 rpms as an example and then you think about compressive and tensile stresses on the file in the curvature it would be very likely that we would separate an instrument around that curve so in deep divisions die lacerations in these instances we have to have another idea other than mechanical shaping certainly in a bifurcation where an instrument has the opportunity to go two ways the rotary file has shape memory it's going to come down and hug the outer wall and it can be caught its tip can be caught literally in a deep division or in a fin as an example off a primary system well there's other reasons for irregular glidepath and that would be pathological certainly when we think
about cases that exhibit internal resorption we can imagine looking at this preoperative film that there's not a lot of working width currently as compared to the healthy contralateral tooth if you imagine picking up that more coronal remnant and sliding an instrument through it that would take you into the resorb t'v defect that we can see at mid root but it would not be necessarily easily to insert the tip of that hand file into the more apical segment of the canal in these instances sometimes we might not initially have a glide path but as we expand the shape manually there might be a moment in time where we can resort to mechanical shaping my good friend Lars Bergman who has worked for many years at the Catholic University of Leuven in Belgium he was a student of Paul Lambrecht he gave me a slide and you can see on the left there is a yellow arrow and a more apical green arrow if you look at the cross-section through all three roots at the level of the yellow arrow you can see that we have a mb1 with an attached stone inside the canal notice the MB to the DB and the palatal all are open Paden canals if you look at the higher section through the green arrow you can see in this instance there is an attached stone associated with a distal buccal root obviously when you have attached stones the instrument that you're using to catheterize the canal could hang up and so we have to be very careful during glidepath management procedures that we don't break these stones off and inadvertently drive them deeper into the canal to promote a serious block the third reason we might not have a regular glide path is when we have iatrogenic events certainly when we're dealing with retreatment scenarios it's normal to have blocked and ledge canals and in these instances even if we can get back into the physiologic canal and can negotiate through that apical 1/3 and establish working length and patency it isn't necessarily true that we we would be able to eliminate the large ledge in which case we wouldn't expect to be using rotary or reciprocating instruments in these instances so let's talk a little bit more about the instances when we have a near regular glide path and how would we know this as clinicians well the assumption is you have already negotiated the canal you have a 15 file at length you have a confirmed working length with either a working film