HOW DOES THE DENTIST PREDICTABLY PREPARE THE GLIDEPATH

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 HOW DOES THE DENTIST PREDICTABLY PREPARE THE GLIDEPATH

by John D. West, DDS

In order to answer this question, I first surveyed the American Association of Endodontists (AAE) and reported my findings at the AAE annual scientific meeting in San Diego on April 16, 2010.2 The title of my presentation was “The Magic of Mastering the Glidepath:What Every Endodontist Should Know.” I asked the following 6 questions (Figure 3). The survey results speak for themselves.

1. What size hand file do you prefer for your Glidepath (Figure 4)?
2. Do you use straight manual files or do you curve them (Figure 5)?
3. Do you “go to length immediately” or do you do “early coronal enlargement” (Figure 6)?
4. When making the Glidepath, what is your preferred irrigating solution (Figure 7)?
5. How do you determine your Glidepath length (Figure 8)?
6. When making the Glidepath, what hand motion do you use (ie, “watch/wind,” “push/pull,” or other) (Figure 9)?

Figure 3. Sample of Glidepath survey letter to endodontists. Answers to Nos. 1 through 6 are presented in Figures 4 to 9.

Figure 4. Hand File Size Preference. More than one-half of endodontists prefer a rotary Glidepath file size No. 15 or larger. As described in this article, the author prefers, instead, a “super loose No. 10.”	Figure 5. Straight or Curved File Preference. The only valid time to use a straight file is sliding into the orifice where the angle of incidence is greater than the angle of access.
Figure 6. Go to Length Immediately or Early Coronal Enlargement. Slightly more endodontists prefer early coronal enlargement, primarily due to the presence of restrictive dentin which restricts finesse and mastery of the first Glidepath file.	Figure 7. Irrigation Solution Preference. Sodium hypochlorite and a viscous chelator (or a combination of the 2) enable digestion of necrotic pulp and the ability to emulsify vital pulp.
Figure 8. Determination of Glidepath Length. The apex locator, or a combination of apex locator and radiographic terminus, is the clinician’s choice. Canal length accuracy is excellent when both methods of length determination validate each other. The important thing to remember is that the length is dynamic and becomes shorter, especially in the early stages of rotary shaping, due to canal shortening.	Figure 9. Hand Motion Preference. Most endodontists prefer “watch/wind.” Only 9% chose “other.” This article describes the critical distinctions of the manual motions of Glidepath preparation. These 4 motions make endodontic files efficient when the dentist learns how, when, and why to use what motion. Glidepath demands that the dentist “thinks” and is “deeply present,” resisting all distractions.

 

Dr. West is the founder and director of the Center for Endodontics. He received his DDS from the University of Washington in 1971 and his MSD in endodontics at the Boston University Henry M. Goldman School of Dental Medicine in 1975. He has presented more than 400 days of CE internationally while maintaining a private practice in Tacoma, Wash. He co-authored “Obturation of the Radicular Space” with Dr. John Ingle in Ingle’s 1994 and 2002 editions of Endodontics and was senior author of “Cleaning and Shaping the Root Canal System” in Cohen and Burns’ 1994 and 1998 Pathways of the Pulp. He recently authored “Endodontic Predictability” in Dr. Michael Cohen’s 2008 Quintessence text Interdisciplinary Treatment Planning: Principles, Design, Implementation. He is a thought leader for Kodak Digital Dental Systems and serves on the editorial advisory boards for The Journal of Advanced Esthetics and Interdisciplinary Dentistry, The Journal of Esthetic and Restorative Dentistry, Practical Procedures and Aesthetic Dentistry, and The Journal of Microscope Enhanced Dentistry.