The Endodontic Glidepath: “Secret to Rotary Safety”

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The Endodontic Glidepath: “Secret to Rotary Safety”

INTRODUCTION
You will do it 5,000 times in your career. Give or take a few…

The ADA estimates that most dentists treat an average of 2 endodontic teeth per week. If we assume there are at least 2 canals per tooth, 47 treatment weeks per year for 25 years, then most dentists will attempt approximately 5,000 Glidepaths in their career: 2 root canals per week x 2 canals per tooth x 47 weeks x 25 years = approximately 5,000 Glidepath attempts.
The amazing fact is that the subject of Glidepath has no formal training in the endodontic curricula of most dental schools. In fact, a PubMed Central search of Glidepath and endodontics reveals 300 references. However, none of them actually describe how to prepare a Glidepath. Most of the references say something like, “Of course you must first make a Glidepath.” That’s all. And so the purpose of this article is to serve as a reference guide for endodontic Glidepath preparation and answer the following questions: What is it? Why is it important? How do you predictably prepare the Glidepath?

Starting with the answer
The purpose of endodontics is to prevent or heal lesions of endodontic origin.1 In order to achieve this purpose, the root canal system must be successfully obturated. In order to be obturated, the root canal system has to be successfully 3-dimensionally (3-D) cleaned and rotary shaped. In order to be 3-D cleaned and rotary shaped, a Glidepath has to be successfully prepared (Figure 1). And so the Glidepath is the answer. It is the starting point of radicular preparations. Without it, cleaning and shaping become unpredictable or impossible because there is no guide for endodontic mechanics.
WHAT IS GLIDEPATH?
The endodontic Glidepath is a smooth radicular tunnel from canal orifice to physiologic terminus (foraminal constriction). Its minimal size should be a “super loose No. 10” endondontic file. The Glidepath must be discovered if already present in the endodontic anatomy or prepared if it is not present. The Glidepath can be short or long, narrow or wide, essentially straight or curved (Figure 2).

WHY IS THE ENDODONTIC GLIDEPATH IMPORTANT?
First, without the endodontic Glidepath, the rationale of endodontics cannot be achieved. The rationale states that “any endodontically diseased tooth can be predictably saved if the root canal system can be nonsurgically or surgically sealed, the tooth is periodontally sound or can be made so, and the tooth is restorable.”1 A nonsurgical seal requires first the creation of a radicular path that can be cleaned of viable and nonviable bacteria, vital and nonvital pulp tissue, biofilm, and smear layer; then shaped to a continuously tapering funnel that can be predictably and easily obturated.
Second, the Glidepath is necessary for quality control. Sustainable excellent endodontic obturations are not possible without it.

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