Manual versus mechanical endodontic glidepath.

This article, the second in a series of 3 articles on the endodontic Glidepath beginning with the September 2010 issue of Dentistry Today (archived articles can be found at dentistrytoday.com), represents an inquiry into the critical distinctions of the endodontic Glidepath. First, we reviewed the need for a confirmed and reproducible Glidepath as prerequisite to rotary or reciprocal shaping. In order to be safe, before rotary shaping, the dentist must always discover that a Glidepath already exists or that one needs to be created. Second, an emphasis was placed on a "finishing checklist" for Glidepath preparation for safe and successful rotary. The checklist is 2 parts: (1) minimum super loose No. 10 file sized k tunnel is verified; (2) the super loose No. 10 file sized tunnel must run from canal orifice through the canal PT to the RT. In this way, patency is preserved and yet the delicate and often fragile cemental anatomy remains undamaged and unchanged, therefore meeting Schilder's fourth mechanical objective of "keeping the foramen as small as practical." Third, we discussed that the question should not be "manual versus mechanical" but rather "manual, then mechanical." Always measure the existence of a Glidepath with manual before mechanical. The key elements for improving your performance of Glidepath mastery include a clear intention of what needs to be accomplished and yet at the same time, restraint; gentleness; copious irrigation with sodium hypochlorite; curved files; randomness; discovery; expecting the unexpected and surrendering to, honoring, and respecting the delicate anatomical structure called the root canal system. After all, nature has been demonstrating how to make a Glidepath for a long time, but we have not been paying attention. We have been too heavy-handed, we have pushed, we have forced, and we have not always been good stewards of nature's fragile framework. She has been giving us and teaching us the Glidepath answer all along. Listen to Mother Nature as she sends her legacy to us: "You have never seen a canal like me before. I am full of curves and booby traps. Treat me gracefully--I know that may sound corny--and respect my delicate tissues and structures. I am waiting for you. All you have to do is follow me to my end. Make me smooth and big enough for safe rotary and you can have your way with me. Once cleaned, shaped, and packed, I will reward you with the gift of healing." In an upcoming issue of Dentistry Today, I will present useful guidelines for implementation of the endodontic Glifepath. Remember, knowing what to do is only half the answer to mastering elegant, artistic, and successful Glidepaths. The other half is to be able to bring these skills into the everyday clinical practice; implementation is often the missing link In order to do this, you will need a plan to design a culture, environment, and ergonomics in your office that will allow the time and energy to do it right.