Message Boards
Today's Active Topics Today's Active Cases Browse Forum Categories My Recent Activity My Messages Private Groups My Marked Threads My Subscriptions
Today's Active Images Today's Active Polls Most Active Topics Global Townie Map Advanced Message Board Search Message Board Terms of Use

GlidePath to Success Diwakar Kinra, DDS, MS

Start Discussion


The molar root canal is probably one of the most challenging procedures in dentistry. Proper planning can help reduce the frustration many of us feel when a difficult case presents itself in our schedule. There is a twofold process when performing a root canal. First is the mental preparation needed to execute and secondly is the technical tools needed to prepare.

Mental Preparation
Before beginning any procedure, I perform what I like to call my "Kinra Kwik Glance." This is simply a 30-second examination of the radiograph to mentally prepare myself for the challenges that lie ahead. I visualize the tooth from cusp tips to the apex. This short amount of time could save you tremendous time, effort and frustration during the procedure. By making this a ritual and remembering the acronym A.P.E.C.S., it might make some of your cases easier to navigate.

A. Angulation
P. Pulp Chamber
E. Entry Angle
C. Canal, Curvature and Calcifications
S. Straight Line Access

Angulation – This can be determined with at least two properly taken radiographs. Taking note of the long access of the tooth and/or rotations will decrease the likelihood of mishaps early on in the procedure. This will allow you to determine the correct angle to access the tooth.

Pulp Chamber – Examining the pulp chamber for calcifications, chamber height and pulp stones will help recognize whether you are "unroofing" the chamber or perforating the floor. Properly opening the pulp chamber will allow you to follow the "map" on the floor of the tooth to guide in canal location.

Entry Angle – This concept refers to the dentinal triangles which are evident at the cervix of the tooth. Realizing these exist and removing them allow for easier access into the canals.

Canals, Curvature and Calcifications – As you are working your way down the tooth notice the number of canals/roots (always search for as many as anatomy allows). Degree of root curvature and width of canals should be focused on before picking up a drill.

Straight Line Access – The goal of the "Kinra Kwik Glance" is to obtain foresight in achieving straight line access. Removing impediments on the glidepath will allow for faster determination of working length. Clinicians should know they have achieved this when the file is taken to working length and then stands straight up. Therefore, the file's reference point is the same cusp as the canal that is being cleaned and shaped.

Previously it was always taught to get working length with hand files before proceeding with the remainder of the root canal, via rotary instrumentation. It was almost a "race" to the apex. Now, modern thinking tells us to pre-enlarge the coronal aspect of the canal to improve straight line access. This removes the triangles, corrects the entry angles and decreases the curvatures, which allow for straighter access to the apex. Taking time in the beginning of the procedure to do this will make cleaning and shaping easier and faster with many rotary endodontic systems. Before, achieving working length was done with mostly hand files. Now, this concept is being modernized with the PathFile.

Technical Preparation
The newest and most revolutionary change to glidepath management is the PathFile (DENTSPLY Tulsa Dental Specialties). This single class of instruments has changed my practice tremendously in the past six months. The ability to negotiate canals has been simplified to just three files. It helps produce a wide open glidepath to assist in determining a quick working length. Once this is achieved, your rotary instrument(s) of choice can be used quickly to shape the canals with less fear of breakage, unwinding or other mishaps normally associated with mechanical treatment.


Fig. 1: PathFile NiTi rotary instruments (DENTSPLY Tulsa Dental Specialties). PathFile 1 (Purple) tip 013, PathFile 2 (white) tip 016, PathFile 3 (yellow) tip 019 taper .02. Endodontic engine setting: 300rpm, torque 5-6 N/cm.

The method described below is how I use these files when a difficult molar presents with calcification and curvature.

Step 1: After location of canals I place a slightly bent #10 C-file into the canal and go down the canal approximately two-thirds of the way. Rinse.

Step 2: Place purple (ISO 13) rotary PathFile to the same length. Rinse. Negotiate white (ISO 16) rotary PathFile to same length. Rinse. By pre-enlarging the coronal two-thirds of the canals, steps 3 and 4 will be quite simple.

Step 3: Place #10 C-file to working length. Confirm with apex locator. Rinse.

Step 4: Enlarge glidepath with PathFile series (purple/white/ yellow). Rinse.

It's at this point that we can reconfirm working length with a #15 handfile. Achieving working length should take less than three minutes total. This initial preparation of the glidepath will now allow for a smoother transition to any rotary instrumentation series of choice. After using this system in 100 cases I have not seen any file breakage. There has been unwinding of the files, which were then easily discarded. There has been reduced unwinding and breakage of my rotary instruments (ProTaper Universal) since implementing this method in my office.

Case Example
A patient presented to my office for root canal therapy on tooth #30. After proper diagnosis, the patient was anesthetized. Before rubber dam placement, the "Kinra Kwik Glance" was performed from cusp tip to apex. The major alerts that were noted (Fig. 2).



Angulation – No major angulation or rotation issues.

Pulp Chamber – Slight chamber recession, and possible pulp stones at distal aspect of the chamber.

Entry Angle – Difficult entrance associated with the mesial canals.

Canals, Curvature and Calcifications – Canals appeared calcified, long and moderate degree of curvature.

Straight-line access – Mesial cervical triangles will need to be removed for proper access to the apex.

Keeping these points in mind throughout the procedure will allow you to focus on the end product: a clean, well-shaped and successfully obturated root canal.

After locating canals, I placed a slightly bent #10 C-file into the canal and went down approximately 16mm, rinsing copiously with sodium hypochlorite after every file placement. Following the rinse, I placed purple rotary PathFile to 16mm followed by a white rotary PathFile to the same length. Next, a #10 C-file was negotiated to working length. After confirmation with an apex locator, I enlarged the glidepath with PathFile series (purple/white/yellow) and reconfirmed working length with a #15 handfile. The working length was set at 24mm and I proceeded to clean and shape with the ProTaper Universal rotary system (DENTSPLY Tulsa Dental Specialties).

This initial glidepath preparation allowed for the remainder of the root canal therapy to be stress free. What previously took 10 to 15 minutes, now takes three to five minutes and without sacrificing efficacy. This new method not only allows for more predictable glidepath management, but the savings in time will allow for a more productive practitioner and satisfied patient (Fig. 3).
Author’s Bio
Diwakar Kinra, DDS, MS, received his dental degree from the University of Michigan School of Dentistry and his master's degree in endodontics from the University of Detroit – Mercy School of Dentistry. He lectures globally on endodontics and practice management. He is in private practice limited to endodontics in Flint, Michigan. Contact him via www.kinraendo.com.
Dentaltown Magazine
September 2025
Dentaltown Magazine September 2025 Read Current Issue Read Archived Issues
Sponsors
Townie Perks
Townie® Poll
Who or what do you turn to for most financial advice regarding your practice?
  
Site Menu
Message Boards Magazine Continuing Education Podcasts Blogs Classifieds Dental News Events Townie® Poll Ebooks Townie Choice Awards
Company Info
Contact Us Advertise With Us Howard Farran DDS, MBA Policies and Agreements
Site Help
Sally Gross, Member Services Specialist
Phone: +1-480-445-9710
Email: sally@farranmedia.com
©2025 Dentaltown, a division of Farran Media • All Rights Reserved
9633 S. 48th Street Suite 200 • Phoenix, AZ 85044 • Phone:+1-480-598-0001 • Fax:+1-480-598-3450