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

Good As Gold by Dr. Reid Pullen

View Comments (4) More by this author (3)
Good As Gold 

A new, fast hybridized canal-shaping procedure for better endo treatment results

by Dr. Reid Pullen


The two most common questions I encounter when I teach general dentists how to perform endodontic therapy are, “How do I find all the canals?” and, “How do I get down them and then shape them safely?”

In root canal therapy, locating all the canals and then negotiating down to working length are two of the most important tasks in the entire procedure. Once this is accomplished, shaping can commence. But what if there was a way to blend both negotiation and shaping?

In this article, I want to discuss a hybridized shaping method that has greatly increased my effectiveness and efficiency at both getting down the canal and shaping them.


The history
I developed what I call the “Slider Gold” method a few years ago when I started experimenting with a new file system designed to fast-track the negotiation phase (getting down the canal). The uniqueness of this method is that it supplants the use of a hand file (e.g., a #10 K file) to negotiate down to the canal to working length.

Before this, negotiation to working length was accomplished with hand files, and it was not recommended to use rotary nickel titanium files to accomplish this procedural step. In my cases, I use a ProTaper Ultimate Slider—M-wire, #15 tip with variable taper, which is designed as a rotary negotiator.

The file I work with was designed to carefully negotiate down the canal and advance to working length or more specifically to patency (exiting the foramen) so you can establish an accurate working length from the electronic apex locator. In my office, I have used it in over 1,500 canals and have a success rate of 80.1%. This means in 80.1% of the canals, the file advanced down the canal to patency (exited the foramen), and I was able to obtain a working length by attaching the clip of the electronic apex locator to the handle of the Slider.

So, in other words, I did not have to use a #10 K hand file to negotiate to patency in those canals—which saved valuable time and enabled me to quickly negotiate to working length and then shape and clean the canals in a very efficient manner.

What about the other 20% of cases? In those canals, there was usually a small apical curve, and it required traditional negotiation with a #8 or #10 K hand file and a small 45-degree apical bend. No big deal! This is what we have all been doing for years so we know how to do this effectively.


The method
I would like to now outline the exact method I use to efficiently and effectively negotiate and shape the canals.

STEP 1
Access and locate all the canals. This is a key step. Use drilling cycles and gently brush away 2–3 mm of dentin in each cycle and then rinse, dry and inspect the access cavity. Course correct and perform another drilling cycle. On molars, it takes on average four or five drilling cycles to pop into a non-calcified pulp chamber. Take your time and gently brush away the dentin to the pulp. Do not gauge the access cavity floor.

STEP 2
Obtain a stick with the endodontic explorer (DG-16) in each canal.

STEP 3
Use a #10 C 21 mm file and perform a coronal negotiation. Explore the coronal third and make sure the canal is open and loose (approx. 10–15 mm down).

STEP 4
Select the ProTaper Ultimate Slider or other appropriate file (400 RPM) and dip the tip into RC Prep or any file lubricant. Place the file into the canal and allow it to advance down the canal. Use passive hands and never push on this file or it can separate. Take your time and perform shaping passes. Each pass consists of four or five engagements/disengagements of the file as it advances down the canal. Irrigate with sodium hypochlorite between each pass. On average, it takes me two shaping passes to advance down to patency and obtain an accurate working length with the Slider. If after three passes the file will not advance down to the estimated working length or it feels as if it is hitting a brick wall, then I stop and move to traditional negotiation with hand files. Never push this file while it is running down the canal. Allow it to run down the canal by itself and just hold it in place with passive hands.

STEP 5
Select the ProTaper Gold Shaper 1 (S1) and use shaping passes to advance down the canal to shape the middle third. On average, it takes two shaping passes for the S1 to advance to working length. Between each pass, irrigate with sodium hypochlorite to remove all the debris created by shaping and then recapitulate (check patency) with a #10 K file.

STEP 6
Bring in the apical finisher. I use the WaveOne Gold Primary, a reciprocating file system that requires the correct type of endodontic motor. Use the file to finish the apical third. On average, it also takes two shaping passes to advance to working length. Once the file has advanced to working length, create a deep apical shape by running the file back to working length three times. Remove the file, irrigate and recapitulate.

STEP 7
Perform an apical verification with a #25 K hand file. If the #25 K file fits snugly at working length, the Primary gutta percha cones should also.

STEP 8
Perform activated irrigation with sonic activation (e.g., SLP EndoActivator) or laser irrigation with SWEEPS (e.g., Fotona) and achieve enhanced disinfection. Use QMix or a 17% EDTA and remove the smear layer.

STEP 9
Fit gutta-percha cones and then take straight and shift cone fit radiographs to verify the fit.

STEP 10
Dry the canals and obturate with your technique of choice.


Case examples and conclusion
Here are a few examples of the final product using the method discussed (Figs.1-4). This method is so fast and easy to use that once you locate the canals it takes less than five minutes (sometimes two minutes total) to completely shape the canals. This concept mostly holds with simple to medium-difficult endodontic cases. Since negotiation and shaping are blended, the procedure can be performed extremely quickly. This then allows plenty of disinfectant soak time and enhanced irrigation and disinfection. This method does require a rotary and reciprocation motor, as well as one file each from three different systems. Happy nerve hunting!
Endodontic Steps
Fig. 1
Endodontic Steps
Fig. 2
Endodontic Steps
Endodontic Steps
      Figs. 3 and 4: Pre-op and post-op #30, respectively.
      In both of these cases the Slider advanced to working length in each canal without the use of a hand file.

Author Bio
Dr. Reid Pullen Dr. Reid Pullen graduated from University of Southern California School of Dentistry in 1999, then was stationed in Landstuhl, Germany, for three years with the U.S. Army. He completed a one-year Advanced General Dentistry residency, then practiced general dentistry in Yorba Linda, California, before doing an endodontic residency at the Long Beach, California, VA. Board-certified in endodontics, Pullen has owned a private practice in Brea, California, since 2007, teaches 2-Day Root Camp Boot Camp live-instruction classes and runs Root Canal Academy. Email: reidpullen@rootcanalacademy.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