Prof. Gianluca Plotino – Barry Barker memorial lecture titled 'How To Negotiate Difficult Root Canals '

After access to the root canal system and localization of the root canal orifices, the most difficult step during endodontic treatment is the need to scout the root canals and to create a safe and predictable glide path. In clinical practice, 80-85% of the root canals in primary treatments may be defined as standard cases, as they present a natural glide path that may be successfully scouted from the beginning and easily enlarged with a single-file basic preparation technique using a reciprocating heat-treaded instrument. The remaining 15-20% of the canals may be defined as complex, as they present anatomical variations that make the scouting procedures the most delicate and challenging phase of the entire treatment. This phase requires skills and clinical experience for its correct management, but is often time-consuming and frustrating. In fact, complex cases in endodontic primary treatments mainly depend on the initial permeability of the canals to their terminus and on the presence or absence of a natural glide path.

Following these considerations, the present lecture will analyze the different possible clinical scenarios, first considering the cases in which an initial manual scouting is successful to negotiate the canal to its terminus, then describing why in some cases there are difficulties to the negotiation caused by coronal or apical impediments and how to clinically deal with these situations predictably, safely and efficiently, using the ideal instruments for each clinical situation. In fact, the use of a small reciprocating glide path file and the need to hybridize the techniques will also be described to solve these clinical cases with the most complex and particular root canal anatomy.

Clinical procedures on how to manage canals with difficult scouting will be clearly explained, to simplify these procedures and ensure more predictable, gold standard endodontic treatments.