Allen_ali_nasseh

Submitted by: Allen Ali Nasseh on 03/11/2018

Category: Endo » Pre-treatment topics

Tags: Instrumentation Philosophy Technique

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Crown Down or Step Back, Which is Better? basic free

A basic review of crown down and step back and some possible advantage.

Description

During a trip to Vancouver, Dr. Nasseh shares an idea from the presentaiton on the difference between crown down and step back technique during root canal instrumentation. 

Comments (12)

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Allen_ali_nasseh

Rank: Faculty General

Comments: 189

Allen Ali Nasseh

No matter what instrumentation system you use, even hand instruments, let me know if you prefer the crown down or step back, or even another way to instrument the canal.
Images

Rank: Sergeant

Comments: 14

Troy Jameson

Thank you Dr. Nasseh. This cleared up a lot of things in my mind. So, I used to use Pro Taper before switching to EndoSequence system for its obturation. Was protaper a stepback file? How about reciprocation? Thanks for the videos!
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Rank: Sergeant

Comments: 6

RWE Admin

Dr. Jameson, rotary files are slightly different than the traditional step back but ProTaper files reach the apex first using scout files S1 and then all subsequent files go to the same length at apex, therefore, they are more of a crown down technique than the EndoSequence Blend Technique that represents a more traditional Passive Crown Down technique in smaller canals by using a crown down sequence of files 30-15 passively. We hope this answers your question.
Allen_ali_nasseh

Rank: Faculty General

Comments: 189

Allen Ali Nasseh

@Troy Jameson: Yes, you are correct. The use of an orifice opener first with either technique helps establish some coronal flaring; but ProTaper files are sequentially taken to the full working length to enlarge apically until master file is achieve. That's a pretty much the standard step back technique. EndoSequence is used in a Crown Down technique with inserting the larger files first passively and letting smaller files glide down sequentially after light coronal shaping. It's sequentially smaller files moving down apically. In next week's video I will be explaining a new protocol for rotary instruments based on these concepts called the EndoSequence Blend. You will have a better understanding of it after that video. Cheers!
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Rank: Officer

Comments: 22

ali al-ausi

Another great video and well explained. Crown down technique is far superior for all the reasons you mentioned and what i have noticed is that i can reach the apex quicker and with less effort when i use this technique. this means less time shaping and more time cleaning with irritants and activation. My sequence is 1) vortex orifice opener 20/08 16mm upto the middle of the root to remove triangles of dentine. 2) size 10 K file as far it can go without binding i.e loose and with glide path. 3) vortex blue 15/04 rotary file upto the length the 10 K file could reach. 4) proper next rotary files X2 and maybe X3 which are 25/06 & 30/07 tips 1mm short of the last rotary file (15/04). 5) then go back to the 10k file and by then it usually reaches the apex and follow the same sequence of rotary files as the above.