Advanced Endodontics

Glide Path Management with PathFiles

May 3rd, 2011 By Clifford J. Ruddle DDS - Advanced Endodontics

Ruddle Report Cliff Ruddle

Many of you who have listened to me over the years realize how much emphasis I place on Glide Path Management.  I’ve often said on stage that I have two things to teach for the rest of my life and one is Endodontic Access Cavity Preparation and the other is Glide Path Management.

If we have a colleague who can be trained to do complete access over and over and over again, and if they can reach the terminus of the canal, and consistently create a reproducible smooth glide path, then virtually anybody’s rotary file systems or reciprocating file systems can carve the shape.  So, really the art still is glide path management. 

And as most of you realize that practice clinical endodontics, glide path management has more or less been the same, static if you will, for the last 50 years.  There’s been a lot of different ways that we have all been taught to create our glide paths.  Some people would advocate a 10 only, but it must be loose, so I want to emphasize the concept – a loose 10 at length.  Others have said, 10 and 15.  The thinking is the 15 carves out a little bit more shape, smoothes and refines the preparation and expands it so that the tip of our rotary files can follow this secured pathway.

Well, additionally, we’ve had some advocates even say that the 10, 15 and 20 or even 25 and 30 hand files should be used first before any rotary instruments move into the canal. What I’d like to say is the more hand instruments we use, the greater the danger is of blocking, ledging, transportating the foramen and a lot of other iatrogenic things that we’re very concerned about. So, I’m an advocate, strongly, of using fewer instruments versus more instruments.

With that said, we’ve had a wonderful new breakthrough in glide path management that takes us kind of out of the old 20th and early 21st century methods and has really contributed to safe, reproducible glide path management.  I’d like to acknowledge the PathFile. 

The PathFile was invented by three of my dear friends, Arnaldo Castellucci, Elio Berutti, and Giuseppe Cantatore.  Affectionately, I call them the Italian mafia.  So, the mafia has once again produced and given all dentists who are interested in securing canals, an easy, fast and reproducible way.  I might add, they can do it very safely, every time. 

So, what is a PathFile?

The PathFiles are three instruments.  They’re 02 tapered and they’re D0 diameters are 13, 16 and 19.  They go into a canal after the canal has been absolutely secured with a 10 file and the 10 file has been used sufficiently so that it is loose.  This means you could take your index finger and push the 10 file from the orifice to the foramen.  We couldn’t do this of course, and this is kind of silly to say, but you should be able to push a 10 file, when the glide path has been properly made, with your nose.  Just your nose alone should push on the handle and deliver the 10 file at length. 

So, once you have a loose 10 file at length, you could take the purple and carry it in, in one or more passes.  It’s rotating at low torque around 200-300 [note update from audio version], spinning at about 300 rpm.  If you use the path file in this manner, you will notice that the first instrument moves quite readily through the glide path and reaches length.  You would follow the purple instrument with the white.  The white band on the handle would mean that’s the second instrument.  It’s the 16/02 and again, in one or more passes, this instrument can be carried to length.  Finally, if you wanted to expand the glide path even further, you can use the yellow-handled stripe, that’s the 19/02, and that instrument would give you a very, very generous glide path.

When you carry these three instruments to length, you’ll notice that they have a very strong resistance to cyclic fatigue.  In fact, some of the information that I actually disclosed and showed at (last) year's AAE meeting in San Diego, where I gave a presentation on new methods for glide path management and shaping, I showed the PathFiles and what was really impressive to the audience was, the material I showed was given to me by Arnaldo Castellucci, and in that material I showed the instruments making more than a 90° bend and they can be rotated for between something like 35 and 45 seconds before they sequentially broke. Obviously the bigger instrument breaks first, the middle instrument, the middle-sized instrument, would break second, and the last one to break was the smallest one.

So, in closing, there is a new game to play in glide path management.  And, glide path management can grow up and become very, very sophisticated when we learn how to skillfully carry a 10 file to length and then we can rapidly expand this shape, this early shape, with 3 PathFiles. 

[Addendum: Subsequent to the posting of this Blog, was the release of ProGlider.  ProGlider is now Dr. Ruddle's preferred instrument for managing the glide path.  However, the concept and importance of glide path management remains the same, no matter which instrumentation sequence is utilized]