Post-treatment image (right) reveals proper apical shaping and obuturation made possible by successful Glidepath preparation.
Root canal system anatomy is often tortuous and in multiple planes not observed in 2-dimensional images.
Glidepaths must ultimately “follow” and replicate the original canal path in order to preserve the position of nature’s portal of exit locations.
Give or take a few…The ADA estimates that most dentists treat an average of 2 endodontic teeth per week. If we assume there are at least 2 canals per tooth, 47 treatment weeks per year for 25 years, then most dentists will attempt approximately 5,000 Glidepaths in their career: 2 root canals per week x 2 canals per tooth x 47 weeks x 25 years = approximately 5,000 Glidepath attempts.
Most of the references say something like, “Of course you must first make a Glidepath.” That’s all. And so the purpose of this article is to serve as a reference guide for endodontic Glidepath preparation and answer the following questions: What is it?
The Glidepath must be discovered if already present in the endodontic anatomy or prepared if it is not present.
The Glidepath can be short or long, narrow or wide, essentially straight or curved (Figure 2). The only valid time to use a straight file is sliding into the orifice where the angle of incidence is greater than the angle of access.
Slightly more endodontists prefer early coronal enlargement, primarily due to the presence of restrictive dentin which restricts finesse and mastery of the first Glidepath file. The apex locator, or a combination of apex locator and radiographic terminus, is the clinician’s choice. Canal length accuracy is excellent when both methods of length determination validate each other. The important thing to remember is that the length is dynamic and becomes shorter, especially in the early stages of rotary shaping, due to canal shortening. When reviewing ToothAtlas teeth, the first realization is the typical root canal system anatomy of a specific tooth is not typical at all.
Once you know the typical number of canals for a particular tooth and you understand some of the anatomical possibilities, then magnification and illumination are essential to finding canals. Any dentist serious about endodontic treatment should be trained in the use of the operating microscope.
With an aging population and therefore aging teeth with their root canal systems, normal calcific degeneration occurs and when these pulps become nonvital, the canals are smaller and more difficult to find without magnification and illumination (Figure 10). Severely calcified canal (left) can be successfully “followed” using microscope and color differentiations. Note canal patency (right) did not occur until a few millimeters from the canal terminus and yet the procedure was entirely safe and minimal tooth structure was removed. The walls of the canal on the left are the same, while the walls of the canal on the right have a longer one and a shorter one.
What the rationale of endodontics requires is the entire length of the root canal system be cleaned and shaped. Four reasons a file will not “follow” to its terminus: (1) Canal is blocked (2) File curvature does not replicate canal curvature (3) Diameter of file is too wide at its tip (4) Diameter of file is too wide in its shaft. Solution: irrigate thoroughly with sodium hypochlorite, make an abrupt apical curve on smallest file in your armamentarium (typically a size No. 8 file), imagine successfully reaching the RT (actually imagine seeing the file at the RT while examining the pretreatment radiograph or digital image), “follow” gently to and touch the blockage, remove the file, irrigate, re-curve the last millimeter of the file and repeat until the file moves deeper into the canal (Figure 13). If you are patient and delicate enough, and if you do not put a time limit on this essential skill, I promise you that you will eventually “follow” successfully to the RT!
Gloves must fit tight so that the balls of the fingers together allow the finest possible touch and delicacy (right). These files offer the finest manual transition between Glidepath files because of their constant and appropriate size increases. While a manual Glidepath is still recommended, the PathFile is an excellent way to increase rotary shaping safety. If the file is at first too tight to easily make short strokes, ie, the file is apparently binding against 2 or more walls, then wiggle the handle left and right without any up or down motion. This simple, safe nuance will wear away the small amount of restrictive dentin and free the file for the smoothing motion. While many endodontists prefer a larger file (55%, as noted in my spring AAE 2010 survey), every increase in size while making a theoretically bigger pilot hole for rotary, also risks creating a shelf in the radicular dentin wall. Rotary files rarely glance over shelves or ledges and must be meticulously removed before proceeding.4 An excellent series of manual files for smooth and progressive Glidepath enlargement are the ProFile Series 29 invented by Schilder (DENTSPLY Tulsa Specialties) (Figure 15).
The proper next step is to remove the file using the “envelope of motion.” The envelope will wear away restrictive dentin by withdrawing and carving to the right, or clockwise, direction.
The other 3 motions require that the file is moving in an apical motion in order to execute. This is a subtle motion and gives the impression that you are wasting your time because nothing is happening. The amount of tooth structure that is removed compared to coronal enamel and dentin preparations is minuscule. Test it out yourself and experience that suddenly, effortlessly, and even miraculously the previous file “follows” deeper. You will experience a newfound freedom and control of the evolving radicular shape which, unfortunately, cannot be observed directly like all other restorative.
If you cannot “follow” to RT, you will almost always at least “follow” closer toward the RT. The dentist may feel safer with a larger size or the walls may not feel as smooth as possible. Originally this motion was referred to as Balanced Force or the Roane Technique, named after Dr. James Roane, the first person to describe this manual motion.6 Simply put, turn the handle of the file clockwise, and then turn it counterclockwise using slight apical pressure so that the file will not “unscrew” its way out of the canal. During the clockwise motion, the file blades cut into the dentin; during the apical counterclockwise motion, the dentin is collected into the file’s flutes. That same file is then used in a “smoothing” motion and the Glidepath is once again finished and ready for rotary shaping. One recent and successful method is the introduction of 3 PathFiles (DENTSPLY Tulsa Specialties) (Figure 16). When properly used, these robust and efficient rotary Glidepath files can take even further risk out of rotary shaping. As with every dental instrument, the dentist must precisely follow the manufacturer’s directions for use.
This article has offered a definition of Glidepath, explained why it is important in producing optimum endodontic mechanics, and described how to prepare a Glidepath for radicular shaping. Four obstacles to Glidepath preparation have been identified along with the solution for each one.
Four manual motions have been distinguished that, if used properly, will produce a safe rotary result and an endodontic experience that you truly control. Perforations, blocks, ledges, and transportations: overcoming barriers to endodontic finishing. He received his DDS from the University of Washington in 1971 and his MSD in endodontics at the Boston University Henry M. He has presented more than 400 days of CE internationally while maintaining a private practice in Tacoma, Wash.
John Ingle in Ingle’s 1994 and 2002 editions of Endodontics and was senior author of “Cleaning and Shaping the Root Canal System” in Cohen and Burns’ 1994 and 1998 Pathways of the Pulp.
Michael Cohen’s 2008 Quintessence text Interdisciplinary Treatment Planning: Principles, Design, Implementation. He is a thought leader for Kodak Digital Dental Systems and serves on the editorial advisory boards for The Journal of Advanced Esthetics and Interdisciplinary Dentistry, The Journal of Esthetic and Restorative Dentistry, Practical Procedures and Aesthetic Dentistry, and The Journal of Microscope Enhanced Dentistry. He can be reached at (800) 900-7668 or at This email address is being protected from spambots.



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