Creating excellence in cleansing and shaping root canal systems is a mixture of both mechanical means (the instrumentation) and bactericidal action (the irrigation). In the simplest sense, files make way for irrigants to flush debris from the root canal system and to kill bacteria.The two are not effective without the other. Irrigants cannot penetrate effectively into the apical third without being given entrance into this space of the canal by files.Effective and predictable instrumentation of root canal systems is essential for ideal final treatment results.

要在根管清洁和成形过程中获得卓越的治疗效果，必须要用设备打开入路，并进行彻底冲洗消毒。简单来说，就是用根管锉为冲洗创造路径，以便冲走根管内的碎片和进行消毒灭菌。两者缺一不可。没有用根管锉创建的入路，冲洗液就无法进入根尖1／3进行有效地冲洗。因此，有效并可预见的根管预备对最终获得理想的治疗结果非常关键。


The goals of endodontic instrumentation are to:
1) Keep the canal in its original position
2) Keep the minor construction of the apical foramen at its original position and size
3) Create a tapering funnel with narrowing cross sectional diameters
4) Create a space that is predictable to obturate but which does not enlarge the canal unnecessarily


根管治疗要达到的目标是：
1．保持根管在原始位置
2．确保根尖孔的微小结构保持原始位置与尺寸
3．构建横断面直径逐渐缩小的漏斗形通道
4．构建可预见封闭效果的空间，避免不必要的根管扩大


Several strategies emerge to create these goals, irrespective of the instruments used in its creation. Two of these strategies are:
1) Hand K files are used to negotiate canals and explore canal spaces before other instruments.Amongst other valuable uses, hand files can determine the canal length, calcification, curvature and the anatomy of the apex. In addition, hand files can be used to create a glide path that can set the stage for rotary nickel titanium (RNT) files. A glide path is created when a #15 hand file will freely spin in the given portion of the canal that is to be instrumented subsequently by RNTs.

In the most general sense, hand filing comes before RNT use as hand files act as glide path creators and canal negotiators. Once the canal path is carefully explored and known to the clinician and the glide path created, the canal is then fully enlarged with RNT files. The author does not use hand files to enlarge canals once the glide path is created as hand files above a size 20 become significantly stiffer,especially the stainless steel variety, and tend to create apical transportations. Despite this, nickel titanium hand files can be used for apical shaping but their RNT counterparts are far simpler to use.The author also does not use Gates Glidden drills as RNT files offer a far safer and simpler solution to the enlargement of canals especially in the coronal third.


针对实现这些目标，形成了数种适合任何设备的治疗策略，其中俩项为：
1．在使用其它设备前，首先用手用K根管锉穿越根管并探查根管空间。除了其它一些有价值的应用之外，手用根管锉还能够确定根管长度、钙化程度、弯曲程度以及根尖解剖结构等。此外，手用根管锉还可用来创建一个供旋转镍钛根管锉(RNT)操作的入路。当#15手用根管锉可以在根管内自由旋转时，旋转镍钛根管锉就可以进人。

一般来说，在使用旋转镍钛根管锉前，先用手动根管锉创建入路和穿越根管。一旦临床医师仔细探查并了解了根管路经，而且创建好了入路，就可以使用旋转镍钛根管锉对根管进行全面的扩大了。以本人为例，一旦入路创建之后，就不再使用手动根管锉进行根管扩充，这是因为20号以上的手动根管锉十分坚硬，特别是各种不锈钢根管锉，可能会造成根尖穿孔。除此之外，镍钛手动根管锉可用于根尖构型，但是其它旋转镍钛根管锉使用起来更方便。本人也不使用Gates Glidden钻针，因为对根管扩大来说，尤其是和冠三分之一处，使用旋转锦钕根管锉更安全、方便。



2) RNT files are a significant advance over their stain less steel hand counterparts with the caveat that care must be taken to prevent their fracture. RNT files possess the quality of super elasticity; they will bend back into their original shape after being used. Clinically this manifests itself as flexibility to negotiate curvatures, and as such, canals of various curvatures can be instrumented far more efficiently than by hand.

The author advocates a “crown down” instrumentation sequence with RNT files. The coronal third is instrumented first, the middle third second and the apical third last. Use of RNT files is gentle, smooth, from the fingers and best powered by an electric motor with auto reverse and torque control. While significant writing and educational material exists with regard to the best use of RNT files, it is recommended by the author that they be used from larger tapers to smaller and from larger tip sizes to smaller with the assumption that they will be used with the tactile control above and with a pre-existing glide path. The author uses the K3 RNT system (SybronEndo, Orange, CA, USA) for its flexibility, tactile “feel”, cutting ability and fracture resistance.

Two key principles of instrumentation in Endodontics have been presented. These principles have value for aiding in the creation of excellent canal shapes and as such, once created, can provide ideal irrigation for maximum cleanliness in the canal with the greatest bactericidal function. The author welcomes your questions and feedback.


2．旋转镍钛根管锉比不锈钢手动根管锉先进得多。不锈钢手动根管锉一般都警告使用者要特别小心防止折断。旋转镍钛根管锉具有超强弹性，在使用后能够回复原先的形状。在临床上，这种超强弹性使其能够适合根管的弯门程度，可以对各种不同弯曲程度的根管进行操作，而且比手动根管锉效率高得多。

本人建议按次序使用旋转镍钛根管锉进行“冠向下”操作。首先处理冠三分之一处，接着处理中间三分之一，最后是根尖三分之一。旋转镍钛根管锉操作柔和、平稳、触觉控制，通过带自动反转及扭矩控制的电动马达提供最佳动力。尽管针对如何最佳应用旋转镍钛根管锉已经有大量的著作和材料，本人的建议是：如果在一个预先创建好的人路内通过上述触觉控制操作该设备，应先使用大锥度、大型号操作头，然后逐渐换为小锥度、小型号操作头。本人一般使用K3旋转镍钛根管锉系统(SybronEnd0，Orange，CA，USA)，因为它具有良好的弹性、触感、切割能力及抗断裂能力、上面介绍了在根管构型中非常重要的两个原则。它们在帮助创建卓越的根管形态方面具有很高的价值，而且一旦创建完成，就可以提供理想的冲洗条件，从而对根管进行最大程度的清洁和消毒灭菌。