An Arithmetic Crown-down Dynamic Tactile Instrumentation Technique: A Case Report of an S-shaped Root Canal.

The preparation of severely curved S-shaped double-curved root canals can be technically challenging. A novel root canal instrumentation technique is proposed, which modifies 2 techniques: the McSpadden crown-down technique and the tactile controlled activation technique. In the McSpadden crown-down technique, the root canal is divided into 2 portions: the coronal zone and the apical zone. However, rather than focusing on the length of file engagement, a formula is proposed to calculate the maximum insertion depths of higher tapered instruments to prevent overflaring of the canal and preserve pericervical dentin. Tactile-controlled activation involves activating martensitic nickel-titanium rotary files upon engagement and then immediately withdrawing the files. The proposed technique recommends 3 apical strokes after the initial engagement before withdrawal to minimize instrumentation time. This novel technique is described in a case report involving the management of an S-shaped double-curved maxillary lateral incisor. The technique presents a new method of crown-down instrumentation that prevents overflaring and avoids instrument separation.