Strategies how to negotiate difficult canals

Gianluca Plotino & Nicola Grande

After the access to root canal system and the localization of root canal orifices, the most difficult step during endodontic treatment is represented by the need to scout the root canals and to create a safe and predictable glide path. In fact, complex cases in endodontic primary treatments mainly depend on the initial permeability of the canals to their terminus and on the presence or the absence of a natural glide path. Following these considerations, the present lecture will analyze the different possible clinical scenarios, first considering the cases in which an initial manual scouting is successful to negotiate the canal to its terminus, then describing why in some cases there are difficulties to the negotiation caused by coronal or apical impediments and how to clinically deal with these situations.

Step by step of the clinical procedures on how to manage canals with difficult scouting will be clearly explained and showed through the use of images and videos of explicative clinical cases, in order to ensure the clinician with gold standard endodontic treatments.


Dr. Nicola M. Grande

  • DDS, PhD
  • Nicola M Grande received his degree in Dentistry (DDS) from the Catholic University of Sacred Heart, Rome, Italy in 1999 with a degree thesis on the fracture of NiTi rotary instruments.
  • After two years in the Department of Endodontics at the the same University, he served as an Assistant Professor in Endodontics from 2001 to 2009.
  • He completed his PhD program at the Catholic University of Sacred Heart, in 2009, with a thesis on an innovative technique for the restoration of the endodontically treated teeth, that he has invented.
  • He has been Professor of Endodontics in the School of Dental Hygiene (2002-2008).
  • From 2009 to 2012 he has worked as Researcher in the Department of Endodontics at the University of Rome “La Sapienza”. From 2013 he is Professor of Endodontics II at the Catholic University of Sacred Heart (UCSC).
  • From 2016 he is Professor and Chair of Endodontics in Magna Graecia University – Catanzaro Italy. His main scientific interests are the preparation of root canals with Nickel-Titanium rotary instruments, the study of anatomy and preparation of endodontic anatomy by micro-computed tomography techniques and the restoration of the endodontically treated teeth with new conservative approach.
  • He contributed in the development of different instrument systems and new techniques, being even titular of international patents in endodontics and oral surgery fields.
  • He is certified member of the European Society of Endodontology (ESE), International Member of the American Association of Endodontics (AAE), active member of the Italian Society of Conservative Dentistry (SIDOC) and he is member of the executive council of the Italian Academy of Endodontics (AIE).
  • Dr. Grande has published extensively in international peer-reviewed journals, he is contributor in several books of endodontic interest, member of the Editorial board of international peer reviewed journals and he is lecturing both nationally and internationally as keynote speaker in the fields of endodontics, microsurgery and restorative dentistry.
  • He works in private practice limited to endodontic and microsurgery in Rome – Italy.