OBTURATION

definition The three-dimensional filling of the entire root canal system as close as possible to the cementodentinal junction American Association Of Endodontists (AAE), 1994

RATIONALE FOR OBTURATION “Bacteria are the primary source of persistent periradicular inflammation and endodontic failure” (Ingle & Bakland, 5th Ed) Coronal seal Coronal.prevents ingress of bacteria, fluids and nutrients from the oral cavity into the cleaned root canal Prevents communication of pulpal space with periradicular tissues through accessory and lateral canals. Densely filled root canal imparts better fracture resistance to tooth than empty/hollow root canal Apical. : prevents egress of remaining bacteria or metabolites out of root canal and ingress of periapical tissue fluids into root canal through apical foramen Lateral seal: Apical seal

When to Obturate ?? Tooth is asymptomatic, or very mildly symptomatic with definite, ongoing symptom resolution Canal preparation dries completely to its terminus Canal is relatively “free” of bacteria No foul odor is noted upon canal system entry Temporary restoration intact and uncompromised No sinus tract is present (debatable) No signs of active infection

Not irritate periradicular tissues Sterile or sterilizable Ideal requirements of root canal filling materials Grossman’s Criteria (1940) Easily introduced Seal laterally as well as apically Not shrink after being inserted Impervious to moisture Bacteriostatic Radiopaque Not stain tooth Not irritate periradicular tissues Sterile or sterilizable Easily removed

classification sealers Core materials Metals Plastics Plastics Cements OBTURATING MATERIALS sealers Core materials Metals Plastics Pastes/ Cements Plastics Cements Pastes

CORE FILLING MATERIALS Metal Silver Stainless steel files Gold Iridioplatinum Tantalum Titanium Amalgam Plastics GP Hydron Resilon Pastes/ Cements: N2 – Sargenti technique Resorcinol – formaldehyde resin (Russian Red Cement) Calcium phosphate cement (CPC) MTA

GP/Sealer Obturation Techniques Lateral compaction (old term –“condensation”) Vertical compaction Thermo mechanical Thermoplasticized Hybrid (thermo- and non Thermoplasticized combined) Master apical impression

Lateral Compaction

Advantages Long track record Replicates canal adequately Seals well Inexpensive Requires little armamentarium Disadvantages Moderately time consuming Can vertically fracture roots May leave vertical voids

years lateral compaction has been the worldwide standard for obturation. If properly done it has proved to be a very acceptable method to obturate most root canals. Some clinicians dip the primary point in chloroform for 1 second only before inserting it in the canal, claiming this makes for a more adaptive seal at the minor foramen.

ISO-normed and color-coded gutta percha.

Gutta percha points from various manufacturers.

Gutta percha and finger spreaders for lateral condensation.

Hand spreaders with increasing sizes.

The spreader is inserted adjacent to the master point to 1mm short of the apical foramen.

Insertion and subsequent lateral condensation of the gutta percha master point.

Insertion and subsequent lateral condensation of the gutta percha master point.

Because of the irregularity of the canal walls, the gutta percha master point does not completely fill it.

Following initial condensation, the gutta percha point is deformed and pressed against the canal walls.

A sealer-coated secondary gutta percha point is inserted into the cavity.

The schematic depicts the laterally condensed gutta percha point and the spreader.

The cross-section schematic shows the third accessory gutta percha point (pink) following lateral condensation.

Condensation of the individual gutta percha points leads to a homogeneous mass, whose percentage composition of sealer is less than 5%.

Following radiographic evaluation of the master point, the point is coated with sealer and inserted into the canal with up and down movements.

Following radiographic evaluation of the master point, the point is coated with sealer and inserted into the canal with up and down movements.

Following radiographic evaluation of the master point, the point is coated with sealer and inserted into the canal with up and down movements.

With a size 30 finger spreader, the gutta percha points are condensed onto/into each other.

The tip of each additional gutta percha point is dipped into sealer and then inserted into the canal.

Condensation of the gutta percha continues until the spreader can only be inserted into the middle third of the root canal.

Following removal of the excess gutta percha using a heated spatula, the remaining material is vertically condensed.

Visual (clinical) and final radiographic check of the complete root canal filling.

Visual (clinical) and final radiographic check of the complete root canal filling.