1. College of Dentistry, Zulfi
30/11/2014
Asalaam Alekum
Root canal Obturation
Dr. Gaurav Garg
Lecturer
College of Dentistry, Zulfi

2. Successful endodontic treatment depends on
Proper diagnosis
Favorable prognosis assessment
Proper disinfection, cleaning, shaping, and
Obturation of the root canals

3. WHY TO OBTURATE THE CANAL ???3

4. Readiness of the root canal for filling
Negative culture
No excessive exudate from the canal
Absence of foul odor
Lack of periapical sensitivity
One look at these so-called “glassy smooth” walls in an electron micrograph leaves one in doubt .The smear layer may also be loaded with bacteria that penetrate out of the layer into the dentinal tubules.

5. Requirements for an ideal root filling material
(by Grossman,1980)
• Easily introduced in the canal
• Radiopaque
• Dimensionally stable
• Seals the canal laterally and apically, conforming to its
complex internal anatomy
• Impervious to moisture
• Inhibits bacterial growth
• Nonirritating to the periapical tissues
• Sterile or can be easily sterilized
• Does not discolor tooth structure
• Easily removed from the canal if necessary

6. GUTTA PERCHA : EVOLUTION INTO DENTISTRY
“GETAH”- meaning gum
“PERTJA”- name of the tree in Malay language
First introduced to dentistry as a temporary filling material by Edwin Truman.

7. Trans-isomer of polyisoprene
CHEMISTRY OF GUTTA-PERCHA
Trans-isomer of polyisoprene
Harder, more brittle and less elastic than natural rubber
Composition :
18-20% gutta-percha
59-76% zinc oxide
1-18% radio-opacifiers
1-4% plasticizers

8. Can be sterilized In 5.25% NaOCl for 1 minute.
Advantages of gutta percha
Compactibility
Inertness
Dimensional stability
Tissue tolerance
Radiopacity
Becomes plastic when warmed
Known solvents ( Chloroform, Xylene, Eucalyptus oil)
Can be sterilized In 5.25% NaOCl for 1 minute.
Disadvantages
Lack of rigidity
lack of length control

9. Silver cones
In 1933, Jasper introduced silver cones. Their rigidity made them easy to place; however, their inability to fill the irregularly shaped root canal system permitted leakage.
Disadvantages:
Inability to fill the irregularly shaped root canal & hence leakage
When in contact with tissue fluids or saliva they corrode
Corrosion products are cytotoxic & produce pathosis or impeded periapical healing.

10. Root canal sealers Zinc oxide containing sealers
Calcium hydroxide containing sealers
Glass ionomer containing sealers
Resin sealers
Silicone-based sealers
Urethane methacrylate sealers

11. Obturation techniques
I. Solid Core Gutta-Percha with Sealants
A. Cold gutta-percha points
Lateral compaction
B. Chemically plasticized cold gutta-percha
Essential oils and solvents
a. Eucalyptol
b. Chloroform
c. Halothane

12. C. Canal-warmed gutta-percha
1. Vertical compaction/ Schilder’s method
2. System B compaction
3. Sectional compaction
4. Lateral/vertical compaction - Endotec II
5. Thermomechanical compaction
Microseal System/ McSpadden Compactor
Ultrasonic plasticizing
D. Thermoplasticized gutta-percha
1. Syringe insertion
a. Obtura
b. Inject-R-Fill, backfill
2. Solid-core carrier insertion
a. Thermafil
b. Sucessfil
c. Simplifil

13. II. Apical-Third Filling
A. Dentin-chip
B. Calcium hydroxide
III. Injection or “Spiral” Filling
A. Cements
B. Pastes
C. Plastics
D. Calcium phosphate

14. Two main types of spreading instruments long handled spreaders
LATERAL COMPACTION OF GUTTA-PERCHA
Objective: fill the canal with gutta-percha points (cones) by compacting them laterally against the sides of the canal walls.
Two main types of spreading instruments
long handled spreaders
finger spreaders
The technique requires selection of a master point, which should seat about 0.5 mm short of the working length. Once the master point is fitted to length and demonstrates a slight resistance to withdrawal (tug-back), accessory points are then inserted alongside the master point and compacted laterally with a spreader until the canal is sealed.
Finger spreaders provide: better tactile sensation & less likely to induce fractures

15. Spreader fit Fit within 1-2mm of CWL.
If not, more shaping is required because apical size and taper is inadequate.

16. Excessive force should be avoided—cold gutta-percha is not greatly compressible, and as little as 1.5 kg of pressure are capable of fracturing the root.

17. Master Cone Fit
Select Master Cone size that corresponds to your MAF size.
Ex. MAF size 30
MC size should also be size 30.

24. Check Master Cone (MC) Length

25. Master Cone Fit 23
If MC is at FWL, you are ready to obturate.

26. Mark the Master Cone to FWL

27. Place MC in the canal system.

28. Mark should correspond to reference point.

29. Master Cone Fit The Master Cone should seat to final working length.
Obturation length= FWL

30. Master Cone Fit
The MC should have a definite apical resistance when MC is placed to FWL.
The MC should exhibit “tugback” or resistance to removal.

31. Mix the Sealer

32. Mix the Sealer

33. Mix the Sealer

34. Mix the Sealer

35. Sealer Placement

71. Lateral Compaction
Do this until the canal is obturated to the cervical line.
Take a radiograph at this time and evaluate fill.
This confirms adequacy of the obturation.

72. Lateral Compaction
If the obturation is satisfactory, the excess gutta percha should be cut to the CEJ level (bucco- lingual).
If obturation is not dense, or if voids are present, remove all the cones and redo the obturation process.

77. Final Radiograph
Remove the rubber dam clamp and rubber dam material and take the radiograph.
*In a real patient, a temporary restoration is placed before rubber dam is removed.

78. Selection of Spreader:
SUMMARY
Selection of Spreader:
A spreader is selected that matches the taper of the canal and When placed in the canal it should be within 2 mm from the working length.

79. Selection of master cone:
SUMMARY
Selection of master cone:
Following canal preparation a master cone is selected that has a diameter consistent with the Master Apical File (MAF).
This “master cone” is measured & grasped with a forceps so that the distance from the cone tip to the forceps is equal to the prepared length.
The cone is placed in the canal & if an appropriate size is selected, there will be resistance to displacement or “tug back”.
The master cone placement is confirmed with a radiograph.

80. Lateral Condensation:
SUMMARY
Lateral Condensation:
Canal is irrigated and dried with paper points.
Sealer is applied to the canal walls and also to the master cone and it is placed in the canal.
Now spreader is inserted to make space for accessory cone.
After placement the spreader is removed by rotating it back & forth as it is withdrawn.
An accessory cone is placed in the space vacated by the spreader.
The process is repeated until the spreader no longer penetrate the coronal 2-3 mm of the canal.
The excess gutta-percha is removed with heated instrument & the coronal mass is compacted with a plugger.
Obturation is checked radiographically.

81. Excellent length control Limitations:
Efficacy of Lateral Compaction
“Gold standard”
Advantage :
Excellent length control
Limitations:
However, this technique may not fill canal irregularities
Gutta-percha cones never merge into a homogeneous mass, but they slip and glide and are frozen in a sea of cement

82. Radiographic evaluation of obturation
Radiolucencies: Voids within the body or at the interface of obturating material and dentin wall represent incomplete obturation.
Density: Material should be of uniform density from
coronal to apical aspects. The margins of gutta-percha should be sharp and distinct with no fuzziness, indicating close adaptation.
Length: The material should extend to the prepared
length and be removed apical to the gingival margin
(anterior teeth) and orifices (posterior teeth).
Taper: The gutta-percha should reflect the canal shape;
that is, it should be tapered from coronal to apical regions.
Restoration: Whether permanent or temporary, the restoration should be contacting enough dentin surface to ensure a coronal seal.

83. Root canal obturation continued…….
7/12/2014
Root canal obturation
continued…….

84. 2. VERTICAL COMPACTION OF WARM GUTTA-PERCHA
Schilder in 1967.
Heated gutta-percha has been shown to flow extremely well into all canal irregularities.
It is particularly useful in situations such as internal resorption, C-shaped canals, and those with fins or webs.

85. Schilder’s pluggeres (9)
Spreader- Heat Carrier
Pluggers- vertical compaction
Schilder’s pluggeres (9)
Tip diameter: 0.40,0.50,0.60,0.70,0.80, ,1.30,1.50

86. Plugger Selection Coronal third- 5-6mm Middle third- 12-15mm
Apical third- 5-6mm

87. Master Cone Selection
The cone must be slightly shorter than the preparation

88. Sealer Application
Sealer is mixed and applied in canal with the help of an endodontic file

89. Master Cone Placement
Master Cone should also be coated with sealer and placed inside the canal at desired length

90. Vertical Compaction
Coronal Third
Middle third
Apical third

91. Advantages: filling of canal irregularities and accessory canals.
Disadvantages :
The risk of vertical root fracture
Less length control than in lateral compaction
Warm vertical compaction is difficult in curved canals where rigid pluggers are unable to penetrate to the necessary depth, requiring that the canals be enlarged and more tapered in comparison with the lateral condensation technique.

92. Use of a flame-heated instrument does not permit temperature control.
The critical level of root-surface heat required to produce irreversible bone damage is believed to be greater than 10°C
Use of a flame-heated instrument does not permit temperature control.
The DownPak Cordless obturation device, the System B, and Touch ’n Heat (SybronEndo) devices, permit temperature control.

93. Endotec II
It is a battery-powered, heat-controlled spreader/plugger..The quick-change, heated tips are sized equivalent to a No. 30 instrument are autoclavable and can be adjusted to any access angulation.

94. root canal under pressure.
THERMOMECHANICAL COMPACTION OF GUTTA-PERCHA
In 1979, McSpadden devised a handpiece-driven ( rpm) compactor, which is effectively an inverted Hedstroem file.
The frictional heat from the compactor plasticises the gutta-percha and the blades drive the softened material into the
root canal under pressure.

95. The compactor is selected based on the size of the canal preparation and inserted with the hand piece activated alongside the gutta-percha cone 2 to 3 mm from the prepared length.
The gutta-percha is heated by the friction of the rotating compector, and is compacted apically and laterally as the device is slowly withdrawn from the canal.

96. Advantages :
simplicity, speed, and the ability to fill canal irregularities.
Disadvantages :
Extrusion of filling material beyond the apex
The potential for instrument fracture
Difficulty in using the technique in curved canals
Uncontrolled heat generation.

97. Use of heat and vibration: DownPak
An alternative to cold lateral compaction with finger spreaders : DownPak Obturation
The DownPak is cordless and designed with a multifunctional, endodontic heating and vibrating spreader device, and can be used for both warm vertical and lateral condensation techniques.

98. 3. Thermoplastisized Gutta Percha
Syringe Insertion- Obtura
Solid-core carrier insertion- Thermafil

99. 1. Obtura System
Consists of a hand-held “gun” with a chamber into which pellets of gutta-percha are loaded, along with silver needles of varying gauges used to deliver the thermoplasticized material to the canal.
The temperature, and thus the viscosity, of the gutta-percha can be adjusted.

100. A wide, well-prepared canal is a prerequisite.
After drying the canal apply a small amount of sealer.
The tip of injecting needle should be kept 3-5 mm short of working length and it should be withdrawn outwards coronally while injecting gutta percha.
The coronal portion of gutta percha should be compacted using a plugger to enhance coronal seal.

101. Advantages:
Easy and less time consuming
3-D obturation
Enhanced apical and coronal seal
Useful in C-shaped, irregular and complex root canals
Disadvantage:
Risk of overfilling
Not suitable for canals with open apices

102. 2. Thermafil Components: Thermafil obturators Size verifiers
Thermafil Oven
Obturators
Thermafil oven

103. Thermafil Technique:
Canal preparation
Obturator selection
Sealer placement
Obturation

104. Advantages:
Easy to use
Obturation of curved canals
3-D Obturation
Disadvantages:
Not suitable for obturation of teeth with immature apices,
Canals with bifurcations or trifurcations in the middle Third
Risk of overfilling

105. Stimulate osteo or cementogenesis Holland et al., found, however,
Dentin Chip Apical Filling
“Biologic seal” rather than a mechanochemical seal.
Stimulate osteo or cementogenesis
Holland et al., found, however,
that dentin chips, if infected, are a serious deterrent to healing (1980)

106. References ENDODONTICS: Arnaldo castellucci
PATHWAYS OF THE PULP (6th Edition): Stephen Cohen, Richard C. Burns
PRINCIPLES AND PRACTICE OF ENDODONTICS (3RD EDITION): Walton & Torabinejad
ENDODONTIC THERAPY (6th Edition): Franklin S. Weine

107. Thank you