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ENDODONTICS
ENDODONTICS
ENDODONTICS
ENDODONTICS
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ENDODONTICS

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  • 1. 98 ENDODONTICSRapid-Flow Filling Technique onsider the following scenario: Your The Rapid-Flow Filling Technique consis- C nickel-titanium (Ni-Ti) canal prepara- tion is finished, rinsed, and dried. A Schilder plugger No. 8 is pre-fit in the canal, tently meets the last 2 of Grossman’s require- ments, ie, the gutta-percha is semisolid upon insertion and becomes solid afterward. This as are finger plugger Nos. 25 and 20. You have has been made possible by Ni-Ti canal prepa- inserted one drop of sealer into the canal. You rations, the Obtura (Obtura Spartan), and pick up your Obtura to back-fill the canal, temperature-controlled gutta-percha, such as condense with the No. 8 plugger, No. 25 finger Schwed regular flow gutta-percha (Charles B.Jay Marlin, plugger, followed by No. 20. You go back to the Schwed) or Obtura 150 gutta-percha (ObturaDMD No. 25 plugger, then the No. 8 Schilder plug- Spartan). Figure 1. Obtura unit. ger—and voilà! You are done! Gutta-percha in a perfect plastic state is What’s unusual with the above? No gutta- injected into the ideally Ni-Ti prepared root percha master cone. What’s the advantage canal space and vertically condensed until the with this scenario? You have completed a gutta-percha has solidified. Scanning electron 3-dimensional warm gutta-percha fill without microscope examination demonstrates the a master cone in less time than it takes to fit adaptation of heat-plasticized gutta-percha to a cone. And, with this Rapid-Flow Filling be equal or superior to fillings produced by Technique, you can rely on consistent results. other clinically accepted techniques.4 MATERIALS The Rapid-Flow Filling Technique has become ProFile series 29 0.06 Ni-Ti instruments an obturation method utilized by practitioners (DENTSPLY Tulsa) used in a light touch, crown-down method provide an excellently who avail themselves of the technical advance- shaped canal with a constriction at the apex and a flare at the orifice. ProTaper series 29 ments in endodontics. Practitioners in general 0.06 files (DENTSPLY Tulsa) used circumfer- practice residencies and endodontic residency entially in a crown-down technique also pro- vide the needed shape. The ProTapers cut Figure 2. Correct consistency as demonstrated by the programs as well as endodontists have mas- with a light, circumferential motion more long, fine strand of gutta-percha immediately prior to efficiently coronally than the ProFile, allow- canal injection. tered the technique with minimal direction. ing deeper penetration of the smaller sizes approaching the apex. HISTORY RC-Prep (Premier Dental Products) is The quest in endodontics is to fill prepared used in the pulp chamber as a lubricant with root canal systems in 3 dimensions. Various Ni-Ti files, and as a mild chelating agent to materials and techniques have been tried, help remove the smear layer. The new Obtura with the profession continuously returning to (Figure 1) has precise temperature settings gutta-percha. Gutta-percha meets all but 2 of required for gutta-percha flow through the Grossman’s requirements for an ideal root 20-gauge and 23-gauge needles. filling material:1 first, that it be a semisolid Gutta-percha formulations with the upon insertion, and second, that it becomes required flow properties at exact tempera- solid afterward. Solvent techniques2 have tures are necessary for successful use of the been able to provide the semisolid property, Rapid-Flow Filling Technique. Although other but evaporation of the solvent has left voids in gutta-percha formulations will work for back- the gutta-percha fillings. Schilder’s vertical filling, they lack the flow characteristics for condensation of warm gutta-percha,3 and the complete fills. With the correct formulation, more recent System B (SybronEndo) varia- gutta-percha can be drawn out to a long, hair- tion of his technique, required fitting a cone in like strand at least 1 foot long (Figure 2). the canal, then plasticizing the gutta-percha Schwed regular flow will work at 160ºC for with heat and condensing it, with repetitions the 20-gauge and 200ºC for the 23-gauge if necessary, until the material reached the Obtura needles (Obtura Spartan). Obtura 150 apex. However, the gutta-percha is not intro- gutta-percha will fulfill this task at 160ºC for duced in a plasticized state. continued on page 100 Figure 3. Endex apex locator.DENTISTRY TODAY • MAY 2006
  • 2. Legend of the Fill New Design, Same Clinical Excellence. Call for special “Trade-Up” offer on all Obturation Units Here’s what the “critics” are saying about the NEW redesigned Obtura.“In my 25 years of using injectable gutta-percha, theredesigned Obtura sets a new paradigm for quality, easeof use, and ergonomics.”- Jay Marlin, DMD, Assoc. Clinical Professor of Endodontics,Tufts School of Dental Medicine, Boston, MA“Once again Obtura has shown innovation in updating theirclassic obturation unit. The new and improved unit featuresbetter ergonomics and many user friendly features. I predict itwill become an indispensable adjunct for those practitionersseeking to achieve endodontic excellence.”- Hugh Maguire, DDS, Founder, Endodontic Learning Centre, White Rock, BC“The Obtura is my favorite device for the delivery of eithergutta-percha or Resilon, because it gives me excellent controlof the filling procedure. The "feel" is incomparable!”- Marga Ree, DDS, MSc,Netherlands“Even the most difficult canal shape is easier to fill withthe new Obtura.”- Jerzy Zbozen, DDS, Kielce, Poland For the confidence, tactile sense and“Obtura III s new aesthetically pleasing design is lesscumbersome than previous units. This ergonomic style provides control you need in Obturation,excellent tactile sensitivity, so necessary for a controlled fill. The the position has been filledpresets make using different obturation materials efficient and – the all NEW Obtura.accurate. Personally I highly recommend the new Obtura, andwill continue to use Obtura Spartan technology in my practice.”- Bobby Mallik, DMD, Green Brook, NJ“The Obtura is a must have piece of equipment for a predictableand efficient backfill in doing root canal treatment.”- Kenneth Lee, DMD, Endodontist, Exton, PAOrder DirectUSA 800 344-1321 • (636) 343-8733 • Fax (636) 343-5794CANADA 877 485-3556 • (905) 633-9656 • Fax (905) 633-9657www.obtura.com BUY DIRECT or circle 60 on card
  • 3. 100 ENDODONTICSRapid-Flow... propriately sized instrument ing two walls of the canal tocontinued from page 98 that can negotiate the apex is prevent dentin cracking during measured with an apex loca- gutta-percha compaction.both size needles. tor such as the Endex (Osada One drop of loose sealer is Roth 811 Elite Grade Electric; Figure 3). Measure- placed 1 mm short of the apicalRoot Canal Cement (Roth Inter- ment is compared with digital preparation. Using a needlenational), mixed thin rather x-ray determination. If this that fits in the middle third ofthan stringy, is the preferred measurement agrees within the canal (Figures 4a and 4b),sealer for this technique. In 1 mm of the apex locator, it is the Obtura is heated to the cor- Figure 4a. A 23-gauge needle correct- Figure 4b. The 20-gauge needles fit inaddition to its sealing proper- considered correct; otherwise, rect gutta-percha temperature ly located in the middle third of the the apical third of one mesial and distal prepared bicuspid canal. canal. Due to the preparation neededties, it must act as a lubricant a radiograph of the instru- so that it can be stretched to a in the distal canal, the needle reachesto aid the flow of the plasti- ment is taken. Once length is fine, hair-like strand (Figure 2). the lowest portion of the middle third ofcized gutta-percha into the determined, 1 mm is deduct- Excess gutta-percha is removed the distal canal.canal preparation. ed, and this measurement is from the needle tip, and it is Schilder pluggers (DENTS- used as the working length. rested to its extent in the mid-PLY Maillefer) Nos. 8 and 9, When the preparation is com- dle third of the canal. Next,and Nos. 20 and 25 stainless plete, it will be 1 mm longer with no pressure on the needle,finger pluggers (Moyco Union than the working length, the flowable filling material isBroach), not spreaders, are since the glide path and com- introduced into the canal untilrequired for condensation. pleted preparation removes the needle rises 2 mm from itsAlcohol prevents the con- the irregularities. resting position. Injection isdensers from adhering to the RC-Prep and NaOCl are stopped, and the needle is then Figure 4c. Injection of gutta-percha Figure 4d. Injection of gutta-percha halfflowable gutta-percha during used copiously during prepa- removed. The gutta-percha between apical preparation and needle. the distance between depth of needle placement and apical preparation.condensation. ration. At the completion of flows half the distance between cleaning and shaping, the the tip of the needle and the TECHNIQUE canal undergoes a final rinse prepared apical constriction,Access is accomplished, ori- with ethylene diamine tetra leaving 2 to 4 mm of distancefices located, and the largest acetic acid (EDTA) followed for the condensers to completetwo Ni-Ti files are used to by NaOCl to remove the the flow as gutta-percha solidi-open the orifices of the canals. smear layer and to expose fies (Figures 4c and 4d).Canals are irrigated with openings of accessory canals. The No. 8 Schilder pluggersodium hypochlorite (NaOCl), The canal is dried, and plug- is dipped in alcohol and intro-and the pulp chamber is gers are fitted to the extent that duced into the canal with firm Figure 5a. Completion of condensation Figure 5b. Completion of root canal and back-filling. Note apical accessory filling.filled with RC-Prep. An ap- they are 1 mm short of touch- vertical pressure short of the canal. pre-fit reference point until the filling material feels solid. Rotate the condenser on its axis and remove. With the No. 25 finger plugger dipped in alco- hol, the same motion is used until the gutta-percha is solid, then rotated on its axis and removed. The same motion is Figure 5c. Six-month postoperative Figure 5d. Healing at 6-month recall repeated with the No. 20 finger recall showing apical healing. showing extent of bone regeneration plugger. At this time the No. 25 and accessory canals visible with this is reintroduced, pushing gutta- angulation. percha circumferentially from the walls into the center of the canal. The Schilder plugger is likewise used and a radiograph taken. With the apex and acces- sory canals filled, the remain- der of the canal is back-filled with the Obtura and con- densed (Figures 5a to 5d). Figure 6a. Molar with periapical Figure 6b. Radiographic bone fill at areas and mid-root lucency at the 6-month recall. DISCUSSION distal surface of the mesial root. The Rapid-Flow Filling Tech- Patient was referred due to block- nique is a 3-dimensional fill- ages in mesial and distal canals. ing process that results in a solid impression of the root canal system and all its retentive flow characteristics required to fit a cone. irregularities. Cones are not of gutta-percha, adequate With experience, the den- required, since the gutta-per- time is available to fill the tist will adapt the Rapid- cha is plasticized outside the properly prepared root canal Flow Filling Technique to a tooth, introduced into the completely and compact the great variety of cases (Fig- canal preparation, which material as it solidifies. Forc- ures 6a to 8b). serves as a mold, and held ing the gutta-percha into under pressure during solidi- the canal intricacies is a nor- CONCLUSION fication. The technique is sim- mal advantage of this obtura- The Rapid-Flow Filling Tech- ilar to the manufacturing of tion method. Often, the com- nique has become an obtura- plastic products we use every plete filling procedure is com- tion method utilized by prac- day. Due to the unique heat- pleted in less time than is titioners who avail them- FREEinfo, circle 61 on card
  • 4. 101 ENDODONTICS XXX tions. Gutta-percha with con- Rapid-Flow Filling Technique, References 3. Schilder H. Filling root canals in three 1. Grossman LI. Endodontic Practice. 6th dimensions. Dent Clin North Am. Nov trolled temperature ranges condensation and obturation ed. Philadelphia, Pa: Lea & Febiger; 1967;723-744. and the new Obtura allow are the same as other estab- 1965:339. 4. Torabinejad M, Skobe Z, Trombly PL, et 2. Callahan JR. Rosin solution for the seal- al. Scanning electron microscopic study introduction of filling materi- lished warm gutta-percha of root canal obturation using thermo- ing of the dentinal tubuli and as an adju- al at the correct temperature techniques4 in significantly vant in the filling of root canals. J Allied plasticized gutta-percha. J Endod. 1978;4:245-250. and consistency. With the shorter chair time.! Dent Soc. 1914;9:53-63.Figure 7. Canine with Rapid-FlowFilling of bifid apex and lateral canal.Figure 8a. Wisdom tooth with No. 8instrument demonstrating severe cur-vature of distal canal. Note the radi-olucency at the base of the distalconvexity.Figure 8b. Recall of tooth in Figure8a. Mesial canals filled with lateralcondensation. Distal canal filled withRapid-Flow Filling Technique to apexshowing accessory canal into previ-ous radiolucent area. First use ofRapid-Flow Filling Technique. (Imagecourtesy of Dr. David Melrod.)selves of the technical ad-vancements in endodontics.Practitioners in general prac-tice residencies and endodon-tic residency programs aswell as endodontists havemastered the technique withminimal direction. Consis-tently accurate apex locatorsshow apical constrictions thatterminate at or just short ofthe apical foramen. Ni-Ti in-strumentation provides idealshapes with apical constric-Dr. Marlin is associate clinical profes-sor of endodontics, Tufts School ofDental Medicine. He can be reached atjmguttagun@gmail.com.Disclosure: Dr. Marlin has a royaltyinvolvement with Obtura for theirneedles. FREEinfo, circle 62 on card

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