Success in Endodontics was originally based on the triad of debridement, thorough disinfection and obturation with all the aspects equally important. At present, successful root canal treatment is based on broader principles, these includes Diagnosis and treatment planning Knowledge of anatomy and morphology Concepts of thorough debridement Obturation of the root canal space Finally the coronal seal / restoration. A meta- analysis of factors influencing the root canal treatment found that the following four factors influenced success: Absence of pre-treatment periapical lesion / Co-existing pathology Root canal fillings with minimal or no voids Obturation to within 2.0mm / or as close as possible to the radiographic apex An adequate coronal restoration.

1. V I O L A S O L O M O N
Panineeya Institute of Dental
Sciences and Research Center
Hyderabad – INDIA

2. V I O L A S O L O M O N
OBTURATION OF THE
ROOT CANAL SPACE
Part - 1
Dr. Raji Viola Solomon., MDS., MFDS., RCPS (Glasgow)
Department Of Conservative Dentistry & Endodontics
Panineeya Institute Of Dental Sciences And Research Center
Hyderabad
INDIA

3. V I O L A S O L O M O N
UNDERSTANDING THE PULP CANAL SPACE

4. V I O L A S O L O M O N
• Although there is tremendous variance in the root canal system, the obturated root canal should reflect a
shape that is approximately the same shape as the root morphology.
• The internal anatomy of the canal space should reflect or mirror the external root surface morphology.
4
GOAL
Dr. Raji Viola Solomon

5. V I O L A S O L O M O N
CONTENTS
• Introduction
• History
• Rationale of obturation
• Apical extent of obturation
• Length of the obturation
• Timing of obturation
• Armamentarium
• Obturating materials
5Dr. Raji Viola Solomon

6. V I O L A S O L O M O N
CONTENTS
• Classification of obturation techniques
• Individual obturation techniques
• Clinical significance
• Conclusion
• References
6Dr. Raji Viola Solomon

7. V I O L A S O L O M O N
INTRODUCTION
• Success in Endodontics was originally based on the triad of
debridement, thorough disinfection and obturation with all the
aspects equally important.
• At present, successful root canal treatment is based on broader
principles, these includes
 Diagnosis and treatment planning
 Knowledge of anatomy and morphology
 Concepts of thorough debridement
 Obturation of the root canal space
 Finally the coronal seal / restoration.
7Dr. Raji Viola Solomon

8. V I O L A S O L O M O N
INTRODUCTION
A meta- analysis of factors influencing the root canal treatment
found that the following four factors influenced success:
• Absence of pre-treatment periapical lesion / Co-existing
pathology
• Root canal fillings with minimal or no voids
• Obturation to within 2.0mm / or as close as possible to the
radiographic apex
• An adequate coronal restoration.
Ng YL, Mann V et al. outcome of primary root canal treatment;
systematic review of literature. IEJ 41; 6; 2008
8Dr. Raji Viola Solomon

9. V I O L A S O L O M O N
DEFINITION OF OBTURATION
• The three-dimensional filling of the entire root canal system as close to the
cementodentinal junction as possible.’
-American Association Of Endodontists(AAE)
• Obturation is defined as the total obliteration of the root canal space and
development of a fluid tight seal at the apical foramen.
9Dr. Raji Viola Solomon

10. V I O L A S O L O M O N
PURPOSE OF OBTURATION
• To eliminate all avenues of leakage from the oral cavity
or peri radicular tissues into the root canal system.
• To seal within the root canal system any irritants / toxins
that cannot be fully removed during the cleaning and
shaping (chemo-mechanical) phase.
10Dr. Raji Viola Solomon

11. V I O L A S O L O M O N
HISTORY
200 B.C. – Oldest known root canal filling -bronze wire -
found inside the root canal in the skull of a Nabatean warrior
1757- Carious teeth were extracted ,filled with gold/ lead &
replanted again
1825- Gold foil by Edward Hudson
11Dr. Raji Viola Solomon

12. V I O L A S O L O M O N
1843- Sir Jose d Almeida – First introduced gutta percha to Royal
Asiatic Society of England
Edwin Truman- 1st introduced gutta percha to dentistry as a
temporary filling material
1847- Hill developed Gutta percha as a root filling material
‘Hill’s stopping (mixture of bleached gutta-percha + carbonate of
lime and quartz)
1848- Was patented and first used as insulation for undersea
cables
12Dr. Raji Viola Solomon

13. V I O L A S O L O M O N
• ‘Gutties’ – Golf balls -The era of Gutta-percha golf balls
lasted from 1845-1900, till the introduction of natural rubber in
its manufacture
• 1867- C. A. Bowman, 1st used gutta percha for canal filling in
an extracted first molar
• 1883-Perry claimed the use of
Pointed gold wire wrapped with some soft gutta-percha
Gutta percha rolled into points and packed into the canal
Chemical softening of shellac coated gutta percha using
alcohol
13Dr. Raji Viola Solomon

14. V I O L A S O L O M O N
 1887- S.S. White Company began to manufacture gutta
percha points
 1893-Rollins introduced new type of gutta percha to which
he added vermilion (pure oxide of mercury)
 1914-Callahan - softening and dissolution of gutta percha to
serve as the cementing agent through the use of rosins-
diffusion technique
 1930- Elmer A. Jasper introduced silver points
14Dr. Raji Viola Solomon

15. V I O L A S O L O M O N
1959- Ingle & Levine – standardization of root canal instruments
& filling materials
1967- Schilder popularized vertical condensation technique.
1977- Yee et al introduced the injectable thermoplasticized gutta-
percha technique
1978- W. Ben Johnson described a technique of obturation with
gutta percha coated endodontic file (forerunner of Thermafil)
1979- Mc Spadden introduced a special compactor for softening
gutta percha by friction
15Dr. Raji Viola Solomon

16. V I O L A S O L O M O N
1984- Michanowicz introduced a low temperature (70C)
injectable thermoplasticized gutta-percha technique- Ultrafil
1994- James B. Roane - Inject R-Fill technique
1996- Steven Buchanan developed a new method of vertical
compaction of warm gutta percha - continuous wave of
condensation technique (System B)
2003 – Martin and Ray introduced Resilon
16Dr. Raji Viola Solomon

17. V I O L A S O L O M O N
Why do we have to obturate?
17Dr. Raji Viola Solomon

18. V I O L A S O L O M O N
18
Hollow tube theory/ stagnation theory -
RICKERT AND DIXON (1931)
Ingle and Dow (1955) supporting this theory showed that
incompletely obturated root canals and root fillings leak.
Prevents percolation and microleakage of periapical
exudates into the root canal space.
Prevents reinfection
Complexity of the root canal anatomy and the
existence of fins, lateral and accessory canals.
Dr. Raji Viola Solomon

19. V I O L A S O L O M O N
Evidence based
Seltzer’s experiments (1961,1964,1968)
Periapical tissues in unfilled teeth remained
chronically inflamed over a long period of time
• Exchange of metabolites between root canal and saliva
/ periapical fluid
• Permeability / microleakage of the occlusal restoration
• Sustained gingival and periodontal disease
19Dr. Raji Viola Solomon

20. V I O L A S O L O M O N
EVIDENCE BASED
Study by Ingle and Beveridge (1985) :
58% Endodontic failures – INCOMPLETE OBTURATION
• They demonstrated that nearly 60% of endodontic failures
were caused by an incomplete obturation of the root canal
system
20Dr. Raji Viola Solomon

21. V I O L A S O L O M O N
21Dr. Raji Viola Solomon

22. V I O L A S O L O M O N
Objectives of obturation
Biological objectives
Total obliteration of the canal space and
perfect sealing of the apical foramen at
the dentino-cemental junction and
accessory canals at locations other than
root apex with an inert, dimensionally
stable and biocompatible material.
Radiological objectives
Radiographically – “a dense, three
dimensional filling which extends as
close as possible to the cementodentinal
junction, without gross over extension or
under filling in the presence of a patent
canal”.
22
Appropriateness of care and Quality Assurance Guidelines” (AAE)
Dr. Raji Viola Solomon

23. V I O L A S O L O M O N
Apical Extent of Obturation
23Dr. Raji Viola Solomon

24. V I O L A S O L O M O N
RATIONALE FOR APICAL LIMIT OF OBTURATION
1) BEYOND THE RADIOGRAPHIC APEX
Proponents of softened gutta percha
technique
‘APICAL PUFF’ OR ‘BUTTON’
• To compensate for shrinkage of the filling
• As an indicator that gutta percha has been
densely packed in to apical preparation
• All aberrations, lateral and accessory canals
have been cleansed and filled
24Dr. Raji Viola Solomon

25. V I O L A S O L O M O N
2) AT THE RADIOGRAPHIC APEX
Must fill lateral and apical ramifications
CDJ/ apical constriction variable
• Radiographic apex fixed point
• Determined by final radiographic examination
• Small excess of filling material well tolerated
25
RATIONALE FOR APICAL LIMIT OF OBTURATION
Dr. Raji Viola Solomon

26. V I O L A S O L O M O N
3) SHORT OF RADIOGRAPHIC APEX
NYGAARD – ØSTBY (1961)
• Apical space filled by connective tissue / Necrotic debris
SJOGREN (1990)
• Obturation materials (especially sealers) may elicit sensitivity and
immune response and should remain in the canal
• SELYE (1959) TORNECK (1966) SELTZER (1964)
26
RATIONALE FOR APICAL LIMIT OF OBTURATION
Dr. Raji Viola Solomon

27. V I O L A S O L O M O N
AT THE CEMENTO DENTINAL JUNCTION
GROVE (1929)
CDJ
- maximal apical constriction
pulp tissue ends
KUTTLER (1951, 1955, 1958)
Average thickness of apical cementum is 0.5 mm
From the apical foramen
CDJ ~ 0.5 mm in young people
0.75 mm in older individuals
•
27
RATIONALE FOR APICAL LIMIT OF OBTURATION
Dr. Raji Viola Solomon

28. V I O L A S O L O M O N
Overfilling – total obturation of the root
canal space with excess material
extruding beyond the apical foramen
Overextension – extrusion of filling
material beyond the apical foramen but
the canal has not been adequately filled.
28Dr. Raji Viola Solomon

29. V I O L A S O L O M O N
• Achievement of hermetic seal is often considered a major
goal.
• Hermetic seal - seal against escape or entry of air
• Hermes Trismesistus / Hermes thrice greatest – God of
wisdom, learning and magic in ancient Egypt – preservation
of oils, spices aromatics etc – simple wax seal of porous
vessel wall - to create Hermetic seal
• 1960’s Grossman coined the term – Hermetic seal
• Endodontically the term – inappropriate
• Ramsey - “fluid impervious seal”/ fluid- tight / bacteria -
tight
29Dr. Raji Viola Solomon

30. V I O L A S O L O M O N
When to obturate????
Negative culture test
No excessive exudate from the canal
Absence of foul odor
Lack of periapical sensitivity
The tooth is asymptomatic
30Dr. Raji Viola Solomon

31. V I O L A S O L O M O N
TIMING OF OBTURATION
31
SINGLE VISIT VERSUS MULTIPLE VISIT
Dr. Raji Viola Solomon

32. V I O L A S O L O M O N
OLIET’S CRITERIA FOR CASE SELECTION - SVE
32
• Positive patients acceptance.
• Sufficient available time to complete the procedure properly.
• Absence of any acute symptoms requiring drainage via the
canal and of persistent continuous flow of exudates or
blood.
• Absence of anatomical obstacles like calcification in the
canals and procedural difficulties (ledge formation,
blockage, perforation).
Dr. Raji Viola Solomon

33. V I O L A S O L O M O N
Studies evaluating Healing of single visit and multiple
visit root canal treatment
33
Trope et al (1999) 64 Vs 74 %
Weiger et al (2000) 83 Vs 71 %
Peters & Wesselink (2002) 85 Vs 71 %
Effectiveness of single- versus multiple-visit endodontic treatment of teeth with apicalperiodontitis: a
systematic review and meta-analysis. C. Sathorn, P. Parashos & H. H. Messer…. International
Endodontic Journal, 38, 347–355, 2005
Dr. Raji Viola Solomon

34. V I O L A S O L O M O N
POST OPERATIVE PAIN
Post-operative pain is greater when endodontic treatment is
performed in single visit.
Literature shows no difference between
SVE & MVE
Foxetal-1970 Alacam-1985
Wolch&Fouad-1975 Fava-1994
Solnoff-1978 Eleazer & eleazer-1998
Etheretal-1978 Weiger et al-2000
Oliet-1981 Soares & cesar-2001
34Dr. Raji Viola Solomon

35. V I O L A S O L O M O N
Armamentarium
• Absorbant paper points
• Endodontic pliers
• Spreaders
• Pluggers
• Heat carriers
• Paste fillers
• Equipment for Gutta percha / MTA
35Dr. Raji Viola Solomon

36. V I O L A S O L O M O N
Paper points
ANSI/ADA Specification No. 73
36
• Color - coded
• Premarked
• Pre-sterilized by irradiation
• Uniformly taper ( 0.2 mm
/mm)
• Smooth – sided paper comes
to which a binder (starch) has
been added to prevent
unraveling and for stiffness
Dr. Raji Viola Solomon

37. V I O L A S O L O M O N
ANSI/ADA Specification No. 73 requirements
• Sizing for absorbent points corresponds to that for
standardized & conventional gutta – percha cones
• Bio compatibility of materials and binders used in their
fabrication
• Should not disintegrate upon immersion in liquid
during use
37Dr. Raji Viola Solomon

38. V I O L A S O L O M O N
Uses Of Paper Points
• To remove residual moisture following irrigation and before
obturation of the root canal
• Earlier placement of medication – soaked absorbent points as
inter appointment dressings
No more used
Medicated absorbent points, act as a wick , drawing the
cytotoxic liquid to the periapical tissues and causing an
acute inflammatory reaction
Overextension of the absorbent point beyond the apex –
may induce a foreign body reaction
• Also to check for timing of obturation -culture
38Dr. Raji Viola Solomon

39. V I O L A S O L O M O N
ENDODONTIC PLIERS
Working part has grooves
For holding gutta percha and absorbent points
Available as
1. Non-locking
2. Locking
For secure transfer of points
39Dr. Raji Viola Solomon

40. V I O L A S O L O M O N
SPREADER
ADA/ ANSI No.71
Is a tapered and pointed instrument
Used to laterally displace gutta-percha cones in the lateral
compaction technique
Materials used - Carbon steel
Stainless steel
Nickel titanium
Available as - hand held instruments
finger held instruments
40Dr. Raji Viola Solomon

41. V I O L A S O L O M O N
41Dr. Raji Viola Solomon

42. V I O L A S O L O M O N
• Nickel-titanium spreaders induced stress patterns distributed
along the surface of curved canals compared to concentrated
spikes of stress when stainless steel spreaders were used.
• They also pointed out that, because of their flexibility, nickel-
titanium “spreaders penetrated to a significantly greater depth
than the stainless steel spreaders in curved canals.
Berry KA, Loushine RJ, Primack PD, Runyun DA. Nickel-
titanium versus stainless steel finger spreaders in curved canals.
JOE 1998;24:752.
42Dr. Raji Viola Solomon

43. V I O L A S O L O M O N
HAND HELD SPREADERS
Usually single ended instruments
e.g. Hu Friedy :D 11, D 11T
size 30-60
calibrated instruments
Premier : RC 25 S
DISADVANTAGES
- Tips of the working end are offset from the long axis of the handles
which results in a loss of balance of instrument and strong lateral
wedging forces on the working ends. Hence there is a risk of
vertical damage to root
- Difficult to use in the posterior region
43Dr. Raji Viola Solomon

44. V I O L A S O L O M O N
FINGER HELD SPREADERS
Introduced by Luks in early 1960’s
Advantages :
Greater control of compaction process (as fingers are close to
the tip of the instrument)
Lesser risk of vertical root fractures
Easier to use throughout the mouth
Available as :non- standardized
standardized
Available as: Stainless steel
NiTI spreaders
Hyflex (Hygenic)
44Dr. Raji Viola Solomon

45. V I O L A S O L O M O N
PLUGGERS
• ADA/ANSI NO.71
• Is a tapered and blunt ended instrument whose main component of
force during use is vertical rather than lateral
• Finger pluggers can be modified into finger spreaders after being
sharpened at their flat ended tip (Gerstein 1984)
• Available as
• Hand held
• single – ended
• double – ended
• Finger held
45Dr. Raji Viola Solomon

46. V I O L A S O L O M O N
Schilder’s Pluggers
• Serrations at five millimeter intervals help to know the
working depth of the various instruments.
46Dr. Raji Viola Solomon

47. V I O L A S O L O M O N
Heat carriers
• This is nothing more than a spreader;
however, it is not used cold to create
space among the cones, but rather
warm to deliver heat to the gutta-
percha cone in the root canal.
• Used to transfer heat to the gutta
percha in the root canal in warm
vertical compaction techniques
47Dr. Raji Viola Solomon

48. V I O L A S O L O M O N
48
TRADITIONAL HEAT CARRIERS
• Hand held instruments
• Similar to pluggers
• Heated over a flame
Eg
Kerr’s No. 3 spreader
5/7 HuFriedy Plugger
PCA D4 (Pulpdent Corp, U.S)
• Instrument is sharp pointed
• Has a bulbous portion at the end of the shank
which retains heat
Dr. Raji Viola Solomon

49. V I O L A S O L O M O N
ELECTRICAL HEAT CARRIERS
• Can be heated to controlled levels
• E.g.Endotec (Caulk / Dentsply Milford)
Touch ‘N’ Heat (Analytic Orange
CA)
System B
DEVICES FOR CUTTING GUTTA PERCHA
• GUTTA CUT (Antaeos VDW)
• Lightweight Cordless device with a special
Gutta Percha removal head
• Battery operated Interchangeable heads
• Several different cutting heads are available
• for both large and narrow root canals
49Dr. Raji Viola Solomon

50. V I O L A S O L O M O N
50
ROTARY OR SPIRAL PASTE FILLERS
Used for
• Placing initial sealer with solid core materials
• Completely filling the canal with paste filling
Designed
• To be used in slow speed contra angle headpiece
• Can also be turned clockwise between fingers
Dr. Raji Viola Solomon

51. V I O L A S O L O M O N
51
LENTULO SPIRALS (Produits Dentaires, Switzerland)
• Should only be used for inserting intra canal sealers, pastes.
COILED WIRE WITH SAFETY DEVICE (Micro Mega France)
• Has a ‘safety spiral’ – wire nearest to handle tightly coiled
• So that it fractures at this point if the instrument binds & may be
safely removed
Dr. Raji Viola Solomon

52. V I O L A S O L O M O N
52
DEVICES FOR PLACEMENT OF MINERAL TRIOXIDE AGGREGATE
• Amalgam carrier
• Messing gun (Moyco – Union Broach Long Island NY)
• MTA Endo Gun (Dentsply, Maillefer)
• Tips of 2 sizes
Yellow
• External diameter 0.9mm
• Internal diameter 0.6mm
Red
• External diameter 1.1mm
• Internal diameter 0.8mm
Dr. Raji Viola Solomon

53. V I O L A S O L O M O N
MTA PLUGGERS
53Dr. Raji Viola Solomon

54. V I O L A S O L O M O N
54
DISADVANTAGE
But even though the
needles were bendable,
the carrier was not
comfortable to use during
surgery
Dr. Raji Viola Solomon

55. V I O L A S O L O M O N
Micro Apical Placement (MAP) System
55Dr. Raji Viola Solomon

56. V I O L A S O L O M O N
End of PART 1