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 - 2
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
OBTURATING MATERIALS
3Dr. Raji Viola Solomon

4. V I O L A S O L O M O N
Ideal Requirements
• Easily introduced
• Seal laterally as well as apically
• Not shrink after being inserted
• Impervious to moisture
• Bacteriostatic or at least not encourage bacterial growth
• Radiopaque
• Not stain tooth
• Not irritate peri radicular tissues
• Easily and quickly sterilized
• Easily removed if necessary
4Dr. Raji Viola Solomon

5. V I O L A S O L O M O N
NATURAL SOURCES
Sapodilla family.
• Palaquium gutta(Malaysian trees)
• Manilkara Bidentata – ‘balata’(Brazilian
trees)
• Mimusops globsa
5Dr. Raji Viola Solomon

6. V I O L A S O L O M O N
Chemical structure
Natural rubber
• Cis-isomer of poly
isoprene
• Elastic nature
Gutta percha
• Trans-isomer of poly
isoprene
• Crystallizes
• More brittle and less
elastic than natural rubber
6Dr. Raji Viola Solomon

7. V I O L A S O L O M O N
PHASES OF GUTTA PERCHA
7Dr. Raji Viola Solomon

8. V I O L A S O L O M O N
PHASES OF GUTTA PERCHA
Alpha (œ)
Direct form/Raw
• Low viscosity
• Sticky, Tacky, Non-
compactable
• No elongation
• Shrinkage (2.2%)
Beta (ß)
Commercial form
/purified
• High viscosity
• Reduced stickiness,
Solid, compactable
• Elongated/Flexible
• Shrinkage(2.6%)
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Two crystalline forms of gutta percha -
difference in crystalline lattice form
Amorphous phase – molten stateDr. Raji Viola Solomon

9. V I O L A S O L O M O N
 Phase  phase Amorphous melt
37° C 42 – 49°C 53 – 59°C
• Slow cooling(0.5°C Per hour) forms  chains
• Rapid cooling forms  chains
High molecular weight Low molecular weight Molten state
9Dr. Raji Viola Solomon

10. V I O L A S O L O M O N
Traditionally beta form of gutta percha was used
to manufacture endodontic gutta percha points to
achieve:
• Improved stability
• Hardness
• Reduced stickiness
10Dr. Raji Viola Solomon

11. V I O L A S O L O M O N
Alpha like forms of gutta percha were
introduced
• Low viscosity and will flow under pressure or
stress
• Increase in tackiness will create homogenous
filling
• when alpha phase gutta-percha is heated and
cooled it undergoes less shrinkage, making it
more dimensionally stable for thermo
plasticized techniques.
11Dr. Raji Viola Solomon

12. V I O L A S O L O M O N
AVAILABILITY
1. Standardized cones : Correspond to ISO Sizes and 0.02 taper
2. Standardized cone with non ISO taper :0.04, 0.06, 0.08
3. Nonstandardized cones:
 Extra fine
 Fine –fine
 Medium-fine
 Fine
 Fine-medium
 Medium
 Medium-large
 Large
12Dr. Raji Viola Solomon

13. V I O L A S O L O M O N
Availability
4. Gutta percha pellets/Bars - Injectable thermoplasitisized
gutta percha systems - Obtura
5. Gutta percha coated on carriers - Thermafil
6. Gutta percha powder in combination with resin- Gutta Flow
7. Medicated gutta percha – containing Calcium hydroxide,
Iodoform, Chlorhexidine (Activ point)
13Dr. Raji Viola Solomon

14. V I O L A S O L O M O N
Composition
Matrix Gutta-percha 18-22% Organic
Filler Zinc oxide 59-67% Inorganic
Radioopacifier Heavy metal sulphate 1-18% Inorganic
plasticizers Waxes
/resins/rosins/trace
materials(1-4%)
1-4% Organic
Coloring agent Erythrosin
14
Friedman et al (1975
Dr. Raji Viola Solomon

15. V I O L A S O L O M O N
Properties
• Biocompatible with periapical tissues
Ingredients of gutta percha such as zinc oxide, may
contribute to cytotoxic effects of some commercial
gutta percha J Endo. 1990
• However –zinc oxide component may reduce the toxicity of
other ingredients especially rosin and resin acids J Endo. 1990
• Cross reactivity between gutta percha and natural latex in
individuals who have immediate type of hypersensitivity
J Endo. 1990
15Dr. Raji Viola Solomon

16. V I O L A S O L O M O N
Solubility
• Easily dissolves in chloroform & halothane
• Heat / solvent plasticized GP – shrinkage of 1-2%)
Radio opacity
• 1mm thick GP- Radiopacity – 6.44 mm aluminium
Volumetric changes
• The use of gutta percha for obturation of canals has been
enhanced by its ability to change volumetrically upon heating.
• The force applied to gutta percha causes it to become compacted
not compressed as originally thought.
16Dr. Raji Viola Solomon

17. V I O L A S O L O M O N
Storage of Gutta percha
When Stored for extended periods of time can become brittle
with aging.
17
Sterilized and used for obturation
Removing it from hot water and immediately quenching in
cold water(less than 20°c) for several seconds
Immersing it in hot tap water(above 55°c) until the
grasping forceps indents the now softened guttapercha.
Dr. Raji Viola Solomon

18. V I O L A S O L O M O N
Sterilization of gutta percha
• Senia at al suggested-Immersion into 5.25% sodium
hypochloride for atleast I minute to kill bacteria and
spores on gutta percha.
• Sequira et al found that a simple immersion in 5.25%
sodium hypochloride eliminated bacillus subtilis spores
after just 1 min of contact.
• Rinse in 96% ethyl alcohol, 70% isopropyl alcohol,
distilled water- remove sodium chloride crystals impair
obturation seal
18Dr. Raji Viola Solomon

19. V I O L A S O L O M O N
Advantages
• Easily sterilizable
• Does not encourage
bacterial growth
• Least irritating
• Least toxic-unless over
extended or overfilled
• Radiopaque
• Easily removed
• Less shrinkage
Disadvantages
• Lack of rigidity
• Limited shelf - life
• Poor sealing
19Dr. Raji Viola Solomon

20. V I O L A S O L O M O N
Advances in gutta percha
• Medicated Guttapercha (Mgp)
• GP+ Chlorhexidine ( Activ Point)
• GP+ Calcium Hydroxide ( 40 - 60%)
• GP + GIC Impregnated (Activ Gp)
• GP + Resin impregnated (EndoRez)
20Dr. Raji Viola Solomon

21. V I O L A S O L O M O N
Medicated Gutta percha
• Developed by MARTIN & MARTIN (1999)
• 10% Iodine/ Iodoform depot centrally located in MGP
• Inert until contact with tissue fluids- activated free iodine
• Takes 24 hours to leach to surface
21Dr. Raji Viola Solomon

22. V I O L A S O L O M O N
GP+ CHLORHEXIDINE ( Activ Point)
• These gutta percha point have slow release of
Chlorhexidine upto 5% and are used as intracanal
medicaments in case of weeping canals.
dead cells.
22Dr. Raji Viola Solomon

23. V I O L A S O L O M O N
GP+ CALCIUM HYDROXIDE ( 40 - 60%)
• ( Reoko/ Coltene/ Whaledent, Germany)
• This system permits placement of medicament within
canal space b/w appointments. Once Ca(OH)2
leaches it can no longer be useful as filling material
& must be removed.
• It is used in cases of weeping, blunderbuss canals
23Dr. Raji Viola Solomon

24. V I O L A S O L O M O N
GP + GIC IMPREGNATED (ACTIV GP)
• Contains 8 % GIC
• Used along with GIC based sealers – better
sealing efficacy & antibacterial activity.
• It is highly radio opaque
• Used in a single cone technique
• Activ -GP sealer - extended 12 min working
time.
24Dr. Raji Viola Solomon

25. V I O L A S O L O M O N
FLEXIPOINTS
• These contain Polypropylene & Baso4.
• They are physiologically inert material with good
biocompatibility.
• They have high elasticity which prevents cracking.
• The main advantage of these gutta percha material
is their easy placement in tortuous canals and easy
removal for retreatment
26Dr. Raji Viola Solomon

26. V I O L A S O L O M O N
Silver points
Same diameter and taper as files and reamers were introduced by
Jasper in 1933
Composition- silver - 99.8%
nickel - 0.04%
copper – 0.02%
27Dr. Raji Viola Solomon

27. V I O L A S O L O M O N
Indications
Fine, tortuous canals that cannot be filled properly with gutta-
percha cone
- Buccal canals of maxillary molars
- Mesial canals of Mandibular molars
- Maxillary first premolars with 2-3 canals
Small or calcified, round tapered canals.
Contraindications
Incompletely formed, large canals - Maxillary anterior teeth.
Surgical cases in which root resection is anticipated.
 Post and core
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28. V I O L A S O L O M O N
Advantages
Good radio opaque materials
Accurately standardized and calibrated
Easily negotiated in small curved canals.
Easy to handle and time saving
Useful in bypassing a ledge or broken instrument
Dimensionally stable
29Dr. Raji Viola Solomon

29. V I O L A S O L O M O N
Disadvantages
Do not seal well laterally and apically because of the lack of plasticity
Inability to conform to prepared canal space.
Leaves too much space to be filled by sealer or cement thus leading to
leakage.
Corrosion of silver points and formation of silver salts-cytotoxic
Non compressible material
Mechanical irritation to periapical tissue if overextended.
Difficulty in removal
Post space preparation difficulties
30Dr. Raji Viola Solomon

30. V I O L A S O L O M O N
Silver percha
Discovered by Negm et al.
Combination of silver and guttapercha
Silver points covered with softened
guttapercha
Showed good sealing abilities
31Dr. Raji Viola Solomon

31. V I O L A S O L O M O N
CRITERIA FOR DETERMINING THE CANAL PREPARATION PRIOR TO
OBTURATION
• Adequate rubber dam isolation
• Clean, white dentin chips – controversial
• MAF three times larger than IAF with adequate “Tug back”
• Pre fitting of compacting instruments to one mm shorter
than WL, to determine their depth of penetration
• No type of fluid/ exudate /hemorrhage /foul odor should be
present in the canal space
• Non-tender to percussion
• Absence of any other co-existing symptoms
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32. V I O L A S O L O M O N
Classification of Obturation
Techniques
33Dr. Raji Viola Solomon

33. V I O L A S O L O M O N
INGLE
I. Solid core Gutta-percha with sealants
A. Cold gutta-percha points
1. Lateral compaction
2. Variations of lateral compaction
B. Chemically plasticized cold gutta-percha
Essential oil and solvents
a. Eucalyptol
b. Chloroform
c. Halothane
34Dr. Raji Viola Solomon

34. V I O L A S O L O M O N
End of Part 2