Obturation.of.the.Root.Canal.Space.Part3

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

OBTURATION OF THE
ROOT CANAL SPACE
Part - 3
Dr. Raji Viola Solomon., MDS., MFDS., RCPS (Glasgow)
Department Of Conservative Dentistry & Endodontics
Panineeya Institute Of Dental Sciences And Research Center
Hyderabad
INDIA

Classification of Obturation
Techniques
3Dr. Raji Viola Solomon

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

C. Canal - warmed gutta-percha
1. Vertical compaction
2. warm vertical compaction-System B compaction
3. Sectional compaction
4. warm Lateral compaction
Endotec II
5. Thermomechanical compaction
a. Mc Spadden
b. Maillefer condenser
c. Hybrid technique
d. J.S. Quick fill
e. Ultrasonic plasticizing 5Dr. Raji Viola Solomon

D. Thermoplasticized gutta-percha
1. Syringe insertion
a. Obtura
b. Inject – R – Fill, backfill
2. Solid-core carrier insertion
a. Thermafil and Densfil,
b. Soft core and Three Dee GP
c. Silver points
II. Apical – third filling
A. Light speed simplifill
B. Dentin – chip
C. Calcium hydroxide
III. Injection or “Spiral” filling
Cements, Pastes, Plastics, Calcium phosphate 6Dr. Raji Viola Solomon

Grossman
1. Lateral condensation method
2. Vertical condensation method
3. Sectional method
4. Compaction method (McSpadden)
5. Metal core obturation
- Silver cone method
- Stainless steel file method
6. Chemically plasticized gutta-percha
7. Injection techniques for obturating canals
- Hydron
- Thermoplasticized guttapercha method
Obtura
Ultrafil

Lateral compaction method

Ralph Sommer – 1946
Most commonly accepted and widely
used
Standard against which other methods of
canal obturation - judged
Criteria –
Canal shape – continuously
tapering till the apical area
Spreader – must reach within 1
to 2 mm of WL
Definite apical stop / seat
Accessory cones – smaller in
dimension than spreader

Important steps –
Spreader size determination
Primary and accessory point
determination
Drying the canal
Mixing and placement of sealer

Spreader size determination
• Reach within 1 to 2 mm of WL , match the taper of
preparation
• Greater taper – apically directed force – overfill
• Lesser taper – displace master cone coronally

12
Rubber stopper is placed at 1mm minus working length
Dr. Raji Viola Solomon

• Fit within 1-2mm of
FWL.
• If not, more shaping is
required because apical
size and taper is
inadequate.

MASTER CONE DETERMINATION
Diameter should be consistent with master apical
file.
One should feel tug back with master gutta percha
point.
Standardized cones – match the instrument used
Conventional size – too tapered with bulk at
coronal area resist spreader penetration

Methods to determine proper fit –
• Visual test
• Tactile test
• Radiographic test
• Patient response

Visual test
Mark the Master Cone to FWL

19
Point measured – grasped with cotton pliers at position
1mm short of WL Dr. Raji Viola Solomon

Mark should correspond to reference point
20
If goes beyond – cut the tip , next larger size point
should be tried – trial and errorDr. Raji Viola Solomon

Place MC in the canal system.

Tactile test
• Apical 3 to 4 mm prepared nearly
parallel walls
• Some degree of force is required to
seat the point and once in position
pulling force is required to dislodge
it
• TUG BACK

PATIENT RESPONSE
• Patients who are not anesthetized during treatment of non
vital teeth and second appointment for vital teeth may feel
gutta percha penetrate through the apex,.
• Adjustments are made based on the patients response until
they are comfortable.
Draw back
• Pulp remnants from short preparation will cause a
sensation of much greater intensity than periapical tissues.

Radiographic test
Final test - film must show point extending
within 1mm from tip of preparation
Better criterion of success than visual/ tactile
Final opportunity to check-
WL was correct
Proper instrumentation following
curve of canal
Procedural errors-perforation

Short of the working length • Check for dentin chips, any ledge
or curve
• Enlarging instrument was not
used to its fullest length
• Larger than standard deviation
between size of instrument and
GP
• Re-instrumentation or select
small size GP
Beyond Select larger cone size
Cut the cone to the working length
S shaped appearence Cone is too small for the canal
Larger cone must be selected
Radiolucent line appearing betn GP
and canal wall
Cone is too small
Canal preparation is not round
Extra canal is present

Drying the canal
While mixing the sealer – absorbent point left in canal
to absorb moisture.
Larger point – followed by smaller – unless
WL-1mm is reached.
To determine moisture – drawing tip along surface of
rubber dam
If paper point – moist – leaves mark as removes
powder from dam

• Bennati and collegues-Mixture
can be held for 10secs on inverted
spatula before dropping off and
will stretch between the slab and
spatula 2cm before breaking.
• Permits ample working time and
minimal dimensional change 27
Mix the Sealer

28
Premeasure master cone is placed to the woking length. Sealer acts as lubricant

30
Spreader has to be kept there for atleast 20 secs- to compact gutta percha. Spreader is disengaged from
the cone by rotating it between the finger tipsDr. Raji Viola Solomon

31
Insert auxillary cone in the space
previously occupied by the spreader

34
Repeat the process untill entire canal is filled

Variations Of Lateral Condensation
• Inverted cone technique
• Tailor made gutta percha roll
• Curved canals
• Chloroform dip technique

Immature open apices or tubular canals
Apical opening is either a flaring foramen or a blunderbuss
shape:
Methods
• Apexification should be tried for apical closure
• Inverted point technique
• Tailor made gutta percha / roll cone technique
• Warm gutta-percha is preferred technique for cases with
such thin walls.

INVERTED POINT TECHNIQUE
Coarse gutta percha is selected as primary point
Serrated butt end is cut with scissors
Point is inverted and tried in the canal
Go full length + tug back
Radiograph is taken to confirm its position
Canal is obturated like lateral compaction technique

INVERTED POINT TECHNIQUE

Tailor made gutta percha roll/roll cone technique
Indication
If the apical opening is so wide that even the largest
inverted gutta percha point is still loose in the canal

Technique
Master gutta percha point is prepared by heating a
number of gutta percha points
Combining them butt to tip until a roll has developed to
match the size and shape of the canal
Roll is chilled with ethyl chloride spray or ice water to
stiffen it
Cone is tried in the canal and this is selected as mater
cone
Lateral condensation technique is followed
45
Outer surface of the stiffened point may also be softened by heat or flash dipping
the point in chloroform, eucalyptol or halothane
To obtain internal impression of the canal, dip in ethyl alchol to stop the cation of
solvent

Tailor made gutta percha roll/roll cone technique

Curved canals
• Flexible spreaders(Ni Ti) are used to compact GP
• Other features are same except the master cone is
placed 2 mm short of apical terminus
• Since more vertical force will be exerted against the
primary points as the spreader will tend to catch the
gutta percha and force apically leading to overfills
• Severe dilacerations, Bayonet shaped or dilacerated
canals thermoplasticized gutta percha technique
should be used.

Efficacy of lateral compaction
Weine, a longtime advocate of lateral compaction, and his associates
have shown that lateral compaction, done correctly, provides an
optimum obturation of the entire canal
48
The Loyola research was
prompted by Schilder’s
characterization of lateral
compaction as ineffective,
that “…gutta-percha cones
never merge
into a homogeneous mass,
but they slip and glide and
are frozen in a sea of
cementDr. Raji Viola Solomon

Efficacy of lateral compaction

ADVANTAGES
• Easy to perform
• Requires minimum
armamentarium
• Average stress along the
root canal is less
• Provides optimum
obturation of the canal
DISADVANTAGES
• Voids
• Difficult to fill accessory
canals
• Not useful in severely
curved canals and in
internal resorption

Chemically plasticized gutta percha
Chloropercha technique
Given by Callahan in 1911.
This is a variation of Callahan –Johnston technique in which
chloroform is used
The problem with the original technique centered around the use
of too much of the chloroform solvent.
Price observed a 24% decrease in volume in vitro. The
chloroform had evaporated leaving powdered gutta-percha

Chemical softener's
Today’s use of solvents is quite modest in
comparison with the older methods. Usually only
the tip of the point is dipped in the solvent and
then only for 1 second.
• Chloroform
• Halothane
• Eucalyptol

Indications
• Perforations
• Curved canals
• Ledge formation

Technique
Primary cone is blunted and fitted 2mm
short of WL
Tip (apical 3-4mm)Dipped in solvent for 1-
2 second (halothane 3-4secs) and kept aside
for partial evaporation
Cone is tamped apically in the canal
several times.the cone is grasped at the
reference point, removed and measured
Softening and tamping is repeated untill it
goes to working length
Cone is removed and solvent is allowed to
evaporate-cone tip shows apical impression 54Dr. Raji Viola Solomon

55
Sealer is placed in the canal
Primary cone is inserted
into the canal
Spreader is placed for 1
minute to allow softened
gutta-percha to flow.
Rest of the canal is filled in conventional way-
spreader insersion, rotation,removal accessory
cone placement Dr. Raji Viola Solomon

Efficacy of Solvent-Customized Gutta-
percha master Points
• Goldman found Kloropercha as a sealer superior to lateral
compaction with ZOE sealer.
• Initially, with the solvent/gutta-percha filling, they achieved
dramatic results .After 2 weeks, however,
Chloropercha shrank 12.42%
Kloropercha-4.68%
Simple chloroform dip shrank only -1.4%.
• However, Morse and the Temple University group used
eucapercha as a sealer and noted that it shrinks less than warm
gutta-percha or guttapercha/ chloropercha.

Efficacy of Solvent-Customized Gutta-percha
master Points

ADVANTAGES
Significantly better seal than standardized points
DISADVANTAGES:-
Inability to control overfilling
More shrinkage (75%)
Evaporation Of The Solvents
Potential Toxicity of these materials -chloroform is
carcinogenic
Irritation to periapical tissues
58
Efficacy of Solvent-Customized Gutta-percha
master Points

WARM VERTICAL CONDENSATION
TECHNIQUE
1967- Schilder popularized vertical condensation technique.

TECHNIQUE
• Conventional cone used
• Fit The Appropriate Gutta
Percha Cone To Radiographic
Apex Which Should Exhibit
Tug Back
• Confirm position with a
radiograph cut off the butt end
of the cone at incisal / occlusal
reference point
• Remove the cone and cut 0.5 to
1 mm from the tip and check
the length and tugback

SELECTION OF PLUGGERS
62
Smallest plugger-3-4mm
from terminus
Broadest plugger-10mm
Narrower plugger-
15mm

Heat transfer instrument
• Traditional heat transfer instruments
• Touch and heat electronic device

• Lightly coat the canal walls
with sealer
• Insert cone to the working
length
• Use spoon excavator to
remove GP from the pulp
chamber to cervical level-
transfer the heat to coronal 1/3
of GP or use Touch and heat
carrier
• Softened GP is folded into
mass and compacted in apical
direction with sustained
pressure with large cold
plugger previously coated with
cement powder as separating
medium

• Second wave –heated carrier
introduced back into GP for 2-3
secs and when retrived carries with
first selective GP removal.
• Immediately mid sized plugger is
submerged into warm GP. This
vertical pressure also exerts lateral
pressure
• Apical 4-5mm of GP is left is
again softened with heat and
narrower plugger is inserted into
the canal
• Apical down pack is now
completed
• Back fill (sectional or thermo
plasticised GP)

EFFICIENCY OF VERTICAL COMPACTION OF GUTTA PERCHA
• Clinically, it is observed that “overextension is more likely to
occur…when the master cone is adapted only 0.5 mm short.”
There were no overextensions with lateral compaction.
• On the basis of a radiographic study of maxillary anterior
teeth, Schilder reported 100% success after 2 years for
cleaning and shaping and three-dimensional obturation by
warm gutta-percha/vertical compaction

CONCERN ABOUT TEMPERATURE
71
A US army group reported
that “
The use of hot instruments for the condensation of
filling material did not appear to endanger the integrity
of the lateral periodontium.
The Boston University group
found
The maximum temperature in the body of the canal to
be 80°C (176°F), whereas in the apical region the
temperature peaked at 45°C (113°F).
Army group again studied
intracanal temperatures,
produced this time with the
Touch ’n
Heat unit.
They felt the operator should restrict the use of the unit
to lower power settings of #2 or #3 and Increase the
length of time the heated tip is activated.
They warned that at the top setting of #6 the unit could
increase the intracanal temperature to as high as
114.51°C, a potentially damaging temperature.

ADVANTAGES
• Dense, homogenous
3 D fill
• Excellent seal
apically and laterally.
• Seals large lateral and
accessory canals or
multiple foramina
DISADVANTAGES
• More time
consuming and
difficult to master
• Risk of vertical root
fracture
• Overfilling

Touch n Heat
Clifford J Ruddle
Electronic device developed for warm vertical condensation of
Gutta percha
Battery / AC models are available
Used with the Schilder’s technique
Similar to schilder pluggers but the heat is generated
automaticaly at the top to the instrument
Capable of providing a range of high
temperatures instantly ranging from 0-7000C

Uses:
Heat carrier
Searing excess GP
Preparation of post space
Pulp testing / bleaching - by changing the tips and
adjusting the heat level.
PRECAUTION
Preparation should be continuously tapering canal whose
diameter is narrowed apically

ADVANTAGES
Fills lateral canals
Homogeneous fill
DISADVANTAGES
• No thermostat & power control knob
• Temperature not controlled
• Heated pluggers should not be placed closer than 4 to 5 m of
canal terminus.
• Plugger binding apically may split the root

System b-Continuous Wave Compaction Technique
• In 1987, Dr. L. Stephen Buchanan
• The System B heat source has digital temperature display and
can monitor the temperature at the tip of its heat carrier
device, delivering a precise amount of heat for an indefinite
time without overheating the gutta-percha.
• They can also be used in schilder technique
• The heat carriers or Buchanan pluggers have shapes that
closely approximate the shape of the tapered root canal
preparation.
• Tip heated to 200°c softens GP in ½ a sec.

Down pack technique
• Appropriate sized GP cone matching the complete
preparation is selected.
• This is confirmed radiographically
• The cone is then removed and the corresponding
plugger is tried for size in the canal.
• It should stop at its “binding-point,” about 5 to 7 mm
short of the working length.
• The stop attachment is then adjusted at the coronal
reference point and the plugger is removed and
attached to the Heat Source.
• The canal is dried.

Wave of heat is produced as the plugger is forced through fitted
cone and is used to drive GP into canal.
As the plugger approaches the apex heat button is released and
apical pressure is maintained for 10 secs-prevent shrinkage
Heat button is pushed again while maintaining pressure –wave
of heat is produced 300°c in 5 sec that separates the plugger
from apical mass of gutta percha.
Back filled with obtura

Backfill Technique
• Using the same size gutta-percha cone and plugger, the cone
is coated with sealer and positioned in the backfill space in
the canal.
• The System B temperature is now set at 100°C.
• Preheat the plugger out of the canal for only 1⁄4 second, cut
the heat, but immediately plunge the plugger into the backfill
cone and hold it in place for 3 to 5 seconds as the gutta-
percha cools.
• Another cone is added in the backfill space and heat is again
applied.
• The final plugging is done with a large cold regular plugger.

ADVANTAGES
• Eliminates voids
• Produces less heat
than touch and heat
DISADVANTAGES
• Breakage
• Kinking of spreaders

SUPER ENDO ALPHA SYSTEM:
Introduced by Tracom Corporation .
A wireless down pack device.
This wireless device has four temperature settings and is
ideal for the continous wave technique.
The temperature of plugger can go upto 230˚C.
Consists of plugger tips ranging from 30 to 60 number with
a taper of 0.04, 0.06 and 0.08.

Warm lateral condensation
82
Considering the ease and
speed of lateral
compaction as well as the
superior density gained
by vertical compaction of
warm gutta-percha,
Martin developed a
device that appears to
achieve the best qualities
of both techniques, called
Endotec II

Endotec
It Consists of :-
• Endotec Handpiece- cordless
• Plugger/Spreader
Small one- size 30 file(for curved
canals)
Larger one-size 45 file (routine use)
• The Temperature at which the
system works is 315.5 - 343.9 C
and it takes 2 sec to cool down.

Master cone is adapted in the canal
Additional GP are placed to residue the possibility of warm
plugger loosening the point when tip retracted
Endotec is placed full length along the side of GP
Activator button is pressed and plugger or spreader moved in
clockwise direction
Release the button and plugger cools immediately
Move it in anticlockwise direction.
This creates a space for additional point to be added
Now cold plugger can be used to compact the softened GP

• GP compaction in a molar with C shaped canal can be
improved by using Endotec in ZAP and TAP method
• Later cold spreader is used and accessory points are placed
85
ZAP ENDOTEC is
preheated for 4-5 sec
before insertion into
GP
TAP The instrument is moved
in and out in short
continuous strokes 10-15
times.
The tip is removed from
the canal when it is still
hot

ADVANTAGES
• Filling is superior
to that obtained
with usual cold
lateral compaction
DISADVANTAGES
• Time consuming
relative to other
methods of lateral
compaction
• Difficult to apply
compaction forces
with the tips as
their use is
primarily for
heating GP cones
in tooth.

Efficacy of the Warm/Lateral Technique.
• Because gutta-percha is heated with this technique, there
must be a commensurate shrinkage when it cools.
• Since Endotec temperatures are lower than with the other
technique, shrinkage following Endotec usage should be
lower as well
• Kersten, in Amsterdam, reported that “Endotec had
significantly less leakage than other methods.
IEJ 1988

Thermomechanical Compaction
In this technique friction between gutta percha and
rotating reverse file generates heat to soften the gutta
percha and forces it apically
Different designs of thermo compactors are available
• Mc spadden
• Modified Mc spadden
• Maillefer gutta condenser
• Zipper thermocompactor/Engine plugger
• J.S. Quick fill

McSpadden Compactor
McSpadden (1979).
Resembles reverse H file fits into latch type hand piece
8,000 and 20,000. rpm.
Disadvantages
Fragility - Fracture of compactor
Overfilling
Difficult to master
Overheating
Use in straight canals only
To overcome these disadvantages, it came with different shapes
and forms

Modified McSpadden compactor
MicroSeal system
It is in the form of NiTi condensers.
Can be used in curved canals.
1000-4000rpm
Technique
• Place primary GP in root canal
• Select appropriate size condenser, coat it with heat gutta
percha (alpha or beta)
• The condenser is spun in the canal at 1000-4000rpm
• Fills the GP laterally and vertically

Maillefer Gutta Condenser
• Modified Hedstrom type instrument as gutta condenser.
• Instrument has less no of compacting blades with deeper
groves and increased sharpness
• It is used for back filling of canals already filled at apical
third

J S Q UICK FILL
Titanium core devices resembling latch type drills
They are coated with alpha phase GP
These are fitted to the prepared root canal and
sealer is applied
As the instrument spins ,frictional heat is generated
which plasticizes and compacts the GP
Compactor is removed +final compaction with
hand plugger
Titanium core is left in place and separated with
inverted cone bur.

Ultrasonic plasticizing
• Moreno Et al
93
Master GP is selected and placed
Ultrasonic unit is activated for 3-4 secs
Energy released by vibrating ultrasonic file -
plasticizes GP
File removed and spreader is inserted to make space
for new cones
Process is repeated until the obturation is completed

• Using the Cavitron PR30, they found very little heat
rise: 6.35°C in 6.3 seconds.
• Using an Enac ultrasonic unit, however, they recorded
a 19.1°C rise in temperature because it took 141
seconds to plasticize the mass. They felt the heat
generated by the Cavitron would not be harmful
ORAL SURG 1989

End of Part 3

Obturation.of.the.Root.Canal.Space.Part3

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