this presentation of mine is a brief overview of root canal obturation. It includes types of Obturating materials , their advantages and disadvantages , sealers . It also includes obturating techniques like lateral compaction , warm vertical compaction , thermoplasticized injection technique and carrier technique etc

1. Dr. Hamza
Department of Operative Dentistry
Armed Forces Institute of Dentistry
National University of Medical Sciences,
Pakistan

2. PRINCIPLES OF ROOT-CANAL
SYSTEM OBTURATION The aims and objectives of obturation are:
 to establish a barrier to the passage of microorganisms from
the oral cavity or root-canal system to the peri-radicular
tissues
 to “entomb” or “incarcerate” and isolate any microorganisms
that may survive the shaping and cleaning process
 to prevent leakage into the canal system of potential
nutrients that would support microbial growth
 to reduce the risk of bacterial movement or fluid
percolation into the canal system space from the gingival
sulcus or periodontal pockets

3. Pre-requisites for obturation Ideally, a number of conditions should be met before a
root filling is placed which include
 absence of pain and swelling
 absence of persistent exudate in the canal
 thoroughly debrided root-canal system (all canals
identified, prepared and irrigated for adequate time)
 adequate time to complete the procedure

4. Single visit Vs Multiple visit
 Completion of the treatment in a single visit has a
number of advantages for both the patient and the
clinicianwhich includes:
 the root-canal system is in the most decontaminated state
immediately after shaping and debridement, while there is
potential for recontamination between visits
 single-visit treatment provides no opportunity for temporary
restorations to leak
 there is less opportunity for teeth to fracture as definitive
restorations can be placed earlier
 the clinician is most familiar with the root-canal morphology
for effective obturation at the completion of the preparation
 there are both financial and time savings

5.  single-visit treatments are particularly beneficial for
medically compromised patients whose conditions
necessitate antibiotic premedication
 the patient is exposed to local anaesthesia, rubber dam
and postoperative discomfort only once

6. MATERIAL It should induce or at least support regeneration of damaged
tissues
 Be antimicrobial
 Not irritate periradicular tissues
 Not be toxic either locally or systemically
 Be easily adapted to the canal walls and have capacity for self
adaptation and self-sealing with dimensional fluctuations over
time
 Have good flow characteristics
 Not stain dentine
 Have good handling characteristics
 Be radiopaque
 Be impermeable to tissue fluids
 Be dimensionally stable
 Be cheap and have a long shelf-life

7. Types of Obturating material
 Solid materials
 Sealers and cements
 Carrier based systems
 Resilon

8. Solid materials
 Solid cores(silver cones, titanium or acrylic cones)
 Gutta Percha
 Resilon

9. Gutta percha Extracted from the palaquium
gutta tree
 Gutta-percha is the most
commonly used root canal
filling material
 It is a linear crystalline
polymer that melts at a set
temperature, with a random
but distinct change in
structure resulting
 It occurs naturally as 1,4-
polyisoprene and is harder,
more brittle, and less elastic
than natural rubber

10. Composition of Gutta percha
cones used in Endodontics Modern gutta-percha cones that are used for root canal
fillings contain
 about 20% gutta-percha
 The major component is zinc oxide (60% to 75%)
 The remaining 5% to 10% consists of various resins, waxes,
and metal sulfates
 Antiseptic gutta-percha with various antimicrobial agents
has been suggested, and several studies are available

11. Properties of Gutta percha
 The crystalline phase has two forms
 the alpha phase
 the beta phase
 The alpha form is the material that comes from the natural tree
product
 The processed, or beta, form is used in gutta-percha for root
fillings
 When heated, gutta-percha undergoes phase transitions.
 The transition from beta phase to alpha phase occurs at around
115° F (46° C)
 An amorphous phase develops at around 130° F to 140° F (54° C to
60° C)
 When cooled very slowly (i.e., 1° F per hour), gutta-percha
crystallizes to the alpha phase
 Normal cooling returns the gutta-percha to the beta phase
 Gutta percha cones soften at a temperature above 147° F (64° C)
 These cones can easily be dissolved in chloroform and halothane
and dissolve less in turpentine or xylene

12.  Obturation with gutta-percha normally requires some
form of compaction pressure, but real compression of
gutta-percha is practically impossible
 Gutta-percha cannot be heat sterilized, other
decontamination methods must be used
 The most practical method is to disinfect the gutta-percha
in NaOCl before use done in 1 minute if the cone is
submerged in a 5% solution of NaOCl

13.  Gutta-percha cannot be used as the sole filling
material; it lacks the adherent properties necessary to
seal the root canal space and requires a sealer
(cement) for final seal
 Manufacturers now supply gutta-perch cones in
tapers matching the larger tapered rotary
instruments (#.02, #.04, and #.06)

15. Resilon Resilon (Pentron Clinical Technologies,
Wallingford, CT), a thermoplastic, synthetic,
polymer-based root canal filling material, was
developed in an attempt to create an adhesive
bond between the solid-core material and the
sealer
 It is designed to be used with Epiphany
(Pentron Clinical Technologies), a new resin
sealer with a bonding capacity to dentin
 Resilon can be supplied in the same ISO sizes
and shapes (cones and pellets) as gutta-percha.
 The manufacturer has stated that it can be used
with any current root canal obturation
technique (lateral compaction,
thermoplasticized, carrier, injection)

16.  When manufactured in cones, Resilon’s flexibility is similar to that of
gutta-percha
 Based on polyester polymers, Resilon contains bioactive glass and
radiopaque fillers (bismuth oxychloride and barium sulfate) with a
filler content of approximately 65%
 It can be softened with heat or dissolved with solvents such as
chloroform
 This characteristic allows the use of current retreatment techniques for
nonhealing cases
 Because it is a resin-based system, it is compatible with current
restorative techniques in which cores and posts are placed with resin
bonding agents

18. Pastes and cements
 Zinc-oxide/eugenol materials (Roths, Pulp canal
sealer, Wachs, Tubliseal, Procosol)
 Calcium hydroxide-containing materials (Sealapex,
Apexit, CRCS)
 Glass ionomer (Ketac-Endo)
 Resins (AH-26, AH Plus, Diaket, Lee Endo-Fill)
 Flexible polymers (Epiphany)
 Bioceramic (Smartpaste)

19. Ideal properties required for
sealers
 The ideal sealer should be
 Biocompatible
 Adhere to canal walls
 Be radiopaque
 Impermeable to tissue fluids
 Dimensionally stable
 Antiseptic
 Not discolour the tooth
 Be easily manipulated

20. ZINC OXIDE EUGENOL BASED
SEALERS
 A history of successful use over an extended period
of time
 Zinc oxide–eugenol sealers will absorb if extruded
into the periradicular tissues
 They exhibit a slow setting time, shrinkage on
setting, solubility, and can stain tooth structure
 An advantage to this sealer group is antimicrobial
activity

21.  Procosol (Procosol, Inc., Philadelphia, PA)
is a modification of Rickert’s formula in
which the silver particles have been
removed (zinc oxide, hydrogenated resin,
bismuth subcarbonate and barium sulfate;
liquid eugenol)
 Tubli-Seal (SybronEndo) is a catalyst/base
zinc oxide–eugenol sealer that is
convenient to mix but has a faster setting
time when compared with the
liquid/powder sealers
 Tubli-Seal EWT provides an extended
working time
 Wach’s sealer (Balas Dental, Chicago,IL)
contains Canada balsam, which gives the
material a sticky or tacky property that
softens the gutta-percha into a more
homogeneous mass when used with lateral

22.  Grossman modified the formulation and introduced a
nonstaining formula in 1958
 This is the formulation in Roth’s Sealer (Roth International)

23. Calcium Hydroxide Sealers Calcium hydroxide sealers were
developed for therapeutic activity sealers
would exhibit antimicrobial activity and
have osteogenic–cementogenic potential
 Unfortunately, these actions have not
been demonstrated
 Solubility is required for release of
calcium hydroxide and sustained activity
 This is inconsistent with the purpose of a
sealer
 Calciobiotic root canal sealer (CRCS) is a
zinc oxide–eugenol sealer with calcium
hydroxide as one ingredient

24.  Sealapex (SybronEndo) is a
catalyst/base system
 The base contains zinc oxide,
calcium hydroxide, butyl benzene,
sulfonamide, and zinc stearate
 The catalyst contains barium
sulfate and titanium dioxide as
radiopacifiers in addition to resin,
isobutyl salicylate, and aerosol R
972
 Apexit and Apexit Plus (Ivoclar
Vivadent, Schaan, Liechtenstein)
consist of an activator (disalicylate,
bismuth hydroxide/bismuth
carbonate, and fillers) and a base
(calcium hydroxide, hydrated
colophonium, and fillers)

25. Glass Ionomer Sealers The glass ionomers have been advocated for
use in obturation because of their dentin-
bonding properties
 Ketac-Endo (3M ESPE, Minneapolis, MN)
enables adhesion between the material and
the canal wall
 It is also difficult to properly treat the
dentinal walls in the apical and middle
thirds with preparatory bonding agents to
receive the glass ionomer sealer
 A disadvantage of glass ionomers is that
they must be removed if retreatment is
required
 This sealer has minimal antimicrobial
activity

26.  Activ GP (Brasseler USA,
Savannah, GA) consists of a
glass ionomer–impregnated
gutta-percha cone with a
glass ionomer external
coating and a glass ionomer
sealer

27. Resin Resin sealers have a long history of use, provide
adhesion, and do not contain eugenol
 AH-26 is a slow-setting epoxy resin that was
found to release formaldehyde when setting
 AH Plus is a modified formulation of AH-26 in
which formaldehyde is not released
 The sealing abilities of AH-26 and AH Plus
appear comparable
 AH Plus is an epoxy-bis-phenol resin that comes
in two tubes and exhibits a working time of
approximately 4 hours
 EndoREZ (Ultradent Products, South Jordon,
UT) is a methacrylate resin with hydrophilic
properties
 When used with EndoREZ resin-coated gutta-
percha cones the dual cure EndoREZ sealer
bonds to both the canal walls and the core
material

28.  Diaket, a polyvinyl resin (3M
ESPE), consists of a powder
composed of bismuth
phosphate and zinc oxide and
a liquid consisting of
dichlorophen,
triethanolamine,
propionylacetophenone, and
copolymers of vinyl acetate,
vinyl chloride, and
vinylisobutyl ether
 The material appears to be
biocompatible

29.  Epiphany (Pentron Clinical
Technologies, Wallingford, CT) and
RealSeal (SybronEndo), have been
introduced for use with a new core
material, Resilon (Pentron Clinical
Technologies)
 Advocates of these sealers propose that
they bond to the canal wall and to the
core material to create a “monoblock”
 One study indicated that the bond
strength to dentin can be influenced by
the irrigant used
 Water and chlorhexidine decreased the
bond strength compared with NaOCl,
NaOCl/EDTA, and NaOCl/MTAD
 The use of EDTA and MTAD did not
improve the bond strength compared
with NaOCl alone

30. Silicone Sealers RoekoSeal
(Coltène/Whaledent,
Germany) is a
polyvinylsiloxane that has
been reported to expand
slightly on setting

31.  GuttaFlow (Coltène/Whaledent) is a
cold flowable matrix that is triturated
 Consists of gutta-percha added to
RoekoSeal
 Material is provided in capsules for
trituration
 Technique involves injection of the
material into the canal, followed
by placement of a single master
cone
 Material provides a working time
of 15 minutes and it cures in 25 to
30 minutes
 Evidence suggests that the
material fills canal irregularities
with consistency and is
biocompatible, but the setting
time is inconsistent and may be
delayed by final irrigation with
sodium hypochlorite
 Sealing ability appears comparable
to other techniques in some

32. Bioceramic Bioceramic (BC) sealer is composed of
zirconium oxide, calcium silicates,
calcium phosphate monobasic, calcium
hydroxide, and various filling and
thickening agents
 The material is available in a premixed
syringe with calibrated intracanal tips
 As a hydrophilic sealer it utilizes
moisture within the canal to complete
the setting reaction and it does not
shrink on setting
 It is biocompatible and exhibits
antimicrobial properties during the
setting reaction
 The manufacturer advocates expressing
the sealer into the coronal one third to
one half of the canal and then seating

33. Obturation Techniques
 Lateral compaction
 Warm vertical compaction
 Thermocompaction and hybrid technique
 Thermoplasticized gutta-percha supported on a solid
core
 Injectable thermoplasticized gutta-percha

34. Cold lateral condensation involves placing tapered gutta-percha cones in the canal
and compacting them under pressure against the walls
of the canal with a metal spreader
 The first gutta-percha cone, called the “master cone or
point”, is ISO standardized so that it matches ISO files
sizes (Fig. 8.203) and should be chosen to customize to
the apical preparation size
 Ideally, the customized master cone (as previously
described) should fit accurately in the apical few
millimetres at the predetermined length (Fig. 8.204a)
 The customized point should not be easily forced
beyond the final preparation point and may
demonstrate a slight resistance to removal called “tug-
back”
 The concept of apical “tug-back” has been widely cited
as a requirement for a wellfitting master cone and
should be valid as long as the taper of the point is
smaller than that of the prepared canal.

35.  Once master point selection and
customization is complete, the canal is dried
for sealer and master point placement
 Subsequent gutta-percha cones are called
“accessory cones”, are non-standardized in
taper and match spreader tapers (Fig. 8.205)
 The metal spreaders can be either finger or
hand manipulated and are preselected by
placing in the canal to reach WL freely (Fig.
8.206) before the master cone is compacted
 The spreader should be left in place for a few
seconds to allow the gutta-percha time to
deform and flow under pressure (Fig. 8.204b)
 Following removal of the spreader, the first
accessory cone with a light coating of sealer is
placed and compacted into place
 This process is repeated until the canal is filled

36.  The selection of the taper (of gutta-percha and
matched spreader) depends on the taper of the canal
at any given segmental level in the canal to maximize
efficiency (Fig. 8.208)
 It is recommended that finger spreaders be used as
hand spreaders very easily generate forces that may
fracture roots (Fig. 8.209)
 It is important that the spreader reaches at least to
within 1 mm of the working length in order to ensure
adequate compaction of the gutta-percha against the
canal walls
 Lateral compaction is by far the best technique for
controlling apical placement of root filing material
and should form the basis of any hybridized technique

37. WARM VERTICAL
COMPACTION Vertical compaction was first
described many years ago but was
made popular in 1967 by Schilder

38. Selection of pluggers

39. compaction
 The pre-fitted master cone is placed to the designated length in the
canal, the walls of which have been coated lightly with sealer (Fig.
8.220)
 The cone is seared off at the canal-orifice level with a hot instrument
 A cold plugger dipped in sealer powder or wiped with alcohol is used
to begin the compaction process
 The coronal-most few millimetres of warmed gutta-percha are
moved laterally and apically
 The heat carrier is now plunged 3–4 mm into the gutta-percha and
quickly removed
 Some gutta percha is removed with the heated instrument and
immediately the remaining gutta-percha is compacted with the next
prefitted plugger
 The body of the gutta-percha is warmed 4–5 mm ahead of the heated
instrument and the compacting action of the cold plugger moves the
gutta-percha apically and laterally
 This procedure is repeated until about 5 mm of well compacted
gutta-percha remains in the apical portion of the canal
 The coronal portion is then back-filled by introducing 3–4 mm
segments of gutta-percha, which are then heated and compacted in
sequence

41.  The compaction of the heated gutta-percha
encourages flow of the obturating material into canal
irregularities and accessory anatomical features
 Careful adherence to the step-by-step approach usually
results in a dense homogeneous fill

42. System B in Warm vertical compaction
 Variations on the warm vertical
obturation procedure have been
introduced to improve and simplify
the procedure
 These include a variety of
electrically-operated heat carriers
available on the market
 These units allow for instant
delivery of heat to the gutta-percha
mass that can then be compacted
 The System-B heating element is
contained within specifically
designed pluggers, the tips of which
vary from 0.30 mm to 0.70 mm in
diameter

43.  The heat carriers or “Buchanan system B pluggers” have
shapes that closely approximate the shapes of tapered
root-canal preparations
 These pluggers currently come in five sizes or tapers;
extrafine (0.04), fine (0.06), fine-medium (0.08),
medium (0.10), and mediumlarge (0.12), which resemble
the greater taper of master cones (Fig. 8.223).
 In addition, these dead-soft stainless steel heat pluggers
are quite flexible, allowing for deeper compaction
especially in narrow, curved canals
 An example of a technique recommended by the
manufacturer for use with the System-B

45.  The System-B “Continuous Wave” obturation technique is based on the
Schilder warm vertical compaction procedure
 Before the master cone is positioned, one of the five System-B pluggers is
chosen
 The plugger (ML, M, FM, F, XF) is fitted to within 5–7 mm of the
working length and the position on the plugger noted
 The heat source is set to 200°C
 The canal orifice is coated with a small amount of sealer and the cone is
placed to length.
 The tip of the plugger is placed into the canal orifice and activated
 It is driven through the gutta-percha to the predetermined length
 The heat is removed, the tip cools rapidly and the plugger’s position is
maintained for 5–10 seconds until the apical gutta-percha has set
 This apical pressure compensates for volumetric changes as the gutta-
percha changes from the amorphous melt form back to the crystalline α-
form
 The tip is reactivated for 1 second in order to release the plugger and to
remove excess guttapercha
 At this stage, the apical portion has been obturated and the remainder
of the canal can be backfilled or post-space can be formed
 The “backfill” can be completed as described by Schilder or using a
variety of injection delivery systems for thermoplasticized gutta-percha

47. INJECTION OF THERMOPLASTICIZED
GUTTA-PERCHA
 This technique involves injecting
molten gutta-percha into the
root-canal system
 Theoretically simple, this
technique demands considerable
care and is associated with the
disadvantages of any
thermoplasticized material

48.  Even though it has been recommended for
obturation of the complete root-canal system, it is
probably prudent to use the injectable heated
guttapercha as a backfilling material as described
above or in cases where apical occlusion is already
assured
 As with all gutta-percha obturations, a sealer must be
used
 A variety of systems are now available (see Fig. 8.224)
 Commonly used systems include the Obtura® system
(“high-heat”) and the Ultrafil (“low-heat”) systems
 Injectable gutta-percha allows for rapid backfilling of
the canal with material that demonstrates excellent
flow properties

49. Obtura system
 The Obtura® system consists of a
control unit and a pistol-grip syringe
designed to accept gutta-percha pellets
formulated for use with the system
 The gutta-percha is heated in the barrel
of the syringe to 160–200°C
 The molten gutta-percha is extruded
through silver needles that are supplied
in20, 23 and 25 gauge sizes
 As the gutta-percha leaves the tip of the
needle, its temperature drops to
between 62°C and 65°C
 The heating barrel reaches full
operating temperature in less than two
minutes thereby eliminating the need
to preheat the gutta-percha

50. Ultrafil system The “low-heat” Ultrafil system
heats cannules containing gutta-
percha to 70°C in a heating unit
 The gutta-percha is supplied in
three different formulations;
regular set; endoset; and firm set
 The cannules must be placed in
the heater at least 15 minutes
before use and must be discarded
after 4 hours’ heating
 The trigger is squeezed gently and
released and the gutta-percha is
allowed to flow out at its own rate
 It is important to avoid excessive
pressure in order to prevent
extrusion of the material from
other channels