Purpose, rationale, and importance of obturation.pdf
1. Purpose,
Purpose, rationale
rationale, and
, and
importance
importance of
of obturation:
obturation:
standard
standard of
of care
care
Homan Zandi 2004
The
The ultimate
ultimate biological
biological aim
aim of
of root
root
canal
canal treatment
treatment is
is either
either to
to prevent
prevent or
or
cure
cure apical
apical periodontitis
periodontitis
2. Functions
Functions of
of the
the root
root filling
filling
„
„ Preventing
Preventing the
the
reinfection
reinfection by
by acting
acting
as a
as a barrier
barrier
„
„ Sealing
Sealing any
any surviving
surviving
bacterial
bacterial cells
cells and
and
their
their irritants
irritants
„
„ Stopping
Stopping influx
influx of
of
periapical
periapical tissue
tissue
fluids
fluids
3. Failure to eliminate these
Failure to eliminate these etiological factors
etiological factors
and to prevent further irritation via continued
and to prevent further irritation via continued
contamination of the root canal system are
contamination of the root canal system are
the
the prime causes of failure
prime causes of failure of
of nonsurgical
nonsurgical and
and
surgical root canal treatment
surgical root canal treatment
4. „
„ Three
Three-
-dimensional (3
dimensional (3-
-D) obturation
D) obturation
„
„ Radiographic evaluation
Radiographic evaluation
„
„ Poor correlation between the quality of the root
Poor correlation between the quality of the root
canal obturation and what is viewed on a
canal obturation and what is viewed on a buccal
buccal
radiograph
radiograph
„
„ When the root filling is
When the root filling is radiograpically
radiograpically
acceptable, the likelihood of leakage is still
acceptable, the likelihood of leakage is still
rather high
rather high
32. „
„ The
The success
success of
of endodontic
endodontic therapy
therapy is
is
commonly
commonly thought
thought of
of in terms
in terms of
of an
an
adequate
adequate apical
apical seal
seal
„
„ However
However,
, the
the coronal
coronal seal
seal achieved
achieved by
by the
the
restoration
restoration may
may be
be considered
considered as
as important
important
for
for the
the ultimate
ultimate success
success of
of endodontic
endodontic
treatment
treatment (Marshall et al,
(Marshall et al, Swanson
Swanson et al,
et al,
Torabinejad
Torabinejad et al,
et al, Magura
Magura et al.
et al. Khayat
Khayat et
et
al,
al, Ray
Ray et al,
et al, Tronstad
Tronstad et al)
et al)
33. Strindberg, in 1956,
Strindberg, in 1956,
considered
considered that
that the
the
most
most common
common cause
cause of
of
failure
failure was
was leakage
leakage of
of
tissue
tissue fluids
fluids apically
apically
around
around inadequate
inadequate root
root
fillings
fillings
Ingle
Ingle in 1965
in 1965 found
found
that
that of
of 104
104 failed
failed
cases, 66
cases, 66 were
were
associated
associated with
with a
a poor
poor
apical
apical seal
seal
34.
35. How much gutta
How much gutta-
-percha should
percha should
be retained to maintain the
be retained to maintain the
apical seal?
apical seal?
36. Camp et al (1983)
Camp et al (1983)
determined
determined that
that
when
when 4 mm
4 mm of
of gutta
gutta
percha
percha was
was retained
retained
only
only 1
1 of
of 89
89
specimens
specimens showed
showed
leakage
leakage,
, whereas
whereas
32
32 of
of 89
89 specimens
specimens
leaked
leaked when
when 2 mm
2 mm
of
of gutta
gutta percha
percha was
was
retained
retained
38. Zmener
Zmener (1980)
(1980)
found
found that
that in
in root
root
canals
canals sealed
sealed with
with
lateral
lateral
condensation
condensation
technique
technique,
, leakage
leakage
was
was reduced
reduced when
when
more
more than
than 4 mm
4 mm of
of
gutta
gutta-
-percha
percha
remained
remained in
in the
the
apical
apical portion
portion
39. „
„ Portell
Portell et al (1982)
et al (1982) determined
determined that
that most
most of
of
the
the specimens
specimens with
with only
only 3 mm
3 mm of
of apical
apical
gutta
gutta percha
percha had
had some
some leakage
leakage
„
„ Mattison
Mattison et al (1984)
et al (1984) found
found significant
significant
differences
differences between
between 3, 5, and 7 mm
3, 5, and 7 mm of
of gutta
gutta
percha
percha, and
, and they
they concluded
concluded that
that at
at least
least 5
5
mm
mm of
of gutta
gutta percha
percha is
is necessary
necessary for an
for an
adequate
adequate apical
apical seal
seal
40. Post
Post space
space preparation
preparation and
and
leakage
leakage
„
„ During
During the
the mechanical
mechanical preparation
preparation of
of the
the
post
post space
space it is
it is possible
possible that
that the
the root
root filling
filling
may
may be
be twisted
twisted or
or vibrated
vibrated,
, with
with disruption
disruption
of
of the
the seal
seal
41. „
„ Provided
Provided a minimum
a minimum of
of 5 mm
5 mm of
of sound
sound
apical
apical root
root filling
filling is
is left
left in
in situ
situ,
, studies have
studies have
shown
shown that
that removal
removal of
of laterally
laterally condensed
condensed
gutta
gutta percha
percha does
does not
not affect
affect the
the apical
apical seal
seal,
,
irrespective
irrespective of
of whether
whether the
the post
post space
space is
is
prepared
prepared immediately
immediately after
after obturation or is
obturation or is
delayed
delayed (
(Zmener
Zmener 1980,
1980, Neagley
Neagley 1969,
1969,
Bourgeois et al 1981)
Bourgeois et al 1981)
42. Endodontic success
Endodontic success
„
„ It is generally accepted that the success
It is generally accepted that the success
rate of the treatment is positively
rate of the treatment is positively
correlated with the criteria for
correlated with the criteria for good
good
technical quality of the root filling
technical quality of the root filling
43.
44. „
„ Even in a good root filling performed
Even in a good root filling performed
under optimal condition, the
under optimal condition, the coronal
coronal
leakage
leakage will be consistent and extensive if
will be consistent and extensive if
the access cavity is
the access cavity is left unfilled
left unfilled and thus
and thus
exposed to fluids
exposed to fluids
45.
46.
47.
48.
49.
50.
51.
52.
53. Obturated
Obturated root
root canals
canals can
can be
be recontaminated
recontaminated
by
by micro
micro-
-organisms
organisms in a
in a number
number of
of ways
ways:
:
„
„ Delay
Delay in
in placing
placing a
a coronal
coronal restoration
restoration.
.
Temporary
Temporary materials
materials will
will dissolve
dissolve slowly
slowly after
after
in time in
in time in the
the presence
presence of
of saliva and
saliva and the
the seal
seal
may
may break
break down
down. A
. A temporary
temporary restoration
restoration of
of
inadequate
inadequate thickness
thickness will
will eventually
eventually leak
leak
54. „
„ Fracture
Fracture of
of the
the coronal
coronal restoration
restoration and /or
and /or
the
the tooth
tooth
„
„ Preparation
Preparation of
of post
post space
space when
when the
the
remaining
remaining apical
apical section
section of
of the
the root
root filling
filling is
is
of
of inadequate
inadequate density
density and / or
and / or length
length
55. Coronal
Coronal leakage
leakage…
…
„
„ Marshall &
Marshall & Massler
Massler, in 1961,
, in 1961, carried
carried out
out a
a
leakage
leakage study
study using
using a
a radioactive
radioactive tracer
tracer
and
and showed
showed that
that coronal
coronal leakage
leakage occurred
occurred
despite
despite the
the presence
presence of
of a
a coronal
coronal dressing
dressing
56. Leakage
Leakage of
of endodontic obturation
endodontic obturation
materials
materials are
are measured
measured by:
by:
„
„ Dyes (
Dyes (Swanson
Swanson et al, Madison et al)
et al, Madison et al)
„
„ Radioactive
Radioactive isotopes (Marshall et al)
isotopes (Marshall et al)
„
„ Bacteria
Bacteria (Mortensen et al,
(Mortensen et al, Goldman
Goldman et al,
et al,
Torabinejad
Torabinejad
et al)
et al)
„
„ Fluid
Fluid filtration
filtration method
method (
(Derksen
Derksen et al)
et al)
57. Allison
Allison et al, in
et al, in
1979
1979 made
made brief
brief
reference
reference to
to the
the
possibility
possibility that
that a
a
poor
poor coronal
coronal seal
seal
might
might contribute
contribute
to
to clinical
clinical failure
failure
58. Swanson
Swanson &
&
Madison, in 1987,
Madison, in 1987,
did
did an in
an in vitro
vitro study
study
where
where they
they showed
showed
that
that after
after only
only 3
3
days
days exposure
exposure to
to
artificial
artificial saliva
saliva there
there
was
was extensive
extensive
coronal
coronal leakage
leakage of
of a
a
tracer dye
tracer dye through
through
aparently
aparently sound
sound
root
root filling
filling
59. Madison &
Madison &
Wilcox
Wilcox, in 1988,
, in 1988,
confirmed
confirmed that
that
exposure
exposure of
of root
root
canals
canals to
to the
the
oral
oral environment
environment
allowed
allowed coronal
coronal
leakage
leakage to
to take
take
place
place, in
, in some
some
cases
cases along
along the
the
whole
whole length
length of
of
the
the root
root canals
canals
60. Torabinejad
Torabinejad et al, in
et al, in
1990,
1990, found
found that
that
50%
50% of
of single
single-
-rooted
rooted
teeth
teeth,
, root
root filled
filled
using
using lateral
lateral
condensation
condensation of
of
gutta
gutta percha
percha and a
and a
sealer
sealer cement
cement,
, were
were
contaminated
contaminated with
with
bacteria
bacteria along
along the
the
whole
whole length
length of
of the
the
root
root after
after 19
19 days
days or
or
42
42 days
days,
, depending
depending
upon
upon the
the
contaminating
contaminating
organism
organism
61. Khayat
Khayat et al, in 1993,
et al, in 1993,
have
have shown
shown that
that root
root
canals
canals obturated
obturated with
with
gutta
gutta percha
percha and
and Roth
Roth’
’s
s
sealer
sealer,
, using
using either
either
lateral
lateral condensation
condensation or
or
vertical
vertical condensation
condensation
were
were contaminated
contaminated
apically
apically with
with bacteria
bacteria
from saliva
from saliva exposed
exposed to
to
the
the coronal
coronal part
part of
of the
the
root
root canal
canal only
only. All
. All
canals
canals were
were
contaminated
contaminated within
within 30
30
days
days of
of exposure
exposure
63. What is more important?
What is more important?
„
„ A good root filling or a good coronal
A good root filling or a good coronal
restoration
restoration
64. „
„ 1010
1010 endodontically
endodontically treated teeth examined
treated teeth examined
radiographically
radiographically
„
„ Good
Good endodontic
endodontic treatment (GE)
treatment (GE)
„
„ Poor
Poor endodontic
endodontic treatment (PE)
treatment (PE)
„
„ Good restoration (GR)
Good restoration (GR)
„
„ Poor restoration (PR)
Poor restoration (PR)
„
„ Absence of
Absence of periraducular
periraducular inflammation (API)
inflammation (API)
„
„ Presence of
Presence of periradicular
periradicular inflammation (PPI)
inflammation (PPI)
65.
66.
67. Conclusion:
Conclusion:
The technical quality of the
The technical quality of the coronal
coronal
restoration
restoration was significantly more important
was significantly more important
than the technical quality of the
than the technical quality of the endodontic
endodontic
treatment
treatment for apical periodontal health
for apical periodontal health
93. Microleakage
Actual bacterial penetration through
obturating materials may not be
necessary to cause treatment failure.
More important may be leakage of
bacterial by-products
Bacterial metabolites, toxins and
degradation products are much
smaller than bacteria and could
penetrate faster
Hovland & Dumsha, in 1985, showed
that most leakage occurs between the
root canal sealer and the wall of the
root canal
94. Prokaryptic
cells (bacteria)
are the smallest
of the
unicellular
organisms.
They are, for
the most part,
approximately
1 to 1.5 µm
wide and 2 to 6
µm long Escherichia coli is
approximately 1 µm in
diameter
95. Bacterial
Bacterial mechanism
mechanism of
of tissue
tissue
damage
damage and
and bacterial
bacterial products
products
Bacterial factors for
colonization and
growth
Bacterial factors for
colonization and
growth
Bacterial factors for
invasion and tissue
damage
Bacterial factors for
invasion and tissue
damage
96. Bacterial
Bacterial factors
factors for
for invasion
invasion
and
and tissue
tissue damage
damage
Direct
Direct Indirect
Indirect
Cytotoxic
products
Cytotoxic
products
Enzymes
Enzymes Inflammatory
response
Inflammatory
response
Tissue damage
Tissue damage
