obturation criteria for ideal obturating materials endodontic sealers obturation techniques criteria for the evaluation of the obturation's quality

1. Obturation
Presented by: Toleen Mazloum
Endodontology

2.  Outline:
"criteria for ideal obturating materials"
• > "criteria for ideal sealers"
• >"techniques for placing sealers"
"endodontic sealers"
• >"lateral condensation of cold gutta-percha"
• >"vertical compaction of warm gutta-percha"
• >"thermomechanical compaction"
• >"custom cone technique"
"obturation technqiues"
"citeria for the evaluation of the obturation's quality"

3.  "Criteria for ideal obturating materials"i
"easily
introduced
into the
canal"
"shouldn't
stain
tooth
structure"
"bacteriostatic
(at least don't
allow bacterial
growth)"
"easily
removed
from the root
canal (when
necessary)"
"sterile (or
easily &
quickly
sterilized prior
to insertion )"
"imprevious
to
moisture"
"seal the
canal
laterally &
apically"
"shouldn't
shrink
after
insertion"
"semi-solid
upon
insertion &
solid
afterward"
"radiopaque
"
"not
irritant to
periapical
tissues"

4. "Endodontic sealers"
 "Criteria for ideal sealer"ii
"shouldn't
stain
tooth
structure"
"bacteriostatic
(at least don't
allow bacterial
growth)"
"soluble in a
common
solvent >> can
be removed
(when
necessary)"
"sets slowly
>> provide
adequate
working
time"
"tissue
tolerant
(doesn't
irritate
periapical
tissues)"
"insoluble
in oral &
tissue
fluids"
"shouldn't
shrink
upon
setting"
"consist of
very fine
powder
particles >>
optimal
mix"
"radiopaque
"
"able to
make
hermetic
seal"
"tacky when
mixed >>
provide good
adhesion with
canal walls"
"shouldn't
provoke an
immune
reponse in
periradicular
tissues"
"non-
carcinogenic
& non-
mutagenic"

5.  "techniques for placing sealers"iii, iv
"lentulo
spiral"
"manual"
"rotary"
"endodontic
files"
"gutta-
percha cone"
"ultrasonic
file"
"direct placement
through intraoral
tips"

6.  "Obturation techniques:"
 "Lateral condensation of cold gutta-percha"
֍ "Technique:"v
• "dry the canal using paper points"
Definition
"in this method, the root canal is filled by condensing gutta-
percha points laterally against one canal wall using spreaders"
• > "select a proper master cone (ideally same size as MAF)"
• > "try the MC in a wet canal"
• > "it should have tug-back at a point 0.5 - 1mm short of the radiographic
apex"
1- "Cone fitting"
• > "dry the canal using paper points"
• > "mix the sealer & coat the canal walls"
• > "coat the master cone (apical part) with sealer & insert into the canal"
• > "insert the spreader next to the master cone against 1 wall (to within
1mm of the WL)"
• > "this spreader compacts GP>> create space for accessory cones"
2- "lateral condensation"
• > "remove the spreader"
• > "insert the proper accessory cone coated with sealer"
• > "place the spreader 1mm shorter than the previous one, remove it,
then place the coated accessory cone"
• > "repreat until spreader can no longer be insterted >> canal is full"
• > "take an X-ray to make sure everything is alright"
• > "remove the excess GP at the canal orifice using a heated instrument"
• > "condense the top of GP vertically with a heated plugger"
• > "clean the pulp chamber"
3- "accessory cones placement"

7. "Summary"

8. ֍ "Indications:"
– "This technique is the most commonly used among other
techniques"
– " it is used in almost all situations except:"
֍ "Advantages:"
֍ "Disadvantages:"
"severely curved
canals"
"abnormally
shaped canals"
"canals with gross
irregularities (ex:
internal
resorption)"
"simple"
"requires
simple
equipment"
"length
control"
"ease of
retreatment"
"adaptation to
the canal wall"
"ability to
prepare post
space"
"positive
dimensional
stability"
"minimized
apical leakage"
"time
consuming"
"not suitable in
certain cases
such as internal
resorption,
severe
curvature..."
"does not
produce a
homogeneous
mass"

9.  "Vertical compaction of warm gutta-percha"
"In general, we'll need 3 pluggers:"
֍ "Technique:"vi
Definition
"this method was introduced by Schilder in which warmed &
softened GP is adapted to irregularities & accessory and lateral
canals within the root canal system (by vertical condensation)"
"the canal should be a continuous tapered funnel & the apex
should be kept as small as possible"
"the widest
plugger"
"for the
coronal 1/3"
"narrower
plugger"
"for the
middle 1/3"
"the
narrowest
plugger"
"for the
apical 1/3"

10. An alternative method of backpacking may be done by injecting plasticized GP such
as Obtura II
֍ "Indications:"
– "This method is an alternative to the cold lateral compaction
method"
– "It's used in cases where the fitting of master cone to the apical part
is impossible"
– Example: "cases where there is
"ledge
formation"
"perforation"
"unusual canal
curvature"
"internal
resorption"
"large lateral
canals"

11. ֍ "Advantages:"
֍ "Disadvantages:"
 "Thermomechanical compaction"
"filling the canal
irregularities"
"preparation of
post space"
"excellent sealing
of the canal
apically, laterally
& obturation of
lateral and
accessory canals"
" lack of length control"
"increased risk of vertical
root fracture"
"time consuming"
"overfilling of canals with
GP or sealer that can't be
retrieved from
periradicular tissues"
" warming process >>
generates temeprature
within the canal"
"difficult in curved canals"
Definition
"this method was introduced by Dr. John McSpadden"
"it consists of a compactor which resembles a reverse H-file (H-file with
blades toward the tip) & placed on a hand-piece (8,000-10,000 rpm)"
" frictional heat from the compactor >> GP is plasticized & forced 1mm
ahead & lateral to the compactor shaft""

12. ֍ "Technique:"vi
֍ "Indications:"
֍ "Disadvantages:"
 "Custom cone technique "
• > "fit a master cone 1.5 mm shorter than the radiographic apex (since later
the compactor will push GP 1mm apically)"
• > "coat the master cone with sealer & introduce it into the canal"
1- "fit the master cone"
• > "select the proper compactor (ideally same size as the largest file used
within 1.5 of the apical stop)"
• > "insert the compactor until a slight resistance is felt"
• > "rotate the compactor to maximum speed"
• > "after 1 second >> advance the compactor apically to the determined
length"
• > "remove the compactor slowly while it's still rotating at maximum speed"
• > "don't withdraw the compactor quickly >> otherwise, voids will occur"
2- "compaction"
"in cases where other techniques are difficult (ex: internal resorption)"
"high rotational speed"
"increased risk of
instrument fracture"
"heat generation"
"risk of fracture around
curves"
"definition"
"in this technique, a GP cone is customized specifically to fit
the root canal."
"chloroform dip technique"
"solvents such as chloroform, eucalyptol or halothane are
used to soften the outer surface of the cone as if making an
impression of the apical portion of the canal."
"Rolled technique"
"in this technique, several large GP cones are heated & rolled
between 2 glass slabs >>> single large cone"

13. ֍ Chloroform Dip Technique:" vii
֍ Clinical tips:"
֍ "Indications:"
"mark the cone for
orientation (to place it
in the same position
each time)"
"never leave the cone in
the canal while it's soft
(its tip may separate
while removing the
master cone)"
"wet with the canal with
irrigants >> to prevent
sticking of softened
point to the canal's
wall"
"canal walls are not
coated with sealer (only
the apical 1/3 of the
master cone)"
"more sealer is added
on accessory cones
before placement"
"choose a large
standardized master
cone that stops 2-4mm
shorter than WL"
"dip the master cone
tip in chloroform for 3-4
seconds to soften it"
"pack the cone apically
in the canal & repeat
several times"
"grasp the cone at the
reference point &
measure it"
"repeat softening &
packing till the cone
reaches the WL"
"the cone tip should
take an impression of
the apical portion"
"after reaching the WL,
remove the cone &
leave it to dry for 2-3
minutes"
"immerse the tip of the
cone in sealer & insert
into canal"
"complete obturation
with lateral compaction
technique"
"cases of open apex
(apical stop is lacking)"
"cases where the
apical portion is
irregular or very large"

14. ֍ "Disadvantages:"
֍ Advantages:
֍ "Rolled Technique:" viii
֍ Indications:"
"chemical solvents
are irritant to
periapical tissues"
"chemically
softened GP is
dimesionally
unstable"
"solvents evaporate
>> shrinkage of the
root filling"
"exact impression of the apical portion is taken >> improve the resultant seal"
"arrange several large
GP cones tip to butt"
"heat them together &
roll them between 2
glass slabs"
"a single large cone is
obtained"
"repeat heating & rolling
till the size of the
obtained GP be similar
to that of the canal"
"cill the Tailor-made GP
cone with ethyl chloride
spray or water"
"try it in the canal"
"it should fit 1-2mm
from the radiographic
apex"
"this cone is used as
master cone"
"continue obturation
with lateral
condensation
technique"
"when the canal is very
wide & no single canal can
be adjusted to fit (even
when dipped in solvent)"
"when the root canal is larger
than the biggest standardized
GP"

15.  "Criteria for the evaluation of the obturation's quality"
1- "Radiographic evaluation:"
"evaluation
criteria"
"radiographic
evaluation"
"clinical
evaluation"
"histological
evaluation"
•> "voids within the body or at the interface of obturation
material & dentin wall >>> incomplete obturation"
"Radiolucencies"
•> "material should be of uniform density from coronal to apical
part"
•> "margins of GP should be sharp & distinct with no fuzziness >>
indicates close adaptation"
"Density"
•> "the length of an ideal fill should be from the canal's apical
minor constriction to the canal orifice (unless a post is planned)"
"Length"
•> "the restoration (whether permanent or temporary) should be
contacting enough dentin surface to ensure a coronal seal"
"Restoration"
•> "the GP should reflect the canal shape (tapered from coronal to
apical region)"
"Taper"

16. 2-"Clinical evaluation:"
"After a successful endodontic treatment, the following should be
achieved:"
3- "Histological evaluation:"
"after a successful endodontic treatment, the histological section should
show"
"Success"
•> "normal PDL thickness
& lamina dura when
compared to adjacent
teeth"
•> "no evidence of
resorption"
•> "hermetic filling of
root canal space"
•> "dissappearance of
radiolucency (if present)
within 1 year"
"Questionable"
•> "radiolucency neither
significantly improved
nor deteriorated"
•> "after endodontic
surgery >> periapical
scarring occurs"
"Failure"
•> "radiolucency has
developed, persisted, or
enlarged"
"3 conditions"
"no pain or
swelling"
"disappearance
of fistula"
"no loss of
function"
"no evidence of
soft tissue
distruction"
"no tenderness
to percussion
or palpation"
"no inflammation"
•> "regeneration of PDL"
•> "evidence of osseous repair with healthy osteoblast
surrounding newly formed bone"
"reconstitution of periapical structures"

17. i
"Dr. Pradnya V.Bansode "Obturating Materials Present and Past: A Review”
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), vol. 17, no. 3, 2018,
pp. 27-33"
ii " Garg N, Garg A. Textbook of endodontics. New Delhi: Jaypee Bros. Medical
Publishers; 2010."
iii "Hoen M, LaBounty G, Keller D. Ultrasonic endodontic sealer placement.
Journal of Endodontics. 1988;14(4):169-174."
iv "Sheetal M, Narayan R, Dhamali D, Singh A, Thakur A, Patil A. Effect of
Placement Techniques on Sealing Ability of Root Canal Sealers. International
Journal of Oral Care & Research. 2016;4(3):201-203."
v"http://ccnmtl.columbia.edu/projects/virtechs2006/pdfs/endolateralcondens
ationtechnique.pdf"
vi
"http://www.uobabylon.edu.iq/eprints/publication_4_472_1726.pdf"
vii
"https://pocketdentistry.com/root-canal-obturation-6/"
viii "https://pocketdentistry.com/root-canal-obturation-6/"