Obturation

OBTURATION
1
OBTURATION
Presented by
Dr. MEENAL ATHARKAR
MDS
DEPT OF ENDODONTICS AND
CONSERVATIVE DENTISTRY

CONTENTS
• Introduction
• Definition of obturation
• Historical aspects
2
• Historical aspects
• Rationale of obturation
• When is the root canal ready for obturation?
• Timings for obturation
• Length and extension of obturation
• Criteria for evaluation of obturation materials and
sealers
• Instruments used in obturation

Sealers:
• Definition
• History
• Classification
• Ideal requirements
• Functions
• Details of different types of sealers
3
• Details of different types of sealers
Obturating materials:
• Ideal requirements
• types
• Silver cones
• Gutta percha
• others

Contents:
• Cold lateral condensation
• Warm lateral condensation
• Warm vertical condensation
4
• Warm vertical condensation
• Continuous wave compaction
• McSpadden thermomechanical
• Thermoplasticized GP injection
• Carrier based gutta percha
• Chemically plasticized gutta percha
• Custom cone
• Immediate obturation

• Reaction to obturating materials
• Success and failure of endodontic treatment
• Management
5
• Management
• Recent Advances
• Conclusion
• References

INTRODUCTION
• Achieving a high quality root filling is one of the
prerequisites for the success of root canal treatment.
• Obturation is a reflection of the cleaning and shaping and is
evaluated on the basis of length, taper, density, level of
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evaluated on the basis of length, taper, density, level of
gutta-percha removal and the coronal seal.
• An obturant (obturating material) should seal the root canal
system three dimensionally.

THE WASHINGTON STUDY OF ENDODONTIC
SUCCESS AND FAILURE
Nearly 58% of the failures in the study were
apparently caused by incomplete obliteration
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apparently caused by incomplete obliteration
of the radicular space.
(Ingle JI, Modern Endodontic Therapy. Endodontics, 4th edn. Malvern:
Ingle and Bakland, 1984: 1–52)

DEFINITION
• Obturation of the root canal system is defined as
“The three dimensional filling of the entire root canal
system as close to the cemento-dentinal junction as possible
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system as close to the cemento-dentinal junction as possible
to obtain a fluid impervious seal which will hinder the
invasion of microorganisms and potential nutrients that
would support biological growth.”
Glossary of endodontic terms

• Obturation of root canal space involves
the use of biologically acceptable chemical and
mechanical treatment that can promote healing and
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repair of periradicular tissues.American ass. Of endodontist’s guide to clinical endodontics.

HISTORY
 200 B.C. – oldest known root canal filling bronze wire found
in the root canal in the skull of a Nabatean warrior
 1825- Gold foil was used by Edward Hudson
 Other materials
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 Other materials
 Lead
 Paraffin
 Amalgam
 Wood points
 Oxychloride of zinc
 Ivory

 1847- Hill developed first gutta –percha material known
as Hill’s stopping.Consisted of bleached gutta-percha;
carbonate of lime and quartz(patented in 1848)
 1867-Bowman- 1st use of gutta percha for canal filling in
an extracted first molar
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an extracted first molar
 1883-Perry claimed the use of
 Pointed gold wire wrapped with some soft gutta-percha
 Gutta percha rolled into points and packed into the canal
 Chemical softening of shellac coated gutta percha using alcohol

 1887- S.S. White Company began to manufacture gutta percha
points
 1893-Rollins introduced new type of gutta percha to which he
added vermilion (pure oxide of mercury)
 1895-1st dental radiograph were taken
 Canals were not cylindric
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 Canals were not cylindric
 Need for additional filling material
 1898- Gysi introduced a formaldehyde paste- Gysi’s Triopaste
 1914-Callahan - softening and dissolution of gutta percha to serve as
the cementing agent through the use of rosins

1924- Hatton- perhaps there is no technical operation
in dentistry or surgery where so much depends on the
adherance of high ideals as that of pulp canal fillings.
1930- Elmer A. Jasper introduced silver points
1946- Sommer provided the technical essentials of
application of the lateral condensation technique
1953- Berg- essentials of vertical condensation
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1953- Berg- essentials of vertical condensation
technique
 - Acerbach- filling of root canals with silver wires
1967- Schilder popularized vertical compaction
technique.
1977- Yee et al introduced the injectable
thermoplasticized gutta-percha technique

1978- W. Ben Johnson described a technique of obturation
with gutta percha coated endodontic file (forerunner of
Thermafil)
1979- Mc Spadden introduced a special compactor for
softening gutta percha by friction
1984- Michanowicz introduced a low temperature (70C)
injectable thermoplasticized gutta-percha technique –
Ultrafil
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Ultrafil
1994- James B. Roane introduced Inject R-Fill technique
1996- Steven Buchanan developed a new method of
vertical compaction of warm gutta percha - continuous
wave compaction technique (System B)

Biological considerations for
obturation
THE HOLLOW TUBE THEORY OR STAGNATION THEORY :
An empty space within living organism tends to fill with tissue fluids within a
short period of time.
Rickert and Dixon 1931
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Rickert and Dixon 1931
”Circulating elements diffusing out of the open ends of the implanted tubes
were not tolerated by the vital tissues.“
The root canal must be filled to the very end of the tooth to
prevent outward diffusion of circulatory elements which
cause inflammation
TORNECK DISPROVED THIS CONCEPT
Reaction of rat connective tissue to polyethylene tube
implants.Oral Surg 1966, 1967
Ingle’s endodontics 7th edition

Hermetic seal
• Ancient Eygytian- Hermes Trismegistus-
• Hermetic means sealed against the escape or entry of air
or made air tight by fusion or sealing.
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or made air tight by fusion or sealing.
• Endodontically speaking, the term Hermetic Seal is
inappropriate.
• Fluid tight, fluid impervious or bacteria tight seals
• 1967- Grossman- Hermetic Seal
Cohen 10th edition

RATIONALE OF OBTURATION
• Total debridement of pulpal space.
• Prevents percolation and microleakage of periapical
exudate into the root canal space
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• Total obliteration of root canal.
• Prevents re-infection.
• Fluid tight seal at the apical foramen.
• Creates a favourable biologic environment for the process
of tissue healing to take place

oObturation should attain a radiographic appearance
of a dense three dimensional filling which extends as
close as possible to the cemento dentinal junction
oAppear approximately the same shape as the root
RADIOGRAPHICALLY….
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oAppear approximately the same shape as the root
morphology
o Appear continuously tapering funnel preparation
without excess removal of tooth structure at any level
of the canal system

WHEN TO OBTURATE THE CANAL?
1. Asymptomatic tooth
2. No discharge/exudates (dry canal)
3. No foul odor from canal
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4. No draining sinus
5. The temporary filling is intact. A broken or leaking
filling causes recontamination of the canal.
6. Negative culture sensitivity tests
Ingle’s endodontics 7th edition

TIMING OF OBTURATION
• Patient’s signs and symptoms
• Status of the pulp and periradicular tissues
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• Status of the pulp and periradicular tissues
• Degree of difficulty
• Patient management

MULTIPLE VISIT
 Treatment in a two visit
model proposed as a standard
►1st appointment
 complete debridement
and irrigation of root
SINGLE VISIT
 Treatment in
a single visit
with or
without intra-
appointment
TIMING OF OBTURATION
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and irrigation of root
canal
 application of calcium
hydroxide for one week
or more
►2nd appointment or later
appointment
 obturation of root canal
appointment
medicaments

Mechanical instrumentation alone causes a 100- to a 1000- fold
reduction in numbers of bacteria but complete elimination in only 20 – 43%
cases
Bystrom, Sundqvist 1981
Added antibacterial irrigation with 0.5% NaOCl provides
disinfection in some 40 – 60% of the teeth thus treated
MULTIPLE VISITS
FIRST CONCERN: BACTERIAL
ELIMINATION
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Subsequent application of a Ca(OH)2 dressing for a suitable
length of time brings the percentage of bacteria-negative teeth
to 90 to 100 %

LENGTH OF OBTURATION
• Earlier- dentinocemental junction
• Tactile sensation- not reliable- for locating CDJ.
• Kuttler (1995)- major diameter and minor diameter
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• Kuttler (1995)- major diameter and minor diameter
• Canals filled 2 mm short of apex harboured necrotic
tissue, bacteria and irritants that when retreated could
be cleaned and sealed.
• According to Cohen- 1mm short of apical foramen.

EXTENSION OF ROOT CANAL FILLING
• Ricucci and Langeland suggested obturation should not
end at
radiographic terminus
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CDJ
1mm from radiographic apex.
• It should end at apical constriction
• (as far as 3.8 mm from the anatomic apex.)
• Therefore, instrumentation and obturation should end
where the instrument stops.
• Schilder- 0.5-1mm from radiographic terminus.

• Overfilling:
• Total obturation of root canal system with excess
material extruding beyond the apical foramen.
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• Overextension:
• Extrusion of filling material beyond apical foramen but
the canal may not be filled completely and apex may not
be sealed.
• Underfilling:
• Filling of root canal system more than 2 mm short of
radiographic apex.

Does The Level Of Root Canal
Filling Affect Success ? Yes
Relationship between level of fill and success
Underfill >2mm – 68% success
0-2mm from apex – 94% success
overfilled – 76% success
Sjogren 1990 JOE
Healing was least successful in overfilled teeth.
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Healing was least successful in overfilled teeth.
Unfilled portion of the canal does not preclude healing.
Davis 1971 OOO
An overextended fill decreases success but underfilling had no influence.
Seltzer/Bender 1963 JADA
Extruded material delayed healing, late periapical changes can occur more than
10 years after treatment.
Molven 2002 IEJ

Does the level of root canal filling
affect success ? continued –NO
The apical extent of the root canal filling, ie underfilled,
flush-filled or overfilled, seems to have no correlation to
treatment failures.
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. Lin 1992 JOE

CRITERIA FOR EVALUATION OF OBTURATING
MATERIALS AND SEALERS:
• Most obturating materials do not fill the canal space
completely.
• Confirmed by: microleakage evaluation- dye penetration,
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radioisotopes, electrochemical, flurometrics, scanning
electron microscopic examination, root clarification,
fluid filtration and fluid transport.
• Voids in obturating materials(apical 3rd)
• Tissue toxicity- cytotoxicity evaluation, subcutaneous
implantation, intraosseous implantation, invivo
periapical reactions.

ARMAMENTARIUM
• Gutta percha points
• Spreaders
• Pluggers
• Absorbent paper points
• Lentulospirals
• Scissors
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• Scissors
• Endogauge
• Endoblock
• Heating device and instruments
• Glass slab, spatula and sealers

• Regarding Sealers-
“Root canal sealers are used in conjunction with a
biologically acceptable semi-solid or solid obturating
material to establish an adequate seal of the root canal
system.”
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system.”
-The American Association of
Endodontists

Sealer’s are the binding agents use to fill up the gap between
the root canal walls and the obturating materials.
It also fill up the irregularities, discrepancies, lateral canals
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It also fill up the irregularities, discrepancies, lateral canals
and accessory canals
Sealer should stick like a glue between gutta- percha points
and in the gutta percha dentin interface.
Fill up the voids that might have been left by gutta-percha.
Acts as a lubricant.

History
1931 – Original ZOE cement by Rickett.
1952 – Biocalex introduced by Bernard.
1955 – Scheufere introduced resin based Diaket sealer.
1956 – Grossman’s non staining ZOE formula appeared as
a sealer.
1976 – Putford recommended endodontic glass ionomer
ketac- endo as a root canal sealer.
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1976 – Putford recommended endodontic glass ionomer
ketac- endo as a root canal sealer.
1985 – Browne developed calcium phosphate cement.
1990’s – Inorganic agents which have biocompatibility
with biological tissues like the bioceramics have been
developed focussed mainly on apatite type and
tricalcium phosphate.
2004 – Epiphany and gutta flow

Ideal Requirements
1. Should provide an excellent seal when set. (hermetic
seal)
2. Produce adequate adhesion among it, the canal walls,
and the filling material.
3. Should be radiopaque.
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3. Should be radiopaque.
4. Non-staining.
5. Dimensionally stable.
6. Should be easily mixed and introduced in to
canals(tacky)
7. To be easily removed if necessary.

8. Insoluble in tissue fluids.
9. Bacteriostatic or discourage bacterial growth.
10. Non-irritating to periapical tissues.
11. Should be slow setting, to ensure sufficient working
time.
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time.
12.Should be absorbable when extruded into periapical
tissues.
13. It should not be mutagenic or carcinogenic.
14. Not provoke any immune response in periradicular
tissues

Functions of Sealers
1. Antimicrobial agent.
2. Binding agent
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2. Binding agent
3. A filler
4. A lubricant
5. Radiopacity

CLASSIFICATION OF SEALERS
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eugenol noneugenol medicated
• Kerr
• Procosol
radiopaqueSilver
diaket
AH26
Diaket A
N2radiopaqueSilver
containing
• Procosol
nonstaining
• Grossman’s
• Tubliseal
• Wach’s paste
Silver free
AH26
Chlorpercha,
eucapercha
Calcium
phosphate
endofill
GIC
polycarboxylate
N2
endomethasone
iodoform
Riebler’s paste
CAOH
polycarboxylate

• Based on absorbability( Dr Clark):
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Absorbable
Kerr sealer (rickert’s
formula)
Grossman’s sealer
Non-absorbable
Diaket
Grossman’s sealer
Roth’s cement
Tubliseal , tubliseal EWT
AH-26 / AH-plus
Ketac endo

• Grossman: • Ingle:
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Zinc oxide resin cements
• v
paraformaldehye
CAOH
pastes
pastes
plastics

• Cohen: (57):
• Type I: core material
Class 1: powder and liquid
Class 2: 2 pastes
Class 3: polymer and resin
• Type II: with or without core
material or sealer.
Class 1: powder and liquid
nonpolymerizing
Class 2: paste and paste
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Class 3: polymer and resin
system
Class 2: paste and paste
nonpolymerizing
Class 3: metal amalgams
Class 4: polymer and resin syst.

Zinc oxide eugenol sealer
• Rickert and Dixon (1931)- silver particles-
radiopacity.(staining)
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• Market- Pulp canal sealer, pulp canal sealer EWT.
• Modification-
• procosol(zinc oxide, hydrogenated resin, bismuth
subcarbonate, barium sulfate, liquid eugenol)

• Advantages:
• Excellent lubricating
properties
• Ratio1:1- wt- more than
• Disadvantages:
• Presence of silver-
staining
44
• Ratio1:1- wt- more than
30 mins.
• Biocompatible
• Greater bulk to fill voids,
auxillary canals and
irregularities.
• Manipulation:
• 1 drop of liquid added to 1
pellet of powder, mixed
with a spatula

• 1. Grossman’s non staining formula (1958)
Powder
▫ Zinc oxide,reagent 42 parts
▫ Staybelite resin 27 parts
▫ Bismuth subcarbonate 15 parts
▫ Barium sulphate 15 parts
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▫ Barium sulphate 15 parts
▫ Sodium borate 1 part
Liquid
▫ Eugenol
• This formulation seen in ROTH’s sealer and TUBLISEAL

• Advantages:
• Plasticity
• Slow setting time
• Disadvantages:
• Coarse particle size
• More spatulation
• Zinc eugenolate is
decompossed by water
46
• Good sealing potential
• Manipulation:
• Setting time: 2 hours at
37 degree.
decompossed by water
through continuous loss of
eugenol which makes it a
weak unstable compound.

2.WACH’s SEALER
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Advantages:
Germicidal
Less periapical irritation
Disadvanatges:
Odor of liquid
sticky

• 3. Tubli- Seal : (1961)
• ( Sealapex Regular , Sealapex EWT)
• Modified for staining property.
• Setting time: 20 min- glass slab, 5 mins- root canal
Base paste Catalyst
▫ Zinc oxide Polypale Resin
▫ Barium Sulphate Eugenol
▫ Mineral Oil Thymol Iodide
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▫ Mineral Oil Thymol Iodide
▫ Corn Starch
▫ Lecithin
• Advantage :
▫ Ease Of Preparation
• Disadvantage:
▫ Rapid setting time

Calcium hydroxide cement
1. Used in conjunction with solid core materials.
2. Solubility is required for release of calcium hydroxide and
sustained activity. This is inconsistent with the purpose of
a sealer.
49
3. The use of Calcium hydroxide paste is based on the
assumption – there is formation of hard structure or
tissue at the apical foramen.
4. The activity of calcium hydroxide stimulate the induction
of alkaline phosphate, thus forming hard tissue.

1.CRCS( calciobiotic root canal
sealer)
• Introduced in 1982
• Is a zinc oxide eugenol eucalyptol sealer to which calcium
hydroxide has been added for its osteogenic effect.
Eg. Sealapex, apexit, apexit plus
50
Eg. Sealapex, apexit, apexit plus
• It is mixed like any other powder:liquid sealer sets both in dry and
wet canals.
• It takes 3 days to set fully in either dry or humid environment,
shows little water sorption which makes it stable and improves its
seal and quality.

2.Biocalex :
• Developed and introduced by Bernard in 1952.
• Powder and liquid are mixed to form a paste.
52
• Powder and liquid are mixed to form a paste.
• Progressively expands to more than 6 times its original
volume. So it is not necessary to prepare the root canal
prior to root canal filling.

• Noneugenol sealers :
• Composition:
Base paste Catalyst
▫ Zinc oxide Hydrogenated resin
▫ Barium Sulphate Methyl abietate
▫ Vegetable oil Lauric acid
53
▫ Vegetable oil Lauric acid
▫ Bismuth oxychloride Chlorothymol
Salicylic acid

• 1.Chlorpercha:
• Gutta percha+chloroform
• 3.Nogenol:
• Periodontal dressing
• Base contains zinc oxide,
barium sulfate, bismuth
54
• 2.hydron:
• Wichterle and Lim 1960.
• Rapid setting hydrophillic,
plastic material
• Used without a core.
barium sulfate, bismuth
oxychloride

GIC sealers:
• Dentin bonding properties.
• Eg. Ketac- Endo
55
• Disadvantages:
• Minimal antimicrobial activity
• Removal difficult
• Eg. Active GP( glass ionomer impregnated gp cone with
glass ionomer external coating and glass ionomer sealer
• Size: 0.04,0.06 tapered cones.

Resin based sealers:
• 1. AH-26:
• Shroeder 1957.
• Composition:
▫ Bis-phenol A epoxy resin - base
▫ Hexamethylenetetraamine for polymerization – catalyst
▫ 60% bismuth oxide
• Advantage :
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• Advantage :
▫ Low solubility
▫ Greater adhesion to dentin
▫ slight shrinkage
▫ High radiopacity
• Disadvantage:
▫ Staining
▫ Very toxic when freshly prepared

• 2.AH-PLUS: (Thermaseal plus)
▫ Esthetic demands
▫ Retained the epoxy resin “glue” of AH26 but added
amines to maintain natural color of the tooth
▫ Working time -4hrs
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▫ Working time -4hrs
▫ Setting time -8hrs
• Advantages:
▫ Decreased solubility
▫ Thinner film thickness

• 3. Methacrylate resin sealers:
• 4 generations:
• 1st:HYDRON (1970s) [ hydrophillic]
• 2nd: ENDOREZ [ nonetching, hydrphillic]
58
• 3rd: RESILON,
REAL SEAL,
REAL SEAL SE [ Self etching]
• 4th: METASEAL [ self adhesive]

Silicone sealers:
• Eg. Roekoseal, gutta flow, gutta flow2 (They contain
gutta percha added to roekoseal.)
59
• It is a polydimethylsiloxane that expands slightly
on setting.
• Disadvantage: setting time is inconsistent

Medicated Root Canal Sealers
1. Diaket A
• (a) Chemically this sealer is similar to Diaket but it also
contains the disinfectant hexachlorphene.
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• (b) Diaket is one of the few medicated cements which does not
contain paraformaldehyde.
Recent advancements in medicated root canal
sealers: An advanced step in creating bacteria free
obturation Dr. Deshpande M Prashanth
International Journal of Applied Dental Sciences
2017; 3(3): 37-41

2. N2
• • Introduced by Sargenti and Ritcher in 1961.
• • N2 refers to the so called second nerve.(pulp)
Initially 2 different types of N2 sealers were
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Initially 2 different types of N2 sealers were
available :
• • N2-Normal – Used for root filling.
• • N2-Apical – Used for antiseptic medication of canal.
• • Recently N2-‘Universal’ a cement containing the
features of both N2-Normal and N2-Apical has been
introduced.
• The formula has been altered by removing
hydrocortizone, prednisolone and barium sulfate

Composition of N2-Universal
62

Toxicity
• • Degree of irritation is severe when overfilling with N2 is
forced into the maxillary sinus or mandibular canal persisting
63
forced into the maxillary sinus or mandibular canal persisting
paraesthesia was observed.
• Blood lead level is increased after the insertion of root filling.
Effectiveness of sealers
• • Apical seal with N2 is better when compared to procosol,
nogenol, tubliseal and diaket.

3. Endomethasone
• • The formulation of this sealer is very similar to N2
composite.
• • Pink antiseptic powder
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• • Pink antiseptic powder
• Endomethasone root canal sealers give rise to pain or
discomfort after 6-8 weeks of insertion.
• This occurs because corticosteroids marks any
inflammatory reaction until it is removed from the area

4. SPAD
• • One visit non irritant radioopaque filler and sealer.
• • It is a resorcinal formaldehyde resin supplied as a
powder and two liquids.
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• Setting time of SPAD is 24 hrs.
Indications
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Indications
• Pulpotomies in both deciduous and permanent teeth.
• For treatment of acute endo infection.
• Teeth with lesions in periapical areas.
• When SPAD is used in treatment of periapical infection a small
amount is intentionally introduced beyond the apex with the belief
that sterilization helps healing.

5. Iodoform Paste (WALKHOFF in 1928)
1. Resorbable paste used alone or in combination with
other core materials.
68
Composition
60 parts iodoform
40 parts parachlorophenol
Commercially known as Kri-1 paste.

Advantage:
Stimulates the periapical tissues
Excess accelerates bone formation.
Disadvantages :
• Periapical irritation.
• Discolouration.
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• Discolouration.
• Causes increased iodine level in blood, hence
contraindicated in patient with sensitive to iodine.
• Camphorated parachlorophenol is a highly toxic
preparation causes tissue necrosis

6. Endoflas• It is zinc oxide based medicated sealer consisting of
powder: liquid formulation.
Powder
• Zinc oxide.
• Iodoform.
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• Iodoform.
• Calclium hydroxide.
• Barium sulphate.
Liquid
• Eugenol.

• Setting time is approximately 30-45 minutes
• Relatively biocompatible and absorbable sealer.
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• Relatively biocompatible and absorbable sealer.
• Induces severe inflammatory reaction in 48 hours and
gradually reduced after 3 months.
• Severe cytotoxicity was observed along with coagulation
necrosis which is attributed to be presence of iodoform
parachlorphenol.

7. Riebler’s paste :
• Paraformaldehyde based Composition
72

Ideal properties:
• Easily manipulated
• Ample working time
• Dimensionally stable
• No shrinkage once inserted
• Seal canal laterally and apically
• Nonirritating
75
• Nonirritating
• Impervious to moisture
• Nonporous
• Unaffected by tissue fluids
• Inhibits bacterial growth
• Radiopaque
• No discoloration
• Sterile
• Easily removable.
Cohen 1oth edition

Types:
Solid
76
Core
semi
solid
Core
materia
l

CORE MATERIALS:
a. solid:
• SILVER CONES:
• 1933: Introduced by JASPER
• Oligodynamic property
77
• Oligodynamic property

Advantage:
Stiffer and easier to insert in very narrow canals
Appeared dense radiographically
Disadvantages:
Require circular canal preparation
78
Require circular canal preparation
Lack of plasticity: do not seal apically or laterally
Remaining space filled with cement or sealer would be
washed away by tissue fluid
Silver points are more prone to corrosion when exposed to
tissue fluids

b. semisolid:
GUTTA PERCHA
• The word ‘Gutta Percha’ is an English derived
word from the Malay origin “Getah Pertja”
meaning ‘strings of sticky plant juices’
Getah – sap
79
Getah – sap
Pertja – strips of cloth

• Gutta-percha is the most popular core material used for
obturation.
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• Its plasticity,
• ease of manipulation,
• minimal toxicity,Advantages • minimal toxicity,
• radiopacity, and
• ease of removal with heat or solvents.
Advantages
• include its lack of adhesion to dentin
and,
• when heated, shrinkage upon
cooling.Disadvantages

• Gutta-percha is the trans-isomer of polyisoprene
(rubber) and exists in two crystalline forms (α and β).
• β α
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heated
• The α form of gutta-percha melts when heated above
65°C.
• When cooled extremely slowly, the α form will
recrystallize.
• Routine cooling results in the recrystallization of the β
form.

PHASES OF GUTTA PERCHA
ALPHA PHASE
 Natural tree product
 Low molecular weight
polymer
 Lower melting point
BETA PHASE
 Processed form
 High molecular weight
polymer
 Higher melting point
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 Lower melting point
 Low viscosity
 Increased stickiness
 Less shrinkage (2.2%)
 Newer products
 Thermafil
 MicroSeal
 Higher melting point
 Higher viscosity
 Reduced stickiness
 More shrinkage (2.6%)
 Most commercial forms

Sizes:
• Standardized
• Core points
• ISO/ADA/ANSI
• File size
• Nonstandardized
• Auxillary points
• Dimensions are
according to tip and
body.
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standardized
• File size
• Eg. 40 no GP of 0.04 taper
cone has
• tip of 0.4 mm with
• taper 0.04mm per millimeter.
• 15-140 size number
• More conical and
pointed
• Eg. extrafine
• fine fine
• fine
• medium fine
• medium large
• large
• extra large
nonstandardized

COMPOSITION OF COMMERCIALLY AVAILABLE GUTTA-
PERCHA
COMPOSITIONCOMPOSITION PERCENTAGEPERCENTAGE
VARIATIONVARIATION
FUNCTIONFUNCTION
GuttaGutta-- perchapercha 1919--22%22% MatrixMatrix
Friedman 1975
Zinc oxideZinc oxide 5959--79%79% FillerFiller
Heavy metal sulfatesHeavy metal sulfates 11--17%17% RadiopacifierRadiopacifier
Waxes / ResinsWaxes / Resins 11--4%4% PlasticizerPlasticizer
86

ADVANTAGES DISADVANTAGES
 Compactibility
 Adapts To The Root
Canal Walls
 Biologically Inert
 Least Reactive
 Minimal Toxicity
 Minimal Tissue
Irritability
87
o Undergoes Shrinkage
When Plasticized
o Does Not Possess
Adhesive Qualities
Irritability
 Least Allergic
 Well Tolerated By
Periradicular Tissues
 Dimensional Stability
 Becomes Plastic When
Warmed
 Does Not Discolour The
Tooth
 It Is Radiopaque
o Lack Of Rigidity
o Undergoes Vertical
Distortion During
Compaction
Needs A Definite Apical
Constriction / Stop

 GUTTA PERCHA PELLETS
/ BARS
 For use in
thermoplasticized gutta
percha
 e.g. Obtura system
FORMS:
 SYRINGES
 As low viscosity gutta
percha
 to be coated on carriers
 e.g. AlphaSeal,
SuccessFil
88

PRE COATED CORE
CARRIER
GUTTA PERCHA
 Stainless steel, titanium
or plastic carrier
precoated with alpha
phase gutta percha
 e.g. Thermafil e.g. Thermafil
GUTTA PERCHA SEALERS
 Dissolving gutta percha
in chloroform /
eucalyptol
 e.g. chloropercha,
eucapercha
89

HYDRON
 Introduced as a root canal filling in 1978
 By Goldman and associates
 Is a polymer of hydroxy- ethyl- methacrylate (i.e., poly – HEMA)
 Is a hydrophilic acrylic resin
Undergoes polymerization in an aqueous environment
 Is self polymerizing
90
 Is self polymerizing
 Is rapid setting
sets in 10 minutes
 Radiopaque
 addition of barium sulfate
 Injected into root canal using a special syringe and needle, that allows
placement in thin and/or curved canals

When inserted into root canalWhen inserted into root canal
Moisture fromMoisture from periapicalperiapical tissuestissues
PolymerizationPolymerization
91
Mechanism:
SwellsSwells PlasticPlastic
Increases sealing abilityIncreases sealing ability conforms to shape ofconforms to shape of
root canalroot canal

It was reported to be
(1) easy to use because of its injectability,
(2) nonirritating,
(3) highly adaptable to the canal walls,
(4) nonsupportive of bacterial growth, and
(5) able to be calcified in the event of inadvertent extrusion of the
sealer into the periapical regions .
92
Kronman JH, Goldman M. Biological evaluation of
Hydron. J Endod 1981;7:441–3.
Murrin JR, Reader A, Foreman DW, Beck M, Meyers
WJ. Hydron versus guttapercha and sealer: a study of
endodontic leakage using the scanning electron
microscope and energy-dispersive analysis. J Endod
1985;11:101–9.

RESILON
(Resilon Research LLC, Madison, CT, U.S.A)
It is a high performance industrial polyester
Alternative to GP.
Consists of
Soft resin matrix
Polymers of polyester
Fillers and radiopacifiersFillers and radiopacifiers
Bioactive glass
Bismuth oxychloride
Barium sulfate
Overall filler content  65% by weight
93

Performs like gutta percha and has the same
handling characteristics
94
Is biocompatible
Also insoluble in water
Easily retrievable for retreatment purposes
Softened with heat
Dissolved with solvents like chloroform

Available as
Master cones
in all ISO sizes
0.04,0.06 taper
Accessory cones – in
different sizesdifferent sizes
Pellets – used for
backfill in warm
thermoplasticized
techniques
95

96
 Can be placed by lateral
compaction
 Warm lateral and vertical
compaction
 Thermoplastic injection
 Core carrier technique Core carrier technique
 Can be thermoplasticized,
but at a lower temperature
 With the Obtura gun
 Reduce the temperature by
20 degrees (i.e. approx. 150 -
170oC)

 Unlike gutta percha
 It is white in colour
 More radiopaque
 Slightly stiffer
Resilon points and pellet
Gutta percha
points and pellet
97
Resilon points and pellet

It is used in conjunction
with
SELF – ETCHING PRIMER
EPIPHANY PRIMER
SEALER
EPIPHANY ROOT CANAL
SEALANT
Dual curable resin – based sealer
98

• The Epiphany primer conditions the dentinal surface of
root canals, demineralizing it, and exposing the collagen
matrix.
99
• The resin sealer bonds to resilon core and attaches to
etched root suface.
• The Epiphany sealer bonds to both the root dentin and
Resilon cones to form a single unit, termed a
“MONOBLOCK”.

EndoRez system (Ultradent, South Jordan, UT)
• In the EndoRez system , conventional gutta-percha
cones are coated with a proprietary resin coating .
• This coating is bondable to a hydrophilic,
100
methacrylate-based dual cured resin sealer.

Activ GP (Brasseler USA, Savannah, GA)
• ActiV GP is marketed as a monoblock system
• gutta-percha cones that are surface coated with glass-
101
• gutta-percha cones that are surface coated with glass-
ionomer fillers.
• The presence of the glass-ionomer filler coated gutta-
percha cone also allows it to be bonded to the root dentin
via a glass-ionomer sealer.
• Size: 0.04,0.06 taper cones

Activ GP Plus
– Also available now
- employs calibration rings for easy depth measurement
- a unique barrel handle which, when placed with
102
- a unique barrel handle which, when placed with
placement instrument (transporter) facilitates easy
placement into the canal.

METHODS OF
OBTURATING THE
103
OBTURATING THE
RADICULAR SPACE

According to J.J. Messing and C.J.R.
Stock (1988)
• Sectional
• Single Cone
104
CLASSIFICATION
• Single Cone
• Multiple cone
• Gutta percha with solvents
• Thermal compaction
• Injection molded thermo-plasticized pastes alone

According to Cohen
• Cold Lateral Condensation
• Warm Vertical Condensation
• Continuous wave compaction technique
105
• Continuous wave compaction technique
• Warm lateral compaction
• Thermoplasticized injection techniques
• Carrier based gutta percha
• Thermomechanical compaction Solvent technique

According to Grossman
• Lateral condensation method
• Vertical condensation method
• Sectional method
• Compaction method (McSpadden)
• Metal core obturation
▫ Silver cone method
▫ Stainless steel file method
107
▫ Stainless steel file method
• Chemically plasticized gutta-percha
• Injection techniques for obturating canals
▫ Hydron
▫ Thermoplasticized guttapercha method
 Obtura
 Ultrafil

DETAILS OF EACH
OBTURATION
108
OBTURATION
TECHNIQUE

1.Cold Lateral compaction technique
Most commonly practiced
Sommer 1946
• Should match the size of the last instrument used at the
apex.
• Methods of determining proper fit of the primary
109
• Methods of determining proper fit of the primary
points:-
▫ Visual test
▫ Tactile test
▫ Patient’s response
▫ Radiographic test

Variations of lateral compaction:
Immature canal and apices
▫ Obturation – tailor made gutta-percha to fit
irregular apical stop or barrier
113

• Ansari BB et al compared radiographic quality of obturation
in molar teeth, obturated with cold lateral condensation and
thermoplasticized injectable gutta-percha technique and
found that no significant difference between both technique,
in terms of post obturation voids and apical termination, as
114
in terms of post obturation voids and apical termination, as
observed in radiographs.
(Ansari BB et al J Conserv Dent. 2012; 15(2): 156–160.)

2.Warm Lateral Compaction
Technique
• Predictable length control
• Endotec II device and Endotwinn tips
• Produced a fusion of GP into solid homogenous mass
115
• Produced a fusion of GP into solid homogenous mass
• Advantage: created less stress
• Disadvantage: heat generation
• Can be used with warm lateral condensation technique

Technique:Adapting master cone
Appropriate size of endotec II tip is selected.
(0.02/20 and 0.02/40)
116
Device is activated and tip is inserted beside
mastercone to within 2-4mm of apex, using
light pressure
Tip rotated for 5-8 sec and removed
Accessory cone is placed. The process is
continued untill canal is filled

3.Warm Vertical Compaction
▫ Schilder’s Boston technique (1967)
▫ Method of filling the radicular space in 3-dimensions.
▫ Indications:
▫ Alternative to cold lateral condensation
117
▫ Fitting of mastercone to apical portion of canal is
impossible
▫ Unusual canal curvatures
▫ Internal resorption
▫ Lateral lateral canals

• Principle:
• filling lateral and accessory canals as well as the main
118
• filling lateral and accessory canals as well as the main
root canal.
• Using heated pluggers, one applies pressure in a vertical
direction to the heat-softened gutta-percha and thereby
causes it to flow and to fill the entire lumen of the canal
• Step back technique

▫ Requirements(Schilder’s objectives):
 Continuous tapering funnel should be present from root
canal orifice to the root apex
 Root canal should be prepared so that it flows with the shape
of the original canal
 Shape of the apical foramen should not be changed or
119
 Shape of the apical foramen should not be changed or
moved
 Apical foramen should be kept as small as possible.

121
Nonstandard cones are selected and fit short of the
prepared length because they more closely replicate the
prepared canal.
Heated pluggers or spreaders are used to apply heat to
the master cone and remove the excess coronal material.

122
Apical compaction is complete
A gutta-percha segment is placed in the
canal, and heat is applied

123
The process is repeated for the coronal portion of
the canal by placing and heating a segment of
gutta-percha
A plugger is again used to compact the heated
material and complete the obturation.

• Heated carriers:
• Root canal plugger
• Electric heat carriers:
Touch n Heat(Sybron Endo)
Sytsem B(Sybron Endo)
124

• Advantage:
▫ Merging of gutta-percha into a dense homogenous
mass
▫ Dense 3 dimensional fill(excellent seal)
▫ Obturation of lateral and accessory canals
125
• Disadvantage :
▫ Time consuming
▫ Uncontrolled heat with heat carrier
▫ Risk of vertical root fracture
▫ Difficult in curved canals
▫ Periodic overfilling cannot be retrieved

4.Warm Sectional Gutta-percha Obturation
• Sectional obturation technique
▫ Also known as “CHICAGO” technique widely
promoted as Coolidge or Blayney technique.
126
promoted as Coolidge or Blayney technique.
• Indications:
▫ Tooth requiring post and core.

• ADVANTAGES:
Seals the canal apically and laterally
In case of post and core, only apical section of canal is
filled
• DISADVANTAGES:
127
• DISADVANTAGES:
Time consuming
If canal gets overfilled , difficult to remove sections of
gutta percha

5.SYSTEM B : CONTINUOUS WAVE COMPACTION
• Developed by Buchanan.
1996.
• Variation in warm vertical
technique
• It is used for warming gutta
128
• It is used for warming gutta
percha in the canal.
• It monitors temperature at the
tip of heat carrier pluggers,
thereby delivering a precised
amount of heat.

• ADVANTAGES
Creates single wave of heating and compacting
Excellent apical control
Less technique sensitive
131
Less technique sensitive
Fast, Easy, Predictable
Thorough compaction of the main canal and
lateral canals

6.Thermoplasticized Injectable Guttapercha
• OBTURA II HEATED GUTTA PERCHA SYSTEM
OR HIGH HEAT SYSTEM
• Technique was introduced in 1977 at Harvard institute
• This technique comprises a pressure apparatus consisting
132
• This technique comprises a pressure apparatus consisting
of an insulated electrically heated syringe barrel and a
selection of needles ranging from 18 to 25 gauge size.
• The plunger is designed to prevent backward flow of the
gutta-percha.

• Obtura III (160 degree)
• Calamus
• Elements
133
• Elements
• HotShot
• Ultrafill 3D(90 degree)

• REQUIREMENTS:
▫ Continuous tapering funnel shaped for unrestricted
flow of softened gutta percha
▫ A definite apical stop to prevent overfilling
• INDICATIONS:
134
• INDICATIONS:
▫ Roots with straight and curved canals
▫ For backfilling of canals
▫ For obstruction of roots with internal resorption or
perforations.

• TECHNIQUE:
• Before starting obturation, applicator
needle and pluggers are selected. Needle
tip should reach ideally 3-5mm of the
apical terminus passively
• Apply sealer along the dentinal walls to
fill the interface between gutta percha
135
fill the interface between gutta percha
and dentinal walls
• Place obtura needle loosely 3-5mm short
of apex, as warm gutta-percha flows and
fills the canal , back pressure pushes the
needle out of the canal.

• Now use pluggers to compact
the gutta percha, pluggers
dipped in sealer to prevent
sticking of gutta percha
• Continuous compaction force
136
• Continuous compaction force
should be applied throughout
the obturation of whole canal
to compensate shrinkage and
to close any voids if formed.

A) Obtura III:
• The Obtura III system (Obtura
Spartan) consists of a hand-held
“gun” that contains a chamber
surrounded by a heating element
into which pellets of gutta-percha
are loaded.
137
• Silver needles (varying gauges of 20,
23, and 25) are attached to deliver
the thermoplasticized material to the
canal.

• Disadvantage: lack of length control.
• Hybrid technique:
• Lateral compaction technique and then fill rest
138
• Lateral compaction technique and then fill rest
of canal with thermoplasticized GP.

B)Ultrafil 3d System:
• System uses low temperature (i.e. 90°c) plasticized
Alpha Phase Gutta Percha
• Here Gutta Percha is Available in three different
viscosities for use In different situations:
139
viscosities for use In different situations:
▫ Regular Set And Firm Set With Highest Flow Properties
Primarily Used For Injection And Need Not Be Compacted
Manually
▫ Endoset Is More Viscous And Can Be Condensed Immediately
After Injection

140
•an injection syringe,
•gutta-percha
cannulas,
• and heating unit.
•(regular:low viscosity-
30 mins30 mins
•Firm set: low viscosity-
4 mins
•Endoset: high viscosity-
2 mins)

OBTURA III ULTRAFIL
Uses high temperature Uses low temperature
Uses gun with heating
element
No heating element
Uses needle of 18, 20, 22,
and 25 guage
Uses needle of 22 guage
141
and 25 guage
Digital display of
temperature
No digital read out
Working time is 3-10 mins Working time less than 1
min

C)Calamus
• Is a thermoplastic device
equipped with a cartridge
system with 20- and 23-
gauge needles .
• The unit permits control of
142
• The unit permits control of
temperature and also the
flow rate.
• Pluggers are also available
for use with the system.

D)HotShot
• The HotShot delivery system (Discus Dental) is a cordless
thermoplastic device that has a heating range from 150° C to
230° C.
• The unit is cordless and can be used with either gutta-percha
or Resilon.
• Needles are available in 20, 23, and 25 gauges.
143
• Needles are available in 20, 23, and 25 gauges.

E)Elements:
• Consist of
• System B heat source
• Plugger
144
• Handpiece extruder for delivering thermoplastic
GP or Real seal from a disposable cartridge.
• Cartridges- 20,23,25 gauge needles (GP)
20.23 gauge needle for RealSeal

Disadvantage:
• Lack of precision in delivering gutta percha near apical
foramen and not beyond,
• Relies on heated and plasticized GP to flow apically
145
• Voids can be seen in the final seal.

7. Carrier Based Technique:
• Thermafil
• Profile GT obturators
• GT series X obturators
146
• GT series X obturators
• Protapers universal obturators
• Success fil
• Gutta flow
• Simplifil

A)Thermafil Endodontic Obturators:
• Devised by W Ben Johnson in 1978
• Specially designed flexible steel , titanium or plastic carriers
coated with alpha phase gutta percha
147

• Originally manufactured with a
metal core and a coating of
gutta-percha.
• The carrier was heated over an
open flame or Thermafil oven.
148
open flame or Thermafil oven.
• The technique was popular
because the central core
provided a rigid mechanism to
facilitate the placement of the
gutta-percha.

• ADVANTAGES:
▫ Requires less chair side time
▫ Provides dense 3- dimensional obturation as gutta
percha flows into canal irregularities
▫ No need to precurve obturators because of flexible
carriers
• Disadvantages
150
• Disadvantages
▫ Metallic core made placement of a post challenging and
retreatment procedures were difficult.
▫ In addition, the gutta-percha was often stripped from
the carrier, leaving the carrier as the obturating material
in the apical area of the canal.

8.Thermo-mechanical compaction
1979 McSpadden
▫ Mcspadden compactor:
 Resembled reverse headstrom file, rotated upto 10,000
rpm
151
rpm
 Heat generated by friction soften gutta-percha, and
bladed design pushed the material apically.
 Flexibility- nickel titanium

Technique:
Mastercone fitting short of apex( 45 no k
file)
Compactor is selected according to size and
inserted along GP CONE 3-4 mm from the
prepared length
152
prepared length
Handpiece activated, friction of rotating bur
heats up GP.
Pliable mass is compacted apically and
lateraly

• ADVANTAGES:
 Ablity to fill irregular canals
 REQUIRES LESS CHAIR SIDE TIME
• DISADVANTAGES:
153
• DISADVANTAGES:
 Instrument fracture
 Extrusion of material
 Inability to use in curved canals

9.Custom cone technique
• Chair side procedure for customizing gp in wide canals.
• Gp is customized to obtain a tug back.
• Softened appropriate size gp with accessory cones with the
help of heat and roll together on glass slab.
• Single master cone of increased diameter.
154
• Single master cone of increased diameter.
• Soften the tip
• On removal gp will carry the impression of the canal.
• Repeat process till snug fit is obtained.

10.Immediate obturation
• Alternative to apexification
• An apical barrier material should confine obturation
materials to the canal space and enhance healing by
155
inducing cementum and bone formation.
• MTA has been successfully employed as an apical barrier
material before obturation.

Temporary coronal filling materials
• The role of the temporary cements is to prevent the
contamination of the root canal system.
Properties of a good temporary cement;
• Good sealing to the tooth against microleakage
156
• Good sealing to the tooth against microleakage
• Lack of porosity
• Dimensional variations to hot and cold close to the tooth
• Good abrasion and compression resistance
• Ease of insertion and removal
• Compatibility with intracanal medicaments
• Good esthetic appearance

Reactions to obturating materials
• Zinc oxide eugenol type of cements are probably
irritating because of eugenol.
• Epoxy resin sealers are more biocompatible.
157
• Epoxy resin sealers are more biocompatible.

Success And Failure In Endodontics
• Causes of failure:
• Lack of judgement
• Lack of adequate debridement
• Traumatic injury to periapical tissues during canal
instrumentation
158
instrumentation
• Irrigating irritants or antiseptics pased beyond the
apical foramen.
• Failure to disinfect root canal
• Infection in accessory canal
• Imperfect root canal obturation
• Foreign body reaction
• Excessive amount of sealer
• True apical cystic lesion

MANAGEMENT
• Loss of working length- regain it.
• Incomplete obturation- reobturation (if earlier
obturation is beyond 2 mm from apical foramen.)
• Overextension- orthograde removal of GP.
159
• - if sealer- periodic radiographs

Bioceramic root canal sealer:
• Endosequence BC sealer
• iRoot SP sealer
• Calcium phosphate silicate based cement
• Premixed, injectable form
• It uses the moisture that remains within
161
• It uses the moisture that remains within
dentinal tubules after canal irrigation to
initiate and complete its setting reaction
• Initial ST-108 Hours
• Final ST- 168 hours
• PH- 12
• Increased bactericidal property.

MTA
• Mechanical mixture of three powders:
• Portland cement(75%)
• Bismuth oxide (20%)
• Gypsum(5%)
• Composition:
162
• Composition:
• Tricalcium silicate
• Dicalcium silicate
• Tricalcium aluminate
• Tetracalcium aluminoferrite
• Calcium sulfate
• Bismuth oxide

Down Pak 3D obturation with heat and
vibration:
• Cordless device with multifunctional, endodontic heating
and vibrating spreader device.
• Suitable with GP, resilon materials.
164
• Vibration increases the gutta percha fill density.
• Used for warm vertical and lateral condensation
techniques.

Trifecta system:
• Combination of successfil and ultrafil.
• 2-3 mm of warm GP retrieved from successfil
syringe on tip of endofile.
165
syringe on tip of endofile.
• It is carried down the sealer coated canal
• When it reaches WL, file is twisted
counterclockwise and removed.
• Compaction done with pluggers.
• Radiograph taken
• After confirmation, backfill done

Monoblock concept
• In response to the shortcomings of gutta-percha
recent introduction of an alternative root filling
material offers the promise of adhesion to root
166
material offers the promise of adhesion to root
canal dentine.
• An ideal endodontic filling material should
create a “monoblock”.

• This term refers to a continuous solid layer that
consists of an etched layer of canal dentin
impregnated with resin tags which are attached
167
impregnated with resin tags which are attached
to a thin layer of resin cement that is bonded to a
core layer of resilon which makes up the bulk of
the filling material

• In other words the monoblock concept means
the creation of a solid, bonded, continuous
material from one dentin wall of the canal to the
168
material from one dentin wall of the canal to the
other.
• Benefit-it strengthens the root by approximately
20 percent.
Tay FR.J Endod. 2007; 33(4): 391–398.

•Classification:
• based on number of interfaces present between
corefilling material and bonding substrate:
A) Primary:
In this obturation is completely done with core
material, for example, use of MTA for obturation in
cases of apexification.
B) Secondary:
169
B) Secondary:
In this bond is there between etched dentin of canal
wall impregnated with resin tags which are attached
to resin cement that is bonded to core layer
C) Tertiary:
In this conventional gutta-percha surface is coated
with resin which bond with the sealer, which further
bond to canal walls.

170
primary
• Hydron
• MTA
• Biogutta
• Polyethylene
fibre post
secondary
• resilon
• Prefabricated
post
tertiary
• endorez
• Activ GP

Fiberfill Obturator:
• The Fiberfill obturator is a resin and glass fiber
post with a terminal gutta percha tip.
• The gutta percha is available either in 5 or 8mm
171
• The gutta percha is available either in 5 or 8mm
lengths.
• The diameter of the post is available in sizes 30,
40, 50, 60, 70 and 80.

Endo-Ezesystem
• The Endo-Eze system (Ultradent,South Jordan,
UT) uses reciprocating instrumentation, a single
guttapercha cone, and a hydrophilic resin sealer
172
guttapercha cone, and a hydrophilic resin sealer
for obturation.
• It is stated that a reciprocating action cleans and
shapes elliptical and ribbon-shaped canals better
than the rotary system

The 3-D obturation of pulp space is a major objective
in successful endodontics.Increased knowledge of
pulp space system has emerged as one of the major
factors in restricting the endodontists to utilize a
• SUMMARY
173
factors in restricting the endodontists to utilize a
single material in form of gutta-percha by different
methods

CONCLUSION
• The choice of obturating material & technique depending
on the skills, experience and the root canal morphology.
174
• To achieve the successful endodontic therapy, it is
crucial that all canals are located, cleaned & shaped,
disinfected & sealed properly, not only in the apical
portion but as well as coronal part of the root canal.

REFERENCES
• Chapter 9- Obturation of the cleaned and shaped
root canal system :James L. Gutmann et al.
• Pathways of the pulp 8th edition Stephen Cohen
175
• Pathways of the pulp 8 edition Stephen Cohen
• Chapter 11-Obturation of Radicular space:John
I.Ingle et al;Endodontics 7th edition , John I.
Ingle
• Grossman
• Wikipedia
• Articles

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