This document discusses obturation, which is the final step in root canal treatment aimed at preventing reinfection of the root canal. It involves using filling materials and techniques to densely fill the entire root canal system and provide a seal from the apex to the cavity surface. Successful obturation requires clean and proper shaping of the root canal as well as placement of a good coronal restoration. The document describes various materials and techniques used for obturation, including gutta-percha, resilon, sealers, and techniques like lateral compaction, vertical compaction, warm lateral compaction, and injection. It stresses the importance of filling the entire root canal system and providing a fluid-tight seal to prevent reinfection.
One of the most dreaded nightmares of any clinician is broken instruments in the midst of an endodontic treatment. NiTi rotary instruments show a high incidence of instrument fracture despite their favourable qualities.
One of the most dreaded nightmares of any clinician is broken instruments in the midst of an endodontic treatment. NiTi rotary instruments show a high incidence of instrument fracture despite their favourable qualities.
explained with Limited matter moreover I have included all the images. if you go through a standard textbook and referred to this PPT it will help you so much I hope It helps you. ask me for the books details.
In this lecture I explain the basic concept of root canal filling or what called obturation. The lectures discuss different techniques used in that matter in step-by-step fashion and explanatory pictures.
It is directed to the level of undergraduate mind.
Biomechanical preparation is the crucial step in endodontic procedure. Biological principles can only be preserved if the mechanical shaping of the perticular canal is completed with the cordial following of the endodontic priciples. This presentation is aimed to simplify the various endodontic techniques for root canal shaping in as conservative as possible manner.
explained with Limited matter moreover I have included all the images. if you go through a standard textbook and referred to this PPT it will help you so much I hope It helps you. ask me for the books details.
In this lecture I explain the basic concept of root canal filling or what called obturation. The lectures discuss different techniques used in that matter in step-by-step fashion and explanatory pictures.
It is directed to the level of undergraduate mind.
Biomechanical preparation is the crucial step in endodontic procedure. Biological principles can only be preserved if the mechanical shaping of the perticular canal is completed with the cordial following of the endodontic priciples. This presentation is aimed to simplify the various endodontic techniques for root canal shaping in as conservative as possible manner.
In this lecture I explain the basic concept of root canal filling or what called obturation. The lectures discuss different techniques used in that matter in step-by-step fashion and explanatory pictures.
It is directed to the level of undergraduate mind.
Recent advances in obturation techniques/ dental implant coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Biomechanical preparation1/ rotary endodontic courses by indian dental academyIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Reconstructive periodontal surgery aims to treat deep pockets which have not be reduced after non surgical periodontal therapy. periodontal regenerative procedures mainly include the use of modified flap techniques , use of bone grafts and newer gene therapies. Biologic mediators play key role in the regeneration process. Guided tissue regeneration and Guided Bone regeneration are commonly used methods for periodontal regeneration. Minimally invasive surgical techniques are preferred surgical methods for treating deep infrabony pockets
Biomechanical preparation/ rotary endodontic courses by indian dental academyIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Interproximal tunneling with a customized connective tissue graft a microsurg...MD Abdul Haleem
Journal Club Presentation - Interproximal Tunneling with a Customized Connective Tissue Graft A Microsurgical Technique for Interdental Papilla Reconstruction.
Reconstructive periodontal therapy
Some of the slides may appear Blank/White/Black, those are the Videos that I added in the presentation.
Kindly Ignore those slides.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Obturation of root canal systems
1. Obturation of Root Canal Systems
BY MOHAMMED SAAD BDS
SUPERVISED BY DR ME’AD ABDUL RAZZAQ BDS MSC
2. Introduction
The purpose of the obturation phase of endodontic treatment is to prevent the
reinfection of root canals that have been biomechanically cleaned, shaped and
disinfected by instrumentation, irrigation and medication procedures. Successful
obturation requires the use of materials and techniques capable of densely filling the
entire root canal system and providing a fluid tight seal from the apical segment of
the canal to the cavo-surface margin in order to prevent reinfection. This also implies
that an adequate coronal filling or restoration be placed to prevent oral bacterial
microleakage. It has been shown that endodontic treatment success is dependent
both on the quality of the obturation and the final restoration. The quality of the
endodontic obturation is usually evaluated using radiographic images upon
completion. Additionally, during the root canal preparation and obturation phases of
treatment, clinical criteria can be identified that are essential for achieving an adequate
root canal obturation.
3. It’s All About Cleaning, Shaping and
Disinfection of Root Canal Systems
Prior to the obturation phase, the clinician must establish the proper shape and size of the root canal.
Figure 1 is an example of a retreatment case; it demonstrates the importance of locating all canals
then cleaning, shaping and sealing them to the proper working length. Proper canal preparation
provides an apical resistance form for the adequate adaptation of filling materials and the prevention
of excessive apical extrusion of these materials. Remember, what is removed from the root canal
during cleaning, shaping and disinfection is more important than what is placed during obturation.
Biomechanical preparation and disinfection are achieved through mechanical instrumentation and
copious irrigation to remove bacterial and tissue debris, and by shaping the root canal space to allow
for a three-dimensional obturation and seal of the root canal system. The importance of maintaining
the original shape of a root canal during and after cleaning and shaping in order to promote
periapical healing in endodontic cases has been demonstrated in several studies. The clinician’s
inability to maintain the original shape and to develop the proper taper of canals can result in
procedural errors such as ledges and perforations.
4.
5. When preparing root canals for obturation the clinician must maintain the working
length during the instrumentation phase of treatment. Figure 2 shows original,
working length and final obturation image with post and core in place. Maintaining
working length is essential for preparing and sealing the root canal to its proper
apical extent. It is also necessary to create an apical resistance form to obtain
adequate compaction of the filling materials and also to prevent excessive
overextension of materials into the periapical tissues. Today’s clinicians have a
number of methods, materials and technologically advanced instruments at their
disposal to achieve these goals. Examples of these are electronic apex locators, nickel-
titanium rotary instruments, various irrigation systems, newly formulated sealers, and
microscopic magnification and illumination.
6.
7. Poor obturation quality as judged by radiographs has been associated with nonhealing in
65% of retreatment cases. The radiographic appearance of a completed case should show the
obturation material: (1) at the apical terminus without excessive material overextending into
periapical tissues; (2) completely filling the root canal system in three dimensions; and (3)
appearing as a dense radiopaque filling of the root canal system. Obturation errors often are
a result of inadequate cleaning and shaping (ledges, perforations, inaccurate working lengths,
and underprepared or overprepared canals). If inadequate obturation is not a result of an
instrumentation error, the clinician should recognize this reversible procedural error on the
obturation check film. The obturation material should then be removed and the canal re-
obturated prior to restoration. If the procedural error is gross overextension of material into
the periapical tissues, removal by conventional means may not be possible and periapical
surgery may be necessary.
8. Why Obturate Canals?
Microorganisms and their byproducts are the major cause of
pulpal and periapical disease. However, it is difficult to
consistently and totally disinfect root canal systems. Therefore,
the goal of three-dimensional obturation is to provide an
impermeable fluid tight seal within the entire root canal system,
to prevent oral and apical microleakage.
9. Preparation of Dentin Surface (Irrigation)
The purpose of endodontic irrigation is to remove debris created
during instrumentation, and to dissolve and/or flush out
inorganic and organic remnants of the pulp system, bacteria and
bacterial byproducts that are not removed by mechanical
instrumentation.
10.
11. Criteria for Judging Technical Success of the
Obturation Phase of Endodontic Treatment
1. Clinical Evaluation. For a case to be considered successful, normal
findings to routine tests such as percussion, palpation, periodontal
probing and visual inspection of the final restoration should be
obtained and recorded in the patient’s record at an appropriate
follow-up visit. If the clinician is concerned about some aspect of
therapy or the prognosis, the reevaluation visit should be scheduled in
a few weeks. Routine reevaluation periods may be 6 months and 1
year. Patients should be informed that if symptoms occur they should
call the office for an appointment
12. 2. Radiographic Evaluation (Length, Shape and Density). (overfilled, overextended
and underextended). Three qualities that should be observed, are length, shape
and 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. The core restoration
should complete this seal to the cavo-surface margin. The shape of the
completed case is somewhat dependent on the obturation technique being
used. Some require a more tapered canal than others. Voids should not be
visible on the radiographic image. In terms of percentage rates of success, a
meta-analysis of the literature showed that obturations 0 to 1mm short of the
apex were better than obturations 1 to 3mm short of the apex; both were
superior to obturations beyond the apex.
13. Coronal Seal
Regardless of the quality of the sealing of the root canal space,
unless this space is protected against ingress of oral
microorganisms, success may not be achieved.
15. A. Sealers
Sealers are used between dentin surfaces and core materials
to fill spaces that are created due to the physical inability of
the core materials to fill all areas of the canal.
17. Techniques for Obturating Root Canal Systems
A. Lateral Compaction: A master cone corresponding to the final instrumentation size and length of the
canal is coated with sealer, inserted into the canal, laterally compacted with spreaders and filled with
additional accessory cones.
B. Vertical Compaction: A master cone corresponding to the final instrumentation size and length of the
canal is fitted, coated with sealer, heated and compacted vertically with pluggers until the apical 3-4mm
segment of the canal is filled. Then the remaining root canal is back filled using warm pieces of core
material.
C. Continuous Wave: Continuous wave is essentially a vertical compaction (down-packing) of core material
and sealer in the apical portion of the root canal using commercially available heating devices such as
System B (SybronEndo, Orange, Calif.) and Elements Obturation Unit™ (SybronEndo, Orange, Calif.), and
then back filling the remaining portion of the root canal with thermoplasticized core material using
injection devices such as the Obtura (Obtura Spartan, Earth City, Mo.) Elements Obturation Unit™
(SybronEndo, Orange, Calif.) and HotShot (Discus Dental, Culver City, Calif.).
18. D. Warm Lateral: A master cone corresponding to the final instrumentation size of the canal is coated with sealer,
inserted into the canal, heated with a warm spreader, laterally compacted with spreaders and filled with additional
accessory cones. Some devices use vibration in addition to the warm spreader.
E. Injection Techniques:
1. A preheated, thermoplasticized, injectable core material is injected directly into the root canal. A master cone is not
used but sealer is placed in the canal before injection, with either the Obtura (Obtura Spartan, Earth City, Mo.), or Ultrafil
(Coltene Whaledent, Cuyahoga Falls, Ohio) or Calamus® (DENTSPLY Tulsa Dental Specialties, Tulsa, Okla.) filling systems.
2. A cold, flowable matrix that is triturated, GuttaFlow® (Coltene Whaledent, Cuyahoga Falls, Ohio), consists of gutta-
percha added to a resin sealer, RoekoSeal. The material is provided in capsules for trituration. The technique involves
injection of the material into the canal and placing a single master cone.
F. Thermomechanical: A cone coated with sealer is placed in the root canal, engaged with a rotary instrument that
frictionally warms, plasticizes and compacts it into the root canal.
19. H. Chemoplasticized: Chemically softened gutta-percha, using solvents such as chloroform or eucalyptol, is
placed on already fitted gutta-percha cones, inserted into the canal, laterally compacted with spreaders and the
canal filled with additional accessory cones.
20. I. Custom Cone/Solvents: 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. However, since shrinkage occurs, it is then removed and reinserted into the canal with
sealer, laterally condensed with spreaders and accessory cones.
J. Pastes: Paste fills have been used in a variety of applications. When used as the definitive
filling material without a ore, they are generally considered to be less successful and not ideal.
K. Apical Barrier: Apical barriers are important for the obturation of canals with immature roots
with open apices. Mineral
trioxide aggregate is generally considered the material of choice at this time.
21. Diagnosis and Assessment of Degree of Difficulty
Avoiding procedural errors by a clinician performing endodontic
treatment is ultimately based on adherence to the scientific
evidence, and biological and technical principles considered to
be the standard of care. The clinician who is able to correctly
diagnose and assess case difficulty before initiating irreversible
procedures will experience a higher rate of success.
22. Summary
If healing of pulpal and periapical disease is to be predictable, a proper diagnosis and
treatment plan is essential. The clinician should also utilize an evidence-based
approach to treatment applying knowledge of anatomy and morphology, and
endodontic techniques to the unique situations each case presents. It is crucial that all
canals are located, cleaned, shaped, disinfected and sealed from the apical minor
constriction of the root canal system to the orifice and the cavosurface margin.
Clinicians should know their level of competency and experience levels when
performing endodontic treatment, and work within these parameters or refer the case
to an endodontist.
24. References
1. Ray HA, Trope M. Periapical status of endodontically treated teeth in relation to the technical quality of the root filling and the coronal restoration. Int Endod J 1995; 28:12-18.
2. Burch JG, Hulen S. The relationship of the apical foramen to the anatomic apex of the tooth root. Oral Surg Oral Med Oral Pathol 1972; 34:262-268.
3. Pineda F, Kuttler Y. Deviation of the apical foramen from the radiographic apex. Oral Health 1972; 62:10-13.
4. Chugal NM, Clive JM, Spångberg LSW. Endodontic infection: some biologic and treatment factors associated with outcome. Oral Surg Oral Med Oral Pathol Oral Radio and Endod 2003; 96:81-90.
5. Sjogren U, Hagglund B, Sundqvist G, Wing K. Factors affecting the longterm results of endodontic treatment. J Endodon 1990;16:498-504.
6. Pettiette M, Metzger Z, Phillips C, Trope M. Endodontic Complications of Root Canal Therapy Performed by Dental Students with Stainless-Steel K-Files and Nickel-Titanium Hand Files. J Endodon 1999;25:230-234.
7. Pettiette M, Delano E, Trope M. Evaluation of Success Rate of Endodontic Treatment Performed by Students with Stainless-Steel K-Files and Nickel-Titanium Hand Files. J Endodon 2001; 27:124-127.
8. Gorni F, Gagliani M: The Outcome Of Endodontic Retreatment: A 2-Yr Follow-Up, J Endodon 2004; 30:1-4.
9. Hoen MM, Pink, Frank E. Contemporary Endodontic Retreatments: An Analysis based on Clinical Treatment Findings. J Endodon 2002; 28:834- 836.
10. Siqueira JF, Arujo MCP, Garcia PF, Fraga RC, Saboia Dantas CJ. Histologic evaluation of the effectiveness of five instrumentation techniques for cleaning at the apical third of root canals. J Endodon 1997; 23:499-502.
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