This document describes and compares various obturation techniques that can be used for filling root canals in primary teeth. It begins by defining obturation and describing the goal of creating a fluid-tight seal to prevent reinfection. It then provides details on 12 different techniques: endodontic pressure syringe, Lentulo spiral, mechanical syringe, incremental filling technique, Jiffy tube, tuberculin syringe, reamer technique, insulin syringe technique, disposable injection technique, NaviTip, bi-directional spiral, and Pastinject. For each technique, it discusses advantages such as ease of use and ability to fully fill canals, as well as disadvantages like difficulty with placement and increased risk of voids

2. OBTURATION TECHNIQUES
IN PRIMARY TOOTH
DR RAMESH R
Second year MDS
Dept of PEDODONTICS & PREVENTIVE DENTISTRY

3. CONTENTS
• Introduction
• Definition
• Goal
• Techniques
Endodontic pressure syringe
Lentulo spiral
Mechanical Syringe
Incremental Filling Technique
Jiffy Tube
Tuberculin syringe
Reamer Technique
Insulin Syringe Technique

4. Disposable Injection Technique
NaviTip
Bi-Directional Spiral
 Pastinject
Other techniques
• JOURNALS

5. INTRODUCTION
Dentistry for child and adolescent- Ralph E McDonald, David R Avery. 10th edition- 9th edition

6. DEFINITION
• Obturate—To fill the shaped and debrided canal space with a
temporary or permanent filling material.
• Obturation technique—The method used to fill and seal a cleaned and
shaped root canal using a root canal sealer and core filling material;
sealers are frequently used as the sole obturating material in deciduous
teeth; there are a variety of techniques used to obturate the canal space
Glossary of Endodontic Terms

7. GOAL
• To create a fluid-tight seal.
• Ideal filling technique should ensure complete filling of the canal
without overfill and with minimal or no voids.
• To prevent recontamination of canal from either apical or coronal
leakage
• To isolate and neutralize any remaining pulpal tissue or bacteria

8. TECHNIQUES
• Endodontic pressure syringe
• Lentulo spiral
• Mechanical Syringe
• Incremental Filling Technique
• Jiffy Tube
• Tuberculin syringe
• Reamer Technique
• Insulin Syringe Technique

9. • Disposable Injection Technique
• NaviTip
• Bi-Directional Spiral
• Pastinject
• Other techniques
• Amalgam plugger – Nosonwitz 1960, King 1984
• Paper points – Spedding 1973
• Plugging action –Donnenberg 1974

10. ENDODONTIC PRESSURE SYRINGE:
• Described by Greenberg (1963)
• The apparatus consists of a syringe barrel,
threaded plugger, wrench and threaded needle.
• The needle was inserted into the canal until wall
resistance encountered.
• Using a slow, withdrawing-type motion, the needle
withdrawn in 3-mm intervals with each quarter
turn of the screw until the canal can be visibly
filled at the orifice with zinc oxide eugenol paste.
• The 13 to 30 gauge needle corresponds to the
largest endodontic file is used to instrument the
root canal.
Aylard SR, Johnson R. Assessment of filling techniques for primary teeth. Pediatric Dentistry 1987;9(3):195-198.

11. ADVANTAGES
• Needles are very flexible and can easily maneuvered in the tortuous canals of
primary molars.
Jha M, Patil SD, Sevekar S, Jogani V, Shingare P. Pediatric Obturating Materials And Techniques. Journal of Contemporary Dentistry
2011;1(2):27- 32.

12. DISADVANTAGES
• Overfill when apical & lateral resorption present.
• Difficulties in placing the rubber stop correctly
• Removing the needle (because of the need to refill the hub of the syringe
several times during the procedure) may lead the clinician to remove and
reinsert the syringe repeatedly, which, in turn, may displace the paste, create
voids, and thus decrease filling quality.
• Need to clean the syringe immediately after use makes this method more
complex and time-consuming
Memarpour M, Shahidi S, Meshki R. Comparison of Different Obturation Techniques for Primary Molars by Digital Radiography.
Pediatric Dentistry 2013;35(3):236-240

14. LENTULO SPIRAL
• Advocated by Kopel in 1970.

15. • Aylard and Johnson and Dandashi et al evaluated root canal obturation
methods in primary teeth in vitro and concluded that the lentulospiral
mounted in a slow speed handpiece was superior in filling straight and
curved root canals of primary teeth.
• The investigators demonstrated no significant differences between the
lentulo and the pressure syringe techniques when filling straight canals.
Aylard SR, Johnson R. Assessment of filling techniques for primary teeth. Pediatric Dentistry 1987;9(3):195-198.

16. • Torres et al concluded similar result stating that calcium hydroxide
radiodensity in a curved canal was significantly greater using a Lentulo
spiral-only technique.
• Similar results were reported by Peters et al and Sigurdsson who reported that
application with a lentulo spiral was more homogenous than injection of
Ca(OH)2 paste.
Peters CI, Koka RS, Highsmith S, Peters OA. Calcium hydroxide dressings using different preparation and application modes:
density and dissolution by simulated tissue pressure. International Endodontic Journal 2005;38:889-895
Torres CP, Apicella MJ, Yancich PP, Parker MH. Intracanal Placement of Calcium Hydroxide: A Comparison of Techniques, Revisited.
Journal Of Endodontics 2004;30(4):225-227

17. • Deonízio et al reported that the 15,000 rpm speed was more effective
in filling the apical third and 5,000 rpm speed was more effective in
filling the cervical and middle thirds in their study utilizing
lentulospirals at different speeds for filling the root canal with calcium
hydroxide paste.

18. ADVANTAGES
• Most effective and straight forward techniques for applying sealers
and calcium hydroxide into permanent tooth root canals or pastes into
primary tooth canals because of its design and flexibility that allow
files to carry the paste uniformly throughout the narrow, curved canals
in primary molars.

19. DISADVANTAGES
• Difficulties with fitting the rubber stop.
• Instrument fracture.
• Tendency for extrusion beyond the apex.
Memarpour M, Shahidi S, Meshki R. Comparison of Different Obturation Techniques for Primary Molars by Digital Radiography.
Pediatric Dentistry 2013;35(3):236-240

22. MECHANICAL SYRINGE
• Proposed by Greenberg in 1971.
• The canal shape governed the selection of the filling technique

23. DISADVANTAGES
• Poor performer in both canal types i.e. curved and straight canals
based on studies conducted by Aylard and Johnson.
• The screw mechanism of the endodontic pressure syringe would be
able to generate far greater pressures than plunger system in the
mechanical syringe.
Aylard SR, Johnson R. Assessment of filling techniques for primary teeth. Pediatric Dentistry 1987;9(3):195-198

24. INCREMENTAL FILLING TECHNIQUE
• First used by Gould in 1972.
• An endodontic plugger, corresponding to the size of the canal, with rubber
stop was used to place a thick mix of zinc oxide-eugenol paste into the canal.
• Length of the endodontic plugger equaled the predetermined root canal
length minus 2 mm.

25. ADVANTAGES
• The material is placed in bulk and pushed into the canals with endodontic
pluggers.
• According to a study conducted by Memarpour et al, an optimal filling result
was obtained more frequently with the Lentulo instrument than with the
packing technique.
Jha M, Patil SD, Sevekar S, Jogani V, Shingare P. Pediatric Obturating Materials And Techniques.
Journal of Contemporary Dentistry 2011;1(2):27- 32.

26. DISADVANTAGES
• Placing the paste in a narrow, apically curved canal is more difficult
than in a wider apical preparation.
• Because the flexibility of endodontic pluggers is limited, the paste
cannot be placed to the full working length of narrow curved canals
• Movements of the plugger during paste application may increase the
risk of large voids.

27. JIFFY TUBE
• This technique was popularized by Rifficin in 1980.
• The standardized mixture of ZOE is back-loaded into the tube.
• The tube tip is placed into canal orifice and the material expressed into the
canal with a downward squeezing motion until the orifice appears visibly
filled.

28. TUBERCULIN SYRINGE
• Aylord and Johnson in 1987.
• The standardized mixture of ZOE was backloaded
into the syringe with a standard 26gauge, 3/8-inch
needle.
• The material was expressed into the canal by slow
finger pressure on the plunger until the canal was
visibly filled at the orifice.
• There appeared to be no difference in the straight
canal filling capabilities of either the tuberculin or
mechanical syringes.

29. DISADVANTAGES
• The main drawback of the tuberculin syringe technique is the difficulty of
separating the tip during injection, which results in the need to repeatedly
replace the needle.
• This compromises optimal filling and increase the presence of voids in the
paste.
• Hartman and Pruhs recommended the use of wet cotton pellet to push the
filling materials into the canals of primary teeth.

30. REAMER TECHNIQUE
• A reamer coated with ZOE paste was inserted into the
canal with clockwise rotation, with vibratory motion to
allow the material to reach the apex, and then
withdrawn from the canal, simultaneously continuing
in clockwise rotary motion.
• A rubber stopper was used to keep the reamer to the
predetermined working length, and the process was
repeated 5 to 7 times for each canal until the canal
orifice appeared filled with the paste.
Nagar P, Araali V, Ninawe N. An alternative obturating technique using insulin syringe delivery system to traditional reamer:
An in-vivo study. Journal of Dentistry and Oral Biosciences 2011;2(2):7-19.

31. ADVANTAGES
• The results of the study by Priya Nagar et al showed that the obturation
quality of both the reamer technique and insulin syringe technique was
found to be similar.
• Lesser chance of occurance of voids
• Good radioopacity can be acheived

32. INSULIN SYRINGE TECHNIQUE
• As described by Priya Nagar et al, a homogeneous mixture of ZOE,
according to manufacturer’s instructions is loaded into the insulin syringe
and a stopper is used after assessing the working length of the canal.
• The needle is inserted into the canal and kept about 2mm short of apex.

33. • The material is then pressed into the canal and while doing so the needle is
retrieved from the canal outwards while continuing to press the
material inside.
• This helps avoid incorporation of voids into the canal.
• Finally, over the orifice more material is pressed and compressed using wet
cotton.

34. ADVANATGES
• With optimum operator skills and proper material mix optimal filling
with less no. of voids and good radiopacity can be achieved

35. DISADVANTAGES
• Length of the needle is short it can penetrate only two third length of
canal

36. DISPOSABLE INJECTION TECHNIQUE
• ZOE can be loaded in a 2-ml syringe with 24-
gauge needle along with stopper adjusted to
measured length taking RCT instrument as
guide and the material is gently pushed into the
canal till the material is seen flowing out of the
canal orifice.
• Now the needle is gradually withdrawn while
pushing the material till the needle reaches the
pulp chamber.

37. ADVANTAGES
• Simple, economical, can be used with almost all filling materials
• Easy to master with minimal chances of failure as reported by
Bhandari et al.
Bhandari SK, Anita, Prajapati U. Root canal obturation of primary teeth: Disposable injection technique.
Journal Of Indian Society Of Pedodontics AndPreventive Dentistry 2012; 30(1):13-18.

38. NAVITIP
• Thin and flexible metal tip was introduced viz.,
NaviTip (Ultradent), in the market to deliver root
canal sealer.
• Available in different lengths and a rubber stop is
also present
• EndoSeal, a syringe delivered zinc oxide eugenol
based canal sealer can be expressed by the NaviTip
system.

39. • Mahtab Memarpour et al concluded in comparative study of anesthetic
syringe, NaviTip syringe, pressure syringe, tuberculin syringe, lentulo
spiral and packing with a plugger that lentulo produced the best results in
terms of length of obturation, while NaviTip syringe produced the best
results in controlling paste extrusion from the apical foramen and having the
smallest void size and lowest number of voids.

40. ADVANTAGES
• Adequate tip thickness,
• Good flexibility,
• Easy to adapt a stopper
• Prevent extrusion of paste from apex
• Lesser chance of voids

41. DISADVANTAGES
• Unfortunately, due to paste thickness, material could not be expressed
via the NaviTip™ lumen

43. BI-DIRECTIONAL SPIRAL
• Dr. Barry Musikant [1998] developed bi-directional spiral.
• This technique ensures that a minimal amount of obturating material will
past the apex.
• This controlled coverage is achieved because the spirals at the coronal end
of the instrument spin the material down the shaft towards the apex, while
the spirals at the apical end spin the material upward towards the coronal
end.
• Where they meet (about 3-4 mm from the apical end of the shaft), the
material is thrown out laterally.

44. ADVANTAGES
• Bi-directional spiral prevented the apical extrusion of the sealer from the
root canals of permanent teeth.
• Ca(OH)2 injected into canal with NaviTip consistently produced better
results than the spirally placed dressings (Gibson et al.)
Gibson R, Howlett P, Cole BOI. Efficacy of spirally filled versus injected nonsetting calcium hydroxide dressings.
Dental Traumatology 2008;24:356–359

45. DISADVANTAGES
• The highest number of voids was seen in canals filled with the lentulo
spirals and bidirectional spiral as observed by Grover et al.
Grover R, Mehra M, Pandit IK, Srivastava N, Gugnani N, Gupta M. Clinical efficacy of various root canal obturating methods in
primary teeth: A comparative study.
European Journal of Paediatric Dentistry 2013;14(2):104-08

47. PASTINJECT
• Pastinject (Micromega) is a specially designed paste carrier with
flattened blades, which improves material placement into the root
canal.

48. ADVANTAGES
• Great flexibility allows it to perfectly follow the shape of the canal
• Translational movement, facilitates the transport of the filling material
and guarantees its perfect application onto the canal walls

49. ADVANTAGES
• In a study conducted by Grover et al, it was concluded that among
lentulospirals, bi-directional spiral, pastinject and pressure syringe
• The pastinject technique has proved to be the most effective, yielding
a higher number of optimally filled canals and minimal voids,
combined with easier placement of the material into the canals.
Grover R, Mehra M, Pandit IK, Srivastava N, Gugnani N, Gupta M. Clinical efficacy of various root canal obturating methods in
primary teeth: A comparative study.
European Journal of Paediatric Dentistry 2013;14(2):104-08

50. ADVANTAGES
• Moreover, it was reported by Deveaux et al and Oztan Meltem et al
that special design of the Pastinject favors better intracanal
placement of calcium hydroxide paste in single rooted teeth
• A Specially Designed Paste Carrier technique is also found to be an
effective technique in the intracanal placement of calcium hydroxide
as reported by Joseph Meng et al.
Oztan MD, Akman A, Dalat D. Intracanal placement of calcium hydroxide: A comparison of two different mixtures and carriers
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94(1): 93-97.

51. DISADVANTAGES
• Bi-directional spiral and Pastinject are used for the placement of
calcium hydroxide and root canal sealers in the permanent teeth, but
there are not enough studies to evaluate their use as obturation
techniques in primary teeth
Tan JME, Parolia A, Pau AKH. Intracanal placement of calcium hydroxide: a comparison of specialy designed paste carrier
technique with other techniques.
BMC Oral Health 2013; 13(52):1-7.

52. JOURNALS

53. 1.Primary Molar Pulpectomy Using Two Different
Obturation Techniques: A Clinical Study
• C. Nagarathna et al
• 2018 Contemporary Clinical Dentistry

54. AIM:
• To determine the efficacy of modified disposable syringe technique in
root canalsof primary molars using digital radiography when obturated
with endoflas.

55. SETTINGS AND DESIGN:
• This clinical study as undertaken in the Department of Pediatric
Dentistry, Rajarajeswari Dental College and Hospital, Bengaluru, for
a period of 6 months.
• Tooth with pulp involement and long standing history of persistant
pain, clinically involved nonvital tooth with pus discharge, continuous
bleeding after amputation of coronal tissue, radiographic evaluvation
showing inter radicular or periapical radiolucency were included in
this study.

56. MATERIALS AND METHOD
• A total of 60 primary a maxillary and mandibular molars were randomly
selected into two groups:-
• Test group: Modified disposable syringe technique
• Control group: Handheld lentulospiral technique

57. CONTROL GROUP
• 1 scoop of powder mixed with 2 drops of liquid to obtain a creamy
mix of Endoflas
• Hand held lentulo spiral of size 25mm, length 21mm inserted into
canal in clockwise motion accompanied by vibratory motion to allow
material to reach apex and withdrawn slightly while continuing in
clockwise rotation
• Wet cotton pellet used to press material

58. TEST GROUP
• 1 scoop of endoflas is mixed with 3 drops of liquid to obtain fluid
flowable consistency
• 1 ml material was loaded into syringe and tapped on solid surface to
prevent bubble entrapment
• Disposable tip was fixed and flow of material was checked
• Rubber stop was placed and tip was placed at pre determined working
length
• Wet cotton pellet used to press material

59. • Radiograph were obtained using paralleling technic and vista scan
• Only palatal canal of maxillary and distal canal of mand molars were
taken for evaluvation based of modification of criteria put forward by
Coll and Sadrian
• Obturation was assessed by double blinding
• Underfilling (score 1) – Canal filled more than 2 mm short of the apex
• Optimal filling (score 2) – Canal filling ending at the radiographic apex
or up to 2 mm short of apex
• Overfilling (score3) – Any canal showing filling outside the root
apex

60. RESULTS
• Independent Chi-square test to compare the results revealed no statistically
significant results in regard to quality of obturation and voids.
• A relatively increased percentage of optimal fillings in the test group
(66.7%) was seen as compared to the control group (60%).
• In contrast,test group showed decreased overfilling as compared to control
group [Table 2].
• Voids in obturation were found in both the groups.
• According to the Mann–Whitney U-test, significant difference was found
in the apical third of root canal (P = 0.01) while coronal and middle thirds
showed no statistical difference for voids [Table3].

63. DISCUSSION
• In the present study the modified disposable syringe performed in par
with traditionally used handheld lentulo spiral in achieving optimal
obturation.
• Hand held lentulospiral showed good results in terms of optimal
obturation in our study
• In the present study, both techniques led to voids in the obturation –
a finding consistent with other reports.
• Voids in obturation using the modified disposable syringe is due to air
entering the barrel while loading the material or the use of a relatively
thick plastic tip.

64. • In the present study, mean number of voids in the apical third was
significantly less in the test group.
• The material was injected into the root canals ensuring a good apical seal
while air entrapment could have occurred in the middle and coronal
regions while withdrawing the syringe.
• Air bubbles may be entrapped during the manipulation of the material or
during the repeated removal and reinsertion of the lentulospiral.
• The presence of voids in both the apical and coronal parts of the root
filling may provide pathways for leakage allowing bacterial regrowth,
reinfection, and culture reversal, leading to posttreatment disease.

65. • There were severalbenefits with the use of the modified disposable syringe. The
operator could check the flow of the material owing to the translucency of the tip,
and there is no tendency for fracture.
• The disposable tip could be cut to a desirable length for obturating the root canals.
Another advantage associated with the modified disposable syringe is there is no
fear of cross contamination as these tips and the syringes are for single use only and
can be safely disposed
• Handheld lentulospiral is designed with consistently spaced spirals which evenly
distribute the material throughout the root canal.
• The design and flexibility of then lentulospiral allows the paste to be carried
throughout the narrow, curved canals in primary molars and provides better control
as it is held by hand. Though lentulospiral is a widely accepted successful
technique for delivery, even experienced operators need to reinsert material to
ensure better filling quality.
• Other studies have shown success rates of 93.3%–95.1% with endoflas
• As per our study, endoflas using the modified disposable syringe technique showed
66.7% optimal fillings

66. CONCLUSIONS:
• Both the hand-held lentulospiral and modified disposable syringe
technique are effective in the obturation of primary molar root canals
in terms of quality of fill.
• Modified disposable cement can be recommended as it is simple, easy
to use, less threatening to child and relatively less time consuming
compared to hand held lentulospiral technique.

67. 2.A comparative In vivo efficacy of three spiral
techniques versus incremental technique in
obturating primary teeth
• Shalini Chandrasekhar et al
• 2018 Journal of Indian Society of Pedodontics and Preventive
Dentistry

68. AIM
• To evaluate the efficiency of four different obturating techniques in
filling the radicular space in primary teeth.

69. MATERIALS AND METHOD
• The study was carried out on children who were referred to the
Department of Pedodontics and preventive dentistry, St. Joseph Dental
College.
• A full mouth dental examination was conducted on 49 healthy and
cooperative children (5–9 years) who had carious lesions.
• Out of which 34 children with 63 pulpectomy indicated primary teeth
were selected and divided into four groups to obturate 40 canals per
group

70. • Group 1 – bi-directional spiral technique
• Group 2 – incremental technique
• Group 3 – past inject technique
• Group 4 – lentulo spiral technique

71. • Two evaluators, blinded to the filling technique, assessed the presence
of voids and canal obturation quality using Modified Coll and Sadrian
criteria:
• 1. Underfilling – canals filled more than 2 mm short of the apex
• 2. optimal filling – canals having Endoflas ending at the radiographic
apex or up to 2 mm short of the apex
• 3. Overfilling – canals showing Endoflas outside the root.
• Voids –Radiographic presence or absence of voids was evaluated in
each canal and tabulated.

72. RESULTS

75. DISCUSSION
• There are many studies to determine the ideal root canal obturating
material for primary teeth, but only a few are directed on determining
an effective delivery system for same.
• A need has always persisted to evaluate the optimum technique of
obturating the primary teeth, to obtain a compact and dense filling of
the root canal system.

76. • In the present study, apical extrusion of material was not observed
with the bi-directional technique similar to studies by Musikant BL et
al. (1998)
• Lentulo spiral caused extrusion of the sealer while the bi-directional
technique prevented the apical extrusion of the obturation material.
• also apical reverse spirals are able to prevent apical extrusion.these
findings were similar to findings observed by parikh et al

77. • In the present study, the efficacy of past inject was not consistent. This
may be because past inject was easily distorted, fractured and also
unwinding of spirals were seen which occurred in higher frequency
when used in curved canals.
• Aylard and Johnson and Dandashi et al. observed in primary teeth root
canals with different obturation methods in vitro and concluded that
lentulo spiral which is mounted on a slow speed handpiece was more
superior in filling the straight and curved canals

78. • In the present study, spiral instruments which were mounted on slow
speed handpiece improved dexterity, decreased operator fatigue and
ease of placement.
• Further research can be directed toward comparing the spiral filling
techniques with other injection filling techniques and comparing the
efficacy of spiral filling techniques in anterior and posterior teeth,
curved and straight canals of primary teeth.

79. CONCLUSION
• Bi-directional spiral technique has proved to be superior to lentulo
spiral technique in preventing overfilled canals in primary teeth.
• Efficacies of past inject and incremental technique in obtaining
optimal filled canals were less compared to other techniques.
• Bi-directional spiral and lentulo spiral techniques can be used in both
maxilla and mandible with equal efficacy except for the past inject
technique which showed a significant difference in producing voids.

80. • Singh R
• The Journal of Clinical Pediatric Dentistry Volume 39, Number
5/2015
3.Evaluation of Different Root Canal Obturation
Methods in Primary Teeth Using Cone Beam
Computerized Tomography

81. AIM
• To evaluate the efficiency of 3 different obturation techniques;
• Motor driven lentulospiral,
• Hand held lentulospiral and
• Reamer
• in primary anterior teeth and presence of voids by analyzing with
CBCT.

82. MATERIALS AND METHOD
• The present in-vitro study was carried out in the Department of Pedodontics
& Preventive Dentistry, Kothiwal Dental College & Research Centre,
Moradabad
• Sixty primary anterior teeth having at least two-thirds remaining root were
collected and placed in 0.9% normal saline.
• Then the teeth were thoroughly cleaned with pumice slurry, rinsed with
water and stored in normal saline.
• The collected teeth were then divided into three groups as-
• Group I- Obturation using motor driven lentulospiral. (21 mm, Mani, Japan)
• Group II- Obturation using hand held lentulo spiral. (21 mm, Dentsply
Maillefer, Switzerland)
• Group III- Obturation using reamer. (21 mm, size 15-40, Mani, Japan)

83. • Teeth were taken from saline and placed on paper to air dry.
• Then the access was gained using #4 round carbide bur.
• Coronal pulp remnants were removed with the round carbide bur itself and the
radicular pulp remnants were removed using barbed broaches.
• The chamber was then irrigated with normal saline.
• A size 15 K- file was inserted into the root canal and radiograph was taken.
• Working length was established by subtracting 1mm from the total canal length.
• The root canal was then sequentially enlarged starting with size 15 K-file and
finished with a 35 size file.
• Final finishing was done using an H- file of the corresponding last K-file used.
• The canals were dried using sterile paper points and obturation was performed using
three delivery systems; a) motor driven lentulospiral paste carrier, b) handheld
lentulospiral paste carrier and c) reamer.

84. • Before obturation the tooth was randomly selected for any one of the
three obturating techniques.
• The teeth were divided into three groups as:
• Group I: 20 teeth obturated using motor driven lentulospiral.
• Group II: 20 teeth obturated using hand-held lentulospiral.
• Group III: 20 teeth obturated using reamer.
• The obturating material used was Zinc Oxide Eugenol cement.

85. • Group I: Lentulospiral mounted in a slow speed handpiece
• A 21mm lentulospiral of size 30 mounted in a slow speed contra-angle
handpiece (1,000 rpm) was used to deliver the zinc oxide eugenol into root
canals.
• Group II: Handheld lentulospiral
• A 21mm handheld lentulo spiral of varying sizes i.e; from 25-40 was used
for obturation.
• Group III: Reamer
• A 21mm reamer of size 30 was used to deliver the zinc oxide eugenol into
root canals.
• Once the root canals in all the groups were obturated, the access cavity was
sealed with a thick mix of zinc oxide eugenol, carried and condensed into the
cavity with a plastic instrument without applying any apical pressure.

86. • Effectiveness of the three obturation techniques was assessed by
viewing the samples under i-CAT Cone Beam Computerized
Tomographic scanner

87. RESULTS

91. DISCUSSION
• In CBCT images the specific location of voids can also be determined
accurately.
• A recent study by Sogur E et al.have proved that CBCT provides a
great detail into the evaluation of length and homogeneity of root
fillings in permanent teeth.
• CBCT was chosen as the tool for investigating the efficacy of root
canal fillings in primary teeth in our study because the management of
endodontic problems is reliant on radiographs to assess the anatomy of
the tooth and its surrounding anatomy.

92. • In the present study the motor driven Lentulo spiral led to the best
filling technique.
• This is consistent with the study by Torres et al who found that the
Lentulo spiral delivered paste into the canals better than injection
systems such as the Ultradent Navi Tip system.
• This finding also reported by other authors like Aylard and Kahn in
their study.
• The motor driven Lentulo spiral is one of the most effective and
straightforward techniques for applying sealers and calcium hydroxide
into permanent tooth root canals or pastes into primary tooth canals

93. • Our comparison of the mean sizes of voids in each third of the root
canal showed that, in general, the voids were larger in the coronal third
portion (p=0.001) and smaller in the apical part (p=0.995).
• Peters also found fewer voids in the canal’s apical third. The author
found that Ca(OH)2 when placed in a simulated canal using motor
driven lentulo spiral had significantly fewer voids than injection
technique.
• Regarding the distribution of voids into root canal thirds, significantly
more voids were detected coronally than in the middle and apical third
which is consistent with our findings. The voids were analysed using
digital radiography

94. • In an another study, conducted by Kahn the authors found that motor
driven lentulo spiral carried the root canal sealer most effectively near
the apical part of the tested samples.
• The authors concluded that motor driven lentulo spiral is the most
effective methods of sealer placement along the canal walls.
• The higher void formation in the coronal third may be related to the
finishing procedure we used in all groups.
• As in the actual clinical procedure, after the canal was filled, we did not
packed the ZOE paste into the access cavity with a cotton pellet as
suggested by Memarpour et al.
• This may have increased the void formation in the root’s coronal third
portion.
• But various studies have reported that void formation is mostly seen in
the middle portion of the root canal which was also confirmed by Estrela
et al.

95. CONCLUSIONS
• Based on this study’s results, the following conclusion can be made.
• The motor driven Lentulo spiral led to the best filling technique.
• All of the three obturating techniques showed presence of voids.
• CBCT can be an efficient radiographic modality for assessment of the
quality of root canal obturation in primary teeth.

96. 4. Root canal obturation of primary teeth:
disposable injection technique
• Bhandari SK et al
• JOURNAL OF INDIAN SOCIETY OF PEDODONTICS AND PREVENTIVE
DENTISTRY | Jan - Mar 2012 | Issue 1 | Vol 30

97. AIM
• To outline a simple, cost-effective technique for obturation of primary
tooth root canals.

98. MATERIALS AND METHODS
• A total of 52 patients involving 75 primary teeth, with age ranging from 3½ to 9 years, participated in the
study. The criteria of selection of patients taken up for the study and followed were as outlined by Camp and
Milledge, which is basically pulpal involved tooth where the pulpal involvement had crossed coronal pulp with
following conditions:
• Restorable tooth. •
• Tooth with no evidence of internal resorption.
• Tooth with no evidence of pulpal floor perforation.
• Tooth without extensive pathologic (non-physiologic) root resorption involving more than one-third of the root.
• Tooth with adequate bone support.
• Tooth with no evidence of dentigerous or follicular cyst or any pathology requiring enucleation.
• Tooth with no loss of tooth structure with intact enamel but shows all signs of irreversible pulpitis or a necrotic
pulp.
• When a tooth has been planned for pulpotomy and excessive hemorrhage is encountered at the time of
treatment.
• The stage of dental development is such that the preservation is important or desirous for at least a space
maintainer.

99. Obturation of the prepared canal/canals:
• a. A disposable 2-ml syringe (Dispo Van, Hindustan Syringes and Medical
Devices Ltd. India) with 25/26-gauge, 1.5-inch needle is taken, and the
sharp edge of the needle is blunted using a sterile diamond point.
• b. The needle is bent so as to get easy access up to the apical foramina of
each of the canals taking care that the length of the needle from tip to the
bend is more than the measured length of the roots.
• c. Unreinforced zinc oxide (DPI Ltd. India) and eugenol (DPI Ltd.) are
mixed on a sterile glass slab in a consistency enough to flow through 25/26
gauge needle under gentle pressure.
• In the study, we used a mix of 1:1.5 (volume by volume) liquid powder
ratio.

100. RESULTS
• A total of 52 patients involving 75 primary teeth, with age ranging from
3½ to 9 years, were treated and followed up for 3 years and 6 months,
with no evidence of clinical or radiologic failure or untimely early
extraction or exfoliation, except in one case with root canal fillings in
four mandibular incisors, where it showed prolonged retention of lower
primary incisors and imbrications of permanent incisors which erupted
lingually.
• The patient was taken up for extraction of primary incisors and was
subjected to orthodontic management.
• In this case, the partial resorption/nonresorption was attributed to
malposition of permanent lower incisors within the jaw bone and not to
pathologic involvement of tooth or root canal therapy.

102. DISCUSSION
• Not many techniques for obturation of primary tooth root canals are discussed in
the literature. The most commonly followed technique is as described by Payne et
al.
• The technique basically involves carrying thick consistency of material into the
chamber with a plastic instrument or a lentulo and packing it into the canal with
root canal plugger or lentulo, which is followed by pushing the material into the
canal using a cotton pellet held in cotton pliers acting as a piston within the pulp
chamber.
• The technique appears simple, but remains difficult to master as it can cause
underfilling because of air entrapment leading to formation of voids and failure to
achieve hermetic seal resulting in ultimate failure.
• Also, the uncontrolled excessive pressure applied can cause overfilling, which at
times is difficult to undo because of thick consistency of the filling material. At the
same time, lentulospiral is supposed to give superior depth of fill.

103. • The disposable injection technique described in this article achieves all
the desired requirements of good primary tooth root canal obturation
as follows:
• a. Homogenous fill up to the desired depth as the obturation starts
from apex upward, leaving no room for entrapment of air and
formation of voids
• b. The problem of apical overfills is addressed by creation of apical
barrier and use of very gentle pressure for obturation while using a
loose-fitting needle into the canal so as to provide escape way for
excess material without pushing the material apically.

104. • c. The technique allows use of any desired filling material as different
workers may prefer different materials.
• d. Gives enough room for correction in case of failure.
• e. The technique described is easy to master without encoring much
expenditure and increasing inventory.

105. CONCLUSION
• The success of obturation using the described technique can be due to:-
• ease of achieving homogenous stereotype filling using the described
procedure,
• ease of mastering the technique described along with economic
considerations;
• clinicians wish to perform pulpectomy of primary tooth can select the
technical procedure as described for better, easier, and cheaper primary tooth
pulpectomy.
• A long-term study involving significant number of subjects is suggested for
analysis toward comparison of various primary tooth root canal filling
techniques and materials

106. 5. REVISIT OF ENDODONTIC PRESSURE SYRINGE
OBTURATION TECHNIQUE PROCEDURES IN
NECROTIC PRIMARY MOLARS.
• Nagarathna, C et al
• International Journal of Current Research Vol. 9, Issue, 11, pp.61473-
61477, November, 2017

107. AIM
To evaluate the efficacy of hand held lentulospiral and endodontic pressure
syringe for obturation in primary molars
Objectives
To evaluate and compare the obturation of primary molars using hand held
lentulospiral technique and endodontic pressure syringe for :-
a) Quality (underfill/optimal fill/overfill) of obturation
b) b) Presence of voids.

108. MATERIALS AND METHODS
Fifteen healthy child who visited the Department of Pedodontics and
Preventive Dentistry Rajarajeswari college and hospital Bangalore aged
between 4 to 9years with 20 infected teeth requiring pulp therapy were
selected for the study.
Inclusion criteria were
History of spontaneous pain
Presence of inter-radicular radiolucency.
Tooth planned for pulpectomy in which the radicular pulp exhibits clinical
signs of irreversible pulpits.
Necrotic teeth with swelling and pus discharge, sinus tract or fistula

109. Teeth were randomly involved into two groups.
Group I: Control Group (10 teeth) were hand held lentulospiral was
used for obtuartion and
Group II: Test Group (10 teeth) were Endodontic Pressure Syringe
(Figure 1) was used for obturating the canals of primary molars.

111. • After ball canals were prepared for obturation a homogenous mixture of
Endoflas (Sanlor and Cia. S. en C.S., Cali, Colombia) was used
according to the manufacturer’s instruction for filling the root canal using
one of the randomly assigned obturation techniques.
• Teeth of group I obturated with size 25 handheld lentulospiral and
• group II, teeth were obturated with endodontic pressure syringe of 30
gauge needle.
• A postoperative radiograph using phosphor imaging plate system and
vista scan was taken immediately.
• A controlled double blinded study was carried out to evaluate the quality
of obturation and presence of voids and their no and area in each third of
canal

112. RESULTS

113. • Mann Whitney U test was compare the mean number of voids in different
areas of root canal using two different types of obturating systems.
• The test results revealed that the number of voids was higher in the control
group at the coronal and apical areas with mean score of 0.9 ± 1.0 and 1.0 ±
0.5 as compared to test group with mean score of 0.1 ± 0.4 and 1.0 ± 0.5
respectively.
• However, there was no statistically significant difference with respect to mean
number of voids at coronal and apical third areas between the two systems,
P=0.11 & P=0.30 respectively.
• In contrast, the test group presented with more number of voids in the middle
third area with mean score of 1.3 ± 0.5 as compared to control group with 0.9
± 1.1.
• But, there was no statistically significant difference between the two systems,
P=0.22.

116. • Present study findings infers that there was lesser number of voids in
the test group compared to the control group, it did not yield a
statistically significant difference between the two obturating systems

117. DISCUSSION
• According to Grossman (1981) the obturating material should extend
up to or be slightly short of the apex in patients of pulpectomy and
preferably extend up to the apical foramen in teeth which show areas
of rarefaction
• Though lentulospiral is a widely accepted successful technique for
delivery, even experienced operators need to reinsert material to
ensure better filling quality.
• Difficulties with fitting the rubber stop, instrument fracture, and a
tendency for extrusion beyond the apex are disadvantages of the
Lentulo instruments

118. • The main advantage of endodontic pressure syringe is the screw
mechanism which generates pressure that helps in pushing the material
into the root canals hence resulted in maximum optimal filled canals.
• Similar results was made by Mallayya et al in which endodontic pressure
syringe produced best results (95.8% optimal fillings) in terms of length
of root canal obturation when compared with jiffy tube, insulin syringe
and local anesthetic syringe (Vashista et al,)
• In the present study there were no under filled canals by using
endodontic pressure syringe. The possible reason could be the design of
the pressure syringe in which hub of the syringe being small and thin,
needle provided a better reach till middle one third of the canals.
• In the present study, more number of overfilled canals were observed
with pressure syringe than under filled canals.

119. • The consistency of the materials and displacement of rubber stopper,
unprecise working length measurement, over instrumentation, resistance
disappearance due to inadequate root canal preparation also could be
factors for overfilled canals in our study.
• However, few drawbacks are associated with endodontic pressure
syringe, namely difficulties in placing the rubber stop correctly and
removing the needle (because of the need to refill the hub of the syringe
several times during the procedure) may lead the clinician to remove and
reinsert the syringe repeatedly, which in turn may displace the paste,
create voids and thus decrease filling quality.

120. • In addition, the need to clean the syringe immediately after use makes
this method more complex and time consuming.
• Voids in lentulospiral also may be due to air bubbles entrapped in the
paste during mixing of the powder with the liquid and due to repeated
removal and reinsertion of the instrument during filling procedure.

121. CONCLUSION
Based on this study results, the following conclusion can be made:
• There was no statistically significant difference between the use of
pressure syringe or lentulospiral on the quality of root canal filling.
• Both techniques gave maximum optimal obturation.
• Voids were more in use of handheld lentulospiral technique than in
pressure syringe technique

122. THANK YOU