This document discusses obturation techniques and materials used for root canals in primary teeth. It begins by outlining the ideal requirements for obturating materials, including that they should resorb with the tooth and not irritate tissues. Several obturation techniques are then described in detail, including using endodontic pressure syringes, lentulo spirals, jiffy tubes, and the incremental filling technique. The techniques are compared in terms of their ability to fill canals and avoid issues like overfilling. Overall, studies have found the lentulo spiral technique produces more uniform and complete fills of root canals in primary teeth compared to other methods.

1. Obturation
technique and
materials
Presented by:Dr.Sanchit kumar

2. Contents
1.Introduction
2.Ideal requirements of obturating materials
3.Obturating techniques
4.Different types of obturating materials

3. INTRODUCTION
• Pulp therapy is widely used in the treatment of
pediatric patients, while attempting to prevent
premature exfoliation loss of the primary teeth.
• Different techniques and treatments have been
proposed in the literature to promote cleansing and
sanitation of the root canals of deciduous teeth.

4. • However, the topography of primary teeth root
canals, which present accentuated curves and a large
number of accessory canals, makes access to and the
instrumentation of these teeth more difficult .
• Besides the anatomical aspect, the process of root
resorption in deciduous dentition occurs irregularly
and is not always detected radiographically.

5. • This fact makes it difficult to establish an apical limit,
both for canal instrumentation and for filling, leading
to possible damage of the periodontium and the
permanent tooth germ .
• -Bengston AL, Bengston NG. Efeito da instrumentação endodôntica em molares decíduos.
Rev. Assoc. Paul Cir. Dent. 1993; 47(5):1149-54.

6. • The overflow of materials presenting
nonbiocompatible and nonresorbable properties could
also affect periapical structures and permit the
permanence of these materials in the bone or gingival
tissue even after primary tooth exfoliation .
• Faraco Jr IM, Percinoto C. Avaliação de duas técnicas de pulpectomia em dentes
decíduos. Rev. Assoc. Paul Cir. Dent. 1998; 52(5):400-4.

7. • Given the characteristics of deciduous dentition,
which impede full manipulation of the root canal, the
success of endodontic treatment depends on the
proportion of reduction or elimination of bacteria not
only within the root canal, but also in locations that
chemical and mechanical preparation are unable to
access

8. • Considering the limitations of primary tooth canal
instrumentation, the use of filling pastes presenting an
antimicrobial capacity represents one of the most
important aspects for achieving success in endodontic
therapy

9. • Developmental, anatomic and physiological
differences between the primary and permanent teeth
call for differences in the criteria for root canal
filling materials

10. IDEAL REQUIREMENTS
The ideal requirements of a root canal filling materials
for primary teeth are as follows :
• The material should resorb as the primary tooth root
resorbs.
• Not irritate the periapical tissues nor coagulate any organic
remnants in the canal.
• Have a stable disinfecting power.
• Any surplus material passed beyond the apex should be
resorbed easily.
• (Catagnola 1952, Rifkin 1980, Woods 1984)

11. • Inserted easily in to the canal and also removed easily if necessary.
• Not be soluble in water.
• Not discolor the tooth.
• Should be radio opaque.
• Harmless to underlying tooth germ.
• Should adhere to the walls of canal and should not shrink.
• Not set as a hard mass, which could deflect erupting successor.

12. Obturating techniques
The aim in obturating the root canal system is to
prevent recontamination of canal from either apical or
coronal leakage and to isolate and neutralize any
remaining pulpal tissue or bacteria

13. Various obturating techniques are -
1. Endodontic pressure syringes
2. Mechanical syringe
3. Lentulo spiral
4. Jiffy tube
5. Tuberculin syringe
6. Incremental filling technique
7. Other techniques-
• Amalgam plugger – Nosonwitz 1960, King 1984
• Paper points – Spedding 1973
• Plugging action –Donnenberg 1974

14. ENDODONTIC PRESSURE
SYRINGE :
• Using the technique described by Greenberg
(1963)
• This apparatus consists of a syringe barrel,
threaded plugger, wrench and threaded
needle.
• needle was inserted into the simulated canal
until wall resistance was encountered.

15. • Using a slow, withdrawing-type motion, the
needle was 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.
• Aylard SR, Johnson R. Assessment of filling techniques for primary teeth.
Pediatric Dentistry 1987;9(3):195-198.

16. • The 13 to 30 gauge needle which corresponds to the
largest endodontic file can be used to instrument the
root canal.
• It has been noted that the needles are very flexible
and can easily be 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.

17. • Overfill is a common clinical finding in the primary
dentition, especially when apical resorption and/ or
the paste is applied through a pressure syringe.
• 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

18. • In addition, the need to clean the syringe
immediately after use makes this method more
complex and time-consuming.
• This technique hasbeen described in detail by
Spedding and by Krakow et al
Memarpour M, Shahidi S, Meshki R. Comparison of Different Obturation Techniques for
Primary Molars by Digital Radiography. Pediatric Dentistry 2013;35(3):236-240.

19. MECHANICAL SYRINGE
• This method was proposed by Greenberg in
1971.
• The canal shape governed the selection of the
filling technique and the mechanical syringe
was a poor performer in both canal types i.e.
curved and straight canals in a study
conducted by Aylard and Johnson.

20. • The screw mechanism of the endodontic
pressure syringe would be able to generate far
greater pressures than could a plunger system
as is seen with the mechanical syringe
Aylard SR, Johnson R. Assessment of filling techniques for primary teeth. Pediatric Dentistry
1987;9(3):195-198.

21. LENTULO SPIRAL
• This obturation technique was advocated by Kopel in
1970.
• 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.

22. • 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.

23. • Torres et al also concluded similar result
stating that calcium hydroxide radiodensity in
a curved canal was significantly greater using a
Lentulo spiral-only technique.
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.

24. • 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
Sigurdsson A, Stancill R, Madison S. Intracanal Placement of Ca(OH)2: A Comparison
of Techniques. Journal of Endodontics 1992;18(8):367-370.

25. • The Lentulo spiral is one of the most effective and
straight forward techniques for applying sealers and
calcium hydroxide into permanent tooth root canals
or pastes into primary tooth canals.
• The design and flexibility of the Lentulo spiralallow
files to carry the paste uniformly throughout the
narrow, curved canals in primary molars.

26. • Difficulties with fitting the rubber stop, instrument
fracture, and a tendency for extrusion beyond the
apex, however, are disadvantages of the Lentulo
instruments.
• Memarpour M, Shahidi S, Meshki R. Comparison of Different Obturation Techniques for
Primary Molars by Digital Radiography. Pediatric Dentistry 2013;35(3):236-240.

27. Jiffy Tube
• This technique was popularized by Rifficin in 1980.
• The material of choice for filling the root canals of
pulpectomized primary teeth is pure ZOE, first mixed
as slurry and carried into the canals using paper
points, a syringe, a Jiffy tube, or a lentulo spiral root
canal filler
•
Dummett CO, Kopel HM. Pediatric Endodontics. In. Ingle and Bakland. Endodontics.
5th ed. London: BC Decker Elsevier; 2002.p.861-902.

28. • The standardized mixture of ZOE is back-loaded into
the tube. The tube tip is placed into the simulated
canal orifice and the material expressed into the canal
with a downward squeezing motion until the orifice
appears visibly filled.

29. Tuberculin syringe
• This syringe was utilised by Aylord and
Johnson in 1987.
• The standardized mixture of ZOE was
backloaded into the syringe with a standard
26- gauge, 3/8-inch needle

30. • . The material was expressed into the canal by
slow finger pressure on the plunger until the
canal was visibly filled at the orifice. [

31. • There appeared to be no difference in the
straight canal filling capabilities of either the
tuberculin or mechanical syringes.
• The tuberculin syringe group had the worst
results for the length of obturation amon other
techniques used in a study conducted by
Memarpour et al

32. • 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 may compromise optimal filling and increase the
presence of voids in the paste.
• Memarpour M, Shahidi S, Meshki R. Comparison of Different Obturation Techniques for
Primary Molars by Digital Radiography. Pediatric Dentistry 2013;35(3):236-240.

33. The Incremental Filling Technique
• This was 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.

34. • Length of the endodontic plugger equaled the
predetermined root canal length minus 2 mm.
• Additional increments of 2-mm blocks were
added until the canal was filled to the cervical
area.

35. • O'Riordan and Coll described a method of
placing the material in bulk and pushing it into
the canals with endodontic pluggers
Jha M, Patil SD, Sevekar S, Jogani V, Shingare P. Pediatric Obturating Materials And
Techniques. Journal of Contemporary Dentistry 2011;1(2):27- 32.

36. • 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 in the full
working length of narrow, curved canals

37. • In addition, movements of the plugger during paste
application may increase the risk of large voids.
• 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.
• Memarpour M, Shahidi S, Meshki R. Comparison of Different Obturation Techniques for
Primary Molars by Digital Radiography. Pediatric Dentistry 2013;35(3):236-240.

38. NaviTip
• Recently, a thin and flexible metal tip was
introduced viz., NaviTip (Ultradent), in the
market to deliver root canal sealer.
• This NaviTip comes in different lengths and a
rubber stop may be adjusted to it.

39. • Guelmann et al assessed the quality of root
canal filling by using three filling systems:
syringe with plastic needle (Vitapex), syringe
with metal needle (NaviTip), and lentulo
spiral.
• Filling quality was determined
radiographically.

40. • Tip thickness, limited flexibility, difficulty to
adapt a stopper and operator experience with
the Vitapex delivery system may explain the
less than ideal results.
• Unfortunately, due to paste thickness, material
could not be expressed via the NaviTip™
lumen

41. • EndoSeal, a syringe delivered zinc oxide eugenol
based canal sealer can be expressed by the
NaviTip system.
Guelmann M, McEachern M, Turner C. Pulpectomies in primary incisors using three delivery
systems: an in vitro study. The Journal of Clinical Pediatric Dentistry 2004;28(4): 323-26.

42. • 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
Memarpour M, Shahidi S, Meshki R. Comparison of Different Obturation Techniques
for Primary Molars by Digital Radiography. Pediatric Dentistry 2013;35(3):236-240

43. The Reamer Technique
• A reamer coated with ZOE paste was inserted
into the canal with clockwise rotation,
accompanied by a vibratory motion to allow
the material to reach the apex, and then
withdrawn from the canal, while
simultaneously continuing the clockwise rotary
motion.

44. • 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.

45. • 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 very closely related
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.

46. 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.

47. • Now the needle is gradually withdrawn while
pushing the material till the needle reaches the
pulp chamber.
• The technique described is simple, economical,
can be used with almost all filling materials used
for the purpose, and is 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.

48. Bi-Directional Spiral
• Dr. Barry Musikant [1998] developed a new
obturation technique with bi-directional spiral.
• This technique ensures that a minimal amount
of obturating material will past the apex.

49. • 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.

50. • Where they meet (about 3-4 mm from the
apical end of the shaft), the material is thrown
out laterally.
• The study by Muskant et al. [1998] observed
that the bi-directional spiral prevented the
apical extrusion of the sealer from the root
canals of permanent teeth.

51. • 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

52. • NS Ca(OH)2 injected into canal with NaviTip
consistently produced better results than the
spirally placed dressings in a conclusion drawn
by the study reported by 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.

53. Pastinject
• Pastinject (Micromega) is a specially designed
paste carrier with flattened blades, which
improves material placement into the root
canal. In a study conducted by Grover et al,

54. • 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

55. • Moreover, it was reported by Deveaux et al
and Oztan Meltem et al that special design of
the Pastinject seems to favor a better intracanal
placement of calcium hydroxide paste in single
rooted teeth.
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.

56. • 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.

57. • 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 specially designed paste carrier technique with other techniques. BMC Oral Health
2013; 13(52):1-7.

58. Obturating material
• A wide variety of obturating materials have been
used for obturation of primary teeth. Some of the
most common used material are :
• Zinc Oxide Eugenol
• Iodoform Paste
• Maisto’s Paste
• Endoflas
• Calcium hydroxide
• Calcium Hydroxide with Iodoform paste (Vitapex)

59. • The ultimate goal of endodontic obturation
has remained the same for the past 50 years:
to create a fluid-tight seal along the length of
the root canal system, from the coronal
opening to the apical termination.
Jha M, Patil SD, Sevekar S, Jogani V, Shingare P. Pediatric Obturating Materials And
Techniques. Journal of Contemporary Dentistry 2011;1(2):27- 32.

60. Purposes of obturation

61. • For this purpose, several techniques have
been used for the filling of material into
primary teeth root canals.
• ideal filling technique should assure complete
filling of the canal without overfill and with
minimal or no voids

62. • It is important to select an obturation
technique that offers consistency and is easy
to use
• Gutmann JL, Kuttler S, Niemczyk S. Root Canal Obturation: An Update.
Pennwell Publications 2010;1-11.

63. ZOE (zinc oxide eugenol)
• Zinc oxide Eugenol is one of the most widely
used materials for root canal filling of primary
teeth.

64. • Bonastre (1837) discovered zinc oxide Eugenol
and it was subsequently used in dentistry by
Chisholm (1876)
• Zinc oxide Eugenol paste was the first root
canal filling material to be recommended for
primary teeth, as described by Sweet in 1930
Praveen P, Anantharaj A, Karthik V, Pratibha R. A review of the obturating material for
primary teeth. SRM university journal of dental science 2011;1

65. • Hashieh studied the beneficial effects of
Eugenol.
• The amount of Eugenol released in the
periapical zone immediately after placement
was 10-4 and falls to 10-6 after 24 hrs,
reaching 0 after 1 month.

66. • Within these concentrations Eugenol is said to
have antiinflammatory and analgesic
properties that are very useful after a
pulpectomy procedure.
• 1930's zinc oxide Eugenol has been the
material of choice.

67. TYPES OF ZOE CEMENTS
1. Type I
2. Type 11
3. Type III
4. Type IV
1. Type I –
• Designed for temporary cementation of indirect restorations.
• It seals the cavity surprisingly well against the ingress of oral
fluids, at least for a brief period.
• Lower strength , to facilitate the removal of restorations.

68. • Type II –
• Designed for a long term applications.
• intended for permanent cementation of restorations or appliances
fabricated outside of the mouth.
• Type III-
• Temprorary filling and thermal insulation.
• Type IV –
• Used as a cavity liners.

69. • It has certain disadvantages like slow
resorption, irritation to the periapical tissues,
necrosis of bone and cementum and alters the
path of eruption of succedaneous tooth.
• Hashieh I A, Ponnmel L, Camps J. Concentration of Eugenol apically released from ZnOE
based sealers. JOE 1999; 22(11): 713-715.

70. PROPERTIES
• Extended working time- but sets faster in mouth
due to increased temperature and humidity.
• Good sealing potential because of small
volumetric changes on setting.
• Eg., Tubliseal, Wach’s cement, Nogenol.

71. REVIEW OF LITRETURE
• First study was done by the RABINOWITZ
(1953) in which he observed seven failures out
of 1363 treated teeth and Starkey (1963)
advocated extirpation of pulpal tissue with
instrumentation of the root canals and
placement of a resorbable treatment paste. This
procedure was a multiple appointment one,
with three to seven visits needed to complete
the pulpectomy procedure.

72. • Success rate were reported after obturating
with Zinc Oxide Eugenol by various authors as
follows 82.3% BARR et al, 82.5% GOULD
J, 86.1% COLL et al.
• Camp JH Dent Clin Nrth Am 1984,28, 651-68
• Gould JM J Dent Child 1972, 39,269-73

73. • ERAUSQUIN AND MURUZABAL 1967
studied the occurrence of cementum, bone and
inflammation of periapical tissues in animals
after obturated with Zinc Oxide Eugenol.
• Used ZOE in 141 rats followed from 1- 90
days .
• ZOE irritated the periapical tissues and caused
the necrosis of bone & cementum.

74. • Extruded ZOE developed fibrous capsules that
prevented resorption.
• Developmental arrest of a premolar following
overfilling the root canal of second primary
molar using ZOE- attributed malformation to
toxic nature of material.

75. • GOULD 1972 clinically investigated 35 primary
molars treated with one – appointment
pulpectomy procedure obturating with ZOE
and reported a clinical success rate of 82.8%
after a 16-month period.
• Gould JM J Dent Child 1972, 39,269-73.

76. • COLL 1993
• Retained ZOE after loss of pulpectomized tooth
• 27.3% after a mean of 40.2 months after loss of
treated tooth – retained
• Short filled retained ZOE less than beyond fills
• Size of the particles of most retained ZOE filler
decreased over time.

77. IODOFORM PASTE
• Rifkin 1980 used KRI paste as the final filling
materials for pulpectomies in primary teeth in a two-
visit technique and as the medicaments between the
visits.
• COMPOSITION
• 2% parachlorophenol
• 4.86% camphor
• 1.215% menthol
• 80.8% iodoform

78. ADVANTAGES
• Disinfectant to treat osteitis after extractions.
• Remains in paste form and never set to hard mass.
• Smooth, viscous material, can be spun in with
lentulo-spiral or injected with pressure syringe.
• resorbable, so if inadvertently expressed into
periapical granulomatous tissue is rapidly removed
and replaced by healthy connective tissue (Castagnola
1952,Woods 1984).

79. • Resorbs in synchrony with roots.
• Easily inserted and removed.
• Resorbs from apical tissues in one or two
weeks.

80. • HOLON ANNA FUKS 1993
• compared ZOE and KRI.
• Success rate of both was similar if underfilled
• Slightly higher when KRI flushed to the apex

81. • GARCIA GODOY 1987
• None of the succedaneous teeth treated with KRI
had enamel disturbances or other morphological
defects.
• KRI paste is bactericidal in root canal, resorbs
from the apical tissues in one or two weeks,
apparently harmless to permanent tooth germs,
radio opaque, does not set to hard mass, and is
easily inserted and removed.

82. Maisto’s paste
• Maisto 1967
• Composition:
• Zinc oxide -14g
• Iodoform- 42g
• Thymol- 2g
• Chlorophenol camphor- 3cc
• Lanolin- 0.50g

83. • ELIYAHU MASS 1989
• Maisto was successful in treating infected molars.
• Iodoform containing pastes are easily resorbed
from the peri radicular region.
• These cause no foreign body reaction like zinc
Oxide Eugenol.
• Overfilling and resorption of iodoform
containing had no effect on success of treatment
rather had positive healing effect.

84. • REDDY VV, FERNANDES 1996
• On clinical evaluation, teeth obturated with
Maisto’s paste showed 100% success.
• Five teeth that were overfilled with Maisto’s paste
showed complete resorption of excess material
within 3 months.
• Zinc Oxide Eugenol treated cases showed only
26.7% bone regeneration while in case of
Maisto’s paste, it was 93%.

85. • Complete healing of the inter-radicular
pathology was seen with Maisto’s paste.
• However, the pathology was present in 40%
of the Zinc Oxide Eugenol treated teeth even
after 9 months.
• Maisto’s paste was thus seen to be superior to
Zinc Oxide - Eugenol.

86. ENDOFLAS
Endoflas is a resorbable paste produced in
South America and contains components
similar to that of Vitapex, with the addition of
zinc oxide Eugenol.

87. • This paste is obtained by mixing a powder
containing triiodomethane and iodine
dibutilorthocresol (40.6%), zinc oxide
(56.5%), calcium hydroxide (1.07%), Barium
sulphate (1.63%) and with a liquid consisting
of Eugenol and Paramonochlorophenol.
Praveen P, Anantharaj A, Karthik V, Pratibha R. A review of the obturating material for
primary teeth. SRM university journal of dental science 2011;1(3).

88. • The material is hydrophilic and can be used in
mildly humid canals.
• It firmly adheres to the surface of the root
canals to provide a good seal.
• Due to its broad spectrum of antibacterial
activity, Endoflas has the ability to disinfect
dentinal tubules and difficult to reach
accessory ca-nals that cannot be disinfected or
cleansed mechanically.

89. • The components of Endoflas are
biocompatible and can be removed by
phagocytosis, hence making the material
resorbable

90. • Endoflas only resorbs when extruded
extraradicularly, but does not wash out
intraradicularly.
• The disadvantage of this material is its
Eugenol content that can cause periapical
irritation.

91. • It also has a drawback of causing tooth
discoloration.
• One study showed a lower success rate of 58%
when there was overfilling but 83% success in
cases with flush and underfilled root canals.
Thus, it can be concluded

92. • That the Endofloss may be successfully used
for root canal treatments in primary teeth
particularly if care is taken not to overfill

93. • Pabla et al. evaluated the antimicrobial
efficacy of zinc oxide Eugenol, Iodoform
paste, KRI paste, Maisto paste and Vitapex®
against aerobic and anaerobic bacteria
obtained from infected non-vital primary
anterior teeth.

94. • Maisto paste had the best antibacterial activity
• Iodoform paste was the second best followed
by zinc oxide Eugenol paste. Vitapex® showed
the least antibacterial activity.
• Pabla T, Gulati MS, Mohan U. Evaluation of antimicrobial efficacy of various
root canal filling materials for primary teeth. J Indian Soc Pedod Prev Dent.
1997 Dec; 15(4):134-40.

95. • Fuks A 2002 conducted a retrospective study using
Endoflas as a filling material in 55 teeth.
• After a follow up of 52 months 70% was successful.
Overfilling led to the success rate of 58%, while in the
combine flush and underfilled the success rate was 83%.
• The paste resorbed extra radicularly, without washing out
intra radicularly.
• Journal of clinical pediatric dentistry, 2002,27(1), 41-46

96. • Moti Moskovitz , Eid Sammara, Gideon Holan
2005 done a study to evaluate rate of success
of root canal treatments in primary infected
molars using Endoflas F.S as a filling material.
• Endoflas F.S. can be used as an alternative
root canal filling material for primary teeth.

97. CALCIUM HYDROXIDE
• Calcium hydroxide is used in various forms for
the management of pulpally involved teeth.
• Bermann in 1930 was one of the first
investigators to use calcium hydroxide on vital
exposed pulps.

98. • Calcium hydroxide is a relatively week
cement commonly employed as direct or
indirect pulp capping agents.
• Due to their alkaline nature they also serve as a
protective barrier against irritants from certain
restorations.

99. Classifications and types:
•According to whether they are setting or non-
setting.
•The setting – Ca(OH)2 are generally used for the
lining or as root canal sealers.
•The non setting Ca(OH)2 is used as dressing for
root canals.

100. •According to the mode of delivery
I. Dry powdered Ca(OH)2 ex: Reogan, Analar
Ca(OH)2
II. Single paste system ex: Hypocal
III. Two paste system ex: Dycal, Basic
IV. Root canal sealer ex: Sealapex CRCS
(Calcibiotic root canal scaler)

101. uses
1. As a base under restorations
2. Vital pulp therapy
• Direct pulp capping
• Indirect pulp capping
• Pulpotomy
• Apexogenesis
3. Treatment of divergent apex in a pulpless tooth (Apexification).
4. Irrigation
5. Routine intracanal dressing between appointments
• Routine dressing
• Long term temporary dressing

102. 6. Large periapical lesions.
7. As an alternative material for the obturation of primary teeth.
8. Control of persistent apical exudates into the canal.
9. Prevention of root resorption .
• Idiopathic
• Following reimplantation or transplantation of a tooth.
10. Repair of iatrogenic perforations.
11. Treatment of root fractures.
12. Constituent of root canal sealer.
13. Dentine desensitizing agent.
14. Microleakage demonstrator.

103. properties
• Calcium hydroxide cements have poor
mechanical properties.
• Compressive strength (low)– 10-27 MPa after
24 hrs.
• Tensile strength (low)- 1.0 MPa.
• Solubility in water is high - .4- 7.8%

104. CALCIUM HYDROXIDE
• Pitt’s 1984 studied the absorbable nature of
Calcium Hydroxide.
• He found that significant wash out of apical
plugs of Calcium Hydroxide occurred during
the first month after placement.

105. • By the ninth month, plugs were virtually gone
from the apical portion of the root canal.
• Adjacent to remaining Calcium Hydroxide
particles, giant cell but no inflammatory cells
were seen.
• Thus displacing a small amount of Calcium
Hydroxide into the periapical tissues are of
minimal concern

106. • Antiseptic
• Osteoinductive properties (Henry 1982, Stevens 1983,
Sjogren 1991)
• Lentulo spiral has been reported to be the most
effective in carrying calcium hydroxide paste to
working length – highest quality filling.
• Resorbs within 1-2 weeks when extruded (Ranly 1991)
• Causes no damage to the permanent tooth (Reyes 1989)
• Can easily be removed.

107. • HS Chawla et al 1998, in his study on five mandibular
molars for six months found Calcium Hydroxide to
show complete healing of peri radicular radiolucency.
• K Rehman 1996 determined the amount and duration of
diffusion of calcium ion from both a Calcium
Hydroxide containing root canal sealer and a intra canal
medicament. There was statistically significantly more
calcium diffusion with the non – setting groups
compared with the sealer groups.
• Isppd 2001, 19 (3), 107-109

109. VITAPEX
• Contains Calcium hydroxide and Iodoform.
• COMPOSITION
• Iodoform – 40.4%
• Calcium hydroxide – 30.3%
• Silicon – 22.4%

110. • Garcia Godoy 1999, evaluated the effectiveness
of VITAPEX (Calcium hydroxide/Iodoform)
paste in the root canal treatment of 26 teeth, 2-7
years for a period of 14 months.
• They found it to be radio opaque, does not set to
hard mass, resorbs from the apical tissues in 1
week to 2 months, apparently harmless to
permanent tooth germs, and can be easily inserted
and removed.

111. • Garcia Godoy 2000 studied the resorption of
VITAPEX on primary anterior teeth and made
a follow up for 38 months.
• They found that the paste resorbs intra and
extra radicularly with out ill effects. However
the paste resorbs in 1-2 weeks

112. DISADVANTAGE
• Allergic reactions to iodine in some individuals (Castognala
1952).
• Discoloration of teeth (Rotstein 2002)
• Iodoform irritating to periapical tissue can cause cemental
necrosis (Erausquin 1969)
• Bismuth iodoform paste has been reported to cause
encephalopathy when used as wound dressing following
head and neck surgery (Roy 1994)

113. • Kawakami 1987 used Vitapex to find the fate
of calcium hydroxide component in root canal
filling paste.
• They found that water based pastes caused
necrosis because of high alkalinity of calcium
hydroxide while silicone based paste
(VITAPEX) shows no necrotizing effect.
JOE 1987, 13(5), 220-223

114. • Mortazavi M, Mesbahi M, 2004 compare zinc oxide and
Eugenol and Vitapex for root canal treatment of necrotic
primary teeth.
• Both ZOE and Vitapex gave encouraging results.
• Overall success rates of Vitapex and ZOE were 100% and
78.5%, respectively .
• International Journal of Paediatric Dentistry Volume 14 Issue 6, Pages 417 - 424

115. • Ozalp N, Saroglu I, Sonmez H, 2005 evaluated
various root canal materials in primary molar
pulpectomies : an vivo study.
• In the ZOE group, all pulpectomies were
successful.
• In the Sealapex group, two pulpectomies and in
the Calcicur group, four pulpectomies showed
complete resorption of the material in the root
canal.

116. • In the Vitapex group, although six
pulpectomies showed resorption of the filling
material within the canals, this had no effect
on the clinical and radiographical success of
the treatment.
• Am J Dent. 2005 Dec;18(6):347-50

117. • Chawla 2008 Evaluated the mixture of zinc
oxide, calcium hydroxide, and sodium fluoride as
a new root canal filling material for primary teeth.
• Calcium fluoride as a reaction product added
radiopacity to the root canal filling material,
without the need for addition of any other
radiopaque material.
•

118. • The addition of fluoride was seen to give this
material a resorption rate that matched the
resorption rate of the roots of the primary
pulpectomized teeth.
J Indian Soc Pedod Prev Dent 2008;26:53-8

119. • Trairatvorakul C, Chunlasikaiwan S , 2008 studied the
success of pulpectomy with Zinc oxide – Eugenol VS
Vitapex paste in primary molars.
• At 6 and 12 months, the ZOE success rate were 48%
and 85%, respectively, and the Vitapex success rates
were 78% and 89%.
• Vitapex appeared to resolve furcation pathology at a
faster rate than Zinc oxide- Eugenol at 6 months, while
at 12 months, both materials yielded similar results.

120. 120
REPORT SUCCESS RATES IN ROOT FILLING PRIMARY MOLARS
Investigator year Follow up
months
No. of teeth
examined
Filling
material
Success rate
%
Gould 1972 7-26 29 ZOE 68.7
Rifkin 1980 12 26 KRI 89.0
Coll 1985 6-36 33 ZOE 80.5
Coll 1985 60-82 29 ZOE 86.1
Garcia Godoy 1987 6-24 55 KRI 95.6
Reyes 1989 6-24 53 KRI+FC+Ca(
OH)2
100
Barr 1991 12-74 62 ZOE+FC 82.3

121. At times we have a many options but
we have to choose the best among