Asalaam Alekum
30/11/2014
Root canal Obturation
Dr. Gaurav Garg
Lecturer
College of Dentistry, Zulfi
Successful endodontic treatment depends on
•Proper diagnosis
•Favorable prognosis assessment
•Proper disinfection, cleaning, shaping, and
•Obturation of the root canals
WHY TO OBTURATE THE CANAL
???
Readiness of the root canal for filling
o Negative culture
o No excessive exudate from the canal
o Absence of foul odor
o Lack of periapical sensitivity
Requirements for an ideal root filling material
(by Grossman,1980)
• Easily introduced in the canal
• Radiopaque
• Dimensionally stable
• Seals the canal laterally and apically, conforming to its
complex internal anatomy
• Impervious to moisture
• Inhibits bacterial growth
• Nonirritating to the periapical tissues
• Sterile or can be easily sterilized
• Does not discolor tooth structure
• Easily removed from the canal if necessary
GUTTA PERCHA : EVOLUTION
INTO DENTISTRY
“GETAH”- meaning gum
“PERTJA”- name of the tree in
Malay language
First introduced to dentistry as a
temporary filling material by
Edwin Truman.
CHEMISTRY OF GUTTA-PERCHA
o Trans-isomer of polyisoprene
o Harder, more brittle and less elastic than natural rubber
Composition :
18-20% gutta-percha
59-76% zinc oxide
1-18% radio-opacifiers
1-4% plasticizers
Advantages of gutta percha
• Compactibility
• Inertness
• Dimensional stability
• Tissue tolerance
• Radiopacity
• Becomes plastic when warmed
• Known solvents ( Chloroform, Xylene, Eucalyptus oil)
• Can be sterilized In 5.25% NaOCl for 1 minute.
Disadvantages
• Lack of rigidity
• lack of length control
Silver cones
In 1933, Jasper introduced silver cones. Their rigidity made
them easy to place; however, their inability to fill the
irregularly shaped root canal system permitted leakage.
Disadvantages:
• Inability to fill the irregularly shaped root canal & hence leakage
• When in contact with tissue fluids or saliva they corrode
• Corrosion products are cytotoxic & produce pathosis or impeded
periapical healing.
Root canal sealers
• Zinc oxide containing sealers
• Calcium hydroxide containing sealers
• Glass ionomer containing sealers
• Resin sealers
• Silicone-based sealers
• Urethane methacrylate sealers
Obturation techniques
I. Solid Core Gutta-Percha with Sealants
A. Cold gutta-percha points
Lateral compaction
B. Chemically plasticized cold gutta-percha
Essential oils and solvents
a. Eucalyptol
b. Chloroform
c. Halothane
C. Canal-warmed gutta-percha
1. Vertical compaction/ Schilder’s method
2. System B compaction
3. Sectional compaction
4. Lateral/vertical compaction - Endotec II
5. Thermomechanical compaction
• Microseal System/ McSpadden Compactor
• Ultrasonic plasticizing
D. Thermoplasticized gutta-percha
1. Syringe insertion
a. Obtura
b. Inject-R-Fill, backfill
2. Solid-core carrier insertion
a. Thermafil
b. Sucessfil
c. Simplifil
II. Apical-Third Filling
A. Dentin-chip
B. Calcium hydroxide
III. Injection or “Spiral” Filling
A. Cements
B. Pastes
C. Plastics
D. Calcium phosphate
1. LATERAL COMPACTION OF GUTTA-PERCHA
Objective: fill the canal with gutta-percha points (cones) by
compacting them laterally against the sides of the canal walls.
Two main types of spreading instruments
long handled spreaders
finger spreaders
•Finger spreaders provide: better tactile
sensation & less likely to induce fractures
Spreader fit
 Fit within 1-2mm of
CWL.
 If not, more
shaping is required
because apical size
and taper is
inadequate.
Excessive force should be avoided—cold gutta-percha
is not greatly compressible, and as little as 1.5 kg of
pressure are capable of fracturing the root.
Master Cone Fit
 Select Master Cone
size that
corresponds to your
MAF size.
 Ex. MAF size 30
 MC size should also
be size 30.
Check Master Cone (MC) Length
Master Cone Fit
23
 If MC is at FWL, you are ready to
obturate.
Mark the Master Cone to FWL
Place MC in the canal system.
Mark should correspond to reference point.
Master Cone Fit
 The Master Cone
should seat to final
working length.
 Obturation
length= FWL
Master Cone Fit
 The MC should have
a definite apical
resistance when MC
is placed to FWL.
 The MC should
exhibit “tugback” or
resistance to removal.
Mix the Sealer
Mix the Sealer
Mix the Sealer
Mix the Sealer
Sealer Placement
Lateral Compaction
 Do this until the
canal is obturated to
the cervical line.
 Take a radiograph at
this time and
evaluate fill.
 This confirms
adequacy of the
obturation.
Lateral Compaction
 If the obturation is satisfactory, the excess gutta
percha should be cut to the CEJ level (buccolingual).
 If obturation is not dense, or if voids are
present, remove all the cones and redo the
obturation process.
Final Radiograph

Remove the rubber
dam clamp and
rubber dam
material and take
the radiograph.
*In a real patient, a
temporary restoration
is placed before
rubber dam is
removed.
SUMMARY
Selection of Spreader:
A spreader is selected that matches the taper of the canal and When
placed in the canal it should be within 2 mm from the working length.
SUMMARY
Selection of master cone:
Following canal preparation a master cone is selected that has a diameter
consistent with the Master Apical File (MAF).
This “master cone” is measured & grasped with a forceps so that the distance
from the cone tip to the forceps is equal to the prepared length.
The cone is placed in the canal & if an appropriate size is selected, there will
be resistance to displacement or “tug back”.
The master cone placement is confirmed with a radiograph.
SUMMARY
Lateral Condensation:
Canal is irrigated and dried with paper points.
Sealer is applied to the canal walls and also to the master cone and it is placed
in the canal.
Now spreader is inserted to make space for accessory cone.
After placement the spreader is removed by rotating it back & forth as it is
withdrawn.
An accessory cone is placed in the space vacated by the spreader.
The process is repeated until the spreader no longer penetrate the coronal 2-3
mm of the canal.
The excess gutta-percha is removed with heated instrument & the coronal
mass is compacted with a plugger.
Obturation is checked radiographically.
Efficacy of Lateral Compaction
•“Gold standard”
Advantage :
• Excellent length control
Limitations:
 However, this technique
may not fill canal
irregularities
Gutta-percha cones never
merge into a homogeneous
mass, but they slip and glide
and are frozen in a sea of
cement
Radiographic evaluation of obturation
Radiolucencies: Voids within the body or at the
interface of obturating material and dentin wall represent
incomplete obturation.
Density: Material should be of uniform density from
coronal to apical aspects. The margins of gutta-percha
should be sharp and distinct with no fuzziness, indicating
close adaptation.
Length: The material should extend to the prepared
length and be removed apical to the gingival margin
(anterior teeth) and orifices (posterior teeth).
Taper: The gutta-percha should reflect the canal shape;
that is, it should be tapered from coronal to apical regions.
Restoration: Whether permanent or temporary, the
restoration should be contacting enough dentin surface to
ensure a coronal seal.
7/12/2014
2. VERTICAL COMPACTION OF WARM GUTTA-PERCHA
• Schilder in 1967.
•Heated gutta-percha has been shown to flow extremely well
into all canal irregularities.
•It is particularly useful in situations such as internal
resorption, C-shaped canals, and those with fins or webs.
Spreader- Heat Carrier
Schilder’s pluggeres (9)
Tip diameter:
0.40,0.50,0.60,0.70,0.80,0.90.1.10,1.30,1.50
Pluggers- vertical compaction
Plugger Selection
Coronal third- 5-6mm
Middle third- 12-15mm
Apical third- 5-6mm
Master Cone Selection
 The cone must be slightly
shorter than the preparation
Sealer Application
 Sealer is mixed and applied in canal
with the help of an endodontic file
Master Cone Placement
 Master Cone should also be
coated with sealer and placed
inside the canal at desired length
Vertical Compaction
 Coronal Third
Middle third
Apical third
Advantages: filling of canal
irregularities and accessory canals.
Disadvantages :
-The risk of vertical root fracture
- Less length
compaction
control
than
in
lateral
-Warm vertical compaction is difficult in
curved canals where rigid pluggers are
unable to penetrate to the necessary depth,
requiring that the canals be enlarged and
more tapered in comparison with the lateral
condensation technique.
Temperature control
•The critical level of root-surface heat required to produce
irreversible bone damage is believed to be greater than 10°C
•Use of a flame-heated instrument does not permit
temperature control.
•The DownPak Cordless obturation device, the System B,
and Touch ’n Heat (SybronEndo) devices, permit temperature
control.
Endotec II
It is a battery-powered, heat-controlled spreader/plugger..The
quick-change, heated tips are sized equivalent to a No. 30
instrument are autoclavable and can be adjusted to any access
angulation.
THERMOMECHANICAL COMPACTION OF GUTTAPERCHA
In 1979, McSpadden devised a handpiece-driven (6000-7000
rpm) compactor, which is effectively an inverted Hedstroem
file.
The frictional heat from the compactor plasticises the guttapercha and the blades drive the softened material into the
root canal under pressure.
•The compactor is selected based on the
size of the canal preparation and inserted
with the hand piece activated alongside
the gutta-percha cone 2 to 3 mm from the
prepared length.
•The gutta-percha is heated by the friction
of the rotating compector, and is
compacted apically and laterally as the
device is slowly withdrawn from the
canal.
Advantages :
simplicity, speed, and the ability to fill canal
irregularities.
Disadvantages :
• Extrusion of filling material beyond the apex
• The potential for instrument fracture
• Difficulty in using the technique in curved canals
• Uncontrolled heat generation.
Use of heat and vibration: DownPak
•An alternative to cold lateral compaction with
finger spreaders : DownPak Obturation
•The DownPak is cordless and designed with a
multifunctional, endodontic heating and
vibrating spreader device, and can be used for
both warm vertical and lateral condensation
techniques.
3. Thermoplastisized Gutta Percha
1. Syringe Insertion- Obtura
2. Solid-core carrier insertion- Thermafil
1. Obtura System
•Consists of a hand-held “gun” with a
chamber into which pellets of gutta-percha
are loaded, along with silver needles of
varying gauges used to deliver the
thermoplasticized material to the canal.
•The temperature, and thus the viscosity, of
the gutta-percha can be adjusted.
•A wide, well-prepared canal is a
prerequisite.
•After drying the canal apply a
small amount of sealer.
•The tip of injecting needle should
be kept 3-5 mm short of working
length and it should be withdrawn
outwards coronally while injecting
gutta percha.
•The coronal portion of gutta
percha should be compacted using
a plugger to enhance coronal seal.
Advantages:
 Easy and less time consuming
 3-D obturation
 Enhanced apical and coronal
seal
 Useful in C-shaped, irregular
and complex root canals
Disadvantage:
 Risk of overfilling
 Not suitable for canals with open
apices
2. Thermafil
Components:
a. Thermafil obturators
Obturators
a. Size verifiers
a. Thermafil Oven
Thermafil oven
Thermafil Technique:
1. Canal preparation
2. Obturator selection
3. Sealer placement
4. Obturation
Advantages:
 Easy to use
 Obturation of curved canals
 3-D Obturation
Disadvantages:
 Not suitable for obturation of teeth with immature apices,
Canals with bifurcations or trifurcations in the middle Third
Risk of overfilling
Dentin Chip Apical Filling
“Biologic seal” rather than a
mechanochemical seal.
•Stimulate osteo or cementogenesis
•Holland et al., found, however,
that dentin chips, if infected, are a
serious deterrent to healing (1980)
References
 ENDODONTICS: Arnaldo castellucci
 PATHWAYS OF THE PULP (6th Edition): Stephen Cohen, Richard C.
Burns
 PRINCIPLES AND PRACTICE OF ENDODONTICS (3RD EDITION):
Walton & Torabinejad

ENDODONTIC THERAPY (6th Edition): Franklin S. Weine
Thank you