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- 1. OBTURATION OF ROOT CANAL SYSTEM BY ABDULRAZAQ ABDULWAHAB FALLUJAH SPECIALIST DENTAL CENTER ENDODONTIC DEPARTMENT
- 2. • After chemo-mechanical debridement of root canal system, the next step is complete (3 dimensional)obturation of root canal space to maintain the tooth functional within the dental arch. • In obturation a solid or semisolid core material is used with a sealer to produce the fluid tight seal by filling the main root canal(s), the accessory canals, voids, spaces and irregularities.
- 4. AIMS OF ROOT CANAL OBTURATION • The achievement of 3 dimensional obturation of the root canal space to prevent ingress of bacteria and body fluids into root canal space, as well as egress of bacteria or their toxins out of the root canal. • The replacement of the root canal space filled with necrotic tissue by an inert filling material to create a favorable healing environment and avoid recurrent infection. • To provide fluid tight seal within all regions of root canal space to prevent microleakage
- 5. TIMING OF OBTURATION • Patient symptoms: the sensitivity to percussion indicative that the inflammation of the periapical periodontal ligament is present. Therefore the obturation has to be postponed until the inflammation subside. In cases of irreversible pulpitis with no tenderness to percussion present, the root canal treatment can be completed in a single visit as soon as the cause of the pain and inflammation has been removed. • Canal wettability: presence of wet canal with purulent exudate, blood or pus is a strong evidence that the periradicular inflammation is still present. Obturation of the root canal at this stage increase the pressure within periradicular region and subsequent tissue destruction may proceed rapidly. Therefore, in cases of active periradicular infection, delaying obturation until all signs and symptoms of inflammation have to be subside is extremely recommended.
- 6. FEATURES OF AN IDEAL ROOT CANAL OBTURATION • Complete 3 dimensional obturation from the coronal orifice of the root canal until CDJ. • Radiographically, the root filling should be within 0.5- 0.75mm from radiographical apex. • The root canal should be completely filled, mainly with root filling material with a minimum amount of sealer.
- 7. • Underfilling: occur when the root canal filling is shorter than total root canal space. This definitely providean environment for initiation ,persistence or recurrence of periradicular infection.
- 8. • Overfilling: occur when the root filling material extended beyond the CDJ.According to Ng et al. 2007 the extrusion of root canal filling is considered to be acceptable within2mm beyond the radiographical apex, if it is associated with 3dimensional sealing of root canal system
- 9. CHARACTERISTICS OF AN IDEAL ROOT FILLING MATERIAL 1. Easily introduced in the root canal. 2. Provide an apical and lateral sealing of the root canal. 3. Dimensionally stable after usage. 4. Bacteriostatic or at least should not encourage bacterial growth. 5. Non staining to tooth structure. 6. Removed easily from canal if required.
- 10. MATERIALS USED FOR OBTURATION • Plastics: Gutta-percha, resilon • Solids or metal cores: Silver points, Gold, stainless steel, titanium and irridio- platinum. • Cements and pastes: Hydron , MTA , Calcium phosphate , Gutta flow.
- 13. SEALERS CAN SERVE SEVERAL FUNCTIONS • Lubricate and aid the seating of gutta percha cones. • Bonding between gutta percha and root canal walls. • Filling gaps and anatomical spaces. • Antimicrobial agent • Radiopacity: identifying the auxiliary canals, resorption regions, root fracture, and the shape of apical foramen.
- 14. DIFFERENT TYPES OF SEALERS ARE AVAILABLE • Zinc oxide–eugenol formulations • Calcium hydroxide sealers • Glass ionomers • Medicated sealers • Silicon sealers • Epoxy resin sealers • Bioceramic
- 15. BIOCERAMIC SEALER • Bioceramic sealer is a material used in root canal obturation during endodontic treatments. It primarily consists of inorganic compounds such as calcium silicates, calcium aluminates, and zirconium oxide. Bioceramic sealers offer superior biological and chemical properties compared to traditional sealers.
- 16. CHARACTERISTICS OF BIOCERAMIC SEALER • High Biocompatibility: Does not irritate surrounding tissues and promotes healing. • Dentin Bridge Formation: Stimulates dentin formation by releasing calcium ions. • Excellent Sealing Ability: Reacts with moisture to form calcium hydroxide, enhancing canal sealing. • Dimensional Stability: Does not shrink or expand after setting, reducing leakage risks. • Antibacterial Activity: Exhibits a high pH upon setting, inhibiting bacterial growth.
- 17. APPLICATIONS • Root Canal Obturation • Lateral Perforation Repair • Retreatment Cases
- 18. ADVANTAGES • Improves long-term success of root canal therapy. • Reduces the chances of endodontic failure. • Works well with the moisture present in the canal. DISADVANTAGES • High Cost: Compared to conventional sealers. • Difficult to Remove: During retreatment procedures. • Long Setting Time: Compared to other types of sealers.
- 20. ARMAMENTARIUM
- 21. COLD GUTTA PERCHA LATERAL COMPACTION TECHNIQUE • The most common obturation compaction technique. • It involves the placement of the master gutta-percha point and accessories under lateral pressure against the canal walls by using a spreader. • Advantages: Simple and cost-effective. • Disadvantages: Risk of voids. • Clinical Indications: Suitable for straight canals or simple root canal anatomies.
- 22. STEPS OF THE TECHNIQUE • Master Cone Selection:Select a gutta-percha cone that snugly fits the working length with proper tug-back. • Sealer Application:Coat the canal walls and the master cone with an endodontic sealer. • Cone Placement:Insert the master cone into the canal, reaching the full working length. • Lateral Condensation:Use a finger spreader to create space alongside the master cone.Insert accessory cones into the created space and laterally compact them.Repeat until the canal is densely filled. • Coronal Filling:Trim excess gutta-percha and compact the coronal part.
- 25. COLD GUTTA PERCHA SINGLE CONE OBTURATION TECHNIQUE • Uses a single gutta-percha cone with a sealer. • It is particularly popular when using rotary NiTi systems that create a uniform, tapered canal shape. • Advantages: Quick and simple. • Disadvantages: Less dense fill • Clinical Indications: Ideal for narrow, straight canals or canals prepared with rotary files.
- 26. STEPS OF THE TECHNIQUE • Master Cone Selection:Choose a gutta-percha cone that matches the size and taper of the last instrument used during canal preparation. • Sealer Application:Apply a thin layer of sealer to the canal walls and the master cone. • Cone Placement:Insert the cone into the canal to the full working length, ensuring good adaptation. • Seating the Cone:Apply gentle apical pressure to ensure the cone reaches the full depth. • Coronal Sealing:Trim the excess gutta-percha at the orifice level and compact it gently.
- 28. SOFT GUTTA PERCHA WARM LATERAL OBTURATION TECHNIQUE • hybrid method combining aspects of both lateral condensation and warm vertical compaction. • It aims to improve the adaptation of gutta-percha to the canal walls while minimizing voids. • Advantages: Enhanced Adaptation, Reduced Voids. • Disadvantages:Risk of Overfilling, Material Shrinkage. • Clinical Indications:canals with irregular shapes or curvatures
- 29. STEPS OF THE TECHNIQUE • Master Cone Selection:A single gutta-percha cone fitting the canal is chosen. • Warming the Cone:The master cone is heated slightly to increase its flowability. • Lateral Condensation:The warmed cone is placed into the canal, and accessory cones are laterally compacted using spreaders.Heat may be reapplied periodically to improve condensation. • Final Compaction:A heated plugger may be used to compact the cones vertically at the apical end, creating a dense fill.
- 30. SOFT GUTTA PERCHA WARM VERTICAL OBTURATION TECHNIQUE • is a method where heated gutta-percha is compacted vertically within the root canal. • It is highly effective for achieving a three-dimensional seal, especially in canals with complex anatomies. • Advantages:Superior Adaptation, Minimizes voids and microleakage. • Disadvantages:Excessive heat can harm periapical tissues. • Clinical Indications:Recommended for multi-rooted teeth and canals with curvatures or lateral canals.
- 31. STEPS OF THE TECHNIQUE • Master Cone Selection:Select a gutta-percha cone that fits the working length and provides proper tug-back. • Sealer Application:Coat the canal walls and the master cone with an appropriate endodontic sealer. • Downpacking:Insert the master cone to the working length.Use a heated plugger to soften and compact the cone apically.Apply vertical pressure to adapt the gutta-percha to the canal walls. • Backfilling:After downpacking, inject warm thermoplasticized gutta-percha into the remaining canal space.Compact vertically to eliminate voids and ensure complete filling. • Coronal Sealing:Trim excess material and compact the coronal portion with a plugger.
- 33. SOFT GUTTA PERCHA THERMOPLASTIC INJECTION TECHNIQUES • involve the use of heated, flowable gutta-percha injected into the root canal system. These techniques aim to achieve a homogeneous and dense fill, especially in canals with complex anatomy. • Advantages: Fills complex anatomies. • Disadvantages: Risk of overfilling • Clinical Indications:Ideal for complex canal anatomies, such as C- shaped or multi-rooted teeth.
- 34. STEPS OF THE TECHNIQUE • Master Cone Placement:Select a master cone and fit it to the working length with proper tug-back. • Sealer Application:Coat the canal walls and the master cone with a suitable endodontic sealer. • Injection of Warm Gutta-Percha:Use a thermoplastic injection device to heat the gutta- percha.Inject the molten gutta-percha into the canal, starting from the apical part and moving coronally. • Vertical Compaction:Use a plugger to vertically compact the material while it is still warm.This helps adapt the gutta-percha to the canal walls and eliminate voids. • Coronal Filling:Trim excess gutta-percha and compact the coronal portion to ensure a complete seal.
- 36. SOFT GUTTA PERCHA CARRIER-BASED GUTTA-PERCHA (THERMAFIL) • utilizes a central carrier coated with thermoplasticized gutta-percha. This technique aims to provide a 3D obturation with improved adaptability and a dense fill. • Advantages:Efficient and Fast, Great for Curved Canals • Disadvantages:Difficult Retreatment, Risk of Overextension • Clinical Indications:Ideal for complex canal anatomies, including curved or multi-rooted teeth.
- 37. STEPS OF THE TECHNIQUE • Master Cone and Carrier Selection:Choose a Thermafil obturator that matches the prepared canal size. • Sealer Application:Apply a thin coat of endodontic sealer on the canal walls. • Heating the Carrier:Place the obturator in a Thermafil oven to heat the gutta-percha coating. • Insertion into the Canal:Once heated, insert the carrier to the full working length in a single, smooth motion.Apply light apical pressure to adapt the material to the canal walls. • Carrier Trimming:After cooling, cut the coronal part of the carrier and compact the remaining gutta-percha in the coronal portion.
- 39. SOFT GUTTA PERCHA THERMOMECHANICAL COMPACTION TECHNIQUE • uses mechanical energy to generate heat within the root canal, softening the gutta-percha and compacting it simultaneously. • Advantages:Effective in Irregular Canals, Reduces voids and gaps. • Disadvantages:Risk of Overextension. • Clinical Indications:Ideal for irregular or oval canals.
- 40. STEPS OF THE TECHNIQUE • Master Cone Selection:Select a gutta-percha cone matching the canal size, ensuring a snug fit at the working length. • Sealer Application:Apply a thin layer of sealer to the canal walls and the master cone. • Cone Placement:Insert the master cone to the full working length. • Thermomechanical Compaction:Use a rotary compactor or a heat-generating file to spin the gutta-percha inside the canal.The frictional heat generated softens the material, allowing it to flow into irregularities and lateral canals.Maintain apical pressure during rotation to ensure a dense fill. • Coronal Sealing:Trim excess material and compact the coronal portion for a complete seal.