Obturation of root canal system

Obturation Of Root Canal
System
It is essential, that endodontic therapy must .
include sealing of the root canal system to
prevent tissue fluids from percolating in
the root canal and prevent toxic by –
products from both necrotic tissue and
microorganisms regressing into the
.periradicular tissue

Ass.Prof.Dr.Mohamed ALsakkaf 1

The current accepted method of .
obturation of prepared canals
employs a solid or a semisolid core
such as gutta – percha and root canal
.sealer

2

The Objectives Of Obturation
To prevent percolation of periradicular .1
exudate into the pulp space via the apical
foramina and / or lateral and furcation
.canals

To prevent percolation of gingival exudate . 2
and microorganisms into the pulp space
via lateral canals opening into the
. gingival sulcus
3

To prevent microorganisms left in the canal . 3
after preparation from proliferating and
escaping into the periradicular tissue via
the apical foramina or / and lateral
. canals

To seal the pulp chamber and canal system . 4
from leakage via the crown in order to
prevent passage of microorganism and /
or toxins along the root canal filling and
into the periradicular tissue via the apical
. foramina and / or lateral canals 4

So the quality of canal obturation .
: depends on
.The complexity of the canal system -
.The quality of canal preparation-
.The materials to be used
.The skills of the operator-
The restoration of the clinical crown to -
prevent leakage into the pulp chamber (Is
?(. obturation the final step in R.C.T
5

Timing Of Obturation
The canal obturation may be delayed for one .
or more visits after preparation to give time
for medicaments sealed into the canals to
reduce or eliminate the microbial population
and for the patients signs specially in
.complex cases

Teeth with little or no problems can be .
. prepared and filled in one appointment
6

Prerequisites for Filling the Root Cana l
Prerequisites for Filling the Root Cana
:A root canal can be obturated when

There is no pain, swelling, tenderness to percussion, 
.or fistulation associated with the tooth
The instrumented canal is dry and free of odor (no 
(exudates or purulent discharges into the canal
If the pulp is necrotic or a periapical lesion is 
present, the root canal cannot be filled before the
.second appointment
Teeth associated with procedural accident, 
perforation must not be filled until another treatment
.are made

EXTENSION OF THE ROOT CANAL
FILLING

Canals filled to the apical dentinocemental junction •
.are filled to the anatomic limit of the canal
Filling to the radiographic end of the root •

:Complicated Cases

Teeth with signs of apical periodontitis .1
(. (tenderness due percussion

.Radiographic signs of apical periodontitis . 2

.Teeth with excessive exudate. 3

9

.Teeth with purulent discharge. 4

Teeth associated with a procedural accident, . 5
. like perforation

Note: Some teeth with these problems can be
. treated in one visit

10

Materials Used For Obturation

A large number of materials have been used to .
obturate R.C.S ranging from orange wood
sticks through precious metals to dental
cements, but most materials that showed a
wild world usage are the Gutta – Percha and
. sealers

11

Root Canal Filling Materials
:Core material 

Solid materials : Silver point a.

.Semisolid materials: Guttapercha b.

Sealers: A root canal sealer is used in
combination with root filling materials
(gutta – percha(. Now the sealer has a
primary role in sealing the canal by
obliterating the irregularities between the
.canal wall and the core material

13

?Why We Use Sealers

Root canal sealers are used with core filling
:materials for the following

Cementing (luting( the core material into .1
. the canal

Filling the discrepancies between the canal . 2
. walls and the core material
14

It acts as a lubricant to help in positioning . 3
. of core material

.Bactericidal agent. 4

Acting as a marker for accessory canals, .5
resorptive defects, and other spaces into
which the main core material may not
. penetrate

15

Requirement Of An Ideal Sealer

.a. Non – irritating to periapical tissue

.b. Insoluble in tissue fluids

.c. Dimensionally stable

16

.d. Hermetic sealing ability

.e. Radiopaque

.f. Bacteriostatic

g. Sticky and good adhesion to canal walls
. when set

17

.h. Easily mixed

.i. Non – staining to dentin

.j. Good working time

.k. Readily removable if necessary

18

:Note

There is no single material that satisfy . 1
. all requirements

Sealers are toxic and cause periapical . 2
irritation when freshly prepared but
. this reduced after setting

19

Most sealers are absorbable, so the .3
. volume must be minimum

Less viscous sealer should be forced by . 4
. core material into canal anastomoses

Excess sealer should ideally flow .5
. backwords out of the canal orifice
20

Types of Sealer

Sealers in use today can be divided into
.four groups based on their constituents

Zinc Oxide – eugenol sealers: .1
Commercial products include:
Tubliseal, Pulp canal sealer, Roth
. sealer
21

:Properties
Once set ZOE sealers form relatively .
weak materials, which are susceptible to
. decomposition

.Potential for sensitization.

.Mutagenic in extremely high doses.
22

These problems are not apparent -
. clinically

They are probably used more often than-
all the other sealer combined and give
. good results

The products have a range of setting -
time and flow properties to satisfy
(. filling difficult canals (slow set 23

:Calcium hydroxide sealers .2

The commercial products involve:
Sealapex, a calcium hydroxide –
.containing polymeric resin, and Apexit

24

:Properties
They preserve the vitality of the pulp stump .
and stimulate healing of hard tissue
. formation at the foramen

.Sealing ability is similar to ZOE.

Soluble and may leach out and weaken the .
remaining cement when expose to tissue
.fluid
25

:Resin Sealers .3

Like AH26 which consists of an epoxy
resin, which set slowly when mixed with an
. activator

:Properties

.Less popular than ZOE and Ca(OH(2.
26

.Good sealing and adhesive properties.

.It has antibacterial activity.

Give an initial severe irritation, which .
. subsides after some weeks

Strong mutagenic potential, which causes .
. allergy and paraesthesia
27

:Glass Ionomer Sealers .4

The products include: Ketac, Endo, Espe,
.Seefeid

:Properties

.Ability to adhere to dentine.

28

Less effective or no difference in the apical .
sealing properties when comparing with
.others

.Less coronal leakage, than ZOE.

Shear bond strength to Gutta – Percha is .
. similar to ZOE sealers

29

:Gutta – Percha
It is the most widely used and acceptable .
. obturating material

G.P is a form of rubber obtained from a .
number of tropical trees. It is
transpolyisoprene, which in its pure form
is hard, brittle and less elastic than natural
. rubber

30

It is mixed with variety of other .
materials to produce a blend G.P
(19 – 22%(, zinc oxide (59 – 75%( and
various waxes, coloring agents,
antioxidants and metal salts to provide
.radiopacity

31

:Advantages Of G.P

.Inert. 1

.Dimensionally stable. 2

.Non – allergic. 3

.Antibacterial. 4
32

.Non – staining to dentine. 5

.Radiopaque. 6

.Softened by heat. 7

.Softened by organic solvents. 8

.Removable from the R.S.C when necessary. 9
33

:Disadvantages Of G.P

.Lack of rigidity. 1

.Do not adhere to dentine. 2

.Can be stretched. 3

34

Obturation Techniques

:There are two main techniques.

(.Lateral Condensation (Cold. 1

(.Vertical Condensation (Hot. 2

35

Methods for Guttapercha
Application
.Lateral Condensation •
.Vertical Condensation •
.Thermomechanical Condensation •
Injection Techniques •

:Lateral Condensation. 1

.This technique is the most popular one .

The core of this technique is placing tapered .
Gutta – Percha cones in the canal and then
compacting them against the canal walls
. under pressure by using spreader

37

IT IS THE MOST POPULAR
.TECHNIQUE OF OBTURATION
INDICATIONS: Lateral Condensation of gutta- •
percha may be used in most cases, exception:
severely curved or abnormally shaped canals or
those with gross irregularities such as internal
.resorption
Three dimensional filling of the canal is
. obtained and bacterial tight seal

:Steps
After the R.C preparation finished, select .1
master Gutta – Percha. Cone whose size is the
same with the largest file used up to the working
length. One should feel the tugback with master
gutta – percha point. It should be notched at
working distance analogous to the level of
. incisal or occlusal edge reference

39

Radiographically make sure that the . 2
cone is fit. Remove the cone if it fit
. and insert it in NaOCL

40

If the cone is going beyond the foramen,
so select the larger number cone or cut
.it to the WL

41

Select the size of spreader to be used . 3
for L.C. It should reach 1 – 2mm of
. true WL

42

The cement (sealer) is mixed and given the 
spatula test to determine the desired
(.consistency (must be soft
The apical half of the master point (except the 
tip) is coated with sealer and inserted into the
.canal to the predetermined depth

Dry the canal using paper point and . 4
. apply sealer into the prepared R.C

44

The nominated and premeasured cone. 5
is coated with sealer and place into
the R.C. After placement of cone, a
selected spreader is placed into the
. canal alongside the cone

45

Spreader acts as a wedge to squeeze the
G.P laterally under vertical pressure
.not by pushing it sideways

46

Spreader then removed from the canal. 6
by rotating it back and forth. This
compacts the G.P and provide space
. lateral to the master cone

47

Place in the created space beside the . 7
master cone an accessory one, and
repeat the same procedure until the
spreader longer cannot penetrate
.beyond the cervical line

48

Protruding G.P points at canal orifice . 8
should be removed by using hot
. instrument

49

Advantages Of L.C Technique

.a. It can by used widely in most cases

b. It prevent overfilling by length control
. during condensation

50

Disadvantages

a. May not fill the canal irregularities
. efficiently

.b. Does not provide homogenous mass

51

C. Space may exist between master and
. accessory cones

52

Warm Lateral Condensation
It is a variant of traditional lateral condensation and is
especially indicated for teeth with internal resorptive
defects
A heated instrument is introduced into a tooth already obturated •
by lateral condensation to soften the gutta-percha mass and
.enhance adaptation to the internal anatomy of the canal
The Endotec instrument is then activated for 4 to 5 seconds •
and moved in short, continuous motions in and out of the gutta-
.percha mass
A cold spreader is introduced and rotated to condense the •
thermoplasticized gutta-percha into the canal anatomy
Accessory points coated with sealer are then added until the •
.canal is completely obturated

Vertical Condensation .2

Vertical Condensation by using warm .
G.P cones to fill the R.C is known as
.Schilders technique

54

Because in the R.C.S may present many.
lateral and accessory canals, which
make the R.C complex, the use of
the heated G.P cones, will be helpful
in the filling of these accessory canals,
by maximum amount of G.P and
.minimum amount of sealer

55

This technique requires the
:following
a) Continuous tapering funnel shape
. from orifice to apex

b) Apical opening kept as small as
. possible

56

c) Decreasing the cross sectional
diameter at every point apically and
. increasing at each point coronally

57

:Steps
After selection the master cone .1
according to shape and size of the
prepared canal, be sure that the
cone fit in 1 – 2mm of apical stop,
to avoid moving the heated cone
.apically

58

Radiographically confirm the fit of the. 2
cone, if fit, remove it and insert in
. NaOCL

.Irrigate and dry the canal. 3

59

Select the instrument for heating .4
(Plugger) according to the shape of
. canal

60

Apply little amount of sealer into the . 5
. canal

Cut the coronal end. 6
' .of selected G.P at canal orifice

61

Heat the plugger and force the G.P by . 7
it into the canal. The blunted end of
plugger provides a depression in the
center of master cone. The outer
walls of G.P then folded inward to
fill the central void, at the same time
mass of softened G.P is moved
apically, and laterally. This
procedure also removes 2 – 3mm
.of coronal part of G.P
62

After completing apical filling, complete . 8
obturation by backfilling. Obturate the
remaining canal by heating small
segments of G.P and condense them by
. heated plugger

64

Do not apply sealer on the softened G.P,. 9
this will prevents their adherence to
. G.P present in the canal

Finally clean the pulp chamber with . 10
. alcohol to remove the remnants

65

:Advantages Of Vertical Condensation

Good sealing of canal apically, laterally
.and obturation of accessory canals

67

Disadvantages

.a) Risk of vertical root fracture

.b) Overfilling

.c) Time consuming

68

Thermoplastic Injection Technique
Gutta-percha heated to 70 °C (158 °F) is injected into •
the root canal by means of a Peripress syringe, and
.is supposed to fill all ramifications
Ampules containing gutta-percha are heated for 15 •
minutes in the apparatus to plasticize the
.guttapercha
A short cannula with a diameter of 0.7 mm is •
.attached to each ampule

Obturation of root canal system

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