Obturation technique

Contents:
• Introduction
• Classification Of Obturating Techniques
• Obturating Techniques
• References And Conclusion

“ Obturation is the method used to fill and seal a cleaned and
shaped root canal using a root canal sealer and core filling
material.”
According to American Association of Endodontists

1847 HILL Introduced “Hill Stopping” ( a mixture of bleached
gutta percha and carbonates of lime and quartz)
1867 BOWMAN First used gutta percha as RC filling material
1883 PERRY packed gold wire wrapped with gutta percha in
root canal
RICHMOND used orange wood coated with gutta-percha
1887 SS White Company started commerial manufacture of
gutta percha
1893 ROLLINS used GP with pure oxide of mercury in RC

1914 CALLAHAN introduced lateral condensation technique
1953 Acerbach used silver wires to fill RC
1961 Sampeck used stainless steel in conjuction with root canal
sealers
1979 MCSPADDEN technique was introduced

PURPOSE OF OBTURATION
• To achieve three dimensional fluid tight seal of the root canal
• To prevent bacterial micro leakage
• To achieve total obliteration of root canal space as to prevent
ingress of bacteria and body fluid into the canal as well as there
removal if present in canal
• To replace the empty root canal space with an inert filling
material to prevent recurrent infection

• The advent of new devices and techniques, such as those utilize
heat, and vibration for warm lateral and warm vertical
condensation, are revolutionizing the practice of endodontics
and making obturation procedures more predictable.

Monobloc
• In endodontics the term monobloc is used to signify a scenario
where in the canal space is perfectly filled with a gap-free, solid
mass that consists of different materials and interfaces with the
purported advantages of simultaneously improving the seal and
fracture resistance of the filled canals.
• This gap free solid mass filling may imply either a root canal
obturating material or a post and core system.
Tay FR.J Endod. 2007; 33(4): 391–398.

Primary monobloc
• Primary monoblocs
• Includes root filling materials that have one interface that
extends circumferentially between the material and the root
canal wall. E
• Mineral Trioxide Aggregate (MTA) for orthograde obturation of
immature teeth with open apices and reduced circumferential
dentin thickness represents a primary monoblock essentially
attempting to reinforce teeth.
Tay FR.J Endod. 2007 ; 33(4): 391–398

Secondary monobloc
• These materials consists of two circumferential interfaces, one
between cement and dentin and other between the cement and
core material. eg Resilon based systems.
Tay FR.J Endod. 2007 ; 33(4): 391–398

Tertiary monobloc
• These systems involve the introduction of a third
circumferential interface is introduced between the bonding
substrate and the abutment material.eg Endorez,
Tay FR.J Endod. 2007 ; 33(4): 391–398

CLASSIFICATIONOFOBTURATING
TECHNIQUES

According to J.J. Messing and C.J.R. Stock
(1988)
Sectional
Single Cone
Multiple cone
Gutta percha with solvents
Thermal compaction
Injection molded thermo-plasticized pastes alone

According to GROSSMAN:
Cold Lateral Condensation
Warm Vertical Condensation
Continuous wave compaction technique
McSpadden thermomechanical compaction
Thermoplasticized gutta percha
Carrier based gutta percha
Chemically plasticized gutta percha
Custom cone
Grossman,12th edition chp12 pg no.282

According to Cohen:
Cold Lateral Condensation
Warm Vertical Condensation
Continuous wave compaction technique
Warm lateral compaction
Thermoplasticized injection techniques
Carrier based gutta percha
Thermomechanical compaction
Solvent technique
Paste and cements
Cohen,11th edition chp7 pg no.301-316

According to INGLE:
Solid core GP
with sealant
Apical Third
Filling: Injection Filling
Cold gutta
percha points
Simplifill
Thermoplasticiz
ed GP
Warm GP
Chemically
plasticized cold
GP
Calcium
Hydroxide
Dentin Chips
Cements
Pastes
Calcium
phosphate
MTA Ingle,5thh edition chp11
pg no.598-99.

Silver Point
• Jasper in 1933 introduced silver points having same diameter as
files and reamers.
• It was popularly used because of its ease of handling and
placement , ductility, radiopacity.
• Timpawat S.et al compared and assessed the quality of apical
seal obtained with gutta-percha cones, silver cones, and
stainless steel files and concluded that root canals filled with
silver cones had significantly less apical leakage than those
filled with gutta-percha or stainless steel files.
Gulati S. et al J Contemp Dent Pract.2012;2(3):114-8.
S. Timpawat, Oral Surg 1983;55(2):180-5

Obturation Technique for Silver Point
1. Selection of trial point:
• The largest file used in apical portion of canal is used to guide
the selection of trial silver point (silver point guage)
2. Preparation of trial points:
• Silver points come from manufacturer as blunt or sharply
flattened end.
• Joe Dandy disk is run on slow speed to turn manufactured
cones into desired shape bevel which approximates the
largest file tip.

3. Placement of trial points:
• Silver point forceps/plier is used to place the points into prepared
canal. (confirmed on radiograph)
4. Filling the canal:
• Kerr root canal sealer is preferred sealer for Silver points.
• Coat the wall with sealer followed by placing tip of silver point
in sealer and the firmly place it into canal until it reaches the
apical area,

Disadvantage:
• Silver points have been shown to corrode spontaneously in the
presence of serum and blood due to an unstable electrochemical
behavior.
• Corrosion byproducts (silver sulfide, silver carbonate, silver
amine hydrate) can also cause irreversible staining of the tooth
structure and surrounding tissues.
• Corrosion products, which cause Argyrosis and periradicular
inflammation, have the potential to induce inflammatory root
resorption.
Ruddle CJ.J Endod 2004;30(12):827-45.

• Silver points lack plasticity, and the consequent failure to flow
and conform to the shape of the root canal system makes them
less favorable as filling materials.
• Post and core buildups become impossible with intact silver
points.
• Apical surgery becomes more complicated due to the
difficulties encountered when attempting a root-end preparation
in canals that are filled with metal.
Ruddle CJ.J Endod 2004;30(12):827-45

Solid core GP with sealant
(Lateral compaction technique)

Lateral compaction Technique:
• This technique encompasses first placing sealer lining in the
canal followed by master cone, that in turn is compacted
laterally by spreader to make room for accessory canals.

Criteria fulfilling canal preparation:
• Continuous taper
• Spreader must reach 1-2mm of working length
• Spreader taper must greater than canal taper, there will be
apically directed force during condensation.
• Accessory cones should be smaller in diameter

Drying the canal with paper points and sealer application on the
prepared root canal.
The spreader 1-2mm short of working length is selected
The “tug back” fit of master cone is checked and also evaluated
it radiographically
Following the canal preparation; the master cone whose
diameter is same as that of master apical file is selected.
Technique:

Shear off the protruding cone at canal orifice with hot
instrument.
Accessory cones are added and the same procedure is repeated
untill spreader no longer penetrates
Spreader is removed by rotating it back and forth so as to create
lateral space to master cone.
Spreader help in compaction of GP cone it acts as wedge that
pushes GP laterally under vertical pressure.
Master cone coated with sealer followed by spreader alongside
of the cone is introduced in canal

Variation of lateral condensation:
1. Curved canal
2. Immature canal and apices:
3. Tubular canal
4. Tailor Made GP roll

Advantages:
• Prevent overfilling by length control during condensation.
Disadvantages:
• Presence of voids
• Less ability to seal intracanal defects
• Cold GP is not compressable
• Excess pressure can lead to root fracture.

• Seyed HM et al , evaluate the incidence of dentinal defects
following root canal obturation Cold lateral compaction (CLC)
and reported that CLC techniques produced dentinal defects.
Seyed HM et al. Dent Res J. 2015 Nov-Dec; 12(6): 513–519.

• Ansari BB et al compared radiographic quality of obturation in
molar teeth, obturated with cold lateral condensation and
thermoplasticized injectable gutta-percha technique and found
that no significant difference between both technique, in terms
of post obturation voids and apical termination, as observed in
radiographs.
Ansari BB et al J Conserv Dent. 2012; 15(2): 156–160.

Solid core GP with sealant
(Single cone obturation technique)

• The single-cone technique was developed in the 1960s, with the
standardization of the endodontic instruments and filling points.
• It was advocated that, after the preparation of the apical stop, a
gutta-perch was selected and locked at the limit of the root canal
preparation.
Single cone obturation technique

The use of these gutta-percha points does not require either
accessory points or the lateral condensation when the root canal
is enlarged with rotary instruments.
This technique uses larger master cones that best match the
geometry of the nickel-titanium rotary systems (NiTi).

• Advantages:
• Minimal extrusion of sealer in apical direction
• Elimination of lateral stresses during obturation
• No risk of tissue damage due to increase in root surface
temperature
• Simplier to use and result in faster oburation

• Disadvantages:
• Porosities and void formation
• Cement dissolution
• Lower adaptation of single cone in middle and coronal third of
canal with irregular shape

• Holland et al. evaluated the influence of the type of endodontic
cement and of the filling technique on the apical marginal
microleakage, and found that the singlecone technique achieved
the best sealing of the root canal than lateral condensation.
Holland et al. Rev Fac Odontol Lins. 2004;16(2):7-12.

• Monticelli et al. compared the apical sealing of two systems of
single-cone obturation with the vertical condensation technique
and concluded that both singlecone techniques did not promote
a durable apical sealing compared with the bacterial infiltration.
Monticelli et al. J Endod. 2007 Mar;33(3):310-3.

Chemically plasticized cold GP

• Modification of lateral condensation technique
• It is known as “Callahan-Johnston Technique” July 1911
• It uses the solvents to soften the GP in an effort to ensure that it
will better conform to apical canal anatomy.
• GP was plasticized with solvents such as chloroform,
eucalyptol, and xylol.

Canal is obturated by lateral condensation by master cone to full
measured working length and then introduce soft GP and
condense laterally
Dipped in solvent for 1 sec
GP cone is blunted and fitted 2 mm short of working length

Advantage:
• Adapt to canal anatomy
• Acceptable seal
Disadvantage:
• Shrinkage caused by evaporation
• Voids
• Inability to control the Obturating material
• Irritation to periradicular tissue.
• Carcinogenic potential of solvents

• Harrington GW et al reported that customizing GP with solvent
application improves the apical seal.
• Harrington GW et al J endod 1984;10:57.

Warm Gutta Percha
(Warm vertical compaction)

• Schilder introduced the concept of cleaning and shaping root
canal in conical shape and obturating space three dimensionally
with warmed GP and compact vertically with plugger.
• Schilders plugger
• Wider-coronal part
• Narrower –middle part
• Narrowest-apical part
• Marked serration at every 5mm

Technique :
Lightly coat the canal with sealer and cut the coronal end of the
GP at occlusal /incisal reference point
Select the pluggers which is prefitted at 5 mm so as to capture
maximum cross section of softened gutta percha.
The master cone that is at least 1-2 mmm short of apical stop is
selected

Once the apical filling is done remaining obturation is done with
backfilling
The blunt end creates a deep depression in center of master cone
outer ends of GP are folded inwards at the same time softened
mass moved apically and laterally.
The heated plugger is used to force GP into the canal

Vertical compaction Technique:

• Advantages:
• GP condensation is best with warm vertical condensation
• Produces movement of plasticized GP ,filling irregularities,
accessory canals.
• Disadvantages:
• Less length control compared to lateral compaction.
• Potential for extrusion of material into peri radicular tissues.
• Difficult in curved canal

• Sobhi MB et al, compared vertical condensation with laterally
condensed gutta-percha technique and reported that warm
vertical technique resulted in a uniform smooth surface and
least observable space between gutta percha and canal wall,
especially in middle and apical region than lateral condensation
technique.
Sobhi MB et al. J Coll Physicians Surg Pak 2004;14(8):455-8.

Warm Gutta Percha
(continuous wave compaction)

Activate the heat source and temperature is set at
200°C
Coat the master cone with sealer and place into canal
The prefitted plugger at 5-7mm short of working
length is selected.
GP was cut 0.5mm short of working length
After appropriate GP fit (radiographically confirmed)

Then with the help cold plugger condense in vertical
direction and back fill
Reactivated heat for 1 sec followed by 1 sec cooling
withdrawn the plugger
Turn off the heat mode then alloow it to cool for 10 sec
Maintaining the apical pressure plugger is moved more
apically
Sear off at orifice and introduce preheated plugger
through GP.

System B:
• Kerr Endodontics introduced System B
• The System B allows to dial in the exact
temperature setting, which it maintains
throughout the procedure.
• Simply set the temperature, and within 12
seconds, a superior apical seal and post space
in a single motion is achieved.

• A sturdy cast-aluminum enclosure with carrying
handle makes it easy to carry.
• The handpiece and cord assembly can be
disconnected and autoclaved.
• With Analytic's rechargeable battery and
provided charge adapter, we get at least one hour
of continuous operation.
• 0.04,0.06,0.08,0.10.0.12 tapered stainless steel
plugger

• Mohsen A et al compare its obturation quality with that of
lateral compaction (LC), warm vertical compaction (WVC) and
continuous wave compaction techniques (CWC) and
reported that CWC technique resulted in better adaptation of
gutta-percha to canal walls than LC at all cross-sections with
fewer voids and faster obturation time compared to other
techniques.
Mohsen A et al J Dent. 2015 Feb; 12(2): 99–108.

Elements:
Elements Obturation Unit puts the Continuous Wave of
Condensation Technique into one simple-to-operate device
• One-touch controls for downpack, backfill and hot
pulp testing
• Each function has preset temperature and duration
• Tip temperature is continuously maintained and
displayed
• Time-out feature prevents overheating
• Automatic shut-off precludes using wrong or worn-
out tip
• Plugger heats instantly for immediate use

• Olczak K et al , evaluate the sealing ability of cold lateral
compaction (CLC group), continuous wave condensation
technique using the Elements Obturation Unit® (EOU group),
and ProTaper obturators (PT group) and reported the highest
leakage in the group of teeth filled with the lateral condensation
technique of cold gutta-perch when compared to other group.
Olczak K. Biomed Res Int. 2017:1-8

Warm Gutta Percha
(Sectional method)

Sectional Method / Chicago technique:
Disengage the plugger from GP by rotating it.
One end of GP is mounted to heated plugger and then carried to
canal and apical pressure is given
Apply sealer to canal walls
Select plugger that loosely fits within 3 mm of working length.
Master cone is selected and cut into sections of 3-4 mm long.

Sectional Method / Chicago technique:

Warm Gutta Percha
(Lateral/ vertical compaction of
Warm GP )

• Vertical compaction causes dense obturation while lateral
compaction provides length control and satisfactory ease and
speed.
Then unheated spreader placed in canal to
create more space for accessory cones.
Insert heated plugger in canal besides Master
cone within 3-4 mm of apex using apical
pressure,
Master cone is adapted to canal and select
Endotec plugger activate device

EndoTec II
• Considering the ease and speed of lateral
compaction as well as the superior density gained
by vertical compaction of warm gutta-percha,
Martin developed a device called EndoTec II that
appears to achieve the best qualities of both
techniques.

“Zap And Tap” Maneuver:
Preheating the EndoTec plugger for 4 to 5 seconds
before insertion (zap) and then moving the hot
instrument in and out in short continuous strokes
(taps) 10 to 15 times.
The plugger was removed while still hot, followed
by a “cold spreader with insertion of additional
accessory points

• Kim HH et al, compared of warm gutta-percha condensation
techniques System B and Endotec II and found Warm lateral
condensation using Endotec II and continuous wave of
condensation using System B produced a denser obturation of
gutta-percha compared with conventional cold lateral
condensation.
• There was no significant difference between warm lateral
condensation and continuous wave condensation
Kim HH et al, J Korean Acad Conserv Dent. 2002;27(3):277-283.

Thermomechanical compaction of
Gutta percha

• New concept of heat softening and compatibility GP was
introduced by McSpadden in 1979.
• Intially McSpadden compactor device resembled reverse H
file/reverse screw design (8000-20,000 rpm).
• Frictional force softens GP and design of blade forces GP
apically.
• In Europe, Mallifer modified H type instrument as gutta
condensor and Zipperer named its modification Engine Plugger
(inverted K-file)

• McSpadden used instrument made by Niti and brought newer
gentle ,slow speed engine driven model.
• Master cone is placed in canal appropriate size condenses spin
1000-4000 rpm.
• Tagger hybrid technique:
• Master cone is coated with sealer and placed into canal.
• Lateral condensation is done followed by placement of engine
plugger size 45/50, 4-5mm into canal and rotate 15,000 rpm
after 1 sec ,it is advanced in canal until resistance is met.

• Zvi Fuss et al Mc-Spadden Compactor, Engine Plugger and
lateral condensation and there was no statistically significant
difference among the three obturation groups.
• Zvi Fuss. J Endodo.1985;11(3):117-121.

Advantages:
• Simplicity of armamentarium
• Ability to fill canal irregularities
Disadvantage:
• Possible extrusion of material
• Instrument fracture
• Gauging of canal wall
• Inability to use in curved canal

JS Quick-Fill
• It is a recently introduced mechanically
thermoplasticized gutta-percha obturation
method in which a titanium carrier is covered
with GP and warmed by wall friction resulting
from rotating it within the root canal.
• The plasticized gutta-percha is impulse
apically, and then the carrier can be removed
from the root canal or left in place.

• Nimet G et al investigate apical leakage of roots filled with
Thermafil, JS Quick-Fill, Microseal, System B and lateral
condensation using a new computerized filtration meter and
concluded that Thermafil, JS Quick-Fill and System B
techniques showed lower leakage than Microseal and lateral
condensation.
Nimet Gençoḡlu.Eur J Dent. 2007 Apr; 1(2): 97–103.

Ultrasonic plasticizing
• Moreno suggested the use of ultrasonic instrument to plasticize
GP.
• The ultrasonic spreaders vibrate linearly and produce heat, thus
thermoplasticizing the GP and achieve a more homogeneous
mass with a decrease in the number and size of voids thus
producing a more complete three-dimensional obturation of the
root canal system.
• Frederick R 2002 et al reported that ultrasonic condensation is
superior to cold lateral condensation with respect to sealing
properties and density of gutta-percha..
Frederick R et al. J Endod. 2002;28:665-667.

Thermoplasticized Gutta percha
(Syringe insertion)

Thermoplasticized technique:
• Harvard institute in 1977 developed gutta percha ejecting out
the prototype pressure syringe that had warmed upto to 160 °C.
• At this temperature gutta percha flows through 18 gauge needle.
• The device is marketed as Obtura III, Hotspot, Ultrafill 3D.

Obtura III:
• Obtura III system consist of hand-held gun
that contains a chamber surrounded by a
heating element into which pellets of gutta
percha are loaded.
• Silver needles of varying guage (20,23,25
guages) are attached to deliver
themoplasticized material into canal.

• The control unit allows the operator to adjust the temperature
and the viscosity of GP.
• The technique require the use of sealer coated over canal wall .
• GP is then preheated in the gun and needle is positioned in the
canal so that it reaches within 3-5 mm of the apical preparation.
• GP is then passively injected by squeezing the trigger of the
gun
• Pluggers are then used to compact GP.

• Shivanna V et al, studied efficacy of single cone, continuous
wave compaction, Thermafil & Obtura III techniques to
obturate the root canal prepared to a constant taper of 0.06.
• Obtura III group showed significantly higher Percentage of
Gutta percha Filled Area (PGFA )followed by Thermafil
compared to other groups.
• CWC demonstrated significantly higher PGFA compared
to Single cone at 4mm only.
• Cold lateral condensation showed least PGFA.

Hotshot:
• Device for extruding warm gutta percha or
Resilon to backfill root canals.
• Available in 20, 23, and 25 gauge sizes, with
the 23 and 25 gauges having swivel capability.
• The GP pellets are precut cylinders measuring
15mm long x 3mm in diameter.
• Place a pellet into the front part of the slot and
then use the plunger to manually push it
forward into the heating chamber

• Shenoi PR et al, evaluate the efficacy of different techniques
used to obturate experimental internal resorptive defects using
stereomicroscope and concluded that to obturate internal
resorption cavities thermoplasticized obturartion technique
(HotShot)are superior then that of traditional lateral
condensation technique.
Shenoi PR et al. ENDODONTOLOGY .2014; 26( 2):286-290.

Ultrafill 3D
Ultrafill 3D (Coltene) is a thermoplasticized
GP injection technique involving GP
cannulas a heating unit and injection syringe.
3 types of GP cannulas:
• Regular Set (white, 30 min.)
• FirmSet® Gutta Percha (blue, 4 min.)
• Endoset® Gutta Percha (green, 2 min. set)
is a higher viscosity gutta percha with
slightly less flow.

• The heater maintains a constant low temperature of 90°C
(194°F), ensuring minimal shrinkage of the gutta-percha
after insertion.
• Each cannula has 22 gauge SS needle measure 21mm length.
• Needle can be precurved
• Place the cannula in warm heater for 3 min and then placed
in canal.

Calamus:
• Activate the 360° cuff to engage the cartridge
and begin the flow of gutta-percha.
• Place the heated tip of the cannula against the
previously packed gutta-percha for 5 seconds.
• Activate the Flow handpiece and dispense 2 – 3
mm of gutta-percha.
• Hold the handpiece lightly when expressing
material to allow the device to back out of the
canal.

• Jindal D et al, evaluated volumetric analysis of root canal
filling with cold lateral compaction, Obtura II, Thermafil, and
Calamus using spiral computerized tomography (SCT) and
reported that the greatest percentage of obturated volume was
obtained with Calamus and Thermafil. Voids were seen in all
root fillings.
Jindal D. Indian J Dent Res 2017;28:175-80

Thermoplasticized Gutta percha
(solid core carrier insertion)

Inject R fill obturation technique:
• It is new thermoplasticized GP obturation technique in which
the carrier is removed and only GP is allowed to remian within
the canal.
• A stainless steel carrier prefilled with GP warmed over open
flame for 1-2 sec and then injected into RC

• Shetty HK et al, compared apical leakage in InjectR fil,Therma
Fil and lateral condensation and they found Inject R fil better
than thermafil and lateral condensation.
Shetty HK.Endodontology.1996; 8:50-54.

Thermafil:
• Introduced as a gutta percha obturation material
with solid core.
• Originally manufactured with metal core and
coating of GP the carrier is heated over an open
flame.
• The technique was popular because the central
core provided a rigid mechanism to facilitate the
placement of GP.

The GP is allowed to cool for 2 -4 mins before resecting coronal
portion of carrier.
The position of carrier is verified radiographically
After drying of canal and coating of sealer to canal wall the
carrier is then placed in heating device, when carrier is heated to
appropriate temperature the clinician has 10 sec to retrieve it
and insert in canal.
The carrier system included development of plastic core coated
with alpha phase GP

• De-Deus G et al, evaluated the percentage of gutta-percha-filled
area (GPFA) obtained by Thermafil and System B techniques
using light microscopy and digital image processing and
concluded that Thermafil system produced significantly higher
GPFAs than lateral condensation and System B techniques.
• De-Deus G.Aust Endod J. 2007 Aug;33(2):55-61.

GuttaCore:
• Gutta core Denstply Tusla
• New generation core material, uses cross linked GP as the
carrier of outer thermoplasticized GP
• Retreatment and post space preparation is easy

• Schäfer E et al, compared different lateral compaction,
GuttaFusion, single-cone, GuttaCore obturation techniques in
terms of the percentage of gutta-percha filled areas (PGFA) and
concluded that independent of the instrument used for canal
preparation, GuttaCore produced very homogenous root canal
fillings with high PGFA and a low incidence of voids.
Schäfer E. J Endod. 2016 ;42(2):294-8.

• Seltzer et al reported that silver cones removed from teeth
treated endodontically from 3 months to 20 years were
moderately to severely corroded.
• Tissue culture studies showed cytotoxic reactions around zones
of corrosion.
Seltzer, S., et al. ORAL SURG. 1972 33: 589-605,.

Advantages:
• Ease of placement
Disadvantages:
• Extrusion of material beyond apex
• GP is often strippes of from carrier leaving the carrier as
obturating material

SimpliFill:
• Apical Gutta Percha Obturators .
• SimpliFill consists of standardised, approximately 4mm-long
gutta-percha tips in standard ISO sizes mounted on a carrier.
• Following a try-in, the appropriate gutta-percha tip is inserted
slowly into the canal without rotating.
• After apical placement, it is separated from the carrier by four
full twists in an anti-clockwise direction.

SimpliFill:
• This allows for fast and safe sealing of the apical canal section
in an easy manner.
• Parallel preparation of the apical third is a prerequisite

• Gopikrishna V et al, evaluate the effect post space preparation
on the coronal seal of root canals obturated with cold lateral
condensation and SimpliFill , Thermafil and warm vertical
compaction and reported that cold lateral condensation leaked
significantly more than the remaining three sectional obturation
groups.
• It was concluded that stresses generated during post space
preparation might be detrimental to the seal obtained by the
obturation.
Gopikrishna V. Aust Endod J. 2006 Dec;32(3):95-100.

Dentin chip filling:
• It is also known as miraculous cure.
• Dentinal chips and dentinal debris often occupy the apical
portion of prepared canal and even seal the apical end of the
canal.
• According to Gottlieb & Orban dentin chips stimulates both
osteogenesis and cementogenesis.
• The material led to quicker healing , minimal inflammation,
cementum deposition.

• Oswald et al observed that dentin chip lead to quicker healing
and minimal inflammation and apical cementum deposition.
• GG drills or H file is used to produce dentin chips and they are
pushed apically to seal the apex.

• Heating of gutta percha outside the tooth and injecting material
into root canal .

Calcium hydroxide
• Calcium Hydroxide should not be used as a permanent root
canal filling material:
• It efficacy diminishes in 7-10 days;
• It will undergo dissolution over time especially if patency filing
has been used or the apical foramen is open;
• If used without removing the smear layer it may actually serve
as food for bacteria.
Barnett F et al. Endod Dent Traumatol.2014;5(1):23-6.

• Its long term use may impact greatly on the strength of the
dentin
• If in contact with the tissues beyond the root apex it my actually
cause tissue destruction, depending the formulation - most
commercial formulations have a pH below the ideal level for
Calcium Hydroxide, which is 11.5-12; but if used at the highest
pH level it can be quite caustic;

• Inability to compact the material in the canal to create an
impervious seal. while this material has been the golden
standard for many years for a wide variety of pulp and
periradicular applications, its usefulness over time is all but nil.
therefore, its use as a permanent root filling material is
contraindicated.

Mineral Trioxide Aggregate
• Mineral trioxide aggregate (MTA) has emerged as a reliable
bioactive material with extended applications in endodontics
that include the obturation of the root canal space.
• MTA also provides an effective seal against dentin and
cementum and promotes biologic repair and regeneration of the
periodontal ligament (PDL)
• The use of MTA as an obturation material might ultimately
provide long-term benefits that enhance the prognosis and
retention of the natural dentition in conventional and complex
therapies.

• Silva WJ et al evaluated physical properties of MTA cements
regarding it use as root canal filling material and concluded that
MTA to be promising root canal filling material .
• Silva WJ. Rev. odonto ciênc. 2010;25(4):386-390

Recent advances in obturating
technique

Fiberfill Obturator:
• The Fiberfill obturator is a resin and glass fiber post with a
terminal gutta percha tip.
• The gutta percha is available either in 5 or 8mm lengths.
• The diameter of the post is available in sizes 30, 40, 50, 60,
70 and 80.

• The canal is instrumented using hand instruments, rotary niti
files or a combination and cleaned using standard irrigation
methods.
• An obturator is selected that matches the final diameter of the
canal.
• The yellow Peeso reamer (included in the kit) is introduced into
the canal set either to 5 or 8mm from the working length.
• Next, the blue Peeso reamer (also in the kit) is taken to the
same depth as the previous reamer.

• The canal is irrigated, disinfected and dried. A drop of primer A
and B are mixed in a dish and applied in the canal with the kits
spiral brush.
• The brush tip is introduced to the depth made by the Peeso
reamers.
• An automix tip is placed on the Fiberfill RCS syringe and the
sealer is introduced into the canal with a lentulo or other sealer
applicator.

• The obturator is gently seated to working length allowing
excess sealer to be expressed coronally.
• The dual cure Fiberfill RCS is light cured to stabilizer the
coronal portion.
• Additional primer is applied on the protruding portion of the
obturator post and over any dentin and enamel that will be in
contact with the core buildup material.

• A resin core buildup material in then injected around the post
filling the coronal portion of the tooth.
• The material is light cured and ready for either crown
preparation or dismissal of the patient.
• The result is a durable restoration with a resin/fiber reinforced
root that is optimally sealed apically and coronally

Endo-Eze system
• The Endo-Eze system (Ultradent,South Jordan, UT)
uses reciprocating instrumentation, a single gutta-
percha cone, and a hydrophilic resin sealer for
obturation.
• It is stated that a reciprocating action cleans and
shapes elliptical and ribbon-shaped canals better
than the rotary system

• Instrument, clean and disinfect canals thoroughly.
• Fit EndoREZ Point master cone or traditional gutta percha point
master cone to length, with tug back.
• Attach mixing tip to the dual-barrel syringe by lining up internal
cap stems with syringe orifices. Twist clockwise to lock.
• Remove small cap from mixing tip and express a small amount
onto pad to verify flow.
• Firmly attach appropriate length NaviTip to Skini syringe.

• Insert mixing tip into back-end of Skini syringe and dispense
enough EndoREZ into syringe to fill all canals.
• Insert plunger and express air until material begins to flow from
NaviTip.
• Verify flow prior to applying intraorally. If resistance is met,
replace tip and re-check.
• Insert NaviTip into canal to within 2-4mm of apex or shorter if
NaviTip binds in canal.
• Express EndoREZ with light pressure into canal while
withdrawing tip.
• Keep NaviTip orifice buried in material while expressing
EndoREZ and withdrawing tip

• Fill canal space to canal orifice ONLY.
• Slowly insert the master cone (Step 5) and seat to working
length.
• Harpoon in accessory cones to fill space as needed.
• Light cure EndoREZ for 40 seconds
• Trim excess gutta percha with a very hot instrument.

• The choice of obturating material & technique depending on the
skills, experience and the root canal morphology.
• To achieve the successful endodontic therapy, it is crucial that
all canals are located, cleaned & shaped, disinfected & sealed
properly, not only in the apical portion but as well as coronal
part of the root canal.

• Seltzer, S., et al: A Scanning Electron Microscope Examination
of Silver Cones Removed From Endodontically Treated Teeth,
ORAL SURG. 33: 589-605, 1972.
• S. Timpawat, J. Jensen, R.J. Feigal, and H.H. Messer. An in
vitro study of the comparative effectiveness of obturating
curved root canals with gutta-percha cones, silver cones, and
stainless steel files. Oral Surg 1983;55(2):180-5.
• Holland R, Murata SS, Tessarini RA, Ervolino E, Souza V,
Dezan Jr E. Infiltração marginal apical relacionada ao tipo de
cimento obturador e técnica de obturação. Rev Fac Odontol
Lins. 2004 Jul- Dec;16(2):7-12.
• Inan U, Aydin C, Tunca YM, Basak F. In vitro evaluation of
matched-taper single-cone obturation with a fluid filtration
method. J Can Dent Assoc. 2009 Mar;75(2):123-123c.

• Monticelli F, Sadek FT, Schuster GS, Volkmann KR, Looney
SW, Ferrari M et al. Efficacy of two contemporary single-cone
filling techniques in preventing bacterial leakage. J Endod. 2007
Mar;33(3):310-3.
• SeyedMohsen Hasheminia, Ali Reza Farhad, Masoud Saatchi,
Hamidreza Sadegh Nejad, and Maryam Sanei. Mechanical or
cold lateral compaction: The incidence of dentinal defects. Dent
Res J (Isfahan). 2015 Nov-Dec; 12(6): 513–519.
• Bilal Bakht Ansari, Fahad Umer, and Farhan Raza Khan.A
clinical trial of cold lateral compaction with Obtura II technique
in root canal obturation. J Conserv Dent. 2012 Apr-Jun; 15(2):
156–160.
• Sobhi MB, Rana MJ, Ibrahim M, Tasleem-ul-Hudda.
Comparison of vertical with lateral condensation technique in
obturation of root canal system. J Coll Physicians Surg
Pak 2004 Aug;14(8):455-8.

• Mohsen Aminsobhani,Abdollah Ghorbanzadeh, Mohammad
Reza Sharifian, Sara Namjou, and Mohamad Javad Kharazifard.
Comparison of Obturation Quality in Modified Continuous
Wave Compaction, Continuous Wave Compaction, Lateral
Compaction and Warm Vertical Compaction Techniques. J Dent
(Tehran). 2015 Feb; 12(2): 99–108.
• Hyun-Hee Kim, Kyung-Mo Cho and Jin-Woo Kim. Comparison
of warm gutta-percha condensation techniques in ribbon shaped
canal: weight of filled gutta-percha. J Korean Acad Conserv
Dent. 2002 May;27(3):277-283.
• Marina Angélica Marciano
I
; Clovis Monteiro Bramante
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Antonio Hungaro Duarte
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Ronald Ordinola-Zapata
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Evaluation
of Single Root Canals Filled Using the Lateral Compaction,
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s Hybrid, Microseal and Guttaflow Techniques. Braz.
Dent. J. vol.21 no.5 Ribeirão Preto 2010

• Zvi Fuss, Bruce D. Rickoff, Lorna Santos-Mazza, Maria
Wikarczuk, BA, and Shalom A. Leon. Comparative Sealing
Quality of Gutta-percha Following the Use of the McSpadden
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• Vasundhara Shivanna. Prashanth B. R. Analysis of percentage
of gutta-percha filled area using single cone, continuous wave
compaction, Thermafil & Obtura II in 0.06 taper prepared root
canals”. Endodontology:70-74.
• Jindal D, Sharma M, Raisingani D, Swarnkar A, Pant M,
Mathur R. Volumetric analysis of root filling with cold lateral
compaction, Obtura II, Thermafil, and Calamus using spiral
computerized tomography: An In vitro Study. Indian J Dent Res
2017;28:175-80

• Katarzyna Olczak and Halina Pawlicka. Evaluation of the
Sealing Ability of Three Obturation Techniques Using a
Glucose Leakage Test. Biomed Res Int. 2017; 2017
• Wang J, Ji AP.Clinical evaluation of root canal obturation of
GuttaFlow. Shanghai Kou Qiang Yi Xue. 2009 Aug;18(4):380-
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• De-Deus G, Maniglia-Ferreira CM, Gurgel-Filho ED, Paciornik
S, Machado AC, Coutinho-Filho T. Comparison of the
percentage of gutta-percha-filled area obtained by Thermafil
and System B. Aust Endod J. 2007 Aug;33(2):55-61.
• Gopikrishna V, Parameswaren A. Coronal sealing ability of
three sectional obturation techniques--SimpliFill, Thermafil and
warm vertical compaction--compared with cold lateral
condensation and post space preparation. Aust Endod J. 2006
Dec;32(3):95-100.

• Schäfer E, Schrenker C, Zupanc J, Bürklein S.Percentage of
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• Franklin R. Tay and David H. Pashley. Monoblocks in root
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• Nimet Gençoḡlu, Hasan Oruçoḡlu, and Dilek Helvacıoḡlu.
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Meter. Eur J Dent. 2007 Apr; 1(2): 97–103

• Alexander K. Deitch, Frederick R. A comparison of filled
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28:665-667.
• Silva WJ. Mineral trioxide aggregate as root canal filing
material: comparative study of physical properties. Rev. odonto
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