OBTURATION AND OBTURATION TECHNIQUES.pptx

Obturation is the final and critical phase of root canal treatment, aimed at the complete sealing of the prepared root canal system to prevent reinfection and promote periapical healing. It involves the three-dimensional filling of the cleaned and shaped canal space with biocompatible materials that prevent the ingress of microorganisms and fluids. The success of endodontic therapy largely depends on the quality of obturation, which should ensure a hermetic seal both apically and coronally. Various obturation materials such as gutta-percha, resin-based systems, and bioceramics—along with different techniques, have been developed to achieve an optimal seal and long-term clinical success.

1. OBTURATION MATERIALS AND OBTURATION TECHNIQUES Dr Vaishnavi Chidrawar (PG 3 rd year) Department of Conservative Dentistry and Endodontics

2. CONTENTS Introduction Rationale of obturation History Length of obturation Timing of Obturation The ideal root canal obturation materials Root canal sealers and core filling material SECTION 1 Dr Vaishnavi Chidrawar

3. CONTENTS Methods of Obturation: Lateral compaction Warm vertical compaction Warm lateral Compaction Thermoplastic Injection Techniques Carrier Based gutta percha Simplifill Sucessfill Thermomechanical compaction SECTION 2 Dr Vaishnavi Chidrawar

4. Thermoplastisized obturation technique (SA Summer 2012, Winter 2013, LA Summer 2020) Monoblock concept in endodontics (SA Summer 2012, summer 2022, Summer 2020) Recent advances in root canal obturation (SA summer 2017, LA Winter 2010) Root canal filling materials (SA summer 2018) Bioceramic root canal sealer (SA Summer 2021) Dr Vaishnavi Chidrawar

5. INTRODUCTION

6. INTRODUCTION In an early radiographic study of success and failure , Ingle indicated that 58% of the treatment failures were due to incomplete obturation. Obturation is a reflection of the cleaning and shaping and is evaluated on the basis of length, taper, density and coronal seal. Obturation of the radicular space is necessary to eliminate leakage - both from coronal and apical end - and the resulting bacterial contamination. Proper obturation also helps to seal the remaining irritants in the canal. Ingle’s Endodontics 7 th edition Dr Vaishnavi Chidrawar

7. DEFINITION Obturation is defined as the three-dimensional filling of the entire root canal system as close to the cemento -dentinal junction as possible. American Association Of Endodontists (AAE) 1994 Dr Vaishnavi Chidrawar

8. RATIONALE OF OBTURATION Microbial irritants( Eg.Micro-organisms,toxins ) and products of pulp tissue degeneration are the prime causes for pulpal demise and its subsequent extension into the periradicular tissue. Failure to eliminate these etiologic factors to prevent further irritation via continued contamination of the root canal system are the primary causes for failure of non-surgical and surgical root canal treatment. Therefore,obturation of the rootcanal system should begin with the root filling and finish with an integrated,well designed and executed coronal restoration. Dr Vaishnavi Chidrawar

9. The Washington Study of endodontic success and failure suggests percolation of periradicular exudate into the incompletely filled canal as the greatest cause of endodontic failure. Nearly 60% of the failures in the study were apparently caused by incomplete obturation of the radicular space . Ingle JI, Beveridge E, Glick D, Weichman J: The Washington Study. In: Ingle I, Taintor JF, editors. Endodontics, Philadelphia, 1994, Lea & Febiger , pp 1–53. Dr Vaishnavi Chidrawar

10. The preliminary objectives of operative endodontics are total débridement of the pulpal space, development of a fluid-tight seal at the apical foramen, and total obliteration of the root canal. By the same token, one must not overlook the importance of a coronal seal. Microleakage around coronal restorations, down through the root canal filling, and out the apical foramen into the periradicular tissues is also a potential source of bacterial infestation. Many studies on the preparation and obturation of root canals, however, indicate that most fillings do not completely fill the root canal system. Dr Vaishnavi Chidrawar

11. The commonly used term “hermetic seal” is not accurate. “ Hermetic”is defined as “airtight by fusion or sealing.”Air is not the problem at the periapex—fluid is the problem.“ Impermeable”is a more accurate term. Hargreaves, Kenneth M., Stephen Cohen, and Louis H. Berman.  Cohen's Pathways of the Pulp . 12 th edition St. Louis, Mo: Mosby Elsevier, Dr Vaishnavi Chidrawar

12. HISTORY 1867-Bowman, 1st use of gutta percha for canal filling in an extracted first molar 1883-Perry claimed the use of Pointed gold wire wrapped with some soft gutta-percha Gutta percha rolled into points and packed into the canal Chemical softening of shellac coated gutta percha using alcohol 1887- S.S. White Company began to manufacture gutta percha points Dr Vaishnavi Chidrawar

13. 1914-Callahan - softening and dissolution of gutta percha to serve as the cementing agent through the use of resins 1930 - Elmer A. Jasper introduced silver points 1946- Sommer provided the technical essentials of application of the lateral condensation technique 1953- Berg- essentials of vertical condensation technique Dr Vaishnavi Chidrawar

14. 1967- Schilder popularized vertical condensation technique. 1977- Yee et al introduced the injectable thermoplasticized gutta-percha technique 1978- W. Ben Johnson described a technique of obturation with gutta percha coated endonotic file (forerunner of Thermafil ) 1979- Mc Spadden introduced a special compactor for softening gutta percha by friction 1984- Michanowicz introduced a low temperature (70 C ) injectable thermoplasticized gutta-percha technique- Ultrafil Dr Vaishnavi Chidrawar

15. 1994- James B. Roane - Inject R-Fill technique 1996- Steven Buchanan developed a new method of vertical compaction of warm gutta percha - continuous wave of condensation technique (System B) Dr Vaishnavi Chidrawar

16. EXTENSION OF THE ROOT CANAL FILLING Canals filled to the apical dentinocemental junction are filled to the anatomic limit of the canal. Beyond this point, the periodontal structures begin. The dentinocemental junction (DCJ) marks the histological boundary where root dentin meets cementum within the canal. Kuttler’s studies demonstrated that this junction lies 0.5–0.7 mm coronal to the apical foramen (the root’s external opening). This distance aligns with the apical constriction (narrowest canal diameter), which serves as a natural barrier against bacterial and material extrusion. Kuttler also noted that the foramen to-constriction distance increases with age b­ecause of cementum deposition. Dr Vaishnavi Chidrawar

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18. A study b­y the Toronto group on the prognosis of retreatment identified perforation, pretreatment periradicular disease, and adequate length of the root canal filling as factors significantly influencing success and failure. The authors speculated that canals filled more than 2 mm short harbored necrotic tissue, ­bacteria, and irritants that when retreated could ­be cleaned and sealed. The success rate for negotiating the apical unfilled canal was 74%. Farzaneh M, Abitbol S, Friedman S: Treatment outcome in endodontics: the Toronto Study. Phases I and II: orthograde retreatment. J Endod 30:627, 2004. Dr Vaishnavi Chidrawar

19. Two terms, overfilling and overextension, are often used interchangeably. This is not correct. Overfilling denotes “total obturation of the root canal space with excess material extruding beyond the apical foramen.” Note the emphasis on “total obturation.” Overextension, on the other hand, may also denote extrusion of filling material beyond the apical foramen but with the caveat that the canal has not been adequately filled and the apex has not been sealed . Dr Vaishnavi Chidrawar

20. TIMING OF OBTURATION Patient’s signs and symptoms Status of the pulp and periradicular tissues The degree of difficulty Patient management. Dr Vaishnavi Chidrawar

21. IDEAL ROOT CANAL OBTURATION MATERIAL According to West, the ideal material must be: Capable of being fully adapted to the prepared root canal walls 2. Dimensionally stable and Non-resorbable for an indefinite period of time 3 . Non-irritating & Nonstaining to teeth 4 . Bacteriostatic, or at least should not encourage bacterial growth 5 . Preferably semisolid upon insertion and solid afterward 6 . Capable of sealing canals laterally as well as apically 7 . Impervious to moisture 8 . Radiopaque 9 . Sterile or sterilizable 10. Easily removed from the root canal, if necessary 11. Easily manipulable 12. Sticking to the canal walls 13. Nonconductor of thermal changes 14. Slightly expandable after placement 15. Able to set in a reasonable period of time Dr Vaishnavi Chidrawar

22. Root canal filling materials are divided into Ingle’s endodontics 7 th edition Dr Vaishnavi Chidrawar

23. Messing’s Classification Dr Vaishnavi Chidrawar

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25. COHEN’S CLASSIFICATION Dr Vaishnavi Chidrawar

26. CORE MATERIALS Gutta-percha Silver points Dr Vaishnavi Chidrawar

27. Gutta-percha Gutta percha has  been used to fill root canals for over a century, and remains the material of choice Gutta-percha is a dried coagulated extract which is derived from Brazillian trees ( Palaquium ). These trees belong to Sapotaceae family. In India, these are found in Assam and Western Ghats. Composition Gutta-percha - 20% Zinc Oxide - 65% for stiffness Metal sulfate - 10% for radiopacity Waxes/Resins - 5 % for handling properties Coloring agent < 1% for visual contrast Hargreaves, Kenneth M., Stephen Cohen, and Louis H. Berman.  Cohen's Pathways of the Pulp . 12 th edition St. Louis, Mo: Mosby Elsevier, Dr Vaishnavi Chidrawar

28. Advantages Plasticity relatively  easy to manage and manipulate easy to remove from the canal relatively biocompatible Disadvantages Lack of adhesion to dentin a slight elasticity, which causes a rebound and pulling away from the canal walls Warmed gutta-percha shrinks during cooling Different forms of gutta-percha Alpha form Pliable and tacky at 56°-64°. Available in form of bars or pellets. Used in thermoplasticized obturation technique. Beta form Rigid and solid 42°-44°. Used for manufacturing gutta-percha points and sticks. Amorphous form Exists in molten stage. Hargreaves, Kenneth M., Stephen Cohen, and Louis H. Berman.  Cohen's Pathways of the Pulp . 12 th edition St. Louis, Mo: Mosby Elsevier, Dr Vaishnavi Chidrawar

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30. DISINFECTION OF GUTTA PERCHA For disinfection of gutta-percha points, they should be immersed in 5.25 percent NaOCl for one minute. Then, gutta-percha should be rinsed in hydrogen peroxide or ethyl alcohol. The aim of rinsing is to remove crystallized NaOCl before obturation, as these crystallized particles impair the obturation. Krishna NV, Babu KC. Evaluation of disinfection of gutta-percha cones using various chemical solutions-An in-vitro study. IOSR J Dent Med Sci, 2020 Dr Vaishnavi Chidrawar

31. Silver cones Jasper introduced cones made of silver, which he claimed produced the same success rate as gutta-percha and were easier to use. The rigidity provided ­by the silver cones made them easy to place and permitted more predicta­le length control. B ut now a days their use has been declined, because of corrosion caused by them. It has been seen that silver corrosion products are toxic in nature and thus may cause tissue injury. They cannot conform with the shape of root canal because they lack plasticity; the use of silver points is not indicated in filling of large, triangular canals as in maxillary anterior teeth. Hargreaves, Kenneth M., Stephen Cohen, and Louis H. Berman.  Cohen's Pathways of the Pulp . 12 th edition St. Louis, Mo: Mosby Elsevier, Dr Vaishnavi Chidrawar

32. Activ GP Activ GP ( Brasseler USA) consists of gutta-percha cones impregnated on the external surface with glass ionomer. Single cones are used with a glass ionomer sealer. Availa­le in .04 and .06 tapered cones, the sizes are laser verified to ensure a more precise fit. The single cone technique is designed to provide a ­bond ­between the dentinal canal wall and the master cone. A ­bacterial leakage study comparing Activ G P/glass ionomer sealer, Resilon /Epiphany, and gutta-percha/ AH Plus demonstrated no statistically significant differences in leakage at 65 days. Dr Vaishnavi Chidrawar

33. PASTES AND CEMENTS Sealers are self-hardening cements used in conjunction with solid or semi-solid materials that serve as the core of the obturation. Pastes (such as Iodoform paste or calcium hydroxide) are used to fill the entire canal. In contrast to sealers/cements, however, they do not harden once placed in the canal and are easily resorbable. Consequently, they are not used as permanent filling materials. Dr Vaishnavi Chidrawar

34. Ideal sealers should be: It should be tacky when mixed to provide good adhesion to the canal wall when set. It should develop a hermetic seal. It should be radiopaque so that it can be visualized in the radiograph. The particles of powder should be very fine so that they can mix easily with the liquid. It should not shrink upon setting. It should not stain tooth structure. It should be bacteriostatic or at least not encourage bacterial growth. It should set slowly. It should be insoluble in tissue fluids. It should be tissue tolerant, that is, nonirritating to periradicular tissue. It should be soluble in a common solvent, if necessary to remove the root canal filling. Dr Vaishnavi Chidrawar

35. Zinc Oxide-based Sealers An early zinc oxide–eugenol sealer was introduced ­by Rickert and Dixon. The most commonly used are Grossman’s Sealer, Roth’s 801 Sealer, and Rickert’s Sealer. Composition Powder: zinc oxide, staybelite resin, bismuth subcarbonate , barium sulfate , and sodium borate (anhydrous) Liquid: eugenol Properties: It has plasticity and slow setting time It has good sealing potential Zn eugenolate is decomposed by water through continuous loss of eugenol which makes the compound unstable. Cement hardens in 2hrs at 37 C Dr Vaishnavi Chidrawar

36. ADVANTAGES Ease of manipulation Antibacterial effect Radiopaque Minimal Staining Ample working time DISADVANTAGES Shrinkage on setting If there is extrusion of cement, may cause inflammatory reaction but it will subside. soluble May negatively affect bonding of core materials Dr Vaishnavi Chidrawar

37. Root Canal Sealers Without Eugenol Kloroperka N-Ø Sealers This formula was given by Nyborg and Tullin in 1965. Kloroperka N-Ø was first introduced in 1939. The powder is mixed with liquid chloroform. After insertion the chloroform evaporates, leaving voids. It has been shown to be associated with a greater degree of leakage than other materials . Composition Powder Canada balsam 19.6 percent Rosin 11.8 percent Gutta-percha 19.6 percent Zinc oxide 49 percent Liquid Chloroform Dr Vaishnavi Chidrawar

38. Chloropercha This is a mixture of gutta-percha and chloroform. Modified Chloropercha Methods: 1. Johnston-Callahan 2. Nygaard-Ostby Johnston-Callahan Method: canal is repeatedly flooded with 95 percent alcohol and then dried. After this, it is flooded with Callahan resin chloroform solution for 2-3 minutes. A gutta-percha cone is inserted and compressed laterally and apically with a plugger until the gutta-percha is dissolved completely in the chloroform solution in the root canal. Additional points are added and dissolved in the same way. Nygaard Ostby: It consists of Canada balsam; colophonium and zinc oxide powder mixed with chloroform. In this technique, the canal walls are coated with Kloroperka, the primary cone dipped in sealer is inserted apically pushing partially dissolved tip of the cone to its apical seal. Additional cones dipped in sealer are packed into the canal to obtain a good apical seal. Dr Vaishnavi Chidrawar

39. Calcium hydroxide sealers Several Ca(OH)2-based sealers are now commercially available, such as Sealapex (Sybron Endo), RealSeal (Sybron Endo) Apexit and Apexit Plus ( Ivoclar Vivadent ). These sealers are promoted as having therapeutic eff­­ects because o­f their Ca content The antimicrobial eff­­ect of Ca(OH)2 is thought to occur because of­ its ability to release hydroxyl ions and by having a high pH. Sealapex Base Calcium hydroxide (25%) Zinc oxide (6.5%) Catalyst Barium sulfate (18.6%) Titanium dioxide (5.1%) Zinc stearate (1%) PROPERTIES In 100% humidity takes 3 weeks to reach final set Expands while setting, healing is more advanced Dr Vaishnavi Chidrawar

40. Apexit plus Base Calcium hydroxide (36.9%) Hydrated collophonium (54%) Fillers (9.1%) Activator Disalicylate (47.6%) Bismuth hydroxide / Bismuth carbonate (36.4%) Fillers (16%) Dr Vaishnavi Chidrawar

41. ADVANTAGES Good therapeutic effect Biocompatible Extruded material resorb in 4-5 months DISADVANTAGES Poor cohesive strength Takes long time to set (3 weeks) Absorb water and expand on setting Dr Vaishnavi Chidrawar

42. CRCS ( hygeinic 1982) Calcibiotic root canal sealer was first calcium hydroxide based sealer CRCS Powder Calcium hydroxide Zinc oxide Bismuth dioxide Barium sulfate Liquid Eugenol Eucalyptol PROPERTIES Setting time 3   days ( in either dry or humid environment ) Because of little water resorption property, it is quite stable Improved sealing Dr Vaishnavi Chidrawar

43. Silicone Based sealer The first of those materials was based on C-silicones (condensation cross- linking silicones); newer materials are based on A-silicones (addition cross- linking) Silicone sealers are supplied in capsules and after mixing can easily be injected into the canal followed by the insertion of gutta-percha. Setting time- 25 to 30 minute Base Bi subnitrate Hydroxy dimethyl polysiloxane Benzyl alcohol Catalyst Tetraethylorthosilicate Polydimethylsiloxane EXAMPLES: Endofill Roeko seal Gutta flow Dr Vaishnavi Chidrawar

44. DISADV ANTAGES Cannot be used with H2O2 – canal should be dried Shrinks on setting – but has affinity to flow in open tubules Endo-fill's bonding ability to the canal walls decreases if it is not used within about 20 min of mixing ADVANTAGES Ease of preparation Adjustable  WT- Setting time can be adjusted from 10-60 min Low working viscosity Easy to remove - due to rubbery consistency Dr Vaishnavi Chidrawar

45. GuttaFlow 2 is  an innovative filling system for root canals that combines two products in one: gutta-percha in powder form with a particle size of less than 30 μm , and sealer. This new filling system works with cold free- flow gutta-percha. Dr Vaishnavi Chidrawar

46. ADVANTAGES 1. Optimal physical qualities. 2. Shows bonding to dentin 3. Shows minimum number of voids. 4. Low surface tension. 5. Optimal flow property DISADVANTAGES It cannot be removed from the root canal in the event of retreatment as there is no known solvent for glass ionomer. However, Toronto/ Osract group has reported that Ketac - endo sealer can be effectively removed by hand instruments or chloroform solvent followed by 1 minute with an ultrasonic No. 25 file. Dr Vaishnavi Chidrawar

47. Glass Ionomer sealer Glass ionomer cement is the reaction product of an ion-leachable glass powder and a polyanion in aqueous solution. On setting it forms a hard polysalt gel, which adheres tightly to enamel and dentin. Because of its adhesive qualities, it can be used as root canal sealer Composition Powder Calcium aluminium lanthanum flurosilicate glass Calcium volframate Cilicic acid Pigments Liquid Polyethylene polycarbonic acid/Maleic acid Copolymer Tartaric acid Water Dr Vaishnavi Chidrawar

48. Resin-based Sealers Resin sealers have a long history of use, provide adhesion, and do not contain eugenol. There are two major categories: Dr Vaishnavi Chidrawar

49. Epoxy resin based sealers AH-26 (DENTSPLY DeTrey, Konstanz, Germany) and AH Plus (DENTSPLY DeTrey ) AH-26 is a slow-setting epoxy resin that was found to release formaldehyde when setting. AH Plus is a modified formulation of AH-26 in which formaldehyde is not released The sealing abilities of AH-26 and AH Plus appear comparable. AH Plus is an epoxy resin-amine based system that comes in two tubes. Dr Vaishnavi Chidrawar

50. AH- 26 COMPOSITION Powder Bismuth Oxide (60%) Hexameltylene (25%) Tetramine Silver oxide (10%) Titanium oxide (5%) Paraformaldehyde Liquid Bisphenyl Diglycidyl ether Properties: Good adhesive property Antibacterial Low toxicity and well tolerated by periapical tissue Sufficient working time Setting time: slow setting (36-48 hrs ) Disadvantages: Formaldehyde release Paraesthesia may occur in overfilled canals (1-2 yrs) Dr Vaishnavi Chidrawar

51. AH Plus COMPOSITION PASTE A Epoxy paste Epoxy Resin Calcium tungstate Zirconium oxide Silica Iron oxide Advantages: Higher radiopacity Better manipulation No release of formaldehyde PASTE B Amine Paste Amines Calcium tungstate Zirconium oxide Silica Silicone oil PROPERTIES Epoxide-Amine  resin pulp canal sealer, developed from its predecessor AH26 Because of color and shade stability, its the material of choice where aesthetic demands are high Its easy-to-mix & adapts closely to the walls of the prepared root canal Provides minimal shrinkage upon setting Outstanding long-term dimensional stability and sealing properties Dr Vaishnavi Chidrawar

52. Properties AH-26 AH-Plus System Working time Setting time Composition Formaldehyde Reaction with H2O2 Uses Powder: Liquid 2:1 6-8 hrs 36-48hrs Silver containing Releases Forms bubbles Obturating material Without core Paste A : Paste B 1: 1 4 hrs 9-15 hrs Silver free No No reaction Only sealer Dr Vaishnavi Chidrawar

53. Diaket A Introduced in Europe by Shuffle in 1952 It is a Polyvinyl resin, a reinforced chelate formed between ZnO and diketone It hardens rapidly PROPERTIES Resistance to absorption More tensile strength Inflammatory reaction in overfilled canals (mortification of cementum and alveolar bone) Frequently used to cement endosseous implant setting time is 6-8 min Dr Vaishnavi Chidrawar

54. METHACRYLATE RESIN BASED SEALER Four generations of methacrylate resin-based root canal sealers have been marketed for commercial use. 1 st Generation Hydron 2 nd Generation EndoREZ 3 rd Generation FiberFill Epiphany Realseal 4 th Generation Meta seal RealSeal SE Dr Vaishnavi Chidrawar

55. Hydron It’s a  rapid setting hydrophilic, plastic material used as a root canal sealer without the use of a core It is available as an injectable root canal filling material Working Time – 6 to 8 mins Setting Time – 10 mins ADVANTAGES Biocompatible Conform the shape of root canal because of its plasticity DISADVANTAGES Short working time (6-8 min) Very low radiopacity Irritant to periapical tissues Difficult to remove from the canals Overfilling with hydron causes long-term periapical inflammation so tissue tolerance of hydron is controversial Khandelwal D, Ballal NV. Recent advances in root canal sealers. International journal of clinical dentistry. 2016 Jul 1;9(3). Dr Vaishnavi Chidrawar

56. Yesilsoy C. Radiographic evidence of absorption of Hydron from an obturated root canal. Journal of endodontics. 1984 Jul 1;10(7):321-3. Dr Vaishnavi Chidrawar

57. The teeth obturated with gutta-percha by lateral method showed a leakage of 10 to 17%; those obturated with gutta-percha by vertical method showed 10 to 14% leakage; and those with Hydron showed 30 to 40% leakage. Rhome BH, Solomon EA, Rabinowitz JL. Isotopic evaluation of the sealing properties of lateral condensation, vertical condensation, and Hydron. Journal of endodontics. 1981 Jan 1;7(10):458-61. Dr Vaishnavi Chidrawar

58. EndoREZ 2nd Generation : UDMAbased methacrylate sealer Non etching, non acidic and hydrophilic Doesn’t require the use of dentin adhesive to enhance the sealer penetration into the dentin tubules  Base & catalyst Dual cured, Radio opaque, Hydrophilic ADVANTAGES Radiographically similar to GP Good adaptation and flow Remains soft and plastic for longer period of time DISADVANTAGES Shelf life (18 months) Poor sealing in apical third Shrinkage Dr Vaishnavi Chidrawar

59.  METHOD FOR USE Apply Primer with paper points Sealer mixed (dual syringe mixed with auto mixing tip)and applied into the canal using lentulo spiral or Master Cone  Highly radiopaque Dual curing, hydrophilic Biocompatible, nonmutagenic , and noncytotoxic Less irritating Improves the fracture resistance of the roots PROPERTIES Khandelwal D, Ballal NV. Recent advances in root canal sealers. International journal of clinical dentistry. 2016 Jul 1;9(3). Dr Vaishnavi Chidrawar

60. EndoRez showed significantly poor apical sealing and had significantly more void and debris in the canal space than the Activ GP and the warm gutta-percha systems. At 2 mm from the apex, almost all the root canals obturated with the EndoRez system had signs of apical leakages. Apparent shrinkages of the resin sealants occurred in the EndoRez group as indicated by the presence of root canal spaces devoid of the sealants after obturation. Royer K, Liu XJ, Zhu Q, Malmstrom H, Ren YF. Apical and root canal space sealing abilities of resin and glass ionomer-based root canal obturation systems. Chin J Dent Res. 2013 Jan 1;16(1):47-53. Dr Vaishnavi Chidrawar

61. Fiberfill Methacrylate resin sealer based on UDMA Consists of Self-etching primer ( Fiberfill primers A and B) Light curable UDMA sealer Fiber post with apical terminus of gutta percha (5-8 mm) Use a separate self-etching primer ( to incorporate the smear layer ) before the application of dual cured resin sealer to primed dentin Dr Vaishnavi Chidrawar

62. Composition Fiberfill root canal sealant Mixture of UDMA, PEGDMA, HDDMA, Bis-GMA resins Treated barium borosilicate glasses Barium sulfate Silica Calcium hydroxide Calcium phosphates Initiators, Stabilizers ,Pigments Benzoyl peroxide Fiberfill primer A Mixture of acetone and dental surface active monomer NTG-GMA magnesium Fiberfill primer B Mixture of acetone and dental methacrylate resins of PMGDMA, HEMA Initiator MANIPULATION Mix equal number of drops of Fiberfill primer A and B. Apply this mix into the root canal. 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 dual cure Fiberfill RCS is light cured to stabilizer the coronal portion.  Kurtzman GM, Lopez L. ENDODONTICS- Fiberfill : A Fiber Reinforced Adhesively Bonded Endodontic Obturator and Post System. Oral Health. 2003;93(1):26-37. Dr Vaishnavi Chidrawar

63. Resilion / Realseal Developed to  replace GP and traditional sealers for root canal obturation WHY NOT GP- Shrinks after application of heat. Shrinkage on cooling: since it does not bind physically to the sealer, it results in gap formation between the sealer and the gutta-percha. Consists of- Self etch primer Resilon sealer Core material (RESILON points)- thermoplastic synthetic polymer based (polyester) Claimed to achieve excellent seal by creating a MONOBLOCK Lotfi M, Ghasemi N, Rahimi S, Vosoughhosseini S, Saghiri MA, Shahidi A. Resilon : a comprehensive literature review. J Dent Res Dent Clin Dent Prospects. 2013 Dr Vaishnavi Chidrawar

64. Pandey P, Aggarwal H, Tikku AP, Singh A, Bains R, Mishra S. Comparative evaluation of sealing ability of gutta percha and resilon as root canal filling materials- a systematic review. J Oral Biol Craniofac Res. 2020 Apr-Jun;10 The result of this study showed that during the initial time-period, resilon /epiphany sealer has better sealing ability than gutta-percha. However, over a period of time the resilon system demonstrated increased fluid flow. Gutta-percha with AH plus sealer showed the best long term sealing ability. Dr Vaishnavi Chidrawar

65.  “Monoblock concept means  the creation of a solid, bonded, continuous material from one dentin wall of the canal to the other” Benefit- Research has shown that it strengthens the root by approximately 20% To satisfy the standards the monoblock should possess adequate bond strength as well as modulus of elasticity comparable to that of dentin. MONOBLOC CONCEPT Dr Vaishnavi Chidrawar

66. Sophia T, Deepak BS (2014). The concept of monoblock in endodontics: a review.Sophia T,. CODS Journal of Dentistry 2014;6:83-89.. PRIMARY MONOBLOCK: Egs ; Hydron, Mineral Trioxide Aggregate (MTA), Polyethylene fibre post-core system SECONDARY MONOBLOCK: Egs Resilon based systems, Fibre reinforced posts TERTIARY MONOBLOCK: Egs ; Endorez , Fibre posts + external silane Dr Vaishnavi Chidrawar

67. The prerequisites of achieving monoblock states that modulus of elasticity of dentin should approximate with that of the monoblock used. This will lead to lower stress generation. Secondary and tertiary monoblocks have higher magnitude of stresses than primary monoblock and the complexities associated with these shrinkage and stress generation becomes higher as we move from primary to tertiary monoblock Nair, Sreeja & Patil, Amit & Jain, Ashish & Mali, Sheetal & Yadav, Pooja & Agrawal, Sonal. (2021). FUNDAMENTAL CONCEPT OF MONOBLOCK IN ENDODONTICS. International Journal of Advanced Research. Dr Vaishnavi Chidrawar

68. Bioceramic root canal sealer It is calcium phosphate silicate based cement which is and hydrophilic, commercially available as EndoSequence BC Sealer ( Brasseler , USA) and iRoot SP (Innovative BioCeramix Inc, Canada) injectable root canal sealer. Bioceramic sealer promote apical closure due to their osseoconductive effect. ADVANTAGES Biocompatibility Hydrophilic nature Dimensional stability Antibacterial property Bioactivity DISADVANTAGES Difficulty in removal Longer setting time Handling challenges High cost Dr Vaishnavi Chidrawar

69. Al-Haddad A, Che Ab Aziz ZA. Bioceramic -Based Root Canal Sealers: A Review. Int J Biomater . 2016; Dr Vaishnavi Chidrawar

70. Brand name Composition Calcium silicate-based sealer Endosequence BC sealer iRoot SP Zirconium oxide, calcium silicates, calcium phosphate, calcium hydroxide, filler, and thickening agents MTA-based sealer MTA- Fillapex MTA-Angelus ProRoot Endo Sealer Salicylate resin, diluting resin, natural resin, bismuth trioxide, nanoparticulate silica, MTA, and pigments Tricalcium silicate, dicalcium silicate, tricalcium aluminate, tetracalcium aluminoferrite , bismuth oxide, iron oxide, calcium carbonate, magnesium oxide, crystalline silica, and residues (calcium oxide, free magnesium oxide, and potassium and sodium sulphate compounds) Powder: tricalcium silicate, dicalcium silicate, calcium sulphate, bismuth oxide, and a small amount of tricalcium aluminate Liquid: viscous aqueous solution of a water-soluble polymer Calcium phosphate-based sealer Sankin apatite root canal sealer (I, II, and III) Capseal (I and II) Powder: alpha-tricalcium phosphate and hydroxy- Sankin apatite in type I, iodoform added to powder in type II (30%) and type III (5%) Liquid: polyacrylic acid and water Powder: tetracalcium phosphate (TTCP) and dicalcium phosphate anhydrous (DCPA), Portland cement ( gray cement in type I and white cement in type II), zirconium oxide, and others as powder liquid: hydroxypropyl methyl cellulose in sodium phosphate solution Dr Vaishnavi Chidrawar

71. Calcium Silicate–Based sealer Examples : iRoot ® SP, EndoSequence ® BC Sealer™, TotalFill ® BC Sealer™ Majority of them are premixed pastes in the syringes, while few materials are produced as liquid/powder formulations. The working time for these materials can be more than 4 h at room temperature, while the setting time is 4  h. ADVANTAGES High ph during setting Antimicrobial activity, Biocompatibility, Bioactivity when set, Long-term dimensional stability S. Drukteinis , J. Camilleri (eds.), Bioceramic Materials in Clinical Endodontics , © Springer Nature Switzerland AG 2021 Dr Vaishnavi Chidrawar

72. The Bio-C Sealer (Angelus, Londrína , PR, Brazil) is a new, premixed, ready for use, injectable hydraulic calcium silicate–based material developed for permanent filling and sealing during root canal treatment working time-60 min; the average setting time is 120 min (maximum up to 240 min) after insertion into the root canal and highly depends on the moisture inside the root canal S. Drukteinis , J. Camilleri (eds.), Bioceramic Materials in Clinical Endodontics , © Springer Nature Switzerland AG 2021 Dr Vaishnavi Chidrawar

73. IRoot SP exhibited good biocompatibility. It has superior penetrability and enhanced antibacterial properties compared to AH Plus, but shown no difference in sealing ability, warranting further in vivo studies and long-term assessments. Li Y, Li B, Lai S, Guo X, Fan Y, Wang H, Cheng L. The Biocompatibility, Penetrability, Sealing Ability, and Antibacterial Properties of iRoot SP Compared to AH Plus: An In Vitro Evaluation. Archives of Oral Biology. 2025 Feb 7:106188. Dr Vaishnavi Chidrawar

74. Bio-C Sealer showed greater penetration and better tubular adaptation than AH-Plus in the three thirds of the root canal SEM images of tubular adaptation (8.00 kx ) of AH-Plus (left side) and Bio-C Sealer (right side) SEM: Scanning electron microscope Caceres C, Larrain MR, Monsalve M, Bengoa FP. Dentinal tubule penetration and adaptation of Bio-C Sealer and AH-Plus: a comparative SEM evaluation. European endodontic journal. 2021;6(2):216. Dr Vaishnavi Chidrawar

75. OBTURATION TECHNIQUES SECTION 2 Presented by: Dr Vaishnavi Chidrawar Department of conservative dentistry and endodontics

76. CONTENTS Introduction Rationale of obturation History Length of obturation Timing of Obturation The ideal root canal obturation materials Root canal sealers and core filling material Classification of root canal obturation SECTION 1 Dr Vaishnavi Chidrawar

77. CONTENTS Methods of Obturation: Lateral compaction Warm vertical compaction Warm lateral Compaction Thermoplastic Injection Techniques Carrier Based gutta percha Simplifill Sucessfill Thermomechanical compaction SECTION 2 Dr Vaishnavi Chidrawar

78. CLASSIFICATION OF ROOT CANAL OBTURATION TECHNIQUES BY GROSSMAN: Cold lateral compaction a. Single-cone obturation technique Warm compaction (warm gutta-percha) a. Warm vertical compaction technique b. Warm lateral compaction technique Continuous wave compaction technique Thermoplasticized gutta-percha injection Carrier-based gutta-percha a. Thermafil thermoplasticized technique b. Guttacore thermoplasticized technique c. SimpliFill sectional obturation technique McSpadden thermomechanical compaction technique Chemically plasticized gutta-percha obturation technique Custom cone obturation technique Dr Vaishnavi Chidrawar

79. CLASSIFICATION OF ROOT CANAL OBTURATION TECHNIQUES BY COHEN: Lateral compaction Warm vertical compaction Warm lateral compaction Continuous wave compaction Thermoplasticized materials Thermomechanical Compaction Carrier based gutta percha Chemically plasticized gutta percha Pastes Dr Vaishnavi Chidrawar

80. CLASSIFICATION OF ROOT CANAL OBTURATION TECHNIQUES BY INGLE: Lateral condensation Vertical condensation Sectional condensation Chemically plasticized Thermo –compaction Thermoplasticized GP technique Ultrasonic plasticizing technique Light speed sectional technique Solid core material technique Hybrid technique Dr Vaishnavi Chidrawar

81. Classification according to J.J. Messing and C.J.R. Stock (1988) Sectional Silver Titanium Gutta percha Amalgam Single Cone Gutta percha Silver Titanium point Multiple cone Cold lateral condensation Warm lateral condensation Hot vertical condensation Custom made Gutta percha with solvents Thermal compaction Injection molded thermoplasticized pastes alone Dr Vaishnavi Chidrawar

82. CLASSIFICATION OF OBTURATION TECHNIQUES BY GUTMANN AND WHITHERSPOON (2002) JL G. Obturation of the cleaned and shaped root canal system. Pathways of the pulp. 1998:293-364. Dr Vaishnavi Chidrawar

83. Lateral condensation method Most common method Involves placing tapered guttapercha cones in the canal and then compacting them under pressure against the canal walls using a spreader. A canal should have continuous tapered shape with a definite apical stop Techniques Dr Vaishnavi Chidrawar

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86. ADVANTAGES Can be used in most clinical situations During compaction of GP it provides length control ,thereby preventing overfilling. DISAVANTAGES May not fill the canal irregularities efficiently Does not fill lateral canals Does not produce homogenous mass. Space may exist between accessory and master cones Dr Vaishnavi Chidrawar

87. VERTICAL COMPACTION OF WARM GUTTA-PERCHA Herbert Schilder (1967) Schilder’s Boston Technique/ 3D Technique INDICATIONS Ledge formation or unusual canal curvature Internal resorption or large lateral canal. Continuous tapering funnel from the root canal orifice to the apex. Dr Vaishnavi Chidrawar

88. Armamentarium Dr Vaishnavi Chidrawar

89. 1. Cone fit checked Dr Vaishnavi Chidrawar

90. 2. Prefitting of plugger checked Dr Vaishnavi Chidrawar

91. 3. Sealer and master cone placement 4 . Down- packing Dr Vaishnavi Chidrawar

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94. 5. Reverse filling (Back packing) Once the gutta-percha has been compacted to about 5–6 mm from the terminus of the preparation, a radiograph is taken to verify that the gutta-percha is seated at the desired location and that the obturation is well compacted. The remainder of the canal (middle and coronal thirds) is filled in a backwards fashion. It can be achieved via two different methods: 1. Introducing small pieces of gutta-percha into the root canal, and rhythmically heating and compacting and them. 2. Using thermoplastic gutta-percha. Dr Vaishnavi Chidrawar

95. Back-packing” with Thermoplastic Gutta-percha Using thermoplastic gutta-percha such as obtura III (spartan corporation), beta 2 (B&L) (figure 22-65), Elements ( sybronendo ), calamus ( dentsply tulsa dental) the reverse filling of the canal can be Performed effectively in a significantly shorter time, especially in multirooted teeth. Dr Vaishnavi Chidrawar

96. ADVANTAGES Dense, Homogenous 3 D Fill Excellent Seal Apically And Laterally. Seals Large Lateral And Accessory Canals. DISADVANTAGES More time Risk of vertical root fracture Overfilling Difficult in filling of unusually curved canals Dr Vaishnavi Chidrawar

97. Non-standardized gutta-percha cones: Variable taper, the tip of point to be adjusted after apical gauging to obtain an optimum fit and apical seal. Standardized gutta-percha cones: Correspond to instrument taper and apical gauge Dr Vaishnavi Chidrawar

98. SINGLE CONE GP WITH SEALANT 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. This technique uses larger master cones that best match the geometry of the nickel-titanium rotary systems ( NiTi ). 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. Pereira AC, Nishiyama CK, de Castro Pinto L. Single-cone obturation technique: a literature review. Revista Sul-Brasileira de Odontologia. 2012;9(4):442-7. Dr Vaishnavi Chidrawar

99. 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 Simpler to use and result in faster obturation DISADVANTAGES: Porosities and void formation Cement dissolution Lower adaptation of single cone in middle and coronal third of canal with irregular shape Dr Vaishnavi Chidrawar

100. The present evidence suggests that the SC obturation technique with CSBC sealer provided similar clinical and radiographic results when compared to alternative obturation materials and techniques in facilitating the healing of apical periodontitis. The results indicate that although the technique may show effectiveness in most cases, a notable risk of failure persists. Sabeti MA, Karimpourtalebi N, Shahravan A, Dianat O. Clinical and radiographic failure of non-surgical endodontic treatment and retreatment using single-cone technique with calcium silicate-based sealers: a systematic review and meta-analysis. Journal of Endodontics. 2024 Mar 27. Dr Vaishnavi Chidrawar

101. CONTINUOUS WAVE COMPACTION Also called SYSTEM B COMPACTION Heating element is contained within specifically designed pluggers( Buchanan pluggers), Tips of which are 0.5 mm in diameter. Pluggers are tapered and made up of stainless steel and come in sizes; 0.06,0.08, 0.10, 0.12. The recommended temperature setting for the System B unit is 200° C Dr Vaishnavi Chidrawar

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106. The combined outcomes showed that the success rates of the thermogenic (WVC) and hydraulic (SC obturation technique) obturation methods were similar. Thermogenic techniques seemed to have an advantage in better canal wall adaptation and fewer spaces than hydraulic techniques. Meanwhile, the SC technique is the advanced technique that saves time and is cost-effective; only a single master cone that is similar to the size of the prepared canal is required. Also, it causes less pressure on the canal walls; therefore, the chances of root fracture are reduced, which is a major disadvantage of the lateral compaction obturation technique.  Dr Vaishnavi Chidrawar

107. SECTIONAL METHOD Widely promoted by COOLIDGE, LUNDQUIST, BLAYNEY – all from Chicago Also called CHICAGO technique Dr Vaishnavi Chidrawar

108. Advantages: Seals Apically &Laterally Post & core Cases only Apical Section filled Disadvantages: Time Consuming Difficult to Remove Sections of Guttapercha , if Canal overfilled Dr Vaishnavi Chidrawar

109. THERMOMECHANICAL COMPACTION 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. MCSPADDEN COMPACTOR Disadvantages : Fragility - Fracture of compactor Overfilling Difficult technique Overheating Use in straight canals only Dr Vaishnavi Chidrawar

110. GUTTA CONDENSER (MAILLEFER) Maillefer modified H-FILE Less compacting blades Increased sharpness Deeper grooves Used for back filling of canals already filled at apical third by either -Warm vertical compaction -Sectional compaction -Cold lateral compaction Dr Vaishnavi Chidrawar

111. Later, McSpadden developed a new technique, combining the principle of the thermomechanical compaction with new materials. The previous compactor was replaced with Nickel Titanium Condensers, of different diameters and tapers, and with “alpha phase” gutta-percha. This gutta-percha was preplasticized in a MicroSeal heater and then introduced into the canal with a rotating instrument, at lower speeds (1,000 rpm to 4,000 rpm) than the original McSpadden Compactor. This system uses MicroSeal gutta-percha master cones and a specially formulated Alpha Phase gutta-percha (low-fusing or ultra-low-fusing) in a cartridge, that is heated in the MicroSeal heater. Maggiore F. MicroSeal systems and modified technique. Dental Clinics of North America. 2004 Jan 1;48(1):217-64. Dr Vaishnavi Chidrawar

112. Thermo mechanical Solid-Core Gutta-percha Obturation. Introduced as the J.S. Quick-Fill (J.S. Dental Co., Sweden/USA). This system consists of titanium core devices that come in ISO sizes 15 to 60, resemble latch-type endodontic drills, coated with alpha-phase gutta-percha. Operates in regular slow-speed handpiece. Friction plasticizes gutta-percha. Dr Vaishnavi Chidrawar

113. THERMOPLASTICIZED GUTTAPERCHA

114. Introduced by Yee et al., Torabinejad et al., and Marlin et al. It consists of injecting gutta-percha, heated by an electrical device, into a prepared root canal. The instrument has a gun-like shape whose cartridges are small gutta-percha cylinders that are heated to a temperature regulated by the user. Exerting pressure on the “trigger” activates a piston that presses the gutta-percha toward the tip of the instrument. The gutta-percha is then conveyed through a thin silver needle that, when appropriately bent, allows its operation in root canals of various sectors of the mouth. Yee et al. demonstrated that it is possible to obtain dense obturation, without entrapped air bubbles, if the technique is accompanied by the use of a sealer. They also demonstrated the presence of filling material in lateral canals, in addition to a good apical seal. Dr Vaishnavi Chidrawar

115. Technique : Canal is prepared, dried and the walls are coated with sealers. GP is preheated in the gun and the needle is positioned in the canal so that it reaches within 3-5 mm of the apical preparation. GP is passively injected by squeezing the trigger of the gun. Needle backs out of the canal as the apical portion is filled. Pluggers dipped in alcohol are used to compact the GP when it gets cooled. Dr Vaishnavi Chidrawar

116. The technique may be confidently used only when there is no risk of introducing material beyond the apex, in the following circumstances: 1. Back-packing, to fill the coronal aspects of the canal following the initial placement and compaction of guttapercha in the apical portion of the canal. 2. Unnegotiable canals where it is necessary to fill the canal space as much as possible, via coronal approach, prior to surgical root-end filling. 3. In partially unnegotiable canals when sometimes, thermoplastic gutta-percha succeeds in obturating portions of canal that had remained unnegotiable to endodontic instruments. In many cases, endodontic surgery or root amputation may not be necessary. 4. After closure and maturation of the root following apexification . 5 . Root canals with internal resorption , after the apical third of the root canal has been obturated in the traditional manner. Dr Vaishnavi Chidrawar

117. ADVANTAGES Better Adaptation to Canal Walls Improved Sealing Ability Managing the canal irregularities. Minimum chair side time DISADVANTAGES Potential for Over-Extrusion Shrinkage Upon Cooling Risk of Voids in Specific Areas Dr Vaishnavi Chidrawar

118. OBTURA III Newest 3 rd generation Heated to 150-200 deg C Available with different viscosites of GP Tip sizes (20, 23, 25) Dr Vaishnavi Chidrawar

119. 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. Heating range: 150º to 230º C 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 Dr Vaishnavi Chidrawar

120. Ultrafil 3D (Hygienic Corp, Akron, OH) Dr. Michanowicz and Czontokowsky . (1984) Low heat technique: 158 º -194 º F ( 70 º – 90 º C ) heater Guttapercha - alpha phase Delivery system - prepacked cannulas - 22 g needles; 21mm length - special sterilizable syringe Dr Vaishnavi Chidrawar

121. Heating Unit GP Cannula ( α phase) Syringe PARTS: Regular Set( low viscosity)- White Cannule – sets in 30 min Firm Set (moderate viscosity) - Blue Cannule – 4 min- Compactable segmentally/ bulk Endoset (high viscosity) - Green Cannule – 2 min - Lateral/ vertical compaction Dr Vaishnavi Chidrawar

122. PROCEDURE:- Heat cannula ( 15 min to reach flowable state) Place it in the sterilizable syringe Place needle 3-5mm from apical matrix Working time :- 60-70 secs Regular set: - Squeeze /release - Count to 3 sec - Squeeze/ release again Needle placed till “ lift ” felt & backflow tends to displace the needle Dr Vaishnavi Chidrawar

123. THERMAFIL Concept by W.B. Johnson ( 1978) Consists of basically:- flexible central carrier guttapercha ( 2mm beyond carrier) THERMAPREP OVEN: Heating temperature- 115 º C 3-7 min depending on carrier size GP sets in 2-4 min Thermoplasticized alpha-phase gutta-percha carried into the canal on an carrier thermafil obturator. Dr Vaishnavi Chidrawar

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125. ISO Standard With Colour Matching Sizes - 20-140 Plastic carrier - liquid crystal plastic ( 25-40) - polysulphone polymer ( 45 & above) Dr Vaishnavi Chidrawar

126. THERMAFIL PLUS OBTURATORS 2 nd generation Thermafil plus obturators: Slight groove along 60deg of circumference Allows backflow of excess GP Pilot point for carrier removal in retreatment Thermaprep oven: 17-45sec Dr Vaishnavi Chidrawar

127. ADVANTAGES Simple, Quick & Easy technique Denser, better- adapted 3D obturation Excellent flow characteristics Less strain during delivery Curved canals – Flexible carriers DISADVANTAGES Exposure of core in apical third and voids Corrosion of metal carriers Post preparation difficult Re-treatment difficult Apical resection difficult Dr Vaishnavi Chidrawar

128. GUTTA CORE OBTURATION New generation core material, uses cross linked GP as the carrier of outer thermoplasticized GP Retreatment and post space preparation is easy Dr Vaishnavi Chidrawar

129. Soft-core Obturators (Soft core systems, Copenhagen) Similar to Thermafil carriers except handle is attached to a removable metallic pin Metal pin Is 9mm in length Hollow plastic core Is 24 mm in length Verifier-plastic also available ADVANTAGE:- Length of the carrier can be adjusted Can also be bent for use in areas of difficult access Dr Vaishnavi Chidrawar

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131. Simplifill (Light Speed Technologies, San Antonio, Texas) Developed by SENIA Available with GP and Resilon apical plug Dr Vaishnavi Chidrawar

132. SimpliFill is a relatively new two-phased obturation method Use of a stainless steel carrier to place Compact a 5 mm segment of gutta-percha into the apical portion Once placed, the carrier is removed by counter clockwise rotations, leaving a plug of gutta-percha. Backfill canal. Dr Vaishnavi Chidrawar

133. The success rate of endodontic treatment using core-carrier obturation was 83%. Short-term postoperative pain was not uncommon (24%). Most teeth (85%) had adequate adaptation using core-carrier obturation material, but a considerable amount of teeth (31%) had overfilling. Wong AW, Zhang S, Li SK, Zhang C, Chu CH. Clinical studies on core-carrier obturation: a systematic review and meta-analysis. BMC Oral Health. 2017 Dec;17:1-0. Dr Vaishnavi Chidrawar

134. GuttaCore was significantly quicker to remove than either Thermafil or thermoplasticized gutta-percha .There was statistically no greater risk of file separation or deformity in this group as compared with the other groups. There was an insignificant trend for carrier-based obturations to be more difficult to remove from the canals than the warm vertical obturations. There were more file separations and unwindings in the Thermafil group, and this obturation material was less efficiently removed than GuttaCore . Beasley RT, Williamson AE, Justman BC, Qian F. Time required to remove guttacore , thermafil plus, and thermoplasticized gutta-percha from moderately curved root canals with protaper files. Journal of endodontics. 2013 Jan 1;39(1):125-8. Dr Vaishnavi Chidrawar

135. GuttaFlow Gutta flow is eugenol free radiopaque form which can be injected into root canals using an injectable system. It is selfpolymerizing filling system in which gutta-percha in powderform is combined with a resin sealer in one capsule. Dr Vaishnavi Chidrawar

136. The GuttaFlow does not create a chemical bond with in the internal tooth structure, but its apical seal is greater than Zno -eugenol/gutta-percha using cold lateral obturation. This study shows that GuttaFlow has potential to replace Zno -eugenol/gutta-percha filling in permanent teeth. Upadhyay, Vinod; Upadhyay, Manoj; Panday, R K; Chaturvedi, T P; Bajpai, Usha. A SEM evaluation of dentinal adaptation of root canal obturation with GuttaFlow and conventional obturating material. Indian Journal of Dental Research 22(6):p 881, Nov–Dec 2011. Dr Vaishnavi Chidrawar

137. Regarding the marginal adaptation and biocompatibility of GF and bioceramics , both have excellent capabilities and are not significantly different. However, bioceramics tend to be more suitable for the use of the single-cone filling technique due to their strong biocompatibility. Vautier ME. Single-cone obturation in endodontics: GuttaFlow vs Bioceramic sealers. A systematic review. 2022 Dr Vaishnavi Chidrawar

138. References Rotstein, I., DDS, & Ingle, J. I., DDS. (n.d.). Ingle’s Endodontics. PMPH USA. Hargreaves, K. M., Berman, L. H., Rotstein, I., & Cohen, S. (2020). Cohen’s Pathways of the Pulp. http://ci.nii.ac.jp/ncid/BB19762720 Gopikrishna, V. (2020). Grossman’s endodontic practice. https://www.amazon.com/Grossmans-Endodontic-Practice-Gopikrishna-V-ebook/dp/B08PP9HXDM Bailey GC, Ng YL, Cunnington SA, Barber P, Gulabivala K, Setchell DJ. Root canal obturation by ultrasonic condensation of gutta-percha. Part II: an in vitro investigation of the quality of obturation. Int Endod J. 2004 Oct;37(10):694-8. doi : 10.1111/j.1365-2591.2004.00858.x. PMID: 15347294. Dhangar K, Shetty P, Makandar SD, Bapna PA, Ghani NRNA, Bakar WZW, Metgud S. Comparative Evaluation of the Percentage of Gutta-percha Filled Areas in Canals Obturated with Different Obturation Techniques. J Contemp Dent Pract . 2022 Feb 1;23(2):176-180. PMID: 35748446. Mancino D, Kharouf N, Cabiddu M, Bukiet F, Haïkel Y. Microscopic and chemical evaluation of the filling quality of five obturation techniques in oval-shaped root canals. Clinical oral investigations. 2021 Jun;25:3757-65. Beasley RT, Williamson AE, Justman BC, Qian F. Time required to remove guttacore , thermafil plus, and thermoplasticized gutta-percha from moderately curved root canals with protaper files. Journal of endodontics. 2013 Jan 1;39(1):125-8. Dr Vaishnavi Chidrawar

139. References Jaha HS. Hydraulic (Single Cone) Versus Thermogenic (Warm Vertical Compaction) Obturation Techniques: A Systematic Review. Cureus . 2024 Jun 22;16(6):e62925. doi : 10.7759/cureus.62925. PMID: 38912073; PMCID: PMC11193544. Beasley RT, Williamson AE, Justman BC, Qian F. Time required to remove guttacore , thermafil plus, and thermoplasticized gutta-percha from moderately curved root canals with protaper files. J Endod . 2013 Jan;39(1):125-8. doi : 10.1016/j.joen.2012.10.014. Epub 2012 Nov 13. PMID: 23228271. Mancino D, Kharouf N, Cabiddu M, Bukiet F, Haïkel Y. Microscopic and chemical evaluation of the filling quality of five obturation techniques in oval-shaped root canals. Clin Oral Investig . 2021 Jun;25(6):3757-3765. doi : 10.1007/s00784-020-03703-9. Epub 2020 Nov 26. PMID: 33244706. Dr Vaishnavi Chidrawar

140. Thank you