Obturation technique

Introduction
Classification Of Obturating Techniques
Obturating Techniques
References And Conclusion

1. OBTURATING TECHNIQUES

2. Contents: Introduction Classification Of Obturating Techniques Obturating Techniques References And Conclusion

3. introduction

4. “ 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

5. history

6. 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

7. 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

8. 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

9. 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.

10. 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.

11. 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

12. 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

13. 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

14. Classification of obturating techniques

15. According to J.J. Messing and C.J.R. Stock (1988)

16. According to GROSSMAN : Grossman,12 th edition chp12 pg no.282

17. According to Cohen: Cohen,11 th edition chp7 pg no.301-316

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

19. OBTURATION technique

20. 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

21. 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.

22. 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,

23. 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.

24. 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

25. Solid core GP with sealant ( Lateral compaction technique)

26. 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.

27. 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

28. Technique:

29. Variation of lateral condensation: Curved canal Immature canal and apices: Tubular canal Tailor Made GP roll

30. 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.

31. 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.

32. 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.

33. Solid core GP with sealant ( Single cone obturation technique)

34. 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

35. 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

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

37. 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 .

38. Inan et al. compared the apical sealing among the single-cone Thermafil and cold lateral condensation techniques , and concluded that the apical sealing through the use of the singlecone technique is comparable with both the lateral condensation and Thermafil techniques . Inan et al. J Can Dent Assoc. 2009 Mar;75(2):123-123c.

39. 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.

40. Chemically plasticized cold GP

41. 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 .

42. 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

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

44. Warm Gutta Percha (Warm vertical compaction)

45. 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

46. Technique :

47. Vertical compaction Technique:

48. 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

49. 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.

50. Warm Gutta Percha (continuous wave compaction)

51. 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.

52. 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

53. 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 .

54. 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

55. 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

56. Warm Gutta Percha (Sectional method)

57. Sectional Method / Chicago technique :

58. Sectional Method / Chicago technique :

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

60. Vertical compaction causes dense obturation while lateral compaction provides length control and satisfactory ease and speed.

61. 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.

62. “ 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

63. 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.

64. Thermomechanical compaction of Gutta percha

65. 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)

66. 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.

67. 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.

68. 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

69. Thermomechanical Gutta percha

70. 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.

71. 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.

72. 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 .

73. Thermoplasticized Gutta percha (Syringe insertion)

74. 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.

75. 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.

76. 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.

77. 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.

78. 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

79. 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.

80. 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.

81. 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.

82. 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.

83. 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 t he 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

84. Thermoplasticized Gutta percha (solid core carrier insertion)

85. 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

86. 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.

87. 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.

88. 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.

89. 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

90. 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.

91. Successfil : : The SuccessFil ® Solid Core Method utilizes high viscosity gutta percha , specially suited to be carried on an instrument into the canal. Here GP used comes in syringe which is inserted into canal The SuccessFil ® Syringe must be warmed prior to use . Always cap the syringe before placement of the syringe in the heater.

92. Successfil Titanium Cores : SuccessFil ® System Cores are biocompatible for obturating the root canal. Made of implant-grade titanium ( Ti 6AL 4V) alloy, they have non-cutting tips and are highly flexible for use in curved as well as straight canals. The cores are intended for use in combination with a coating of SuccessFil ® Gutta Percha as an obturation material. SuccessFil ® Cores are available in 25mm lengths with color-coded handles in ISO sizes 20-80.

93. 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 ,.

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

95. Apical third filling

96. 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.

97. 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

98. 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.

99. 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.

100. 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.

101. “ Microseal Technique” This technique utilizes cones of gutta-percha and pre - plasticised gutta-percha, both made with new generation high plasticity gutta-percha, as well as spreaders and thermo-mechanical condensers in NiTi capable of working in all the canal pathways

102. . The presence of a master cone which engages the apex and whose physico -chemical characteristics allow integration with pre-heated gutta-percha enables a complete, but controlled filling of the endodontic space.

103. Marciano MA et al s tudied the percentage of voids using Lateral compaction (LC ), MicroSeal ( MS) and found   no significant difference between both the groups. Marciano MA et al Braz Dent J (2010) 21(5): 411-415 .   

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

105. Gutta Flow : It consist of cold , flowable matrix that consist of polydimethylsiloxane matrix filled with very finely grounded GP. The material is provided in capsules for trituration in an amalgamator . The technique involves injection of material into canal and it provides a working time of 15 mins and it cures in 25-30 mins. It fills canal irregularities with consistency and biocompatibility.

106. Wang J et al, evaluate the clinical effects of GuttaFlow on root canal obturation and concluded that the root canal obturation of GuttaFlow plus gutta-percha cone is an easier and faster filling system for root canals.  Wang J et al.Shanghai Kou Qiang Yi Xue .   2009;18(4 ):380-2

107. 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.

108. 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; Barnett F et al. Endod Dent Traumatol.2014;5(1 ):23-6.

109. 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. Barnett F et al. Endod Dent Traumatol.2014;5(1 ):23-6.

110. 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 .

111. 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

112. Recent advances in obturating technique

113. 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 .

114. 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.

115. 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.

116. 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.

117. 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

118. 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

119. 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 .

120. 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 . V erify 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

121. 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.

122. conclusion

123. 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.

124. Thank you

125. References

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