Obturation techniques

Different techniques of Root canal Obturation

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

3. 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

4. CRITERIA FOR OBTURATION
The canal should be reasonably dry with
no weeping of fluids in the form of
bleeding or serous discharge
When patient is without sensitivity to
percussion
Teeth with no periradicular
radiolucency
After optimal cleaning and shaping is
achieved

5. Factors influencing the
efficacy of primary root
canal treatment :
1) ABSENCE of pretreatment
periapical lesion.
2) Root canal fillings with NO VOIDS.
3) OBTURATION to within 2.0 mm of
the apex.
4) An ADEQUATE coronal restoration.

6. Spreaders :
•2 types of spreaders :
# Hand Spreaders
# Finger Spreaders
• Finger spreaders provide better tactile sensation &
are less likely to induce fracture in the root when
compared with the more traditional hand spreaders.
•Spreaders made from Nickel-Titanium are available
and are considered better when compared with
Stainless Steel as they provide :
1) FLEXIBILITY
2) STRESS
3) DEEPER PENETRATION

7. Spreaders

8. Paper Points
They are
used for
drying the
canal
after
irrigation.

9. TECHNIQUES OF OBTURATION
:
1.Cold Lateral Compaction
2.Warm Compaction
(a) Vertical
(b) Lateral
3.Continuous Wave Compaction Technique
4.Thermoplasticized gutta-percha injection
5.Carrier-based gutta-percha
(a) Thermafil thermoplasticized
(b) SimpliFill sectional obturation
6.McSpadden thermomechanical compaction
7.Chemically plasticized gutta-percha
8.Custom cone

10. COLD LATERAL COMPACTION
Provides for length control during the
compaction.
Disadvantage : May not fill the canal
irregularities as well as warm vertical or
thermoplasticized techniques.
Is not able to achieve three-dimensional seal.

11. Clinical considerations :
1)Sealer considerations- Sealer application on
the canal walls can also be performed using a
lentulo spiral or with the master gutta-percha
cone itself.
2)Spreader considerations-
Size of the spreader is determined by the
width of the prepared canal and the lateral fit
of the primary cone. THE GREATER THE
SPACE BETWEEN THE CANAL WALL AND
THE BUTT END OF THE GUTTA-PERCHA ,
THE LARGER (wider) THE SPREADER USED.

12. The spreader size should reach within 1-2mm of the
working length in order to obtain optimal apical
compaction.
3) Master cone considerations :
- Minimal force should be used on the spreader
during the compaction process in order to avoid
root fractures.
- Additional secondary cones are inserted until the
spreader cannot be reinserted, an INDICATION
THAT THE ROOT CANAL IS FULLY COMPACTED
LATERALLY.
4) Several radiographs must be taken while
obturation.

13. Gutta percha

14. Lentulo spiral

15. Pretreatment radiograph

16. Working length radiograph

17. Coronal access opening
Prepared
mesio-buccal
canal

18. Standard
master cones
with coronal
reference
marked

19. Standard
master cones
fit to length
as they
exhibit
minimal taper
and permit
deeper
penetration
of the
spreader

20. Master cone radiograph

21. Finger
spreader in
place

22. Accessory
cone placed in
the space
created by the
spreader

23. Finger spreader
placed in
preparation,
creating space
for additional
accessory
cones.

24. Additional cones
are placed until the
spreader does not
penetrate past
the coronal one
third of the canal.
The cones are then
removed at the
orifice with heat,
and the coronal
mass is vertically
compacted with a
plugger.

25. Interim
radiograph
may be
exposed to
assess the
quality of
obturation.

26. Posttreatment
radiograph
demonstrating
adequate
length,
density, and
taper. The gutta-
percha is
removed to the
level of the
orifice, and a
coronal seal
has been
established with
an adequate
provisional
restoration.

27. LIMITATIONS :
1) The presence of voids in between the
filling as :
May not fill the canal irregularities as well
as warm vertical / thermoplastic
techniques.
Doesn’t produce a homogenous mass.
2) Warm compaction techniques have a
better ability to seal intracanal defects
and lateral canals than cold lateral
compaction.

29. WARM COMPACTION METHOD

30. A) WARM VERTICAL
COMPACTION :
By Schilder
It is a method of three-dimensional filling
the radicular space
Preparation requirement : Preparing the
canal with a continuously tapering funnel and
keeping the apical foramen as small as
possible.
Instrument requirements : Variety of
pluggers and heat source.

31. Using heated pluggers, one applies pressure in
a vertical direction to the heat-softened gutta-
percha and thereby causes it to flow and to fill
the entire lumen of the canal.

33. Schilder’s objectives :
A continuous tapering funnel should be present
from the root canal orifice to the root apex.
The root canal should be prepared so that it
flows with the shape of the original canal.
The shape of the apical foramen should not be
changed or moved.
The apical foramen should be kept as small as is
practical so that excess gutta-percha will not be
forced through it during vertical compaction.

34. Indications :
As an alternative to the cold lateral
compaction technique.
When the fitting of a conventional master
cone to the apical portion of the canal is
impossible, as when there is a ledge
formation, perforation, or unusual canal
curvatures, internal resorptions, or large
lateral canals.

35. Techniques :
A primary nonstandardized or greater taper
gutta-percha cone corresponding to the last
instrument used is fitted in the canal in the
usual manner.
The canal wall is coated with a thin layer of
root canal sealer.
The primary gutta-percha cone or master
cone is inserted upto the working length.
The coronal end of the cone is cut off with a
heated instrument.

36. A “heat carrier” such as root canal plugger, is
heated to redness and is immediately forced
into the coronal third of the gutta-percha. (An
alternative is to employ electric heat carriers
like Touch n Heat or System B as they permit
temperature control of the heat carrier
instrument.
The coronal gutta-percha is seared off be by
the plugger as it is removed from the canal.
A vertical condenser or plugger of suitable
size is inserted, and the vertical pressure is
applied to the heated gutta-percha to force
the plasticized material apically.

37. This alternative application of heat carrier
and condenser is repeated until the
plasticized gutta-percha seals the larger
accessory canals and fills the lumen of the
canal in three dimensions up to the apical
foramen.
The remaining portion of the canal is plugged
with warm sections of additional pieces of
gutta-percha.

38. Advantages :
Excellent seal of the canal apically and
laterally.
Obturation of the larger lateral and
accessory canals.

39. Disadvantages :
The amount of time it takes.
The risk of vertical root fracture resulting
from undue force.
Periodic overfilling with gutta-percha or
sealer that cannot be retrieved from the
periradicular tissues.

40. B) WARM LATERAL
COMPACTION :
This provides length control during obturation.
Placement of master cone and lateral
compaction using heat carriers such as Endotec
II tips and EndoTwinn tips.
The device is placed beside the master cone
and activated followed by placement of an
unheated spreader in the space previously
occupied by the heat carrier.
Accessory cones are then placed and the
process repeated until the canal is filled.

41. CONTINUOUS WAVE COMPACTION
TECHNIQUE:
This is a variation of the warm vertical
compaction technique introduced by
Buchanan.
Employs the use of gutta-percha cones
and pluggers that mimic the tapered
preparation, thereby permitting the
application of greater hydraulic force
during warm compaction.

42. It uses Nickel-Titanium systems to prepare
the canal.
Pluggers are selected in consistence with the
size of the shaping instruments used.
Tapered pluggers #.06 , #.08 , #.10 , #.12 with
a tip diameter similar to the tapered gutta-
percha points, respectively, are employed.
This procedure is carried out with a heat
carrier system (System B, SybronEndo)

43. Buchanan System B pluggers

47. THERMOPLASTICISED GUTTA-
PERCHA INJECTION TECHNIQUES
PRINCIPLE:- This technique comprises a
pressure apparatus consisting a electrically
heated syringe barrel and a selection of
needles ranging from 18-25gauge size.
The plunger is designed to prevent the
backflow of the Gutta percha.
The degree of heat is regulated to provide
proper extrusion of the gutta percha
according to the size of the needle.

48. TECHNIQUE
EXAMPLE:- OBTURA III(OBTURA SPARTAN)
A suitable gauge needle is selected to be
positioned at 3-5mm short of working length.
TEMPERATURE:- 200
o
C.
 In the injection method, the canal
preparation is restricted apically with flaring
of the body of the canal toward the access
opening.

49. LIMITATION
Lack of precision.
Creation of voids in the final set filling.

51. CARRIER BASED GUTTA PERCHA
TECHNIQUES
Thermafil Thermoplasticised Technique
It is a carrier based gutta percha obturation
system comprising a plastic core carrier
coated with alpha phase gutta percha.
It is available in ISO standardised sizes as
well as variable tapered sizes suitable for
canals prepared with nickel-titanium tapered
instruments.
Used in conjunction with a heating device
known as THERMAPREP PLUS OVEN

54. SIMPLIFIL SECTIONAL
OBTURATION TECHNIQUE
It is a carrier based sectional gutta percha
obturation system used in conjunction with
the light speed rotary instruments.
The Simplifil carrier has an apical 5mm plug
of gutta percha which performs cold
sectional obturation of the root canal.
The carrier size is chosen according to the
diameter of the master apical file(MAF).

55. After drying the canal and applying the
sealant , the carrier is applied up to the
working length.
The handle of the carrier is rotated quickly in
the counter clockwise direction three to four
times to disengage the apical plug of gutta
percha from the carrier.
The remaining coronal space can be filled
with lateral compaction or thermoplasticised
gutta percha methods .

57. McSPADDEN
THERMOMECHANICAL
COMPACTION METHOD
This method used heat to decrease the gutta
percha viscosity and increase its plasticity.
The heat is created by rotating a compacting
instrument in a slow speed contra angle
handpiece at 8000-10,000 RPM alongside
gutta percha cones inside the root canal.
The compactor whose spiraled 90
0
flutes are
similar to the flutes on HEDSTROEM FILE ,
but in reverse , forces the softened gutta-
percha apically and laterally.

58. As the comparator blade breaks easily if it
binds , this method should be used to fill
straight canals only.
Step back method is used to enlarge the
canals.
Gutta percha cones are inserted in the
prepared canal short of the root apex and a
comparator blade selected according to the
width and length of the prepared canal , is
inserted between the gutta percha and the
canal wall.

59. With a stop on the comparator blade , the
rotating tip of the blade is guided to within
1.5mm of the root apex.
Restriction of the blade within the canal
prevents the forcing of thermoplasticized
gutta percha through the root apex.
The plastic gutta percha moves laterally and
apically because the reversed flutes on the
compactor blade push the softened gutta
percha forward and sideways even when one
is withdrawing the rotating blade from the
canal.

60. ADVANTAGES
Ease of selection and insertion of gutta
percha cones.
Economy of time.
Rapid filling of canals apically and laterally ,
including irregular spaces within the canal if
one uses a sealer.

61. DISADVANTAGE
Inability to use the technique in narrow
canals.
Frequent breakage of compactor blades.
Frequent overfilling of the canals.
Shrinkage of the cooled , set filling.

63. CHEMICALLY PLASTICIZED GUTTA
PERCHA TECHNIQUE(EUCAPERCHA ,
CHLOROPERCHA)
Gutta percha can be plasticized by chemical
solution such as chloroform , eucalyptol or
xylol.
The advantage is it can be used in unusually
curved canals.
The disadvantage of using a chemical solvent
filling material is its inability to control
overfilling with resultant periapical tissue
reaction and shrinkage of the filling after
setting , resulting in a poor apical and lateral
seal.

64. CUSTOM CONE TECHNIQUE
Custom cone technique is a chair side
procedure employed for customizing the
gutta percha in wide angles where traditional
master cone cannot be adapted.
The clinician has to customize a gutta percha
point to achieve a tug back.

65. TECHNIQUE:-
Soften an appropriate sized gutta percha with one
or more accessory cones with the help of heat and
heat and roll together between two glass slabs. A
spatula may also be used as an alternative. A single
master cone of incresed diameter is created which
is then sized within the canal.
Soften the tip of the master cone with chloroform ,
eucalyptol or halothane for few seconds and gently
place it to the working length with a locking plier.
On removal , the softened gutta percha carries the
impression of the canal and this process is
repeated till a snug fit is achieved. Ensure that the
gutta percha remains semirigid during this process.

66. References :
Cohen’s Pathways of the Pulp 10
th
edition
Grossman’s Endodontic Practice13
th
edition

68. 1) In Obtura III , the gauge needle
is selected to be positioned at?
1-2 mm short of working length
2-3 mm short of working length
3-5 mm short of working length
0.5-1 mm short of working length

69. 2) The spreader should reach
within how much of the working
length?
1-2 mm of working length
2-3 mm of working length
3-5 mm of working length
0.5-1 mm of working length

70. 3) In SimpliFill Sectional
Obturation, a heating device is
used in conjunction with the
obturators.
True
False

71. 4)Which phase of gutta-percha is
most commonly available
commercially?
Alpha phase
Beta phase
Gamma phase
Both Alpha & Beta

72. 5)
Hand spreader
Plugger
Finger spreader
Lentulo spiral