Techniques of Root Canal Obturation

note on different techniques of obturation

1. DEEPTHI P.R. III YEAR MDS DEPT. OF CONSSERVATIVE DENTISTRY & ENDODONTICS TECHNIQUES OF OBTURATION

2. INTRODUCTION Many methods: old & new Plasticity/ flow of GP Flow into the RC Compress against the walls Fill fine tortuous canals Seal various exits Compact into a solid core filling

3. Different techniques Cold Lateral Compaction Warm Compaction (warm GP) A. Vertical B. Latera l 3. Continuous wave Compaction technique 4. Thermoplasticized GP injection 5. Carrier- based GP A . Thermafil thermoplasticized B. SimpliFill sectional obturation 6. McSpadden thermomechanical compaction 7. Chemically plasticized GP 8. Custom cone

4. Cold lateral compaction Most widely taught & practised Sealer considerations Spreader considerations Master cone considerations Radiographs

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7. technique Endodontic Topics 2005, 12, 2–24

8. Butt end of the GP: cut off with heated instrument Warm vertical compaction: coronal GP Chamber cleaned Restoration placed

9. Cold lateral compaction Advantages “ Deep spreader penetration”: minimize apical leakage/ percolation P ositive dimensional stability of the root canal filling Less likelihood of carrying filling material beyond the root apex Limitations Presence of voids Increased sealer : GP ratio Less able to seal intracanal defects & lateral canals Less homogeneous mass Time consuming JOE—Volume 32, Number 4, April 2006 Endodontic Topics 2005, 12, 2–24

10. Variants on cold lateral compaction Warming spreaders before each use in a hot bead sterilizer Softening gutta percha with heat before insertion of the cold spreader Mechanical activation of finger spreaders in an endodontic reciprocating handpiece Application of an ultrasonically energized spreader Application of an engine-driven thermomechanical compactor which creates frictional heat and advances the material apically within the canal Endodontic Topics 2005, 12, 2–24

11. studies Bal et al. Hembrough et al. Wilson & Baumgartner Better results with warm techniques: Collins et al. Da Silva et al.

12. Warm vertical compaction Herbert Schilder Berg Heated pluggers Objectives defined: preparation for obturation with this technique Indications

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16. Warm vertical compaction

17. Warm vertical compaction Pulp Canal Sealer, Kerr Endodontic Topics 2005, 12, 2–24

18. Warm vertical compaction Advantges Irregularities & accessory canals better filled Excellent seal of the canal laterally & apically Disadvantages Time consuming Risk of vertical fracture from undue force Less length control O verfiling with GP or sealer that cannot be retrieved from periradicular tissues Difficult in curved canals

19. Warm lateral compaction Warm GP hybrid technique; Martin Master cone placed Lateral compaction: heat carriers Unheated spreader & accessory cones Endotec II, Endo Twinn , EI DownPak

20. Warm lateral compaction Endo Tec II: Liewehr et al. Increased weight of GP: 14.63% Kersten et al. Collins et al. Endo Twinn : Kulid et al. JOE—Volume 32, Number 8, August 2006

21. Continuous wave compaction technique Buchanan Greater hydraulic forces Tapered pluggers: System B

22. Continuous wave compaction technique

23. Continuous wave compaction technique

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27. Continuous wave compaction technique Mean temperature change near CEJ: 4.1 o C Silver et al. Elevation > 10 o C Flore et al. temperature setting > 250 o C- hazardous

28. Thermoplastic injection techniques Harvard/ Forsythe Institute: 1977 Obtura III Calamus Elements HotShot Ultrafil 3D- 90 o C Obtura II- 160 o C

29. Obtura iii Hand-held gun Ag needles Control unit

30. Obtura iii

31. Obtura iii Length control: Hybrid technique Tani - Ishii et al. Weller et al. Jacobsen et al.

32. calamus Cartridge system : 20 & 23 G needles Control of temperature Flow rate Pluggers 360 degree activation switch

33. Ultrafil - 3d GP cannulas Heating unit Injection syringe 3 types of Cannulas: Regular set, Firm set & Endoset

34. elements System B heat source & plugger Extruder 20, 23 , 25 gauge needles: GP 20, 23 gauge: Real Seal

35. hOtshot Cordless thermoplastic device 150 o C to 230 o C GP or Resilon 20, 23, 25 gauge needles

36. guttaflow Polydimethyl siloxane with finely ground GP Capsules WT: 15’; curing: 25- 30’

37. Carrier- based GP Thermafil Profile GT obturators GT Series X Obturators ProTaper Universal Obturators Successfil SimpliFill JS Quick-Fill

38. thermafil GP with a solid core Metal core & coating of GP Advantages Disadvantages Obturators : correspond to file systems Sealer: required

39. thermafil

40. thermafil

41. thermafil Advantage Disadvantage Pro Post drills Retreatment Plastic carriers- non toxic material

42. successfil Associated with Ultrafil 3D GP: syringe Carrier inserted into syringe Sealer coated on canal walls: carrier with GP paced

43. Trifecta technique Hygenic Corporation Succesfil GP injected onto sterile K-file tip Carried into most apical part: turned counter-clockwise Soft GP condensed Remainder: Ultrafil GP Modified Trifecta: rest with lateral condensation Chandra & Shetty . Endodontology .

44. simpiFill LightSpeed Instruments Apical 5mm GP plug Carrier: MAF Seated & carrier removed Lateral compaction/ thermoplastic

45. Js quickfil Alpha phase GP coated Ti cores ISO: 15 to 60 Spun into the canal at low speed Maybe left behind or removed

46. Thermomechanical compaction McSpadden compactor H- file in reverse Slow speed handpiece Advantage Disadvantages Microseal condensers

47. Solvent techniques CHCl 3 , Eucalyptol, xylol . Disadvantages Callahan- Johnson technique 95% ethyl alcohol solution, chlorosin solution Nygard - Ostby technnique JOE — Volume 32, Number 4, April 2006

48. Solvent techniques A small amount of chloropercha is streaked onto the walls of the dry root canal with a fine root canal spreader or other suitable instrument. The apical third of the master cone is dipped into the chloropercha paste , and the entire master cone is gently repositioned into the canal . The material in the canal is now forced laterally with root canal spreaders , making room for additional GP cones which are added repeatedly in sufficient number to provide a dense root canal filling . JOE — Volume 32, Number 4, April 2006

49. Each piece of GP blends with the GP & chloropercha already in the canal to form a homogeneous mass which conforms quite adequately to the configuration of the root canal system. The lateral pressure on the plastic GP– chloropercha mixture automatically imparts a small vertical component of pressure, owing to the shape of most prepared canals. The entire mass moves apically during lateral condensation with any solvent technique. JOE — Volume 32, Number 4, April 2006

50. Single- cone obturations 1960s: ISO standardization Circular , stop preparation in the apical 2mmof the canal: single GP, Ag, sectional Ag or Ti Cemented in place: thin & uniform layer of traditional sealer Ergonomic matched file & cone Endodontic Topics 2005, 12, 2–24

51. conclusion Wide array of options and materials Wisely chosen & applied depending on the clinical situation

52. Thank you!!