OBTURATION

Francis prathyusha

WHY OBTURATE???

• Dr Herbert Schilder – first to publish classic article on filling root canal space in 3 dimensions

(DCNA 1967:723-44)

– Final objective of endo therapy: “total obturation of root canal space”

– “sealing of complex root canal system from periodontal bone ensures health of attachment apparatus against breakdown of endodontic origin”

Commentary on: Filling Root Canals in Three Dimensions Harold E. Goodis, DDS copyright © 2006 by the American Association of Endodontists. doi:10.1016/j.joen.2006.02.029

The three-dimensional filling of the entire root canal system as close as possible to the cementodentinal junction

American Association Of Endodontists (AAE), 1994

DEFINITION

• When obturation objectives are met, we help to produce an optimal environment for periradicular tissue healing and health, and thus for successful endodontic therapy.

These objectives are • Replicate ,• Seal ,• Control.

OBJECTIVES OF ENDODONTIC OBTURATION

RATIONALE FOR OBTURATION

• “Bacteria are the primary source of persistent periradicular inflammation and endodontic failure”

(Ingle & Bakland, 5 t h Ed)

Coronal seal

Lateral seal: Apical seal

WHEN TO OBTURATE ??

• Tooth is asymptomatic, or very mildly symptomatic with definite, ongoing symptom resolution

• Canal preparation dries completely to its terminus

• Canal is relatively “free” of bacteria • No foul odor is noted upon canal system entry • Temporary restoration intact and uncompromised • No sinus tract is present (debatable) • No signs of active infection

Grossman’s Criteria (1940)

Easily introduced Seal laterally as well as

apically Not shrink after being

inserted Impervious to moisture Bacteriostatic

IDEAL REQUIREMENTS OF ROOT CANAL FILLING MATERIALS

Radiopaque Not stain tooth Not irritate periradicular tissuesSterile or sterilizable Easily removed

According to Grossman

CLASSIFICATION

OBTURATING MATERIALS

Core materials sealers

Metals

Plastics

Pastes/ Cements

Plastics

Cements

Pastes

ANSI/ ADA CLASSIFICATION:

ANSI/ADA

Specification No.78

(ISO No. 6877) Endodontic obturation

points Sealing materials

Type I : Core standardized points to be used with sealer & cement

ANSI/ADA

Specification No.57

(ISO No. 6876)

Type II : Auxiliary (conventional or accessory points) of non standardized taper 

CORE FILLING MATERIALS

Metal

SilverStainless steel files•Gold•Iridioplatinum•Tantalum•TitaniumAmalgam

Plastics

• GP• Hydron• Resilon

Pastes/ Cements:• N2 – Sargenti

technique

• Resorcinol – formaldehyde resin (Russian Red Cement)

• Calcium phosphate cement (CPC)

• MTA

Introduced by Jasper in 1933Pure silver molded in a conical

shape – same diameter & taper as files & reamers

AdvantagesStiffer than gutta-perchaEasier to insert in very

narrow/ fine tortuous canals

 DisadvantagesPoor lateral seal.

SILVER POINTS

Presence of small amounts of other trace metals (e.g. 0.1% to 0.2% of copper and nickel)

Presence of metal restorations or posts in the tooth

Loss of integrity of coronal restoration and exposure to saliva

Canal irrigantsZielke DR, Brady JM, del Rio CE.Corrosion of silver cones in bone: a scanning electron microscope and microprobe analysis. J Endod 1975;1:356–60.Zmener O, Dominquez FVCorrosion of silver cones in the subcutaneous connective tissue of the rat: a preliminary scanning electron microscope, electron microprobe, and histological study. J Endod 1985;11:55–61.

Corrosion of silver cones due to:

Introduced by Sampeck in 1961Used to fill

Fine, tortuous canalsHeavily calcified dilacerated narrow

canalsUsed instead of silver conesInvolved cementing one file & cutting off

handle with a high-speed hand piece, 3-4mm below occlusal surface

STAINLESS STEEL FILES

Advantages• More rigid than silver cones• Inserted into canal with greater ease• Less susceptible to corrosion

Disadvantages• Cannot independently seal the root canal,

needs a cementing medium• Excess sealer collects in the flutes of the

instrument rather than being forced against canal walls

DISADVANTAGES OF METAL CORE MATERIALS

• Require an absolutely circular canal preparation • Often bind in one or two places in the root canal

wall, giving a false sense of fit • Radiographically are deceptive because they give

a dense appearance to the root canal fill• Corrode when in contact with either

periradicular tissue fluids or oral fluids• Corrosion products are highly cytotoxic • Cannot obturate the canal system three

dimensionally - requires a sealer

CORE FILLING MATERIALS

Metal

SilverStainless steel files•Gold•Iridioplatinum•Tantalum•TitaniumAmalgam

Plastics

• GP• Hydron• Resilon

Pastes/ Cements:• N2 – Sargenti

technique

• Resorcinol – formaldehyde resin (Russian Red Cement)

• Calcium phosphate cement (CPC)

• MTA

GP/SEALER OBTURATION TECHNIQUES

• Lateral compaction (old term –“condensation”)

• Vertical compaction • Thermo mechanical• Thermoplasticized • Hybrid (thermo- and non

Thermoplasticized combined)• Master apical impression

LATERAL COMPACTION

Advantages • Long track record• Replicates canal adequately• Seals well• Inexpensive • Requires little armamentarium

Disadvantages • Moderately time consuming• Can vertically fracture roots• May leave vertical voids

VERTICAL COMPACTION

Vertical compaction of warm gutta-percha. Fitting the master gutta-percha cone. The cone is fit to the radiographic terminus.

Advantages • Replicates well • Seals well

Disadvantages • Most time consuming technique• Requires significant flaring for deep

condensation• Requires increased number of

instruments

• GP plasticized by frictional heat in root canal

• McSpadden Compactor– Used with regular β phase GP cones– H-file design (pushes GP apically)

THERMOMECHANICAL COMPACTIBLE GP:

• Disadvantages:• Extrusion of material• Instrument fracture• Inability to be used in curved canals• Heat generation• Void formation; poor seal

Thermomechanical Compaction

Compactor + Gutta percha cone

Operator coated compactors

Multi – phase II Pac Mac compactors

‘triple coated compactor’

0.02 or 0.04 taper compactor coated with

Multiphase I (beta phase GP)

&

Multiphase II (alpha phase GP)

+Sealer

Mc Spadden compactor

Gutta Condenser

Engine Plugger

USE

Beta phase GP cone

+

Stainless steel compactors

Multi – phase technique

Beta phase GP cone

+

NT Condenser coated with alpha phase gutta percha

Microseal system

Alpha phase GP cone

+

Microseal condenser coated with alpha phase GP

Precoated Compactors

THERMOPLASTICIZED Heat softened GP is injected into

the canal or carried inside on a carrier.

Indications • Canal irregularities • C-shaped canal systems • Internal resorption

Conti.

Advantages • Replicates the canal space better

than other techniques • Seals well• Fills internal defects• Best method for accessory canal

obturation• Fastest technique

Conti..

Disadvantages • Extrusion of GP and sealer is common

- Poor apical control

- Apical matrix required.• Expensive equipment• Poor tactile feedback during injection• Requires increased preparation flare for

applicator tip (inappropriate for many curves)

Apical seal comparison of low-temperature thermoplasticized gutta-percha technique

and lateral condensation with two different master cones

Mercedes Pérez Heredia1, Javier Clavero González 1, Carmen María Ferrer Luque 2, María Paloma González Rodríguez 3

(1) Graduate in Dentistry

(2) DDS, MD, PhD: Associate Professor

(3) DDS, PhD: Assistant Professor. Department of Dental Pathology and Therapeutics. School of Dentistry. University of Granada (Spain)

AIM:• To compare the apical sealing in mesio-buccal

canals of extracted molars obturated with low-temperature thermoplasticized gutta-percha or cold lateral condensation techniques using a .06 or a .02 mm/mm tapered gutta-percha master cone.

• The secondary aim was to evaluate the depth of spreader penetration in root canals using a .06 or a .02 mm/mm tapered gutta-percha master cone.

MATERIALS AND METHODS Group-1

Ultrafil® 3D

Group 2 (n=12):Cold

lateral

condensatio

n

Group 3 (n=12):

Cold later

al condensation

Control group(n

=8)

RESULTS: • There were no differences among the three

group, which showed a very similar mean microleakage .

• The difference in spreader penetration between the groups filled by cold lateral condensation was significant

CONCLUSION OF THE STUDY

• The Ultrafil® 3D system and cold lateral condensation techniques with .06 or .02 tapered master cones were equally effective in the apical sealing of curved canals.

• The spreader penetrated deeper using a .02 mm/mm tapered gutta-percha master cone.

HEROFILL:A THIRD GENERATION OF

ROOT CANAL FILLING

Assistant, Department of Dental Medicine, EPS Farhat Hached Sousse, Tunisia

** Professor, Department of Dental Medicine, EPS Farhat Hached Sousse, Tunisia

DENTAL NEWS, VOLUME XII, NUMBER III, 2005

Abstract• Tremendous progress has been made in the last

quarter of a century in understanding the nature of root canal system and obturation material. New techniques and materials are expected to increase the already high success of NITI rotary canal preparation. Adapted obturation is required for such cases.

• This article reviews the specificity of HEROfill system and how this procedure based on a plastic core coated with thermoplastic gutta-percha has evolved.

• Recently herofill was introduced by MicroMega Corporation to replace classic gutta-percha.

• HEROfill system is a 3rd generation endodontic obturator which was developed to give the practitioner a fast and reliable means of obturating a root canal, and is based on the principle of a solid plastic core coated with thermoplastic gutta-percha.

• The enhancements created in this system comparatively to other similar generation such as THERMAFIL, QUICKFILL,

ADVANTAGES• Detachable handle, that can be pre-bent up to

90° for a better angle in restricted access canals.• Adjustable working length.• Easy control by HEROfill® Verifiers.• No preheating of oven, short heating times.

Four obturators can be heated at the same time. In addition, we can save an obturator even heated if we decide not to use it.

• Hollow core in the coronal part of the carrier.• Natural GP free of any toxic components

DISADVANTAGES

• Under preparation of the canal space could cause “stripping” of the gutta-percha from the carrier as it was forcefully placed in the canal.

• The result - basically a single cone - metal or plastic carrier obturation in the apical portion – is undesirable. So like Warm vertical compaction, this too was “technique-dependent”.

• Retreatment and surgical procedure difficult

SCHEMATIC ILLUSTRATION SHOWING HEROFILL TECHNIQUE STEPS:

SEM observation :1/CERVICAL THIRD

Fig. 1: Marginal adaptation ofgutta-percha with presence of sealer

Fig. 2: No space betweengutta-percha and dentin wall

1: Carrier system2: Gutta-percha3: Sealer4: Dentin wall

2/MIDDLE THIRD

Fig. 3: Penetration of sealer insidesurface dentin; better seal

Fig. 4: Interface dentin/obturatorHEROfill™: good adaptation

1: Carrier system2: Gutta-percha3: Sealer4: Dentin wall

3/APICAL THIRD

Fig. 5: Acceptable marginal adaptation Fig. 6: Acceptable fitting at dentin wall

1: Carrier system2: Gutta-percha3: Sealer4: Dentin wall

CONCLUSION

• HEROfill obturation is considered among the fast, reliable and easy obturation methods. It can be used in the same situations as the lateral condensation; it is however preferred in many circumstances, such as with internal and root end resorption.

• Its main advantage is the ability to adapt the warmed and softened gutta-percha to the irregular root canal system

• Lateral compaction and Obtura II®• Continuous wave of condensation

HYBRID OBTURATION TECHNIQUES (COMBINATION OF THERMO- AND

NON-THERMOPLASTICIZED)

• A technique combining thermoplastic and non-thermoplastic GP is preferred over thermoplastics alone. This combines the best features of several techniques, including better apical control (than thermoplasticized alone) and better canal replication (than lateral compaction alone).

• Obtura II® is the most popular thermoplasticized GP system. The “hot glue gun” approach keeps GP molten for injection.

• Prefit proper applicator tip near the junction of the coronal and middle thirdsPrefit compactors to lengths required (using stops or instrument graduations)

Conti..

• Fit and select master cone• Use of sealer is essential• Insert master cone (laterally compact 1-2

accessory cones if necessary)• Sear off at 2-3 mm from canal terminus and

vertically compact.Passively inject Obtura II® GP

• Segmental addition • Compact each increment immediately

following injection

CONTINUOUS WAVE OF CONDENSATION

• The non-standardized master cone is heat softened in place, using the System B® heat source and down-packed with a Buchanan plugger. Various sizes of heating tips and pluggers needed. The GP is alternately seared and down-packed, going deeper into the canal each time, until within 3-4 mm of the canal terminus. The middle and coronal canal space is backfilled with incremental Obtura II® injection and compaction.

Advantages • Able to combine the best of several

methods • Potential for excellent replication, seal

and reduced extrusion

Disadvantages • Expensive equipment• Still tends to extrude sealer• Short track record

Hybrid Methods:SimpliFiL (Hygenic corp, Akron, OH)

– 5mm apical plug of GP or Resilon + metal carrier

– Carrier removed after apical plug is placed

– Backfilling with injectable thermoplasticized GP or post given

Trifecta System

– Blocks the apex & prevents extrusion

– A plug of gutta percha at the apical foramen • SuccessFil (carrier based)

– Backfilling• UltraFil (thermoplasticized injection)

The percentage of gutta-percha-filled area in simulated curved canals when filled using Endo

Twinn, a new heat device source

G.PAGABINO,L GIACHETTI etalINTERNATIONAL ENDODONTIC JOURNAL , VOL 39 ISSUE 8 Pgs 610-615.Aug 2006,

12

3 4

1)Stainless steel2)Ultrasonics3)NiTi 4)Cutting spoon tips.

AIM 

To compare the percentage of gutta-percha-filled area (PGP) in simulated root canals when varying the penetration depth and function of the pluggers (heat versus heat plus vibration) using Endo Twinn

RESULTS 

• At the 1.25 mm level PGP was significantly greater using the vibration function .

• At the 2.5 mm level the PGP was greater in the canals with 0.8 taper compared with a 0.4 taper with or without vibration

• In 0.4 taper canals the PGP was greater when the vibration function was activated.

• At the 4 mm level in 0.8 taper canals there was no significant difference in PGP with or without the vibration .

CONCLUSION OF THE STUDY  

• 0.8 taper canals had significantly greater PGP than 0.4 taper canals. At the 1.25 mm level there was significantly greater PGP when the vibration function was activated

• Calcium Hydroxide Containing GP

• Iodoform Containing GP

MEDICATED GP:

• Chlorhexidine – Impregnated GP

• Tetracycline Containing GP

FLOWABLE GUTTA PERCHA (GUTTA FLOW):

Gutta-Flow with single gutta percha master cone creates an apical seal that is equivalent to GP/AH Plus with warm vertical compaction

Brackett et al, JOE 2006; 32(12): 1188-90

•Non-heated/Cold flowable obturation material •Combines GP & Sealer in one product•Consists of polydimethylsiloxane based sealer used with single /multiple cone obturation

EndoRez Points (Ultradent Products, South Jordan, UT)

• GP coated with proprietary resin coating• Polybutadiene-diisocyanate-methacrylate resin

coated GP

(

COATED GUTTA PERCHA

• Seal dependent on penetration of hydrophilic sealer into dentinal tubules & lateral canals

• Resin tags were demonstrated impregnating canal walls, but interfacial leakage was not prevented

Tay et al, JOE 2005; 31: 659-664)

Management of Open Apex Situations, including Master Apical Impression Technique

– Preparation of “tailor-made” gutta-percha roll.

A: Number of heated, coarse, gutta-percha points are arranged butt to tip, butt to tip on sterile glass.

B: Points are rolled with spatula into rod-shaped mass

C: By repeated heating and rolling, the roll of gutta-percha is formed to approximate size of canal to be filled. No voids should exist in mass.

D: Before trial point testing of tailor-made roll, gutta-percha should be chilled with ethyl chloride spray.

Activ GP (Brasseler USA, Savannah, GA)

• Marketed as “monoblock” sytem

• Gutta percha cones are surface coated

with glass ionomer fillers

• Helps achieve a stiffer GP cone –

Transforms it into a GP core/cone– Acts as filling cone +

– Carrier core

ActiV GP Precision Obturation System.ActiV GP Plus cones come with a handle and depth markings to expedite insertion into the canal

The regular ActiV GP System includes gutta-percha points that are manufactured in a traditional design, with the further enhancement of being impregnated and coated with glass ionomer. The other choice, ActiV GP Plus, has a different cone design. It employs calibration rings for easy depth measurement and a convenient handle that facilitates easy insertion into the canal

A hermetic seal can be created if there is a monobloc between the canal wall, the sealer, and the master cone.

A NEW MONOBLOC MATERIAL AND TECHNIQUE

Resilon system

New technology in endodontics– the Resilon-Epiphany system

for obturation of root canals

1 Department of Conservative Dentistry, Medical University of Białystok,Poland,2 Department of Dentistry Propaedeutics, Medical,University of Białystok, Poland,3 Department of

Paedodontics,Medical University of Białystok, Poland

Pawińska M1*, Kierklo A2, Marczuk-Kolada G3

Advances in Medical Sciences · Vol. 51 · 2006 · Suppl. 1 ·

REALSEAL (RESILON/EPIPHANY)

• The core• The sealer is a dual-cure sealer.• In addition the system comes with a self-etching primer.

Advances in Medical Sciences · Vol. 51 · 2006 · Suppl. 1 ·

Resilon can be placed as single cones, warm vertical compaction thermoplastic injection, or lateral compaction.

#35, 0.04 tapered cone bent to show the flexibility of the cones

Resilon cones

Resilon Pellet

Thermoplastic ResilonMaterial through an Obtura gun (150°C)

Primer and Sealer

• During the cleaning and shaping procedures, alternating rinses of EDTA and sodium hypochlorite remove the smear layer and open the dental tubules for penetration of the resinous sealer. Because resins will not set in the presence of oxygen, the oxygenating agent sodium hypochlorite should not be the last irrigant before the resin sealer is introduced into the canal. The last irrigant should be EDTA, followed by sterile water or 2% chlorhexidine solution.

Mono block

Material and methods

5 men 16 women

Aged 14-55,

(5 incisors, 1 canine, 6 premolars and 12 molars)

Endodontically treated 48 root canals(24teeth)

Advances in Medical Sciences · Vol. 51 · 2006 · Suppl. 1 ·

One year after the treatmentImmediately after the treatment

Laboratory evaluation – 4 extracted tooth

Transverse cross-section of the root canal obturated with Resilon-Epiphany system. Sealer (U) adheres tightly to dentine (Z) and Resilon (R), sealer tags are visible in dentinetubules (arrow). Magnification 3000x

• Transverse cross-section of the root canal obturated with Resilon-Epiphany system: a) A 1,2 m wide gap visible between sealer (U) and Resilon (R) (arrow). Magnification 2 500x

Visible is the sealer (U) adhering to dentine (Z) as well as gaps between the sealer and Resilon (R) (arrows), a likely result of root cutting. Magnification 3 000x

Resilon-Epiphany system has yielded positive outcome both in clinical and microscopic examinations.

Micrograph demonstrating intimate contact of sealer and Resilon.

SEM demonstrating intimate contact with methacrylic sealer and Resilon, and dentinal tubula penetration of the sealer. (RS - methacrylic sealer; D - dentin)

SEM demonstrating microgaph formation with AH 26 epoxy sealer due to polymerization shrinkage. (ES - epoxy sealer; D - dentin)

A Fluid Filtration Comparison of Gutta-Percha versus Resilon, a New Soft Resin Endodontic Obturation System

Abstract 

The purpose of this study was to compare the sealing ability of gutta-percha and AH Plus sealer versus Resilon and Epiphany Resin Root Canal sealer using three different final irrigants with the fluid filtration model.

Ryan K. StrattonMichael J. Apicella, DDSPete Mines, DDSJournal of Endodontics Volume 32, Issue 7 , Pages 642-645, July 2006

Result

• Two-way ANOVA analysis indicated significantly less leakage using Resilon with Epiphany sealer compared to gutta-percha and AH Plus sealer. There was no statistical significance between any of the irrigants used for either obturation group

Limited Ability of Three Commonly Used Thermoplasticized Gutta-Percha Techniques in

Filling Oval-shaped Canals

Journal of Endodontics,volume 34, Issue 11 , Pages 1401-1405, November 2008

•Gustavo De-Deus, DDS, claudia Reis, DDS, MS,Sidney Paciornik, DsC

yesplatform+mauthorauthor

Result

• Thermafil system, wave of condensation, and thermomechanical compaction produced significantly higher PGFAs than lateral condensation

 Comparative Study of Five Different Obturation Techniques

Lumnije Kqiku (1), Andreas Weiglein (2), Peter Städtler (1)

  1 - Department of Operative Dentistry, University Dental Clinic, Graz, Austri

Available online: March 25, 2006

Abstract

The aim of the study was to evaluate the adaptation and quality of root fillings achieved by the lateral condensation, vertical condensation, Thermafil, Ultrafil and Obtura II techniques..

 

figure1 figure2

figure3 figure4

RESULT

Radiographic evaluation of material adaptation• The quality of obturation obtained with the five

techniques was compared with the Kruskal-Wallis test and the Mann-Whitney U-test. Overall, there were no significant differences in the radiographic quality

• In the overall radiographic obturation quality the techniques showed good adaptation in the apical middle and coronal third of the root canal .

CONCLUSION

All the thermoplastic filling systems tested demonstrated acceptable root canal filling and good adaptation to the root canal wall with no statistically significant difference between them and in comparison to lateral condensation.

In vitro Evaluation Of ThreeTechniques To Obturate 0.06 Taper

Canal Preparations

• By Solaiman M. Al-Hadlaq, BDS, MS, PhD1 and Abdulmohsen A. Al-Rabiah, College of Dentistry, King Saud University.Riyadh , Saudi Arabia.

• AUSTRALIAN ENDODONTIC JOURNAL VOLUME 31 No. 2 AUGUST 2005

AbstractThe aim of this study was to evaluate the ability of three obturation methods to seal root canals prepared using 0.06 taper rotary instruments.

The positive control group, no casting wax or nail varnish was applied

to the root surface.

Negative control .coronal access was sealed with casting wax and the entire root surface was covered with two layers

of nail varnish.

Experimental control group4 teeth

49 teeth

Group 1

Group2

Group 3

System B technique with 0.06 taper

standardised gutta-percha Points

System B technique with non-standardised MF guttapercha points

cold lateral condensation technique using

standardised 0.02 taper master gutta-percha

points.

All samples were stored for 10 days in a humid chamber at 37°C to allow for

complete setting of the sealer cement.

RESULT• The positive control teeth showed complete dye

penetration, whereas negative control group teeth showed no dye leakage.

• Two teeth, one from the 0.06 taper gutta-percha group and one from the MF non-standardised gutta-percha group, were excluded from the final sample due to vertical root fractures.

Group 1 < Group2 < Group3

Obturation of internal resorptioncavities with 4 different techniques:

An in-vitro comparative study

Professor and Head,

Deptt. of Conservative Dentistry and Endodontics,

Saveetha Dental College and Hospitals,

Chennai, India.

Group-1,lateral compaction

Group-2,ultrasonic condensation technique

Group-3 Thermafill

GROUP-4, Obtura-11

Materials and methods

24,extracted max CI

• Conclusion• Results with Thermafill and lateral

condensation were inferior compared to Obtura and ultrasonic condensation technique for obturation of internal resorption cavities.

• Therefore, the later two techniques are recommended to be used to obturate the defects of internal resorption cavities in clinical practice

Analysis of the gutta-percha filled area in C-shapedmandibular molars obturated with a

modified MicroSeal technique

Aim: to analyse the gp filled area of c shaped molar teeth root filled with the modified microseal tchnique with reference to the radiographic features and c shape canal configuration

International Endodontic JournalVolume 42, Issue 3, pages 186–197, March 2009 PMID: 19228207 [PubMed - indexed for MEDLINE

Ordinola-Zapata , Bramante CM et alDepartment of Endodontics, Dental School of Bauru, University of São Paulo, Brazil.

23 ext. mand 2nd molars

merging

symmetrical

Asymmetrica

l

saline at 4 °CType 1

Type 2

Type 3

TYPES

Type I merging Type 2 symmetrical

Type 3 asymmetrical

shows a void Increment of the sealer area -in a more apical level

a complete C-shaped pulp chamber

middle third C1 configuration - good adaptation of the α and β gutta-percha in the distal and mesial canal

Radiograph of an obturated Merging type C-shaped molar

Proximal radiographic view of an obturated asymmetrical C-shaped molar

A complete C-shaped pulp chamber

Middle third section shows a good adaptation of the a and b gutta-percha in the distal canal and accessory points arevisible in the large isthmus

show an increment in the sealer area; observe the division of the distal canal

the good adaptation of the root canal filling in the mesio-lingual canal.

Gutta-percha is absent in the isthmuses - partially filled with sealer and debris

C1 canal configuration is evident in the apical section

An incomplete C-shaped pulp chamber

shows a C-shaped symmetrical type canal

C3 canal configuration -coronal section

C1 canal configuration

An incomplete C-shaped pulp chamber

communication between the middle and apical third

C2 large distal canal with an isolated mesio-lingual canal

gutta-percha is evident in the isthmus

• The percentage of area filled with gutta-percha was similar in the three radiographic types and canal configuration categories of C-shaped root canal systems of mandibular second molars;

• The percentage of the gutta-percha filled area was lower in the apical third.

• These results reflect the difficulty of achieving predictable filling of the root canal system when this anatomical variation exists.

Conclusion

First described by Wichterle and Linn (1960)

– For use as a biocompatible implant material Introduced as a root canal filling in 1978

– By Goldman and associates Rapid setting hydrophilic plastic material used as

sealer without core – first attempt at Primary Monoblock

Polymer of hydroxyethyl-methacrylate (poly HEMA)

Hydrophilic acrylic resin – Injected into canal to set in situ– Undergoes polymerization in aqueous envirnt

HYDRON (HYDRON TECHNOLOGIES, FL, USA)

Properties:– Self polymerizing– Rapid setting : 8-15 mins– Radiopaque – barium sulfate

DisadvantagesSealing ability questionableConcerns of tissue toxicity by the unset

materialAbsorption of the root filling material with

timeLack of homogeneityNot stiff enough to reinforce rootsClinical use – proved unsatisfactory

Hydron versus gutta-percha and sealer: A study of endodontic leakage using the scanning electron microscope and energy-

dispersive analysis*

Abstract :This in vitro study compared the apical sealing efficacy and permeability of Hydron with laterally condensed gutta-percha and Grossman's sealer.

James R. Murrin, DDS, MS ,Al Readex Dennis, F. Michael Beck, DDS, Journal of EndodonticsVolume 11, Issue 3 , Pages 101-109, March 1985

Result

• Hydron was found to be significantly more permeable to managanese ions than gutta-percha with Grossman's sealer.

CORE FILLING MATERIALS

Metal

SilverStainless steel files•Gold•Iridioplatinum•Tantalum•TitaniumAmalgam

Plastics

• GP• Hydron• Resilon

Pastes/ Cements:• N2 – Sargenti

technique

• Resorcinol – formaldehyde resin (Russian Red Cement)

• Calcium phosphate cement (CPC)

• MTA

N2 / SARGENTI PASTE

Ingle • The prominent endodontic textbook, Endodontics,

by John Side Ingle, Leif K. Bakland, states, "The Sargenti method has become a cult and, like most cults, is based more on testimonials than on facts.... [Dr.] Sargenti himself indicated a double standard of endodontic treatment when he publically stated 'If I had endodontic problems myself, and I wished to have an exact endodontic treatment, I would certainly ask Dr. Herbert Schilder to treat me'".  Dr. Schlider was an expert on endodontic treatment and did not use Sargenti Paste.

• Term coined by Angelo Sargenti

– To describe the “second nerve”– Coincided the color of the filling material

(red) to the color of the pulp• Formaldehyde containing zinc oxide – eugenol

paste• Introduced by Sargenti and Ritcher in 1954• Used as a core filling material - known as

‘Sargenti technique’• Also used as a sealer with core• American counterpart : RC2B

N2 / SARGENTI PASTE

Properties:

Very toxic

– Causes coagulations necrosis of tissues in less than 3 days• Tissues irreversibly

altered

– Irreversibly inhibits nerve tissue - paresthesia

– Loses substantial volume when exposed to fluid

Anaphylactic shock during endodontic treatment due to allergy to formaldehyde in a root canal sealant.

Abstract

A 41-yr-old patient experienced an anaphylactic shock reaction caused by formaldehyde in a root canal sealant during endodontic treatment. The clinical events, positive skin tests, and a high level of immunoglobin E to formalin RAST (class 4) suggest the involvement of immunoglobin E-dependent mechanisms toward formaldehyde. This very infrequent observation in endodontic therapy focuses attention on the different pathological manifestations related to formalin, their mechanisms, and the prevention possibilities in dentistry.

• PMID: 11199795 [PubMed - indexed for MEDLINE]

J Endod. 2000 Sep;26(9):529-31.Haïkel Y, Braun JJ, Zana H, Boukari A, de Blay F. Dental Faculty, University Louis Pasteur, Strasbourg, France.

Called as “Russian Red” cement Used primarily in Eastern Europe, Russia,

China Consists of

– Formaldehyde / alcohol - liquid– Resorcinol - powder– Sodium hydroxide – catalyst– Zinc oxide / barium sulfate – radiopacifier

(optional)

RESORCINOL – FORMALDEHYDE (RF) RESIN THERAPY

When 10% sodium hydroxide is added to the mixture, polymerization occurs

Forms a brick – hard red material that has no known solvent

Disadvantages– Retreatment is difficult– Contains 2 potentially toxic components

• Formaldehyde• Resorcinol

– Shrinks on setting– Resorcinol discolors tooth structure

• Introduced by W. E Brown and L. C Chow (1985) for complete canal obturation

• 2 calcium phosphate powders– Acidic – Dicalcium phosphate dihydrate /

anhydrous dicalcium phosphate– Basic – Tetracalcium phosphate

CALCIUM PHOSPHATE CEMENTS (CPC)

• When mixed with water sets into a hardened

mass - hydroxyapatite • Sets within 5 minutes

– By adding glycerin to mixture, setting time can be extended

– Can be extruded from a 19-gauge needle • Final set cement• Nearly all-crystalline

– As radiopaque as bone– Nearly insoluble in water, saliva and blood– Readily soluble in strong acids– Porosity in direct proportion to amount of solvent

(water) used• Excellent resistance to leakage – only 0.15mm dye

penetration

Disadvantages Of Paste Fills

– Toxicity

– Porosities in paste fills

– Most pastes resorb in time resulting in leakage, percolation and strong possibility of ultimate endodontic failure

– Antigenic chemical components – causing immunologic response

– Apical control difficult

• Introduced by Mahmoud Torabinejad in 1993

at Loma Linda University

• Composed of:

– 75% Portland cement – 20% Bismuth oxide– 5% gypsum

• Mainly used for obturation of apical third– Open apex cases

MINERAL TRIOXIDE AGGREGATE (MTA)

• Orthograde obturation with MTA as apexification material represents a contemporary version of the primary monoblock - attempt to reinforce immature tooth roots

Advantages– Excellent sealing ability

(dye/fluid/bacterial/endotoxin leakage studies)– Good marginal adaptation– Extremely biocompatible

• Least cytotoxic• Cemento conductive• Osteo inductive

Disadvantages:– Poor handling characteristics– Long setting time – 3hrs or more

1. Bondability:

Volumetric shrinkage of PC : 0.1% on setting– But MTA not bonded to

dentin – no shrinkage stresses at interface

• High bond strength of MTA (38-40 Mpa) in push-out bond strength tests despite no dentin bonding due to 2 reasons

JOE Vol 33(4) 2008)

MTA as Primary Monoblock:

2. Root Reinforcement ability:

• Portland cement modulus of elasticity: • 1700MPa at early set• increases to around 30,000 Mpa

after 14 days (in w:p ratio of 0.33)

– Theoretically – MTA can reinforce roots

• Fracture resistance of MTA treated immature sheep teeth tested

– no difference b/w saline & MTA groups

(Andreasen et al, Dent Traumatol 2006: 154-6)

• No benefit in root strengthening by MTA due to:

– Lack of dentin bonding– Low strength in tension

• Sealing ability of orthograde MTA root canal filling against human saliva

– Both gray & white MTA – more resistant to human saliva leakage than vertically condensed GP/sealer

(JOE 2005; vol 31, no 6)

– Lamb et al - Minimum 3mm thickness for adequate sealing

– Thickness of MTA barrier - no significant difference in microleakage (dye penetration)

ROOT CANAL SEALERS

Type I Materials: used with

core material

– Class 1 – powder and liquid that set through a non polymerizing process

– Class 2 – two pastes that set through a non polymerizing process

– Class 3 - polymer and resin systems that set through polymerization 

CLASSIFICATION

Type II Materials: with or without core material  

Class 1 - powder and liquid that set through a non polymerizing processClass 2 – 2 pastes that set through a non polymerizing processClass 3 – metal amalgams Class 4 - polymer & resin systems that set through polymerization

2. According to Composition by Messing:

A. Eugenol B. Non Eugenol C. Medicated

i. Silver containing

ii. Silver Free

•Rickert’s formula/ Kerr’s Sealer

•Procosol Radiopaque silver cement

•Procosol Non-staining cement

•Grossman’s sealer

•Tubliseal

•Wach’s paste

•Diaket•AH 26•AH Plus•Hydron•Chloropercha•Eucapercha•Nogenol•Endofil•Glass ionomer•Polycarboxylate•Calcium phosphate cements•Cyanoacrylates

•Diaket-A•N2•Endomethasone•SPAD•Iodoform paste•Riebler’s paste•Calcium hydroxide paste•Biocalex

Articles

99 teeth

Zinc oxide Eugenol sealer(fill canal)

Epoxy resin(AH-Plus).

Glass ionomer sealer(Ketac-Endo)

ResultAH plus showed less leakage than

other sealers

W.A.De Almeida M.R.Leonardo, Evaluation of apical sealing of three Endodontic sealers. IEJ 2000; 33:25-27.

In a study they compared the sealing ability of AH-26/silver free,a modified version of AH26,a resin based sealer was compared with tubliseal ,a zinc oxide eugenol based sealer using methylene blue dyepenetration method.

AH-26/silver free showed superior sealing ability.

Other study

Suprabha BS,Sudha P,Vidya M .A comparitive evaluation of sealing ability of root canal sealers. Indian J Dent Res.2002 Jan-Mar;13(1):31-6.

WHICH TECHNIQUE IS GOOD AND WITH WHICH SEALER IS GOOD??

EFFECT OF OBTURATION TECHNIQUE ON SEALER CEMENT THICKNESS AND

DENTINAL TUBULE PENETRATION

M. V. Weis, P. Parashos & H. H. Messer

School of Dental Science, University of Melbourne,AustraliaInternational Endodontic Journal, 37, 653–663, 2004

Abstract

Aim To compare the average sealer cement film thickness and the extent and pattern of sealer penetration into dentinal tubules in association with four obturation techniques in curved root canals.

CROSS-SECTIONS OF EACH OF THE FOUR-OBTURATION TECHNIQUES 3 MM FROM

WORKING LENGTH

Mean sealer thickness at the gutta-percha core and canal wall interface at the 1, 3 and 5 mm levels for each of thefour obturation techniques.

RESULTS• Thermafil demonstrated superior GP adaptation at all

levels with a mean overall sealer cement thickness , followed by lateral compaction , continuous wave and SimpliFill .

• SimpliFill also demonstrated the highest frequency of voids . Sealer cement penetrated dentinal tubules as far as the outer one-third of dentine, with greater penetration observed buccally or lingually.

• Penetration was not significantly affected by obturation technique, but on average was deeper and more frequent at the 3 and 5 mm levels than at the 1 mm level.

CONCLUSION

• Sealer thickness was strongly dependent on obturation technique. Assuming that minimal sealer thickness and fewer voids are good measures of long-term sealing ability, Thermafil resulted in the best outcome.

BEST ??

• It is quite possible that after 100 years, gutta-percha will suffer its demise as an endodontic filling material, as it did for golf balls. In its place we may well see modern chemical compounds as the obturating material of the future. Today, Resilon ,thermoplastic cones, soluble in chloroform but not in water. Pellets of Resilon may even be heated and expressed through an Obtura gun.

• In addition, the polyester points are sealed to place with a resin-based composite sealer, Epiphany or RealSeal.

• These sealers have the advantage of bonding chemically not only with the polyester cones but the dentin walls as well = monoblock that seals the canal and the tubuli.

Resilon – ephiphany system- striaght canals Thermoplastized techinique Curved or c or complex anotomy

CONCLUSION

Scope for further research and development remains ripe

Continuous efforts are being made to develop better sealer and core obturation materials & techniques but till date none of the materials & techniques have safely reached the highest biologic and technical level. There is no universally accepted ideal root canal filling material and technique.