techniques of root canal obturation
TRANSCRIPT
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D E E P T H I P . R .I I I Y E A R M D S
D E P T . O F C O N S S E R V A T I V E D E N T I S T R Y & E N D O D O N T I C S
TECHNIQUES OF OBTURATION
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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
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DIFFERENT TECHNIQUES
1. Cold Lateral Compaction2. Warm Compaction (warm GP)A. VerticalB. Lateral3. Continuous wave Compaction technique4. Thermoplasticized GP injection5. Carrier- based GPA. Thermafil thermoplasticizedB. SimpliFill sectional obturation6. McSpadden thermomechanical compaction7. Chemically plasticized GP8. Custom cone
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COLD LATERAL COMPACTION
• Most widely taught & practised• Sealer considerations• Spreader considerations• Master cone considerations• Radiographs
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TECHNIQUE
Isolation & drying the canals with
paper pointsSelection of master cone
Checking for apical “TUG
BACK”
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TECHNIQUE
Inadequate fit- beyond the apex• Tip cut off: reinserted primary cone fits snugly at the WL• Next larger size GP inserted & verified
Inadequate fit- short of the apex• Patency established to the corrected length• Another primary GP inserted & verified
At working length
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TECHNIQUE
• Sealer manipulation• Canal coated
• Master cone inserted till WL• Spreader inserted alongside: level 1mm short of the WL- 10 to 60
sec
• Spreader disengaged• Placement of sequential accessory cones by lateral compaction
Endodontic Topics 2005, 12, 2–24
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• Butt end of the GP: cut off with heated instrument• Warm vertical compaction: coronal GP• Chamber cleaned• Restoration placed
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COLD LATERAL COMPACTION
Advantages • “ Deep spreader
penetration”: minimize apical leakage/ percolation• Positive 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 2006Endodontic Topics 2005, 12, 2–24
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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
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STUDIES
• Bal et al. • Hembrough et al.• Wilson & Baumgartner• Better results with warm techniques: Collins et
al.• Da Silva et al.
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WARM VERTICAL COMPACTION
• Herbert Schilder• Berg • Heated pluggers• Objectives defined: preparation for obturation
with this technique• Indications
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TECHNIQUE
•
Primary non std. or greater taper
GP cone corresponding to
the last instrument
Canal coated with thin layer of RC
sealerPrimary GP cone inserted to WL
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TECHNIQUE
•
Coronal end of the cone – cut off
wih a heated instrument
“ Heat carrier”: plugger, electric
heat carriers: orced into the
coronal 3rd of GP
Coronal GP seared off by the plugger as it is
removed from the canal
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TECHNIQUE
Vertical pressure with condenser/
plugger of suitable size
Forces the plasticized
material apically
Alternate application of heat carrier &
condenser: 3D FIll
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WARM VERTICAL COMPACTION
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WARM VERTICAL COMPACTION
Pulp Canal Sealer, Kerr
Endodontic Topics 2005, 12, 2–24
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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• Overfiling with GP or
sealer that cannot be retrieved from periradicular tissues
• Difficult in curved canals
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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
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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
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CONTINUOUS WAVE COMPACTION TECHNIQUE
• Buchanan• Greater hydraulic forces• Tapered pluggers: System B
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CONTINUOUS WAVE COMPACTION TECHNIQUE
Master cone selected &
plugger prefitted: 5-
7mm from WL
System set in Touch mode:
200oC
Cold plugger initillay placed
against GP; firm pressure
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CONTINUOUS WAVE COMPACTION TECHNIQUE
Plugger rapidly moved: 1-2 sec within 3mm o binding point
Heat inactivated; firm
pressure maintained: 5-
10 sec
Cooled; 1 sec heat application
separates plugger
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ppdentistry.com
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ppdentistry.com
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ppdentistry.com
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CONTINUOUS WAVE COMPACTION TECHNIQUE
• Mean temperature change near CEJ: 4.1oC• Silver et al. Elevation > 10oC• Flore et al. temperature setting > 250oC-
hazardous
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THERMOPLASTIC INJECTION TECHNIQUES
• Harvard/ Forsythe Institute: 1977• Obtura III• Calamus• Elements• HotShot• Ultrafil 3D- 90oC• Obtura II- 160oC
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OBTURA III
• Hand-held gun• Ag needles• Control unit
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OBTURA III
Canal dried, coated with sealer
GP preheated: needle within 3-5 mm of apical prepaartion
Gradually & passively injected; compacted with pluggers dipped in alcohol
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OBTURA III
• Length control: Hybrid technique• Tani- Ishii et al.• Weller et al.• Jacobsen et al.
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CALAMUS
• Cartridge system : 20 & 23 G needles• Control of temperature• Flow rate• Pluggers• 360 degree activation switch
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ULTRAFIL- 3D
• GP cannulas• Heating unit• Injection syringe• 3 types of Cannulas: Regular set, Firm set &
Endoset
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ELEMENTS
• System B heat source & plugger• Extruder • 20, 23 , 25 gauge needles: GP• 20, 23 gauge: Real Seal
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HOTSHOT
• Cordless thermoplastic device• 150oC to 230o C• GP or Resilon• 20, 23, 25 gauge needles
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GUTTAFLOW
• Polydimethyl siloxane with finely ground GP• Capsules• WT: 15’; curing: 25- 30’
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CARRIER- BASED GP
• Thermafil• Profile GT obturators• GT Series X Obturators• ProTaper Universal Obturators• Successfil• SimpliFill• JS Quick-Fill
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THERMAFIL
• GP with a solid core• Metal core & coating of GP• Advantages• Disadvantages• Obturators: correspond to file systems• Sealer: required
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THERMAFIL
Canal dried; light coat of sealer applied.Carrier set to predetermined lengthdisinfected
Paced on heating deviceRetrieved & inserted into canal : 10 secRapid insertion: enhances obturation
Position verified radiographically2-4 minutes: coolingResection of carrier
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THERMAFIL
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THERMAFIL
• Advantage• Disadvantage • Pro Post drills• Retreatment• Plastic carriers- non toxic material
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SUCCESSFIL
• Associated with Ultrafil 3D• GP: syringe• Carrier inserted into syringe• Sealer coated on canal walls: carrier with GP
paced
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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.
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SIMPIFILL
• LightSpeed Instruments• Apical 5mm GP plug• Carrier: MAF• Seated & carrier removed• Lateral compaction/ thermoplastic
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JS QUICKFIL
• Alpha phase GP coated Ti cores• ISO: 15 to 60• Spun into the canal at low speed• Maybe left behind or removed
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THERMOMECHANICAL COMPACTION
• McSpadden compactor• H- file in reverse• Slow speed handpiece• Advantage• Disadvantages• Microseal condensers
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SOLVENT TECHNIQUES
• CHCl3 , Eucalyptol, xylol.• Disadvantages • Callahan- Johnson technique• 95% ethyl alcohol solution, chlorosin solution• Nygard- Ostby technnique
JOE — Volume 32, Number 4, April 2006
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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
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• 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
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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
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CONCLUSION
• Wide array of options and materials• Wisely chosen & applied depending on the clinical
situation
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Thank you!!