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Root Canal Obturation & Sealers Thilanka Umesh Sugathadasa

Obturation in endodontics

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Page 1: Obturation in endodontics

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Root Canal

Obturation &

Sealers

Thilanka Umesh Sugathadasa

Page 2: Obturation in endodontics

Thilanka Umesh Sugathadasa

Purpose of Obturation

1. To achieve total obliteration of the

root canal space so as to ingress of

bacteria & body fluids in to root

canal space as well as egress of

bacteria which are left in the

canal.

2. To attain fluid tight seal

3. To prevent recurrent infection

4. To seal the root canal space as

well as to have coronal seal for

long term success of root canal

therapy.

Timing of Obturation

1. Patient symptoms

-If patient present with

sensitivity on percussion, It

indicates inflammation in

periodontal ligament space, Canal

should not be obturated before

the inflammation has subsided.

Also in case of irreversible pulpitis

the obturation can be completed

in a single visit.

2. Pulp & periradicular status

- Teeth with vital pulp can be

obturated in same visit.

- Teeth with necrotic pulp may

be completed in as single visit if

tooth is asymptomatic.

- Presence of even a slight

purulent exudate may indicate

possibility of exacerbation.

Extent Of Obturation

Obturation should be done at the

level of the Dentinocemental

junction.

We should prevent overfilling &

overextension.

Overfilling – is complete

obturation of root canal system

with excess material extruding

beyond apical foramen.

Overextension – Is extrusion of

filling material beyond apical

foramen but the canal may not

have been filled completely.

Page 3: Obturation in endodontics

Thilanka Umesh Sugathadasa

Characteristics

1. Easily introduced in to the canal.

2. Seal the canal laterally & apically.

3. Dimensionally stable after being

inserted.

4. Impervious to moisture.

5. Bacteriostatic or at least should

not encourage bacterial growth.

6. Radio opaque.

7. Non staining

8. Non irritating

9. Nontoxic /Non allergic

10. Ability to sterilized easily

11. Remove easily from the canal if

required.

Materials

1. Plastics –

Gutta-percha

Resilon

2. Solid or metal cores –

Silver points

Gold

Stainless steel

Titanium

3. Cements & pastes -

Gutta flow

MTA

Hydron

Composition of commercially

available GP

Organic

Matrix(GP) - 20%

Filler(ZnO) - 66%

Inorganic

Radioopacifiers (Heavy metal

sulfates) - 11%

Plasticizers(Waxes or Resins)

- 3%

A- Resilon

B- Matching sealer

Page 4: Obturation in endodontics

Thilanka Umesh Sugathadasa

Different forms of GP

Alpha form

Pliable & tacky at 560C-640C

Available in form of bars or

pellets.

Used in thermo plasticized

obturation technique

Beta form

Rigid & solid 420C – 440C

Used to made GP points & Sticks.

Amorphous form

Exist in molten stage.

Phases of GP

These phases are interconvertible.

α – Runny , Tacky & sticky

β – Solid , Compactable &

Elongatable

γ – Unstable form

On heating GP expand, which means

increased volume of materials. Then GP

shrinks when it returns to the normal

temperature, So vertical pressure should

be applied in all warm GP technique to

compensate for the volume changes

during cooling.

Aging of GP causes brittleness

Because of the oxidation process. GP

cannot be heat sterilized. For

disinfection of GP points, They should be

immersed in 5.25% NaOCl for one

minute, Then GP points should be rinsed

in Hydrogen Peroxide or Ethyl alcohol,

The aim of rinsing is to remove

crystallized NaOCl before obscuration, as

these crystallized particles impair the

obscuration.

Cold lateral condensation

Thermoplastic condensation

GP should always be used with

sealers & cement to seal root canal

space as GP lacks adhering quality. GP is

soluble in solvent like chloroform.

Current Available Forms Of GP

1. GP points –Standards cones are

same size & shape as that of ISO

endodontic instruments.

Page 5: Obturation in endodontics

Thilanka Umesh Sugathadasa

2. Auxiliary points – Non

standardized cones

3. Greater taper GP points –

Available in 4%, 6%, 8%, 10%

tapers.

4. GP pellets / bars – They are used

in thermoplastisized GP

obturation system.(Obtura

system).

5. Precoated core carrier GP points –

Here using stainless steel,

Titanium or plastic carriers are

precoated with alpha phase GP for

use in canal (Thermafil).

6. Gutta flow – GP powder is

incorporated in to resin based

sealer.

7. Syringe system – Low viscosity GP

(α)

8. Medicated GP – Chlorhexidine

diacetate, Calcium hydroxide,

Iodoform containing GP

9. GP sealers like chloropercha – GP

is dissolved in chloroform.

Advantages

Compactability

Inertness (Non-reactive)

Dimensionally stable

Tissue tolerance

Radio opacity

Plasticity(become plastic when

heated)

Dissolve in some solvents

Disadvantages

Lack of rigidity(Difficult to use in

smaller canals tend to bend)

Easily displaced by pressure

Lacks adhesive quality

Medicated GP

Calcium hydroxide containing GP

Advantages

Ease of insertion & removal.

Minimal or no residue left.

Firm or easy insertion.

Disadvantages

Short-lived action.

Radiolucent.

Lack of sustained release.

Iodoform containing GP

Free iodine releasing & these

are showing antibacterial effects.

Chlorhexidine diacetate containing

GP

Page 6: Obturation in endodontics

Thilanka Umesh Sugathadasa

Obturation Technique

Can mainly divide

1. Use of cold GP

Lateral compaction technique

2. Use of chemically softened GP

Chloroform

Halothane

Eucalyptol

3. Use of heat softened

Vertical compaction technique

Lateral cold condensation

Armamentarium for Obturation

Primary or accessory GP

Spreaders & Pluggers

Absorbent paper points

Lentulospiral

Scissors for cutting GP

Endo guage for measuring length

of the GP

Endo block for measuring GP

points.

Endo Organizers to arranging the

GP & accessory points in various

sizes.

Heating device

Heating instrument

Lateral compaction technique

1. Select the master GP. One should

feel the tugback with master GP.

Master GP is notched at the

working distance analogous to the

level of incisal or occlusal edge

reference point.

2. Check the fit of cone

radiographycally.

- If found satisfactory, remove

the GP from the canal & place it in

the Sodium hypochlorite.

- If cone going beyond the

working length cut the GP or

select the larger no.

3. Select the spreader. It should

reach the 1-2mm of true working

length.

4. Dry the canal with paper points.

5. Apply sealers in the prepared root

canal.

Page 7: Obturation in endodontics

Thilanka Umesh Sugathadasa

6. Now premeasured cone is coated

with sealer & placed in to the

canal. Then do lateral compaction

using spreader.

7. After placement remove spreader

from the canal by rotating it back

& forth movement.

8. Accessory cone is placed & above

procedure is repeated. until the

spreader can no longer penetrate

beyond the cervical line.

Advantages

1. Can be used in most clinical

situation.

2. Decrease the chance of over

filling.

Disadvantages

1. May not fill the canal irregularities

efficiently.

2. Does not produce homogenous

mass.

3. Spaces may exist between

accessory & master cones.

False

tugback

Page 8: Obturation in endodontics

Thilanka Umesh Sugathadasa

Variation Of Lateral Compaction

Technique

For tubular canals.

1. Tubular canals are generally large

canals with parallel walls.

2. Since these canals don’t have

apical; constriction, The main

criterion of obturation is to seal

the apical foramen in order to

permit the compaction of

obturation materials

3. These cases can be obturated by

tailor made GP or with GP cone

Which has been made blunt by

cutting at tip.

For curved Canals

1. Canals with gradual curvature are

treated by same basic procedure

which includes the use of more

flexible(NiTi) spreader.

2. For these canals, Finger spreaders

are preferred over hand spreader.

3. For canals with severe curvatures

like bayonet shaped or dilacerated

canals, thermo plasticized GP

technique is preferred.

Blunderbuss/Immature Canals

1. Blunderbuss canals are

characterized by flared out apical

foramen. So a apical procedure

like apexification is required to

ensure apical closure.

2. For complete obturation of such

canals, tailor made GP or warm GP

technique are preferred.

Chemical Alterations of GP

GP is soluble in Chloroform,

Eucalyptol,etc

This property of GP is used to adapt it in

various canal shapes.

Teeth with blunderbuss canals

Root ends with resorptive defects

Teeth with internal resorption.

So in these cases following methods are

using.

Root canal cleaned & shaped

properly.

The cone is held with the plier &

adjusted to the working length.

The apical 2-3mm of cone is

dipped for a period of 3-5s dish

containing solvents.

Page 9: Obturation in endodontics

Thilanka Umesh Sugathadasa

Softened cone inserted in the

canal with slight apical pressure

until the beaks of plier touches

the reference point.

Here take care to keep the canal

moistened with irrigation,

Otherwise some of softened GP

may stick to the desired canal

walls, Though this detached

segments can be easily removed

by using H-files.

Radiograph is taken to verify the

fit & correct working length. Then

irrigate with 99% Isopropyl

Alcohol to remove residual

solvents.

After this canal is coated by sealer,

cone is dipped again in the solvent

2-3s then inserted in to the canal

with continuous apical pressure

until the plier touches the

reference point.

Use finger spreader

Accessory GP points are then

placed.

Page 10: Obturation in endodontics

Thilanka Umesh Sugathadasa

Vertical compaction technique

Here we use heated pluggers, pressure is

applied in vertical direction to heat

softened GP which causes it to flow and

fill the canal space.

Requirements

Continuous tapering funnel shape

from orifice to apex.

Apical opening kept as small as

possible.

Decreasing the cross sectional

diameter every point apically.

Advantages

Excellent sealing of canal apically,

Lateral & obturation of lateral as

well as accessory canals.

Disadvantages

Increased risk of vertical root

fracture.

Overfilling of canal with GP or

sealer from apex.

Time consuming.

Page 11: Obturation in endodontics

Thilanka Umesh Sugathadasa

Root canal Sealers

The purpose of sealing root canal is

to prevent periapical exudates from

diffusing in to unfilled parts of the canal,

to avoid reentry of colonization of

bacteria & to check residual bacteria

from reaching the periapical tissues.

Therefor to accomplish the fluid

tight seal, root canal sealer is needed.

Basic Functions

It lubricates & aids the seating of

the master GP cone

Act as binding agent between GP

& the canal wall

Fill the anatomical spaces where

the primary filling material fails to

reach.

As antimicrobial agent

Fill the discrepancy between the

material & Dentin wall.

Giving Radiopacity.

As canal obturation material.

As lubricants.

As binding agent

Requirements

1. It should be tacky when mixed so

as to provide good adhesion

between it & the canal wall when

set.

2. Should create hermetic seal.

3. Radiopaque

4. Should not shrink when set.

5. Ability to mix easily.

6. Should not stain the tooth.

7. Bacteriostatic

8. Set slowly

9. Good biocompatibility.

10. Nontoxic/ Non allergic

11. Insoluble in tissue fluids.

12. Should be soluble in common

solvents.

Page 12: Obturation in endodontics

Thilanka Umesh Sugathadasa

Classification

According to composition

Eugenol

Silver containing

- Kerr sealer

- Procosol radiopaque silver

cement.

Silver free

-procosol nonstaining cement

-Tubliseal

-Grossman’s sealer

-Wach’s paste

Non Eugenol

Diaket

AH-26

Chloropercha & Eucapercha

Nogenol

Calcium Phosphate

Polycarboxylate

Endofill

Hydron

Medicated

Diaket-A

N2

Endomethazone

SPAD

Iodoform paste

Ca(OH)2 cement

According to Grossman

ZnO resin cements

Ca(OH)2 cements

Paraformaldehyde cements

Pastes

According to Clark

Absorbable

Non Absorbable

According to Ingle

Cements

Pastes

Plastics

Experimental sealers

Root canal sealer also may be divided in

to

Zinc oxide-eugenol based

Resin-based

Dentin adhesive materials(GI)

Calcium hydroxide

Combination

Page 13: Obturation in endodontics

Thilanka Umesh Sugathadasa

ZnO Eugenol Sealers

1. Kerr Root canal Sealer

Composition

Powder

ZnO

Precipitated silver

Oleo resin

Thymol iodide

Liquid

Oil of cloves

Canada balsam

Advantages

Excellent lubricating

properties.

It allows a working time of

more than 30 minutes,

When mixed in 1:1 ratio.

Germicidal

Biocompatibility.

Disadvantages

Silver makes the sealer

extremely staining if any

material enters the dentinal

tubules.

2. Tubiseal

Slight modification has been made

in Rickert’s formula to eliminate

the staining properly. It has

marketed as 2 paste system

containing base & catalyst.

Advantages

Easy to mix.

Extremely lubricated.

Does not stain the tooth

structure.

Expands after setting.

Disadvantages

Irritant to the periapical

tissues.

Very low viscosity makes

extrusion through apical

foramen.

Short working time.

Page 14: Obturation in endodontics

Thilanka Umesh Sugathadasa

3. Calcium Hydroxide Sealer

The pure Calcium

hydroxide powder can be used

alone or It can be mixed with

normal saline solution. The

alkalinity of the Calcium hydroxide

stimulates the formation of

mineralized tissues.

Advantages

Induce mineralization.

Induce apical closure via

cementogenesis.

Inhibit root resorption

subsequent to trauma.

Inhibit Osteoclast activity via

an Alkaline pH.

Seal or prevent leakage as

good as or better than ZnO

sealers.

Less toxicity than ZnO sealers.

Disadvantages

Calcium hydroxide contents

may dissolve, leave the voids.

No proof having about

which it having any added

advantages.

Although It’s having dentin

regenerating ability. Without vital

pulp it’s not possible.

Page 15: Obturation in endodontics

Thilanka Umesh Sugathadasa