Removal of Obturation Materials

Removal of Obturation MaterialsMohamed Ali AlazragBDS.MscTripoli Medical center .Libya

Obturation Materials GuttaperchaSolid core obturators.PasteResilonSilver points.

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Removal of Guttapercha

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it is depend on the quality of obturation :

Single cone GP

Condensed GP

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Removal of Single cone GP

H file

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Removal of Single cone GP

H file

Ultrasonic files

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Over extended GP

Removal of Condensed GPRemoval of gutta percha manually

Removal of gutta percha using rotary system

Removal of gutta percha using LASER

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Removal of gutta percha manually:

Probing of the orifice

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Removal of gutta percha manually:Probing of the orifice

Heating endodontic carrier (to remove the coronal part) avoid over heat.

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Touchn, heat device

e.g. the heat should be applied in a short burst to allow the instrument to penetrate the gutta-percha mass, followed by cooling, which will cause the material to adhere to the heat carrier facilitating its removal11

System B

Removal of gutta percha manually:Probing of the orificeHeating endodontic carrier (to remove the coronal part) avoid over heat.

Using small Gates gliding drills. (to remove any remaining coronal material)

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Removal of gutta percha manually:Probing of the orificeHeating endodontic carrier (to remove the coronal part) avoid over heat.

Using small Gates gliding drills. (to remove any remaining coronal material)

Using gutta percha solvents (to remove the remaining material in the apica part of the canal).

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Exposure of dental personnel to chloroform in root-filling procedures.Allard U, Andersson , Endod Dent Traumatol 8:155, 1992.

Chloroform in the endodontic operatory.McDonald MN, Vire DE, J Endod 18:301, 1992.

Risk assessment of the toxicity of solvents of gutta-percha used in endodontic retreatment.Chutich MJ et al , J Endod 24:213, 1998.

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Removal of gutta percha manually:Probing of the orificeHeating endodontic carrier (to remove the coronal part) avoid over heat.Using small Gates gliding drills. (to remove any remaining coronal material)Using gutta percha solvents (to remove the remaining material in the apica part of the canal).

Small hand files (#15 C+ file to penetrate the remaing root filling and enhance it is dissolution by solvent).

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Removal of gutta percha manually:Probing of the orificeHeating endodontic carrier (to remove the coronal part) avoid over heat.Using small Gates gliding drills. (to remove any remaining coronal material)Using gutta percha solvents (to remove the remaining material in the apica part of the canal).Small hand files (#15 C+ file to penetrate the remaing root filling and enhance it is dissolution by solvent).

Radiographic assessment.

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An in vivo comparison of two frequency-based electronic apex locators.Welk AR, Baumgartner JC, Marshall JG, J Endod 29:497, 2003.

Accuracy of two root canal length measurement devices integrated into rotary endodontic motors when removing gutta-percha from root-filled teeth.Uzun O, Topuz O, Tinaz C, et al, Int Endod J 41:725, 2008.

It has been shown that apex locators may be less accurate in retreatment situations however: in this study the error was that readings indicated a working length that was too short. In a more recent study, an apex locator built into a rotary handpiece indicated working lengths that were too long in simulated retreatment situations.21

Removal of gutta percha using rotary system:

Protaper Universal Retreatment files (DentSply)

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Mtwo R (VDW)

With active cutting tip used with 300rpm 1.2ncm24

GPR (MANI, JAPAN)

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D-RaCe (FKG)

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Recioroc (VDW)

This novel niti reciproc file created by Dr.Gassn yard. It is made from M-Wire that offers greater flexibility and resistance to cyclic fatigue than traditional nickel titanium files.

This novel niti reciproc file created by Gassn yard it is cut in counter clock wise M-Wire has both greater resistance to cyclic fatigue Recipro system Size 40 6% ( apex 3mm) Size 50 5% ( apex 3mm)28

Reciprocation

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Removal of Gutta percha using Laser

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Removal of gutta-percha from root canals using an Nd:YAG laser. ( In vitro study )

Viducic D, Jukic S, Karlovic Z, et al; Int Endod J, 2003.

N.B: Further investigation required to proving safety and efficacy of laser during gutta-percha removal .

He examine the use of Nd:YAG laser in removing guttapercha as root canal filling without solvent and with solvent eucalyptol,DMF dimethylformamide as solvents The time taken to remove the gutta-percha was within the range of other studies of mechanical gutta-percha removal. also addition of solvents did not improve the performance of the laser. As in most other studies, varying amounts of gutta-percha, was left in the canals after laser removal.The Root surface temperatures did increase, However, further investigation required to proving safety and efficacy, laser during gutta-percha removal .

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Remove solid core obturators

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With the increased use of carrier-based systems such as Thermafill we should understand how to retreat carriers, and we must be aware of the different types of carriersThree Types of solid carriers are found on these system:The first generation: Metal (Stainless steel or titanium) core and a coating of guttapercha

The second generation: Plastic core coated with alpha form of guttapercha e.g. Thermafill (Dentsplay)

The last generation: Modified GP core (cross linked guttapercha ) rather than plastic core e.g. GuttaCore (Dentsply).So these nonsoluble solid cores can be difficult to remove during retreatment of obturated root canal.

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Thermafill plus with vent N.B: Obturator with groove for better backflow and retreatment.

A solvent (chloroform) can be used to soften the gutta-percha in order to facilitate the penetration by the nickel titanium instrument along the carrier. The rotation speed of the NiTi instruments should be 600 to 800 revolutions/minute.36

GuttaCore (Dentsply) Modified GP core (cross linked guttapercha )

The last generation: Modified GP core (cross linked guttapercha ) rather than plastic core e.g. GuttaCore (Dentsply). The cross-linking connects the polymer chains, which changes the material and gives the carrier different properties than the plastic carriers. The gutta-percha surrounding the carrier is alpha-phase gutta-percha, which is identical to that which encompasses the plastic carrier based systems.

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Techniques for removal of metal core obturators:

1st Heat application to the carrier to soft GP surrounding it to facilitate its removal with with plier or Steiglitzforceps.

Endodontic retreatment of Thermafil versus laterally condensed gutta-percha. Wilcox LR,Juhlin JJ. J Endod.1994

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2nd : Use of solvent and removal of surrounding GP with small hand instrument ,followed by ultrasonic toughing around the carrier and remove it like separated instrument.

Problem solving in endodontics. Prevention, identification, and management.Editors: Gutmann JL, Dumsha TC, Lovdahl PE, Hovland EJ, ed 3, St. Louis, 1997, Mosby.

Often there is not enough of carrier remaining in the access to grasp with forceps

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Techniques for removal of plastic core obturators:

1st technique: Use of solvent and Hand files to remove the GP surrounding the carrier then a large Hedstrom file used to remove the carrier.

Removal of Thermafil root canal filling material.Bertrand MF, Pellegrino JC, Rocca JP ; J Endod 1997

Removal of plastic carriers is similar to removal of guttapercha root fillings,

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2nd technique: The manufacture recommended the Use of rotary System e.g. Profile 0.04 taper

Efficiency of the 0.04 taper ProFile during the re-treatment of gutta-percha-filled root canals. Baratto Filho F, Ferreira EL, Fariniuk LF, Int Endod J, 2002.

It has been suggested by the manufacturer of Thermafil that a 0.04 taper ProFile, which corresponds to the size of the carrier, should be used at 1500rpm to facilitate removal. It is inserted alongside the carrier until resistance is met. The theory is that the heat generated by friction will soften the gutta-percha and allow the instrument to advance into the root filling.

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Efficacy of Reciprocand ProfileInstruments in the Removal of Gutta-Percha from Straight and Curved Root Canalsex Vivo.Journal of Oral & Maxillofacial Research. Marfisi K et al. (Sep) 2015

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R25 Reciproc file

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3rd technique: Using of System B heat source

Thermafil retreatment using a new System B technique or a solvent. Wolcott JF, Himel VT, Hicks ML, J Endod ,1999.

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Removal of Modified GP core carrier. (GuttaCore,DentSply) Rotary System e.g. Protaper universal Retreatment system

Time required to remove GuttaCore, Thermafil Plus, and Thermoplasticized gutta-percha from moderately curved root canals with ProTaper files. Beasley RT et al ; J Endod 2013

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Protaper universal Retreatment system

Paste removal

Various types of paste have been used as a root canal obturation materials they are used for many years but due to paste toxicity and poor quality of filling it is not used now in modern endodontics.

In the early 1950s, a Swiss dentist named Angelo Sargenti began filling roots with a paste that contained paraformaldehyde. Over the years, the formula's name and ingredients have changed many times, but paraformaldehyde has always been included. The names used have included "Sargenti Paste," "N2,.53

Removal of Non sitting or Soft pasteSolventHand or rotary instrument (copious Naocl irrigation ).Ultrasonically activated and irrigated files.

Problem solving in endodontics. Prevention, identification, and management.Editors: Gutmann JL, Lovdahl PE, ed 5, ELSEVIER, 2011 Mosby.

Easy to remove 54

Hard Sitting Paste

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Resorcinol-formaldehyde resin Russian Red endodontic therapy. Schwandt NW, Gound TG. J Endod 2003

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Removal of Hard sitting pastes:Burs , Ultrasonic tips ( accessible straight portion of the canal )Precurved small hand files (apical area)Use of Solvent (Endosolve R, Septodent )

The effect of endodontic solutions on resorcinol-formalin paste in teeth. Gambrel MG et al; J Endod 2005.

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(Endosolve R, Septodent )

Removal of ResiloneResilon system compsed of :Primer (self etching)Resilon sealer Riselon core material

The removal of Resilon root filling is normally attempted in a manner similar to the removal of condensed gutta-percha with heat, solvent and mechanichal instrumentation.

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The complete removal of Resilon may be challenging since the resin sealer can penetrate into the dentinal tubules. This is why Guttapercha still the 1st choice for filling of root canals.

Removal of Silver Point

It is apart of history, it has been used in the past because of their ease of handling and placement. Not used now days as it corrode with time ,loss of the apical seal and the the corrosion products are toxic and irritate to apical tissue.

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1st technique :is to establish a proper access.Carefully remove core material around the sliver cone by use of ultrasonicSolvent to dissolve the sealer around the coneGrasp the exposed end of the silver point with plier.

pliers66

2nd technique : The Hedstrom file technique:The sealer around the silver cone is dissolved by use of solvent.Small file are negotiated as far apically as possibly in two to three areas around the silver point.The spaces surrounding the silver point are carefully instrumented to size 15, and then small Hedstrom files are gently screwed in as far as possible apically.The files then twisted together and pulled out through the access.

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The Hedstrom file technique

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3rd technique: Use Instrument removal kits

Thank You

ReferencesCohens Pathway of the pulp 11th editionEndodontic Principles and Practice 4th Edition Problem solving in endodontics. Prevention, identification, and management. Editors: Gutmann JL, Lovdahl PE, ed 5, ELSEVIER, 2011,Mosby.Removal of root filling materials." Duncan, Henry Fergus, and BUN SAN CHONG. ,Endodontic topics 19 (2011): 33-57.

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