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‘Discuss and evaluate the different techniques for obturation of the prepared root canal’.

‘Discuss and evaluate the different techniques for obturation of the prepared root canal’.

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In reviewing the appropriate literature, I include a brief description of the materials used as obturating materials.
I provide a description of the techniques used historically, at present and those being developed. Also include evaluations of these various techniques as seen in many studies and a comparison of the various techniques.
In reviewing the appropriate literature, I include a brief description of the materials used as obturating materials.
I provide a description of the techniques used historically, at present and those being developed. Also include evaluations of these various techniques as seen in many studies and a comparison of the various techniques.

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Published by: Undergraduate Awards on Sep 01, 2012
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05/13/2014

 
‘Discuss and evaluate thedifferent techniques for obturation of the prepared root canal’.
Marian Cottrell
IRISH ENDODONTIC SOCIETYESSAY COMPETITION.
 
The aim of this literary review is to discuss the various techniques used both, historicallyand at present to obturate a prepared root canal. The purpose of obturation is to place a biocompatible, inert filling material in the space previously occupied by pulp tissue, (Wesselink,1990). The key to successful obturation is to obtain a complete seal, both apically and coronallyso as to prevent the possibility of microleakage, which adversely affects the success of root canaltherapy
1
. Microleakage, in the root canal is the movement of periradicular fluids,microorganisms and their toxins along the interface of the root filling material and the dentinalwall. It has been suggested that 60% of endodontic failure is due to incomplete obturation, (Ingleand Bakland, 1994). Therefore the development and modification of obturation techniques has been the focus of many studies over the years.In reviewing the appropriate literature, I will
Include a brief description of the materials used as obturating materials.
Include a description of the techniques used historically, at present and those being developed.
Include evaluations of these various techniques as seen in many studies.
Include a comparison of the various techniques.
Include details of new obturating techniques and materialsHistorically materials such as silver points, plastic points, amalgam, and titanium wereused as obturating materials
2
. Silver points were found to be biocompatible and provided goodapical seal. Both silver and titanium points can be placed using the ‘
Sectional Technique’ 
. A point of adequate size is seated to the correct working length. It is removed and the apical 3-5mmis then half sectioned with a disc or bur. The point is then coated in sealer and inserted using firmapical pressure. The shank is rotated and withdrawn leaving the sectioned tip in position. The
 Messing Technique
2
, is a modification of this involving tips that screw into the shank. The tip,which is coated in sealer, is held in place by tug-back and then the handle rotated in an anti-clockwise direction to unscrew the tip. The latter technique was proven to be better due to thefact that points in the ‘Sectional Technique’ tend to break or tend to be placed in the wrong position. Modern materials have replaced obturation using silver points. This is partly due to thefact that silver can corrode causing toxicity and also don’t fit very well as they can’t becompressed to suit the canal shape.Amalgam was well tolerated as an obturating material, non-absorbable and capable of forming a good seal
2
. It was used to obturate canals and in a surgical procedure as a root-endfilling material. Amalgam is carried to the size 55, 60 or 80 canal using a Dimashkieh carrier,which is loaded by pressing the tip into freshly mixed amalgam
2
. The working length is markedon the shank of the carrier. It is inserted to the full working length and then withdrawn 1mm.Depressing the head of the handle ejects the amalgam. The carrier is withdrawn and the amalgamcondensed using the matching condenser. Several increments are required to fill the apical 3mm.The disadvantages of amalgam techniques include the need for large amounts of canal preparation and the fact that it is almost impossible to remove
3
. It is therefore rarely if at all used presently.Gutta-percha is the most commonly used filling material and has been dentally acceptedfor more than 100 years
4
. It originates from trees and is a trans isomer of poly-isoprene. It existsin many phases with the
β−
 phase being the unheated, solid, compactable phase. The
α
-phase iswhen GP reaches 42
°
-49
°
and is soft, sticky and non-compactable. The
γ 
-phase has similar phasesto this and exists when GP reaches 52
°
-62
°
4
. GP in its
β
-phase is favoured as an obturationmaterial as it is inert, dimensionally stable, tissue tolerant, compressible, radiopaque, can plasticise with heat and has known solvents
5
. Many techniques have been developed over theyears in order to obtain adequate obturation using GP.2
 
 Lateral Condensation
5
is the most widely taught technique and is the standard againstwhich other techniques are compared (Ingle & Bakland 2002). A master cone of same size asthe master apical file is selected and seated into the dry canal to ensure correct length is obtained.A suitable sealer is applied using a reamer to the correct working length. The master cone is thencoated in sealer and placed apically into the canal using a pliers. Once correctly seated a finger spreader of same size as the master GP is inserted alongside the master cone and apical pressureapplied. Ideally the spreader should reach to within 1-2mm of the master cone. The spreader isleft for a few seconds and then rotated counter-clockwise out of the canal. The accessory conesare also dipped in sealer and placed in the space vacated by the spreader. The spreader not onlyfunctions to make space but it also pushes the other GP points laterally into the irregularities of the canal. The process continues with the spreader having shallower penetrations each time.Once the GP points won‘t penetrate more than 1/3 of the canal the procedure stops. The GP issevered at the level of the canal orifice and vertically condensed into the canal. A radiograph istaken to evaluate the quality of the canal at this stage.Marshell and Massler state that this technique gives GP the best apical seal and it remainsthe most popular filling technique for the Diplomates of the American Board of Endodontics.Sakkal et al.
6
has shown that it is the lateral condensation that creates a 3-D mass, whichincreases its sealing ability. Schilder has voiced opposition to this technique saying it doesn’t produce a dense mass of GP but leaves individual cones suspended in cement
5
. No study as yethas disproved this theory.Schilder in 1967 described the
Vertical Condensation Technique
7
. It involved obturationusing plasticised GP to allow for better adaptation to the canal walls and better homogenicity.The technique involves choosing a master cone, which is wider than the MAF. Sealer is placed inthe canal and the cone is placed. The cone will seat a few mm short of the apex. Severing of thecoronal section is carried out and a heated spreader is applied in an apical direction to heat thecone. A cold plugger is used to vertically condense the GP as it returns to its
β
-phase. Repeat of the heating and condensing steps forces the GP into voids and irregularities it wouldn’t havefilled in its original state. When the apical section is completed more GP is introduced insections, which are heated and condensed until the remainder of the canal is filled. Thistechnique is indicated especially when the master GP cone can’t fill the apical portion. For example, when there is ledge formation during preparation, unusual curvature, internal resorptionor large lateral canals. It can also be used to correct voids formed during lateral condensation byremoving the coronal portion and repacking the canal.Modifications to Schilder's technique have been developed
8
. These include the '
Touch 'n Heat 
' system, which involves using a heated spreader during obturation. There is limited researchon this technique. A second technique, the '
System B/ Continuous Wave Technique
' has also beendeveloped
9
. This involves seating the Master GP cone to the correct working length and thensearing the excess off at the orifice level. An electrically heated plugger is then inserted into theGP with gentle apical movement to a point of 5-7mm short of the working length. The activityspring of the plugger is then released, allowing the GP to cool while keeping light pressure onthe GP for 10sec. The plugger is then removed leaving an apical mass of GP. The rest of thecanal is back-filled using a conventional vertical condensation technique or by an injectable GPsystem.Studies have been done to compare these modified techniques
7, 8
. System B proved to produce more voids at 2,3,4 and 5mm from the apex. It was found that using a sealer decreasedthe number of voids produced and allows 'System B' to be an acceptable method, however thereis still a chance of apical failure. The time taken to obturate using the 'Touch 'n Heat' system was~7.5min longer than the quicker 'System B' method (~1.05min). It is generally accepted that a10°C elevation in temperature at the root surface can irreversibly damage the periodontium,(Hardie, 1986. Gutmann et al, 1987. Saunders, 1990. Weller et al, 1995). Current findings
7
suggest that 'Heat 'n Touch' produces >10°C increase. This along with the increased time createsthe potential for damage to the periodontium and therefore contraindicates the use of 'Heat nTouch'. 'System B' doesn't produce such an increase3

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