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

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

American Association Of Endodontists (AAE), 1994

OBJECTIVES OF ENDODONTIC OBTURATION
• 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. •

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

( Ingle & Bakland, 5 th 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

IDEAL REQUIREMENTS OF ROOT CANAL FILLING MATERIALS

Grossman’s Criteria (1940)

vEasily introduced vRadiopaque vSeal laterally as well as vNot stain tooth vNot irritate apically vNot shrink after being periradicular tissue vSterile or inserted sterilizable vImpervious to moisture vEasily removed vBacteriostatic

CLASSIFICATION

According to Grossman
OBTURATING MATERIALS

Core materials
vMetals vPlastics vPastes/ Cements

sealers
vPlastics vCements vPastes

ANSI/ ADA CLASSIFICATION:
ANSI/ADA Specification No.78 (ISO No. 6877) ANSI/ADA Specification No.57 (ISO No. 6876) Sealing materials

Endodontic obturation points

vType I : Core standardized points to be used with sealer & cement vType II : Auxiliary (conventional or accessory points) of non standardized taper

CORE FILLING MATERIALS vMetal Silver Stainless steel files Gold Iridiopla tinum Tantalu m Titanium Amalga m

vPlastics

vPastes/ Cements: N2 – Sargenti GP technique Hydr Resorcinol – on Resil formaldehyde on resin (Russian Red Cement) Calcium phosphate cement (CPC) MTA
             

SILVER POINTS
Ø Introduced by Jasper in 1933 Ø Pure silver molded in a conical shape – same diameter & taper as files & reamers
Ø Advantages vStiffer than gutta-percha vEasier to insert in very  narrow/ fine tortuous canals

Ø Disadvantages
vPoor lateral seal.

Ø

Corrosion of silver cones due to:  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 irrigants Zielke 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 FV Corrosion 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.

STAINLESS STEEL FILES
Ø Introduced by Sampeck in 1961 Ø Used to fill ØFine, tortuous canals ØHeavily calcified dilacerated narrow canals Ø Used instead of silver cones Ø Involved cementing one file & cutting off handle with a high-speed hand piece, 34mm below occlusal surface

Ø Advantages
  

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

Ø 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 vMetal Silver Stainless steel files Gold Iridiopla tinum Tantalu m Titanium Amalga m

vPlastics

vPastes/ Cements: N2 – Sargenti GP technique Hydr Resorcinol – on Resil formaldehyde on 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
 

THERMOMECHANICAL COMPACTIBLE GP: • GP plasticized by frictional heat in root canal • McSpadden Compactor
– Used with regular β phase GP cones – H-file design (pushes GP apically) – –

• 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 vMc Spadden compactor vGutta Condenser vEngine Plugger USE Beta phase GP cone + Stainless steel compactors Microseal system
Alpha phase GP cone + Microseal condenser coated with alpha phase GP

Precoated Compactors Multi – phase technique
Beta phase GP cone + NT Condenser coated with alpha phase gutta percha

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

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 lowtemperature thermoplasticized guttapercha 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 lowtemperature 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

• 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

• • 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.

CONCLUSION OF THE STUDY

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 guttapercha 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

• Retreatment of these cases required removal of the carrier prior to re-cleaning and repacking of the canal. • Surgical treatment of these cases was more difficult than normal due to complications caused by metal carriers.

SCHEMATIC ILLUSTRATION SHOWING HEROFILL TECHNIQUE STEPS:

SEM observation : 1/CERVICAL THIRD

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

Fig. 2: No space between gutta-percha and dentin wall

1: Carrier system 2: Gutta-percha 3: Sealer 4: Dentin wall

2/MIDDLE THIRD

Fig. 3: Penetration of sealer inside surface dentin; better seal

Fig. 4: Interface dentin/obturator HEROfill™: good adaptation

1: Carrier system 2: Gutta-percha 3: Sealer 4: Dentin wall

3/APICAL THIRD

Fig. 5: Acceptable marginal adaptation

Fig. 6: Acceptable fitting at dentin wall

1: Carrier system 2: Gutta-percha 3: Sealer 4: 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

HYBRID OBTURATION TECHNIQUES (COMBINATION OF THERMO- AND NONTHERMOPLASTICIZED)
• Lateral compaction and Obtura II® • Continuous wave of condensation

• A technique combining thermoplastic and nonthermoplastic 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 thermoplasticizedGP system. The “hot glue gun” approach keeps GP molten for injection. • Prefit proper applicator tip near the junction of the coronal and middle thirds Prefit 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-perchafilled area in simulated curved canals when filled using Endo Twinn, a new heat device source

G.PAGABINO,L GIACHETTI etal INTERNATIONAL ENDODONTIC JOURNAL , VOL 39 ISSUE 8 Pgs 610615.Aug 2006,

1

2

1)Stainless steel 2)Ultrasonics 3)NiTi 4)Cutting spoon tips.

4

3

   

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 •

MEDICATED GP:  Iodoform Containing GP • Calcium Hydroxide Containing 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

COATED GUTTA PERCHA

EndoRez Points (Ultradent Products, South Jordan,
UT)

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

– – – –

• 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

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

ActiV GP Plus cones come with a handle and depth ActiV GP Precision Obturation System. markings to expedite 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
Pawińska M1*, Kierklo A2, Marczuk-Kolada G3
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

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. Resilon can be placed as single cones, warm vertical compaction thermoplastic injection, or lateral compaction.
Advances in Medical Sciences · Vol. 51 · 2006 · Suppl. 1 ·

Resilon cones

#35, 0.04 tapered cone bent to show the flexibility of the 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
Endodontically treated 48 root canals(24teeth)

Aged 14-55,

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

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

Immediately after the treatment

One year 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 dentine tubules (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 microgaph formation with AH 26 epoxy sealer due to polymerization shrinkage. (ES - epoxy sealer; D dentin)

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

A Fluid Filtration Comparison of GuttaPercha versus Resilon, a New Soft Resin Endodontic Obturation System
Ryan K. StrattonMichael J. Apicella, DDSPete Mines, DDS Journal of Endodontics Volume 32, Issue 7 , Pages 642-645, July 2006

 

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.

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

DsC

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

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 Three Techniques 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


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

cess was sealed with casting wax and the entire root surface was 49 teeth

System B technique Negativetaper standardised gu with 0.06 control .

ed for 10 days in a humid chamber at 37°C to allow for c

4System B technique with non-standardised MF gu teeth Experimental control group

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

cold lateral condensation technique using standardised 0.02 tap

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 resorption cavities 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.

Materials and methods

24,extracted max CI

Results
Radiographic evaluation of quality of obturation of simulated internal resorptive cavities
Groups Samples Total obturation Partial obturation

1 2 3 4

6 6 6 6

2 6 3 6

4 0 3 0

Table II : Stereomicroscopic evaluation of nature of predominant filling material in the simulated internal resorption cavities.
GROUP-1 Type3 1(sealer) Type-2 (GP) 1 Type-3 2 (sealer+Gp) Group-2 0 5 1 Group-3 2 1 3 Group-4 0 5 1

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 Cshapedmandibular molars obturated with a modified MicroSeal technique
Ordinola-Zapata , Bramante CM et al Department of Endodontics, Dental School of Bauru, University of São Paulo, Brazil.

 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 Journal Volume 42, Issue 3, pages 186–197, March 2009  PMID: 19228207 [PubMed - indexed for MEDLINE

Type 3  Type  2  Type 1 

saline at 4 °C

TYPES

Type I merging

Type 2 Type 3 asymmetrical symmetrical

Radiograph of an obturated Merging type C-shaped molar

a complete C-shaped pulp chamber

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

shows a void

Increment of the sealer area -in a more apical

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 are visible 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.

shows a C-shaped symmetrical type canal An incomplete C-shaped pulp chamber

C3 canal configuration -coronal sec

C1 canal configuration is evident in the apical Gutta-percha is absent in the isthmuses partially filled with sealer and debris section

communication between the middle and apical third An incomplete C-shaped pulp chamber C2 large distal canal with an isolated mesio-lingual canal

C1 canal configuration

gutta-percha is evident in the isthmus

Conclusion
• The percentage of area filled with guttapercha 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.

HYDRON

(HYDRON TECHNOLOGIES, FL, USA)

Ø First described by Wichterle and Linn (1960) – For use as a biocompatible implant material Ø Introduced as a root canal filling in 1978 – By Goldman and associates Ø Rapid setting hydrophilic plastic material used as sealer without core – first attempt at Primary Monoblock Ø Polymer of hydroxyethyl-methacrylate (poly HEMA) Ø Hydrophilic acrylic resin – Injected into canal to set in situ – Undergoes polymerization in aqueous envirnt •

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

Disadvantages

üSealing ability questionable üConcerns of tissue toxicity by the unset material üAbsorption of the root filling material with time üLack of homogeneity üNot stiff enough to reinforce roots üClinical use – proved unsatisfactory

Hydron versus gutta-percha and sealer: A study of endodontic leakage using the scanning electron microscope and energy-dispersive analysis*
James R. Murrin, DDS, MS ,Al Readex Dennis, F. Michael Beck, DDS, Journal of Endodontics Volume 11, Issue 3 , Pages 101-109, March 1985

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

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

CORE FILLING MATERIALS vMetal Silver Stainless steel files Gold Iridiopla tinum Tantalu m Titanium Amalga m

vPlastics

vPastes/ Cements: N2 – Sargenti GP technique Hydr Resorcinol – on Resil formaldehyde on 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.

• Sargenti paste always contains paraformaldehyde and sometimes contains lead and mercury. • Paraformaldehyde is a powder form of formaldehyde and is highly toxic. It can cause severe and irreversible damage to tissues, nerves, and bones that can be detected immediately after the procedure or months later. • The formaldehyde emits gasses that can escape from the confines of the tooth. It enters the blood stream during the root canal procedure. If the paste is extruded out the bottom of the tooth (called an overfill) or seeps out of the porous structure of the tooth, it can cause severe and devastating results, often becoming permanent lifealtering conditions and even fatal.

N2 / 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 •

Ø 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

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.

RESORCINOL – FORMALDEHYDE (RF) RESIN THERAPY
Ø Called as “Russian Red” cement Ø Used primarily in Eastern Europe, Russia,  China Ø Consists of – Formaldehyde / alcohol - liquid – Resorcinol - powder – Sodium hydroxide – catalyst – Zinc oxide / barium sulfate – radiopacifier (optional)

Ø When 10% sodium hydroxide is added to the mixture, polymerization occurs Ø Forms a brick – hard red material that has no known solvent Ø Disadvantages – Retreatment is difficult – Contains 2 potentially toxic components • Formaldehyde • Resorcinol – Shrinks on setting – Resorcinol discolors tooth structure

CALCIUM PHOSPHATE CEMENTS (CPC)
• 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

• 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 •

Ø 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

MINERAL TRIOXIDE AGGREGATE (MTA)
• 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

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

Ø Advantages
– Excellent sealing ability (dye/fluid/bacterial/endotoxin leakage studies) – Good marginal adaptation – Extremely biocompatible
• Least cytotoxic • Cemento conductive • Osteo inductive

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

ØMTA as Primary Monoblock: 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)

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 difference in microleakage penetration)

no significant (dye

ROOT CANAL SEALERS

CLASSIFICATION

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

Type II Materials: with or without core material Class 1 - powder and liquid that set through a non polymerizing process Class 2 – 2 pastes that set through a non polymerizing process Class 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

Silver ii. Silver Free containing
 

Procosol Non- Diaket Rickert’s formula/ staining cement AH 26 AH Plus Kerr’s Sealer Grossman’s Hydron Procosol sealer Chloropercha Radiopaque Eucapercha silver cement Tubliseal Nogenol Endofil Wach’s paste Glass ionomer Polycarboxylate Calcium phosphate cements 
 

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

Articles

Zinc oxide Eugenol sealer(fill canal)

Result 99 teeth Glass ionomer sealer(Ketac-Endo) AH plus showed less leakage than other seal
Epoxy resin(AH-Plus).

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

Other study
 

In a study they compared the sealing ability of AH26/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.



    

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,Australia

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.

International Endodontic Journal, 37, 653–663, 2004

CROSS-SECTIONS OF EACH OF THE FOUROBTURATION 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 the four 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 Resilon – ephiphany system- of Resilon may even chloroform but not in water. Pellets striaght canals be heated and expressed through an Thermoplastized techinique Obtura gun. In addition, the or complex are sealed to • Curved or c polyester points anotomy 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.

CONCLUSION 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.

e for further research and development remains

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