OBTURATION (RECENT ADVANCES

)
INTRODUCTION
The root canal system has many variations in anatomy such as
irregularly shaped canals, lateral and accessory canals, a variety of fins
which lead to difficulty in preparing the canals to form conducive to
complete obturation with filling materials.
The objective of obturation is to attain a fluid tight seal of the
root canal system. Over the years semi-solid filling material such as
gutta-percha has been used in conjunction with a sealer for obturation.
Dow and Ingle have stated that the poor obturation was the root cause of
failure in endodontic therapy. Conseuently various obturation
techniues have been introduced through the years. !very method has
certain advantages and disadvantages. "ence the method of obturation
varies with every case.
OBJECTIVES OF CANAL OBLITERATION
Total obliteration of the canal space and perfect sealing of the
apical foramen at the dentinal cementum junction and accessory canals
at locations other than root ape# with an inert, dimensionally stable and
$
biocompatible material are the goals of successfull endodontic
treatment.
"owever, one should %eep in mind that success of the canal
obturation is dependent on the e#cellence of endo cavity design and
thorough canal cleaning and shaping.
& '-dimensionally well-fitted root canal system does the
following(
$. )revents )!*CO+&TIO, of )a e#udates into the *C.
-. )revents *!I,.!CTIO,.
'. Creates a .&/O0*&1+! 1IO+O2IC&+ !,/I*O,3!,T for
the process of tissue healing to ta%e place.
4hen is the root canal ready to obturate5
CRITERIA
$6 The tooth is asymptomatic, no pain, tenderness, or apical
periodontitis.
-6 The canal is dry. There is no e#udates 7 seepage.
'6 ,o sinus tract.
-
86 There is no foul odour 9suggests residual infection 7 reinfection6
due to anaerobe.
:6 Temporary filling is intact 91ro%en 7 lea%ing filling causes
recontamination of the canal6.
;6 & negative culture.
ROOT CANAL FILLING MATERIALS
Over the years a large variety of *C filling materials have been
advocated. 3aterials such as plaster of paris, asbestos and bamboo to
precious metals such as gold and platinum. 1ut none of the materials
satisfied the reuirements of an ideal root canal filling material.
*C filling materials can be divided into(
O*T"O2*&D! *!T*O2*&D!
ORTHOGRADE MATERIALS:
1) Pastes.
- <nO
- =ynthetic resins 9cavit6.
- !po#y resin 9&"--;6.
- )olyvinyl resin 9Dia%et6.
- )olycarbo#ylate cement.
'
- =ilicone rubber.
- Chlorpercha paste.
2) SEMI-SOLID MATERIALS
- 2utta-percha
- &crylic
'6 SOLIDS : There are divided into(
FLEXIBLE TYPE RIGID TYPE
- =ilver cones.
- =tainless steel instrument
- /itallium.
- Cr-Co implant cone
9They can be precurved before
insertion and made to follow the
curvature of toturous canal6.
They are infle#ible, and cannot
follow curvatures. There are used
as !ndosseous implants 7
stabili>er as an internal strength
reinforcement cones for root
fractures, 9root respectively6 and
rebuilding of multilated crowns.
Advanta!"
- Do not corrode.
- Tolerated by tissues.
D#"advanta!"
8
- ,on-compressible.
- *ely on sealer to obturate
the canal.
RETROGRADE: S#$v!% a&a$a&' GIC' S()!% EBA' IRM' CRC
- 0sed mostly in !ndo-surgical techniues. In cases of(
a. Internal and e#ternal root resorption.
b. )erforations.
c. To seal large accessory canals.
d. &pical fillings.
Advanta!":
- 4ell-tolerated.
- ,on-absorbable.
- .orms of a good seal.
T*+ &a#n d#"advanta!":
- Difficulty in removal.
- *euires the root canal to be prepared to at least si>e 8? to
the full 4+ for correct placement and condensation.
:
PLASTIC:
These have been suggested as *C. materials but are(
$6 1rittle and so have little use as a filling material.
RE,UIREMENTS FOR AN IDEAL RCF MATERIAL
$6 It should be easily sterili>able.
-6 It should have ease of manipulation with ample 4T.
'6 It should be dimensionally stable, not shrin% 7 change form after
being inserted.
86 =hould produce good apical and lateral seal and conform to
contours of the canal.
:6 ,ot irritate )a tissues.
;6 =hould be impervious 7 non porous to fluids.
@6 1e unaffected by tissue fluids and insoluable in tissue fluids, not
corrode 7 o#idi>e.
A6 =hould be bacteriostatic, atleast not encourage bacterial growth.
B6 ,ot discolour the tooth-structure.
;
$?61e radio-opaue, easily discernible on radiographs.
$$61e easily removed from the canal if necessary.
GUTTAPERCHA
)opulari>ed by 1owman in $A;@, in its pure molecular structure,
gutta-percha is the transiomer of polyisoprene and has an appro#imately
;?C crystalline form.
The amorphous form is CI=-I=O3!*, is a natural rubber. 2utta-
percha is obtained from the sap of the Indian rubber trees indigenous to
3alaysia. 1ut gutta-percha now comes e#clusively from central =outh
&merica. 2utta-percha is white in colour as it comes from the trees it is
dyed to colours li%e red and pin% to match the color of the pulp, it has to
replace.
The composition of gutta-percha varies according to the
manufacturer. The suggested composition by 2rossman is(
3atri# D -?C - 2uttapercha.
.iller D ;;C - <inc o#ide.
*adioopacities D $$C - "eavy metal sulphate.
)lastici>ers D 'C - wa#es 7 resins.
@
P-a"! t%an"#t#+n" +. t%an"/)+$0#"+)%!n!
2uttapercha at room temperature is considered to be in the β
phase. In this stage gutta-percha is solid, compatible and elongatible.
4hen heated to 8-E to 8BEC it undergoes a phase change to α
phase. In this phase it is runny, tac%y, stic%y, non-compatible and non-
elongatible.
The '
rd
7 γ-phase occurs when heating is raised to :;E to ;-EC.
The properties are similar to the -
nd
phase.
The significance of these phases in addition to change in physical
properties, is that the materials e#pand when heated from the β to the γ 7
α phase from less than $C to almost 'C when cooled down to the β
phase, a shrin%age ta%es place, of similar percentiles, but the deree of
shrin!ae a"#ost a"$a%s is reater than the deree o& e'(ansion and
#a% di&&er b% as #u)h as 2*. That means if gutta-percha is heated
above 8- to 8BEC and then inserted into a prepared canal, a condensation
procedure should be applied 7 some method used to lesser the problem
of shrin%age.
2utta-percha in the β phase has a number of &D/& as a *C.
material.
A
$6 It is compactible, compressible and adapts e#cellently to the
irregularities and contours of the canal.
-6 It is inert.
'6 Dimensionally stable.
86 Tissue tolerance 9non-allergenic6.
:6 It is radioopaue.
;6 "as %nown solvents D Fycol, chloroform.
@6 It can be easily removed from the canal, if necessary.
A6 !longability when fresh, brittle when old 9good test to predict the
compatibility of the products6.
DISADVANTAGES OF USING GUTTAPERCHA
$6 It lac%s rigidity, smallest standardi>ed gutta-percha cones are
difficult to use unless canals are enlarged to ,o. -:.
-6 It lac%s adhesive uality D sealer has to be used.
'6 It can easily be displaced on pressure- can lead to over e#tension
during condensation. To increase rigidity of, &crylic reinforced
gutta-percha.
B
2uttapercha is available as(
STANDARDI1ED
GUTTAPERCHA
NON/STANDARDI1ED
GUTTAPERCHA
- They appro#imate
the diameter and taper of
root canal instruments.
- &vailable as
primary cones 9,o. $: to
$8?6
- 3ore tapered in shape,
hence used as au#iliary cones in
lateral and vertical
condensations.
SEMISOLID FILLING MATERIALS FOR OBTURATION:
$6 2uttapercha 9β-phase6.
-6 Compacted gutta-percha.
'6 Injection moulded Obtura II, 0ltrafil.
INDICATIONS TO USE SEMI/SOLID FILLING MATERIALS
$6 4hen the canal has irreu"ar $a""s and has a non-)ir)u"ar sha(e.
-6 4henever a condensation techniue is utili>ed that reuires a
&"are (re(aration to si+e ,-.
'6 In cases where a "atera" . or an au'i"iar% )ana" is anticipated 7
#u"ti("e a(i)a" &ora#en present.
$?
86 4henever there is a strong (ossibi"it% o& o))urren)e o& an
over&i""in 9as semi-solid materials are well tolerated by tissues6.
:6 In cases of interna" resor(tion.
;6 In cases where a(i)a" surer% has to be (er&or#ed.
METHODS OF OBTURATION (a22+%d#n t+ G%+""&an)
$6 +ateral condensation.
-6 /ertical condensation 9warm gutta-percha6.
'6 =ectional condensation.
86 Compaction 93c =padden techniue6.
:6 Thermoplastici>ed gutta-percha techniue.
;6 Chemically plastici>ed gutta-percha 9chloropercha6.
ACCORDING TO COHEN
I. Obturation $ith a se#i-so"id #ateria" / utta-(er)ha.
a6 .itting of primary gutta-percha cone.
b6 Chloroform D dip techniue.
c6 =ingle D cone techniue.
$6 .abrication of customi>ed gutta-percha cone.
$6 +ateral condensation.
-6 +ateral and vertical condensation method.
$$
'6 =ectional method.
86 /ertical condensation with warm gutta-percha.
:6 Chloropercha method.
3odified
a6 Gohnston D Callahan.
b6 ,ygaard D Ostby.
;6 2uttapercha-!ucapercha method.
@6 Thermomechanical condensation method.
A6 Thermoplastici>ed gutta-percha 9injection molded method6.
B6 )astes.
$?6"ydron, a hydrophilic plastic *C. materials.
$$6)ressure D syringe injection techniues.
$-6,
-
and related pastes.
II. 0ana" obturation $ith so"id #ateria"s:
$6 =ilver cones
a6 Cone selection, fitting and cementation.
b6 =plit 7 sectional cone techniue.
c6 Techniue with apical silver cones.
d6 Techniue with improved silver cones.
-6 =tainless steel points.
$-
III. 0ana" obturation $ith RI1ID 0O2ES:
a6 /itallium.
b6 Cr-Co implant points.
ACCORDING TO INGLE
I. SOLID-0ORE 13TTAPER04A 5IT4 SEALA2TS
&6 Cold gutta-percha points.
$6 +ateral compaction.
-6 /ariations of lateral compaction.
16 Chemically cold gutta-percha
$6 !ssential oils and solvents.
a6 !ucalyptol.
b6 Chloroform.
c6 "alothane.
C6 Canal warmed gutta-percha
$6 /ertical compaction.
-6 =ectional compaction.
'6 +ateral 7 vertical compaction.
a6 !ndo-techniues.
86 Thermo-mechanical compaction.
$'
a6 3icro-flow, 3C, engine, plugger and 3aillefer
condensation.
b6 Huic%fill.
c6 Canal finder.
d6 0ltrasonic.
D6 Thermoplastici>ed gutta-percha
$. =yringe insertion.
a6 Obtura.
b6 0ltrafil.
-. =olid-core carrier insertion
a6 Thermafil and Densfil.
b6 =uccessfil.
II. A(i)a" ,
rd
&i""in:
a6 Dentin-chip.
b6 Ca9O"6
-
III. I26E0TIO2 . SPIRAL 7ILLI21:
a. Cements plasters.
b. )assles Ca phosphate.
 &s with many aspects of dental profession, a three dimensional
obturation is the %ey to success of an endodontic treatment.
$8
=ince the late $B??Is uite a few obturation techniues have
come into the picture, some of which have been discarded due to their
obvious disadvantages while the others have been improved upon.
&s all of us are uite familiar with the conventional methods of
obturation which we have been using till date and which have stood the
test of time, hence in this seminar, I shall be giving you an insight into
the more recently developed obturation methods with their advantages
and disadvantages comparable to the conventional method.
The major disadvantages of old techniues commonly used i.e.
lateral condensation.
$6 Time consuming.
-6 Difficult in fine and curved canals.
V!%t#2a$ 2+nd!n"at#+n
0sage of spreaders and pluggers in
both the techniue for
condensation of the mass.
$6 Stresses caused #a% de&or#
the roots and )ause #i)ro-
&ra)tures $ithin the dentin.
0nder occlusal load this
deformation may propogate and
manifest later as longitudinal root
fractures, especially after post
preparation.
$:
 These techniues produce many irregularities in the mass
of gutta-percha.
 It does not reproduce canal fins and irregularities.
 The surface of the material is freuently rough and pitted
with inadeuate dispersion of the sealer.
 The voids that are produced may remain empty 7 filled
with sealer which may resorb in time, thus decreasing the
effectiveness of obturation.
In case of chemically plastici>ed gutta-percha obturation(
 The main drawbac% of the method is that once the solvents
evaporates the gutta-percha may shrin% and a space may
be created.
To overcome these disadvantages the thermoplastici>ed gutta-
percha techniues have been introduced.
These techniues are classified by 1hatti and Goshi 9$BB@6 as(
Int%a%ad#2($a% E3t%a%ad#2($a%
- In this the gutta-
percha is heated with in the
canal and is allowed to follow
into the *C.
- In this the gutta-
percha is heated outside the
mouth and then placed in the
*C.
$;
I) THE INTRARADICULAR
TECHNI,UES:
5ARM LATERAL 0O2DE2SATIO2
- !ndotech.
- Thermopact.
5ARM 8ERTI0AL 0O2DE2SATIO2
- Touch JnI heat.
- =ystem 1.
a4 THE EXTRARADICULAR
TECHNI,UES
I26E0TIO2 PASTES
- 0ltrafil.
- Obtura II
- )&C D $;?.
SOLID 0ORE MATERIAL
- Thermafil.
- Densfil.
- =uccessfil.
49:RID M3LTIP4ASE
- Trifecta.
$@
- α seal.
OT4ERS
- /acuum pressure techniue.
- Ca )O
8
pastes.
- =argenti techniue.
5ARM LATERAL CONDENSATION TECHNI,UE
1asic devices employed are(
$6 !ndotech, -6 Thermopact.
ENDOTECH:
Considering the ease and speed of lateral compaction as well as
superior density gained by vertical compaction of warm gutta-percha as
stated by =childer in $B;@, Martin developed a device that appears to
achieve the best ualities of both techniues.
This device called J!ndotechI is a thermal compactor consisting
of a(
- Cordless handpiece containing a battery that supplies
energy to heat the attached spreader 7 plugger tips. 4hen
not in use, the handpiece sits in a battery D charger base
9.ig. 8-;$ Ingle6.
$A
- The tips used are '? si>e file D in curved canals for greater
fle#ibility. & large tip eual to si>e 8: file. The heat is
thermostatically controlled by a activator button to soften
the gutta-percha.
- It is capable of achieving temperatures up to ':?EC.
Advanta!":
The techniue follows the lateral condensation procedure and
produces three di#ensiona" &i""in su(erior to that obtained $ith usua"
)o"d "atera" )ondensation.
PROCEDURE
- Canal preparation with continuous taper design and with
definite apical stop.
Dry the canal.
&pply sealer.
)rimary 7 master cone adaptation with hand 7 finger spreader,
plugger.
&dditional gutta-percha placed to reduce the possibility of
warm plugger loosening the point when the tip is retracted.
$B
!,DOT!C" is placed in the canal to full depth alongside the
gutta-percha.
+ater activator button is pressed and plugger 7 spreader moved
in cloc%wise direction.
*elease the heat button, and the plugger cools immediately.
,ow remove in CO0,T!*C+OCK4I=! direction.
This motion creates a space for additional point to be added.
)rocedure is repeated.
,ow the plugger can be used cold to compact the softened
gutta-percha.
In this manner the canal is completely obturated by using
!ndotech plugger.
V!%t#2a$ )%!""(%! *#t- "*!!)#n $at!%a$ )%!""(%!
Martin in $BB? showed the !ndotech creates less stresses than
cold lateral condensation.
To complete the procedure a cold hand plugger can be used to
firmly condense the fused gutta-percha bolus.
-?
&n, air force rou( in 1;;, also found that they could improve
the gutta-percha compaction in a molar $ith 0 sha(ed )ana" b% usin
the !ndotech in a <&) and tap method.
PROCEDURE 6 METHOD:
<&) D )reheat the endotech for < to = se)onds before insertion into the
gutta-percha filled *C space.
T&) D 3ove the instrument in and out in short )ontinuous stro!es 1--
1= ti#es. The tip is removed from the canal when it is still hot. +ater
cold spreader is used and accessory points are placed.
The two causes of concern with this treatment may be(
- Overheating.
- Development of stresses.
Castelli in $BB$ stated that there was no heat related damage to
periodontium from !ndo-tech.
& 0= &rmy group showed that heat produced by !ndotech is
ma#imum :??EC and is less than that of other heat devices li%e the
touch JnI heat 9@??-A??EC6.
-$
They stated that even though the internal temperature may reach
upto $?-EC gutta-percha and dentin are poor conductors of heat, so the
temperature may not cause damage to periodontium.
A22+%d#n t+ C+-!n:
$6 The techniue is time consuming relative to other methods of
lateral compaction.
-6 The euipment comes with a limited number of si>ed tips for heat
distribution even though the tips appear to be similar to a root
canal spreader, it is difficult to apply compaction forces with
these tips and their use is primarily for heating the gutta-percha
cones in the tooth.
THERMOPACT
It consists of unit containing a trans&or#er and an electronically
controlled )ir)uit for heat eneration and )ontro"> and a hand(ie)e
adapted with different si>ed spreaders and a heat carrier. The
temperature can be selected, regulated and maintained at any desired
level from 8?E to @?EC.
2uttapercha  α D 8- D 8BEC.
γ D :;-;-EC.
--
Sauvenr suggested that thermopact must be ideally set and
maintained at 8-EC for warm lateral condensation and at about :BEC for
warm vertical condensation.
4hen one is using thermopact device, the operating temperature
shou"d be set (re)ise"% and #aintained )onstant. It should range within
the limits of the groups going from β 9or solid6 phase to alpha 9or
plastici>ed6 phase at appro#. 8-EC, or from the alpha plastici>ed phase
to the amorphic phase where partial decomposition begins to occur,
appro#imately at ;?EC.
4&*3 +&T!*&+ CO,D!,=&TIO, using thermopact device.
The warm spreaders soften and depress the gutta-percha laterally,
allowing the instruments to gently and deeply penetrate to the desired
apical level. Therefore more gutta-percha cones can be added
successively in the space created by the warm spreaders and coalesced
into a denser mass.
Advanta!:
The techniue produces a ho#oenous"% )o#(a)ted &i""in $ith
a))urate )ontro" o& a(i)a" e'trusion> #a'i#u# utta-(er)ha and
#ini#a" sea"er.
-'
*egular spreaders may also be heated and stoc%ed in a glass bead
container with the temperature set to ;?EC. 4hen inserted into the root
canal, the spreader would have a temperature of around 8:EC. This
temperature is sufficient to heat gutta-percha from β solid phase to α
plastici>ed phase allowing for a more effective lateral condensation.
• 4arm lateral condensation effectively provides a dense more
compact obturation with a ma#imum amount of gutta-percha and
a minimum amount of sealer. 9The minimal condensing pressure
used to obtain a compact and accurate filling is a decided
advantage in the prevention of numbers6.
• Warm Guttapercha vertical compaction method: Is used, then
thermopact device is adapted with a heat carrier. The temperature
is set and maintained at ;?EC. This temperature is sufficient to
heat the gutta-percha from β solid phase through α plastici>ed
phase to the amorphic phase.
5ARM VERTICAL CONDENSATION METHOD
a6 Touch JnI heat.
b6 =ystem 1.
The Tou)h ?n@ heat unit is used with the =childerIs techniue.
-8
The Tou)h ?n@ heat =--, is an electronic device is especially
deve"o(ed &or the $ar# verti)a" )o#(a)tion o& utta-(er)ha.
1attery 7 &C models are available. It e#hibits the same thermal
properties as the original heat carrier used by =childer in $B;@ but has
the advantae o& eneratin heat and auto#ati)a""% at the to( o& the
instru#ent. The instrument is capable of providing a range of high
temperatures instantly ranging from ?-@??EC.
The device may also be used for (u"( testin 7 bleaching by
9other uses6 changing the tips and adjusting the heat level.
PROCEDURE
The softened warm gutta-percha can be readily compacted
apically into the irregularities of the *C system.
The objective of this techniue is to )ontinuous"% and
(roressive"% )arr% a $ave o& $ar# utta(er)ha a"on the "enth o& the
#aster )one starting coronally and ending apically.
PROCEDURE
The =childerIs pluggers are selected and prefitted.
Coronal $7'
rd
wide.
3iddle $7'
rd
D narrow.
&pical $7'
rd

-:
D+*n )a27#n:
P%+2!d(%!:
 The prepared canal walls are first coated with sealer.
 The selected master cone is a non-standard gutta-percha
point with the apical tip cut off.
 It is fitted to achieve apical tub-bac% at about $mm from
the 4+.
 9If the canal diameter is wider than the first point a second
point is fitted6.
 2uttapercha protruding from the canal orifice is removed
with a hot instrument.
 The widest plugger is now used to compact the gutta-
percha into the canal using --'mm vertical stro%e.
 & series of overlapping stro%es is used if the canal is wider
than the plugger.
 The heat transfer instrument, heated to cherry red, is again
plunged into the mass of gutta-percha to a depth of '-8mm and
-;
uic%ly withdrawn 9this high temperature ensures a mass of
gutta-percha to be removed with the carrier6.
 The appropriate prefit plugger is then used as already
described.
 !ach time-this seuence is repeatedL some gutta-percha is
removed with the heat carrier and a smaller plugger is placed
close to the 4+.
 It is rarely necessary to compact closer than :mm from the
4+.
Advanta!": .ills accessory canals homogenous filling.
D#"advanta!":
$6 /oids 9inadeuate control of the depth of insertion of the filler.
-6 =mall plugger is ineffective.
'6 )lugger binding apically may split root.
This cycle is completed by a sustained firm apical pressure held
for a few seconds till the clinician feels that the thermosoftened mass
-@
has cooled. This ' dimensional adaptation and apical and lateral
movement of gutta-percha is termed as.
M 4&/! O. CO,D!,=&TIO,N
It should be noted that the master apical gutta-percha cone has
not been heated in the middle and apical $7'
rd
yet.
The activated heat carrier becomes red-hot almost instantly and is
allowed to plunge about ' to 8 mm into the gutta-percha coronally. ,ote
the progressive apical transfer of heat through the gutta-percha master
cone.
- The heat carrier is deactivated and after momentary hesitation,
the cooling instrument is removed along with a bite of gutta-
percha.
Advanta!":
$6 There is progressive apical transfer of heat along the master cone
to another 8 to : mm.
-6 The removing of bite of gutta-percha is that a smallest -
nd
prefit
plugger can be placed progressively deeper into the preparation.
Thus producing a -
nd
wave of condensation.
-A
- This procedure is done for about 8 to : times depending on the
length of the canal. It is important to note that it is impossible to
overe#tend gutta-percha periapically.
*epeat by carrying heat carriers 8 to :mm from ape# and
condense with prefitted condensers.
PRECAUTIONS
a6 There should be a continuous tapering canal preparation
whose diameter is narrowed apically.
b6 3aster cone is fitted correctly.
c6 Temperature of T JnI instrument should not e#ceed 8:EC.
d6 "eat pluggers should not be placed closer than 8 to :mm
of canal terminus.
BAC8 PAC8ING PHASE:
- The most effective and efficient 1-) techniue is Obtura II
utta-(er)ha un.
- The smallest -' gauge needle is attached to the Obtura II gutta-
percha gun until it comes in contact with the previously pac%ed
gutta-percha apically. The hot tip, will ensure concession and
-B
homogeneity during procedure. The Obtura gun is held firmly
and slowly suee>e the trigger injecting a controlled 8 to :mm
segment of uniformly thermosoftened gutta-percha against the
previously pac%ed apical '
rd
. If this is performed properly the
clinician feels the gun bac% out of the canal easily. The smallest
prefit plugger is used to condense the guttapecha. Through a
series of gutta-percha injection and condensation the *C is
completely obturated. & confirmatory radiograph is ta%en.
SYSTEM B:
*ecently analytic technology introduced s%ste# : heat sour)e
#ode" 1--. This instrument has a diita" te#(erature dis("a% and a
variable resistan)e )ontro" that allows the user to attain a desired
te#(erature.
These heat carriers are designed as pluggers that concentrate the
heat at the ti( o& the )arrier. This system 1 is also based on the =childer
techniue. The tips of the pluggers can be heated to -??EC. this softens
the gutta-percha in O seconds.
& wave of heat 9-:?-'??EC6 is produced as the plugger is forced
through the already fitted cone and is used to drive the gutta-percha into
the canal.
'?
 &s the plugger approaches the ape#, the heat button is
released and a(i)a" (ressure is #aintained $ith the ("uer for a
$? second. It sustains push to ta%e up the shrin%age that occurs on
cooling.
The heat button is pushed again while maintaining pressure.
- & wave of heat is produced '??EC : seconds that immediately
separates the plugger from apical mass of gutta-percha. Thus it
can be rapidly withdrawn.
- The canal is then bac%filled with the sa#e te)hniAue $ith obtura.
Advanta!":
$6 /oids elimination created during normal lateral condensation of
warm gutta-percha.
D#"advanta!":
$. 1rea%age.
-. Kin%ing of spreaders.
=ilver 2.K. et al in $BBB conducted a study on Mcomparison of -
vertical condensation obturation techniues D Touch and "eat and
system 1.
They concluded that(
'$
- =ystem 1 may produce an acceptable obturation and produces
less heat than T JnI ".
- "e also concluded that the obturation by this method was faster.
THERMOCOMPACTION
In this techniue &ri)tion bet$een utta-(er)ha and the rotatin
Breverse &i"eC enerates heat to so&ten the utta-(er)ha and forced
apically. Thermocompactors available have different designs which
determine these properties.
$. Old 3c =padden.
-. ,ew 3c =padden nic%el-titanium
thermocompactor.
'. 3aillefer gutta-condenser.
8. <ipperer.
:. Huic%fill.
Mc Spadden( & new concept of heat softening gutta-percha
introduced by 3c =padden in $B@B. Initially called the 3c =padden
compactor.
- *esembles the reverse 4-&i"e which fits into a latch type
handpiece rotates at D>----2->--- r(# and generated frictional
heat that softened gutta-percha and forced the #ateria" a(i)a""%
'-
and "atera""%. &s )ana" $as &i""ed> the )o#(a)tor $as &or)ed out
)orona""%.
''
D#"advanta!" +. t-#" t!2-n#9(!" *!%!:
$6 .ragility of the instruments hence fracture D could not be used in
curved canals.
-6 Overfilling of the canals.
'6 Difficulty in mastering techniues.
86 Overheating.
:6 *esorption and an%ylosis.
Therefore lead to its demuse.
"owever it rose again in different shapes and forms.
$6 3c spadden in the meantime modified his original design and
introduced the ,T condensers. It is supplied as an enine driven .
hand (o$ered 2-T instru#ent.
- It has increase number of compacting blade.
- =hallower grooves.
- Decreased sharpness.
- 3ade of ,iTi for fle#ibility.
0sed(
- 4ith heat softened gutta-percha 9α-phase6 and β gutta
percha.
- 0sed mainly in curved canals.
'8
PROCEDURE
- )lace primary gutta-percha cone.
- =elect the appropriate si>e condenser coat with gutta-
percha 9heat softened6 gutta-percha I 9α6 and gutta-percha II
9β).
- The condenser is then spun in the canal at $???-8???rpm
which flings the gutta-percha laterally and vertically.
- The speed is controlled by ,iTi matic handpiece.
Open Apex cases 9at the ape# D low heat gutta-percha I bolus with a
large ,T condenser allowed to cool and harden  &pical )lug6
-6 3allefer 2utta condenser
3allefer modified the hedstro# t%(e instru#ent as gutta
condensor.
- It has less number of compacting blade.
- Increased sharpness.
- Deeper grooves.
0sed(
.or bac% filling of canals already fitted at apical '
rd
by either.
a6 4arm vertical compaction.
b6 =ectional compaction.
c6 Cold lateral compaction.
':
'6 <I))!*!* T"!*3OCO3)&CTO* 7 !,2I,! )+022!*
- This thermocompactor resembles an inverted K-file.
- Increased number of flutes.
- 0sed for bac%filling canals already filled at apical '
rd
.
- In hybrid techniue. 9Gaggert6
86 G= Huic%fill
This system is designed for a ther#o#e)hani)a" so"id )one utta-
(er)ha obturation te)hniAues.
This system has titaniu# )ore devices resembling latch type
drills. These are )oated $ith α (hase utta-(er)ha. These are then
fitted to the prepared root canal and then, the sealer is applied. &s the
instrument spins in the canal with regular low-grid latch type
handpiece frictional heat is liberated. This heat plastici>es the gutta-
percha and it is also compacted.
&fter compaction either the compactor may be removed and final
compaction done with hand plugger 7 the titanium core may be left in
place and separated by an inverted cone bur.
';
,!4 CO"!, 9@
th
!dition6
II. A3TOMATED PL311ER
The canal finder plugger is a ste($ise &"e'ib"e ("uer
sha(ed "i!e a te"es)o(e.
It is used in a )ana" &inder hand(ie)e $hi)h de"ivers a
ra(id verti)a" stro!es varies bet$een 1 to ,##.
III. PRO0ED3RE
=ealer placement
3aster cone placement.
,e#t, the vertically vibrating plugger is %ept.
The edges of the plugger blades catch the gutta-percha.
2uttapercha gets compacted vertically and laterally.
This method may have some discrepancies.
I8. 3LTRASO2I0 PLASTI0IEI21
- =uggested by 3oreno in $B@@.
- "e used a cavitron sealer with a )* '? insert.
- Can be used only in anteriors 9Cavitron6
'@
PROCEDURE
9a6
- )rimary point is placed.
- 0nit is placed beside gutta-percha.
- The ultrasonic unit with the rheostat set at right angles is
activated for '-8 seconds.
- The ultrasound thermal energy released by vibrating
motion of the ultrasonic file plastici>ers the gutta-percha.
- The file is removed and the spreader is immediately
inserted to ma%e space for new cones.
- Joiner in 1989 found that the heat produced was ;.':EC in
?.' seconds by this method. "e thus concluded that the
heat produced by the cavitron would not be harmful.
9b6
The !nac ultrasonic unit has also been used with a certain degree
of success by 1aumgardnee in $BB@.
- In this unit a s(reader is atta)hed.
- In this method the utta-(er)ha $as not ("asti)i+ed.
Fdisadvantae).
'A
- They felt that the spreader more easily penetrated the
access of gutta-percha than did the finger spreader and
that, is the end the energi>ed spreading led to a more
homogenous mass with less stress and less apical
microlea%age.
- The heat generated with the !nac ultrasound unit was
found to be more i.e. $B$EC rise in temperature because it
too% $8$ seconds to obturate. This system is inferior to the
cavitron P,O unit.
'B
SECTIONAL METHOD
LIGHT SPEED SECTIONAL METHOD:
- & two phase obturation techniue has been proposed by
light speed technology by MTe#asN.
- This techniue advocates the use of a stainless steel carrier
to place and condense a :mm section of gutta-percha into
the apical portion of the canal.
- Once placed, the carrier is turned and removed leaving a
gutta-percha plug.
- The second phase uses a rotary instrument to bac%fill the
remainder of the canal with the Ketac-endo and a single
guttapercha cone.
- The techniue was first studied by =antos D.3. et al in
$BBB.
METHOD
& gutta-percha cone, the same si>e as the master apical rotary
93&*6 instrument was selected.
(MAR( is the final apical si>e of the instrument which is used to prepare
the canal last6.
8?
The canal and the gutta-percha plug were coated with sealer.
The plug was inserted and vertically condensed to 4+ by using
moderate apical pressure.
The carrier is removed by turning its handle counter cloc%wise
until the plug was released and the carriers could be removed, easily
detached from the gutta-percha.
The 2
nd
(hase
& light speed bac%fill instrument was used to carry the %etac-
endo sealer into the canal orifice.
This was rotated at $???--??? rpm and advanced apically till the
apical gutta-percha plug was reached.
The instrument was then removed while against one wall.
This was repeated till the canal was filled with the sealer.
The master cone was then coated with the sealer and placed till
the apical plug.
The e#cess gutta-percha was then removed at the level of canal
orifice.
8$
The += techniue is P to the sectional method described by
2rossman and Coolidge.
The difference with this techniue is that slight apical force seats
the tapered plug into a parallel apical preparation 9disadvantage6.
THERMOPLASTICI1ED INJECTABLE GUTTAPERCHA
OBTURATION
The two major injectable gutta-percha techniues available to the
clinician are the Obtura II and the 3"tra&i". The third being PA0-1G-.
These techniues have also been referred to as high-heat
techniue and a low-heat techniue respectively. this is mainly due to
the temperature reuired to soften the gutta-percha for delivery into the
canal.
Obtura !echni"ue: 2uttman emphasises that canals to be obturated
must have a continuously tapering funnel form, the apical matri# to the
canal orifice.
Of significance is a properly shaped canal in the apical to middle
mainstand area particularly in curved canals.
8-
The proper shaping is essential to confine and retain the gutta-
percha in the canal system, as filling beyond the end of the root canal
easily occur.
&pical D -: 7 '? and coronal ;? file.
Obtura was first introduced in $B@@ 9G 3artin6.
.rom this early model a more efficient system was developed and
presented.
The device mar%eted now a days is Obtura II heated gutta-percha
system.
$6 The silver needle si>e has been reduced to either 2- aue FeAua"
to a 2- &i"e).
-' gauge for a 9eual to a no. 8? file6. &g needle is used for
fle#ibility 9it consists of a6 with digital readout of temperature an
electrical control unit, b6 a pistol grip syringe and c6 specially
designed gutta-percha pellets.
- The gutta-percha e#trudes from the Mneedle tip with a
temperature rane o& G2 to G=H0.
- The pistol s%rine is #ore resistant to hiher te#(erature.
8'
- The control is euipped with a diita" readout o&
te#(erature and fact safe circuitry with precise
temperature control.
- *egular β-phase gutta-percha is used.
- The gutta-percha is heated appro#imately to F1G- to
2--H0) D Ingle, 9$A: to -??EC6 - Cohen.
ndicated: It is beneficial when managing $6 Canal irregularities such as
film webs 7 cutl-de-sacs
- Internal resorption
- C shaped canals
- &ccessory 7 lateral canals.
- & bridged foramena.
Ea"0 .$+* (tta/)!%2-a
- 3aintains its s#ooth &"o$ )onsisten)% at "o$er
te#(erature and has a "oner $or!in ti#e.
- It favours the management of comple# cases in which
$. !#tensive compaction is necessary.
-. =mall curved canals.
'. .avours in e#perience need clinicians.
88
Reu"ar &"o$ utta-(er)ha is a homogeni>ed formulation with
superior flow characteristics and aid in infection control.
Advanta!":
$6 The removal of the smear layer and obturation of canals with the
injectable system result in the movement of gutta-percha and
sealer into the dentinal tubules.
-6 The adaptation of the injected thermoplastici>ed gutta-percha to
the canal walls has been shown to be significantly better than
lateral compaction.
D%a*:a27":
$6 )otential for e'trusion o& the utta-(er)ha and sea"er beyond the
apical foramen.
-6 The possibility of heat damaged to the periodontium has been
identified as a possible drawbac% to this techniue.
8:
M!t-+d" +. U"!:
=ealer and compaction is necessary for this method.
$. =ealer serves its usual role of filling the microscopic
interface between the dentin and gutta-percha as well as
acting as a lubricant.
Compaction became necessary to close spaces and gaps while
forcing the gutta-percha laterally and vertically. It also compensates for
simulating as the gutta-percha cools.
4ith the needle in its proper position in the canal, the gutta-
percha is passively injected into the *C system, avoiding apical pressure
on the needle.
The needle is introduced into the canal at the junction of the
middle and apical '
rd
. The applicator tip is prefitted to ensure that it does
not bind against the canal walls, pluggers are also prefitted for
compaction. In case of curved canals 2iTi ("uers are used.
In 2 to = se)onds the so&tened #ateria" &i""s the a(i)a" se#ent
and beins to "i&t the need"e out o& the tooth.
8;
During this lifting, by the softened, flowing mass the middle and
coronal portions of the canal are continuously filled until the needle
reaches the canal orifice.
-. =ealer must be carefully placed in the canal to prevent its
movement beyond the confines of the canal apically and to
ensure the placement of gutta-percha at the terminus of the
canal system.
'. O drops of sealer are placed with an instrument of choice
to the appro#imate depth of the prefitted needle.
<. A &ast settin sea"er is not re)o##ended
 Controlled compaction with the prefitted plug to adapt the gutta-
percha to the prepared canal walls.
 If necessary additional amounts of gutta-percha can be easily injected
to achieve complete obturation.
 Do not use e')essive )o#(a)tion (ressures but &o"d the #ateria" in
on itse"& as (revious"% des)ribed &or verti)a" )o#(a)tion. Mu"ti("e
variations e'ist $ith this te)hniAue.
8@
The softened materials can be placed in the apical - to 'mm and
compacted at that point. =ubseuently the remaining of the canal can
be filled as above 7 segment additions can be added and compacted.
It is used in conjunction with (
$. +ateral compaction techniue.
-. /ertical compaction techniue.
2) The u"tra&i" s%ste# : :% Dr. Mi)hano$i)+
 Continuously tapering canal.
 )roper shaping 9apical D -:7'? and coronal ;?6.
 =ealer and compaction.
 The same reuirements as those described for the Obtura II %ey.
The ultrafil system comes with gutta-percha prepac%aged in cannules
with attached 22-aue need"es.
 The material is prepared in an α-(hase.
 It softens at a temperature appro#imate $:AE to $B8E. 9@? to B?EC6 in
a special heater. The warmed cannules are placed in a special
sterili>able syringe for delivery to the prepared canal.
 The gutta-percha comes in , )onsisten)ies based on vis)osit%.
8A
a. *egular 9low viscosity6 white cannule.
b. .irm set 9moderate viscosity6 1lue.
c. !ndoset 9high viscosity6 green
 )lacement of the needle and sealer are somewhat similar to the
Obtura II techniue. ,eedle placement is usually farther from the apical
matri# such as A to $? nm 4T is appro#imately ;? to @? seconds.
T-! d!$#v!%0 +. t-! %!($a% "!t : (5-#t! 2ann($!)4
The syringe trigger is suee>ed and released, and after a wait of '
seconds, suee>ed and released again. This sends a bolus of gutta-percha
towards the apical preparation. The needle is not withdrawn but is left in
place until the mass of softened gutta-percha is felt to lift the needle
9bac%flow6 from the canal. It reaches a full set after '? minutes.
$. 1ecause of "o$ vis)osit% the e'trusion o& the #ateria" is o& #aIor
)on)ern.
-. &s it cannot be compacted, the possibility for shrin%age must be
considered and this cannot be compensated by increased amount
of sealer.
'. *estricted to cases with a substantial. &pical matri# and minimal
apical foramena opening.
8B
3oderate to high viscosity gutta-percha controlled compaction
can follow the injection delivery of the material.
"ere, as with the Obtura II, the material can be segmentally 7
bul% delivered before compaction. The time available for compaction
varies based on the material chosen.
The high viscosity gutta-percha has less flow can be compared
with plugger gutta-percha and spreader i.e. vertical 7 lateral compact.
End+"!t 2+&)$!t!$0 "!t" #n ; &#n(t!":
 1ecause of the flow characteristics of the light bodied !ndofil-
regular 7 firmest, bro%en instruments may be bypassed if based in the
canal7internal resorptive defects may be filled.
 3icrolea%age studies showed ultrafil obturation to be as good as
lateral compaction.
 =ome showed superiority over lateral compaction, Obtura and
thermafil 9firm set6.
PAC/<=>
 In $BA$ =choeffel designed heat built, a prototype delivery systems
to operate indefinitely and accurately at $;?EC. This unit uses
:?
standardi>ed gutta-percha. The device is called )&C-$;? as it gives
precision apical control at $;?EC.
Cav#t0 )%!)a%at#+n:
- =light flare coronally.
- Definite apical construction.
Advanta!":
- .ills multiple foramina.
- Irregular configurations of the root canal.
- Temperature is not more than $;?EC.
PRESOFTENED NON/INJECTABLE TECHNI,UES
The development of gutta-percha in different isomeric forms such
as α and β phase led to creation of Thermafil and successfil, whereby
alpha phase gutta-percha could be heated, placed on a carrier and
delivered into the canal in the thermoplastici>ed state without an
injection system.
S(22!"".#$ t!2-n#9(!:
In competition with thermafil the hygienic corporation,
introduced successfil. It too consists of a solid cone carrier coated with
α-phase gutta-percha. 1ut in this case, the gutta-percha in a warm
:$
plastici>ed state is added to the carrier just before it is inserted into the
canal.
The successfil syringes contain high viscosity gutta-percha that
sets in - minutes. =uccessfil core D carrier are titanium 7 radioopaue
plastic.
=ealer is lightly coated on the canal walls, avoiding any large
apical pooling of material.
They are inserted to the measured depth into the gutta-percha in
the syringe and are then e#truded by forcing the plugger.
M!t-+d:
& successfil core, the same numbers as the last apical file, is
selected and tested for si>e in the canal. It should go fully to length
without binding. It is withdrawn and set aside while the dried canal is
wor%ed with sealer.
The core coated with gutta-percha is immediately inserted to full
depth without twisting with a vertical plugger dipped in alcohol the
gutta-percha is better compacted around the carrier.
&fter radiographic confirmation the core is separated by holding
the handle and severing the core shaft -mm above the orifice.
:-
E..#2a20 +. t-! "(22!"".($ "0"t!&:
To date no reports have been published regarding this techniue.
&n unpublished study done by /ertucer and Debrood found less apical
lea%age with successful than thermafil.
THERMAFIL
So"id )ore-)arrier insertion.
- In 1;JD :en 6ohnson described a uniue yet simple
method of canal obturation with thermoplastici>ed α-
(hase utta-(er)ha )arried on an endodonti) file.
- In 1;DD this s%ste# &ina""% ot re)onition> was introduced
as Thermafil and copy cat daughter D Densfil.
- Thermafil is patented endodontic obturator consisting of a
&"e'ib"e )entra""% )arried> si+ed )ore and ta(ered to #at)h
standard endodonti) &i"es that are uni&or#"% )oated $ith
re&ined and tested α -(hase utta-(er)ha.
Initially( The stainless steel carriers were introduced, they were
heated in a flame and then introduced into the canal. +ater the carriers
were made of titaniu#. radioo(aAue ("asti).
:'
It is recommend that all three types should preferably be heated
in the thermapreparation oven at 11=H0 &or ,-J #inutes de(endin on
the si+e $hi)h ranes &ro# 2--1<-.
The utta(er)ha )oatin e'tends be%ond the )arrier b% 1-2##.
P%!)a%at#+n:
Continuous taper preparation is re"uired
The coronal portion of the carrier has mar%ings with a rubber
stop. The gutta-percha normally covers the $
st
graduation mar%s at $A,
$B and -? mm
)lastic carriers are used now-a-days. There are relatively fle#ible,
small si>es 2=> ,-> ,= have a in)re#enta""% reater ta(er than the
nor#a" 2=> ,-> ,= si+ed &i"es.
- =i>es below 8? are made of a liuid plastic crystal and are
not soluble.
- =i>es above 8: are made from a polysulfone polymer and
may be dissolved in orgnica solvents.
- Gohnson suggested that final compaction can be completed
and improved if a 8-:mm piece of regular gutta-percha is
then inserted into the softened gutta-percha.
:8
- & large plugger can also be used to apically compress the
gutta-percha all around the central carrier.
- .inal set is reached in --8 minutes.
- 4hen the gutta-percha reaches the apical stop the metal or
plastic carrier still continue apically.
- 1ecause more compaction apically and laterally.
I&)+%tant )+#nt":
$6 In teeth with multiple canals the other orifices must be sealed
with damp cotton wood or the gutta-percha may bloc% the other
orifice.
-6 The coronal everts may also be performed to avoid bloc%age of
other canals.
P+t!nt#a$ )%+:$!&":
$. !#trusion.
-. )ost spee preparation
'. *etreatment.
::
P%!)a%at#+n:
There are strongly recommended if a post is to be placed. The
latest device to melt the gutta-percha and plastic carrier is the pre-post
preparation instrument M)repiN that is used in a latch type handpiece.
.rictional heat is generated by this bladeless metal ball melts the
material.
P%!)a%at#+n:
- The step bac% techniue is effective for this obturation
techniues.
- & thermafil obturator is selected which corresponds to the
master apical file, the obturator should go to the entire
length of the canal without being twisted 7 rotated.
- The canal is coated very light with a suitable sealer D
ThermasealL &"--;, =ealape# 7 <nO with canals.
- The thermafil obturators are heated over an open flame 7 in
the thermapreparation oven. It offers more stable heated
source and uniformity for plastici>ing the gutta-percha.
:;
- Once the gutta-percha attains a surface shine it is
introduced into the canal with firm apical pressure to the
established 4+.
- &fter radiographic verification the carrier shaft is severed
to a point $ to -mm above the canal orifice while applying
firm plugger pressure to the obturator handle. The handle
is removed and discarded.
In )ase o& #eta" )arrier:
- 2uttapercha is removed at the reuired level using a bur.
- The carrier is notched with a diamond bur.
- Cross sectional diameter of the carrier is reduced to
?.;mm
- The heated carrier is reached to the full 4+ with rotation.
- Once fully separated the coronal part of the carrier is
separated by applying apical pressure and thinning the
handle cloc%wise.
- Thermafil obturator may be curved to match curved
canals. They may also used to fill internal resorptive
cavities as well as open apices.
:@
The metal carrier they are scored on the brea%off point 8 to :mm
from the ape# and then twisted off countercloc%wise after the obturator
fully reaches the ape#.
Advanta!":
$. Huic% and easy.
-. They can be curved to fill curved canals.
'. Internal resorptive defects.
8. Open apices.
E..#2a20 #n <?@? C-%#"t!n"!n "tat!d t-at:
$6 Thermafil
- &llows simple fast predictable filling of root canals.
- =pecially useful for small 7 curved canals.
- Techniue sensitive.
-6 =hoenroc% felt that the plastic carriers provided the most comple#
system.
'6 In $BB@ 4eller ,.*. studied adaptation to the canal walls with
these techniue and found that the order of perfect adaptation was
plastic Q titanium Q stainless steel.
*etreatment of canals may prove difficult because carriers
jammed in the canals are very difficult to remove.
:A
& study conducted by 4ellen and co-wor%ers 9GO! ,ov. B@6
comparing the ' types of Thermafil obturators, Obtura II and lateral
condensation.
2roup I - Thermafil with stainless steel.
2roup II - )lastic
2roup III - Titanium
2roup I/ - Obtura II
2roup / - +ateral condensation
*esults showed that space normally remained between the
obturator and the end of the prepared canal. !#posure of underlying
plastic 7 metal carriers accounted for the high incidence of voids.
TRIFECTA
& variation on the successful ultrafil techniues, uses the best of
both approaches to canal obturation. & small amount 9$ to -mm6 of
alpha phase successfil gutta-percha is placed on the tip of a carrier one
to two placed in the canal, the carrier is placed to the depth of the canal
and is slowly rotated countercloc%wise and withdrawn from the canal.
This is followed by compaction of the small mass of gutta-percha in the
canal. The coronal portion of the canal is bac%filled with one of the '
types of ultrafil gutta-percha which is compacted if appropriate.
!valuative studies have shown this techniue to be uite easily mastered
:B
with good adaptability of the gutta-percha and a canal seal comparable
to that of other commonly used techniues.
JOE (<??A)B ;C: <<4
& study was carried out by ,orman et al to compare the
adaptation of the gutta-percha to the canal walls by using ' different
techniues(
$. Thermoplastic -. Obtura II '. +ateral condensation
↓ ↓ ↓
)lastic 1est adaptation +east adaptation
Titanium
=tainless steel obturator
!D Traumatol 9-???6L $; ( Dewani, "ayes, Gummes D & study 9in-vitro6
was carried out to evaluate the Trifecta obturating techniues with the
conventional lateral condensation. They found that Trifecta showed(
- !#trusion of sealer.
- )oor radiographic uality.
1ut 1!TT!* =!&+&1I+ITR when compared to lateral condensation.
 Though the no>>le D vacuum was applied. The vacuum
pump 91iovision, 2ermany .reibyrg6.
;?
 &s soon as the vacuum reached a stable value of at least
$?hpa, the pump was slopped.
 The decrease of pressure was monitored by 9Diaval6 D/
$??? 9+ey bold <urich =wit>erland6.
 The filling paste 9&" )lus-DentsplyL 2ermany6 was mi#ed
by hand and evacuated using the same vacuum pump.
9GO!6 &. +ussi, =u%en and G. 2rosrey. It was demonstrated in
vitro that it is possible to achieve obturation of the *C system with a
system utili>ing a reduced pressure of $:3pa 93 bar6.
&n in vitro study showed that an absolute reduced pressure of
$?hpa was reuired, to fill the root canal system.
Ind#2at#+n":
- Internal resorption in the apical region.
F+% t-#" )%+2!d(%!:
- 3inimal hand instrumentation is done followed by apices
irrigation with ,aOCl.
;$
- Then the canal is dried with the help of seated no>>le. &s the new
hydrodynamic method would not produce enlargement of canalsL
it is impossible to obdurate by conventional means.
Advanta!":
$. ,o removal of dentin.
-. +ess lea%age when compared to lateral
condensation.
'. ,o pain 7 discomfort is e#perienced by the
patient because of high pressure.
8. =ufficiently dense *C obturations without
the need of gutta-percha cones.
C+nt%a#nd#2at#+n":
- The reservoir was filled with the *. matri# a steel ball
placed over the latter, and the vacuum pump turned on
again 9The metal ball avoids air aspiration6.
- The desired vacuum was reached again and later the tap in
the tube connecting the reservoir with the *C was opened.
;-
- This allowed the filling paste to be suc%ed into the *C by
vacuum.
;'