CHAPTER

Obturation of root canal

Osama Asadi, B.D.S, Published for Iraqi Dental Academy Blog

LECTURE OUTLINE
Objectives of Obturation

Heat-softened gutta-percha techniques

When to Obturate?

Warm Vertical Compaction

Smear Layer

Rotating condenser technique

Obturation Materials

Precoated carrier

Gutta-Percha Obturation

Injection delivery systems

Cold Lateral Compaction Technique

Solvent-softened gutta-percha

Solving some problems in Lateral Compaction

Sealers

In modern endodontics, cleaning and preparing root canal system is more important than filling it, which is
also important. Obturation of root canal serves two purposes: first, to prevent microorganism from entering
root canal second to isolate the remaining microorganism in root canal system from outer tissue fluids and
nutrients sealing of the tooth, with base and restoration, is equally important.
OBJECTIVES OF OBTURATION
SMEAR LAYER
1. To prevent microorganisms which remain in the
root canal after preparation from proliferating and
passing into periapical area
2. To seal the pulp chamber and root canal system
from outer oral environment
3. To prevent passage of periapical exudate and microorganism to the canals system
4. To prevent gingival microorganism from passing
into the root canals via lateral canals.

It consist of organic and inorganic components, that

found on the root canal walls after instrumentation.
The current research emphasis on removal of smear
layer using 17% EDTA or other chelating agents.

WHEN TO OBTURATE?
The decision of single visit or multi-visit endodontic
treatment is controversial. However, Teeth with no sign
of apical periodontitis can be treated in single visit.
While it is preferred to treated symptomatic teeth with
apical periodontitis in several visits, with placement of
intracanal medicament such as calcium hydroxide.
Tooth can be obturated when:
There is no pain or swelling
No sign of sinus, fistula or abscess
The canal is dry and free from necrotic tissue or
pus.

Figure 1. an images shows treated dentinal wall after application of

chelating agent. Notice the opened dentinal tubules that are ready to
.be filled with sealer
OBTURATION MATERIALS
The ideal properties of an obturating material are:

Biocompatible
Dimensionally stable
Capable of sealing the canal laterally and apically

 Unaffected by tissue fluids and insoluble

Bacteriostatic
Radiopaque
Easily removed from the canal if necessary.
Do not stain the tooth

Methods of filling root canal with gutta-percha can

be classified into three groups:
1. Cold gutta-percha
2. Heat-softened gutta-percha
3. Solvent-softened gutta-percha

The available obturation materials are:

Gutta-percha
MTA
Hydrophilic polymer
Resilon

COLD LATERAL COMPACTION TECHNIQUE

Outdated materials are:

Silver points
Paste Fillers (Paraformaldehyde, resorcinol, etc..)
Gutta-percha is the most commonly used one, and its
procedures will be described here.
GUTTA-PERCHA OBTURATION
Gutta-percha is a natural rubber obtained from topical
trees of the sapotaceae family.
Gutta-percha points consists of:
Gutta-percha 20%
Zinc oxide 59%
Various waxes, coloring agents, antioxidants, and
metal salts to provide radiopacity

Properties of gutta-percha points:

Inert (biological inactive)

Dimensionally stable
Non-allergenic
antibacterial
Radiopaque
compactable
Softened by heat
Softened by organic solvents
Removable when needed

This technique is taught and practiced throughout the

world. It is the technique of choice for many clinicians.
And it is fast and easy technique. After canal preparation, master cone that matching the size of master apical file is used to fill the canal. Then accessory points
are compacted laterally using finger or hand spreader.

Procedure in detail:
Irrigate the canal and dry
Select a master cone that is the same size as the
master apical file
Set a mark on master cone to the working length
Dip master cone into the sealer and coat the canal
wall using up and down motion
Now insert the master cone to the full working
length. It should have a tug back (resistance on
withdrawal. If not, cut 1 mm from the tip and reinsert, or choose larger gutta-percha point)
Select a finger spreader that reach to the full working length to the apical stop

Place spreader alongside the master point and

compact using firm apical pressure only.
Leave the spreader in place for 3 seconds (to
create deformation in the gutta-percha)

 Select accessory points and dip them into the sealer

and insert them alongside master cone.
Use spreader to compact accessory points laterally.
Repeat this procedure by adding more accessory
points until the canal can not take any more points.

Figure 2. Lateral compaction under the microscope.

Notice the laterally compacted cone

Cut excess gutta-percha using heated plugger.

Place Resin-modified glass ionomer cement and
apply final restoration
Take a periapical radiograph for follow-up

SOLVING SOME PROBLEMS IN LATERAL

COMPACTION

Gutta-percha cone reach the working

length but it is loose
Sometimes there are some gutta-percha cones that are
malsized. It is a manufacturing error. So try another
.gutta-percha of the same size
If that did not worked, then Cut 1 mm from the
tip of the cone with sharp instrument and reinsert
again. This increase the tip diameter.
Or select a one size larger gutta-percha cone.

Gutta-percha cone passes beyond

working length
This either results from improper apical stop, or gutta-percha cone is small. If apical stop is not prepared
well enough, then you either can re-prepare the canal
with larger instruments until apical stop is created, or
remove 1 mm from the tip of the canal until the cone
fits the canal.

Gutta-percha does not reach the

working length

2. Rotating Condenser (Gutta-Condenser)

Extracanal heating techniques: it involves heating gutta-percha outside the root canal
1. Precoated carriers (Thermafil)
2. Thermoplastic delivery systems (Obtura III)
WARM VERTICAL COMPACTION
Also known as schilders technique, and continuous
wave of compaction technique (with some modifications). This technique is considered the gold standard
for endodontic obturation. It is particularly useful in
situations such as internal resorption, C-shaped canals,
and those with fins and webs.
In summary, a non-standradized gutta-percha cone is
fitted into the canal. Using a selected plugger (that fits
to the working length minus 5-7 mm) heat is applied
to the gutta-percha, cooled, and then compacted apically. Then the rest of the canal either filled with the
same technique or filled with back-filling (injectable
gutta-percha technique).

Procedure in detail
Fit a gutta-percha cone and mark it at the working
length
System-B will be used to heat gutta-percha cone inside the canal

It is the most common situation. It can occur due to

several reasons:
The gutta-percha cone is larger than expected, due
to manufacturing errors. In this case select a cone of
the same diameter and try
Or the canal was not prepared well enough. Use
master apical file and prepare the canal until the file
is loose.
Blockage of the canal. This can results from insufficient irrigation of the canal with copious sodium
hypochlorite. Blocked canals are difficult to clean. Select one of the system-B pluggers that fits in the
Recapitulation with small files and passive ultracanal 5-7 mm short of the working length. Set a
sonic irrigation might help.
rubber stop at this level.

HEAT-SOFTENED GUTTA-PERCHA TECH?
NIQUES
When heat softened gutta-percha compacted into the
canal, it can flow in the lateral canals, fins and ramifications. This result in superior obturation quality.
Heat-softened GP techniques are divided into two
subgroups:
Intracanal heating techniques: it involves heating
gutta-percha inside root canal
1. Warm Vertical Compaction (Touch N heat, System
B)

 The tip of the plugger is placed in the center of the

gutta-percha cone, heat is applied, and the plugger
Also select a conventional plugger to fit to the same
is carefully pushed down the canal to the selected
distance
depth. This should take 3 seconds.

Dry the canal with paper points

Apply thin layer of sealer to the apical part of the
cone, then insert it inside and coat the wall with
sealer by up and down movement.
Insert gutta-percha cone to the full working length.

Set temperature in System-B to 200 Celsius and cut

the coronal part of the gutta-percha cone.
Then heat is then turned off and the plugger is remained in place for a further 10 seconds.

 With fast motion, turn on the heat and withdraw the ROTATING CONDENSER TECHNIQUE
plugger. A piece of gutta-percha will come along
with the plugger, and the apical piece remain in the In this technique an engine-driven compactor is placed
into the canal and rotated at 12000 rpm, which genercanal.
ate heat that plasticize and soften the gutta-percha. A
rotating stainless steel instrument is used to generate
this heat and compact gutta-percha laterally and apically. Although original devices are no longer made, other
similar devices such as Gutta-Condenser, Thermal Lateral Condenser are available. Most of these devices are
made from Ni-Ti and rotated at 8000 rpm.
The technique in summary: a gutta-percha cone is fitted
into the canal and the the condenser is insert into the
canal alongside master gutta-percha cone and rotated
at 800 rpm. The generated heat will plasticize the gutta-percha and compact it laterally and apically.
Concern has been found regarding the possibility of
The apical piece is compacted using conventional apical extrusion of the plasticized gutta-percha and
modifications to the original technique has been sughand plugger.
gested. The modification involve lateral compaction of
gutta-percha master cone and a few accessory points,
which will seal the apical part of the canal, then the
condenser is introduced and rotated to fill the rest of
the canal. Additional cones are added to the canal and
plasticized if needed.

The remaining part of the canal is either filled in the

same method until the canal is full, or back-filled
using other system such as injectable gutta-percha
technique:

Figure 3. Gutta-Condenser bur, which resemble inverted

Hedstorm file. It should be engine-driven at 8000 rpm
PRECOATED CARRIERS

The a layer of RMGIC is placed and tooth is restored.

In this technique a carrier made of plastic that is coated with gutta-percha is introduced into a softening machine and then it inserted into the canal. Most common
device is Thermafil.
It should be noted that this technique require canal
preparation with files of at least 0.04 taper. Canals prepared with hand files of taper 0.02 will not work.

Procedure
Dry the canal
Use carrier verifier of estimated size and insert it to
the full working length and a radiograph is taken to
confirm the position.

Figure 4. Coated carrier and verifier along

each other
Coat the canal with sealer
Coated carrier of the same size as verifier is inserted in the conditioning oven for appropriate time

One modifications of this technique is to use cold

compaction for the apical part of the canal and then
using a coated carrier for the rest of the canal.
INJECTION DELIVERY SYSTEMS

The heated carrier is then inserted into the canal

shorter of the working length by 0.5 mm.

In this technique the gutta-percha is heated in a special device (gutta-percha gun) and delivered into the
canal as creamy softened gutta-percha. This technique require a very definitive apical stop, and the
possibility of apical extrusion is very high.
Some modification of this technique called sectional
injection technique, in which a piece of gutta-percha
is melted to a plugger of suitable size and then introduced into the apical portion of the canal. Then
gutta-percha can be injected for the rest of the canal.
Injection delivery systems are very popular for
back-filling the middle and coronal portion following
warm vertical compaction or lateral compaction.
Commercially available injection delivery systems is
Obtura series.

After gutta-percha has been cooled, the carrier is

cut and condensed vertically. Additional gutta-percha can be added if needed.

time are also available

They are porous and susceptible to dissolution in
presence of tissue fluids
One technique is to fill the root canal with solution of They are cytotoxic if extended beyond the apex,
rosin in chloroform, and the master cone is seated into
and causes cellular response, although it is clinicalthe canal. Chloroform soften the surface of master cone
ly insignificant.
and made it swell, and the rosin act as a glue to make the
mass stick to the canal walls. Also some ready products
Calcium hydroxide sealers
are available such as Kloroperka, and Chloro-percha.
Another technique is called chloroform dip technique. Their sealing ability is similar to zinc oxide-eugenol sealers
In this technique, the apical 2-5 mm of the master cone
is dipped in chloroform for a few second and then with- May be soluble in tissue fluids
drawn. The cone is left to dry. Chloroform soften the Available products are: Sealapex, Apexit Plus,
Acroseal
outer layer of master cone, and when seated into the
canal it take its shape.
SOLVENT-SOFTENED GUTTA-PERCHA

SEALERS

Resin-based Sealers

Less popular than zinc oxide-eugenol sealer

Sealers are used to fill the space between obturation AH Plus product has good sealing ability, less cytotoxicity and low solubility
mass and prepared dentinal wall.
EndoREZ product is recommended for use with
EndoREZ points, to increase bonding of obturation
Objective of using a sealer are:
mass to dentin
Other available products are: Hybrid Root SEAL,
Cementing obturation material to the canal
MetaSEAL
Filling the spaces between obturation material and
the canal
Act as lubricant
Glass Ionomer Sealers
Act as antibacterial agent
It has sealing ability similar to traditional sealers
Activ GP product is used with Activ GP points
Ideal properties of sealer are:

Not irritating to periapical tissue

Insoluble in tissue fluids
Dimensionally stable
Good sealing ability
radiopaque
bacteriostatic
Good adhesion properties
Ease of manipulation
Non-staining to dentin
Easily removed when necessary

Sealers that are available in use today:

Zinc oxide-eugenol sealers

Calcium hydroxide sealers
Resin sealers
Glass ionomer sealers
Silicone-based sealers

Zinc oxide-eugenol sealers

Most commonly used sealers
Available products: Tubli-Seal, Roth Sealer, Pulp
Canal Sealer.
Also modified products with extended working

Silicone-based Sealers
RoekoSeal product manufacturer claim this sealer expand slightly on setting, and is highly radiopaque, and has good sealing ability. However, no
difference were noted between this sealer and AH
Plus
GuttaFlow product is also expandable slightly on
setting, and has less cytotoxicity than some other
sealers
REFERENCES
1. Hartys Endodontics in Clinical Practice - Churchill
Livingstone; 6 edition (May 18, 2010)
2. Endodontology, Michael A. Baumann
3. Pocket Atlas of Endodontics
4. A Clinical Guide to Endodontics, P. Carrotte, British Dental Journal.