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Classification:
I) ACCORDING TO GROSSMAN:
1. Lateral condensation
2. Vertical condensation
3. Sectional condensation
a. Lateral condensation
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c. Sectional method
e. Chlorpercha method
i. Johnson – Calloson
i. Pastes
1. Silver cones
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1. Vitallium
a. Cold GP points
i. Lateral compaction
b. Chemically plasticized GP
1. Eucalyptol
2. Chloroform
3. Halothane
c. Canal warmed GP
i. Vertical compaction
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1. Endotech
V. Thermomechanical compaction
2. Hybrid technique
4. Ultrasonic plasticizing
d. Thermo plasticized GP
i. Syringe insertion
1. Thermafill, Densfill
3. Ag points
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Intraradicular Extraradicular
Endotechnique Ultrafil
Thermapast Obtura II
PAC 160
System B Densefil
Success file
Sargenti technique
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a) Lateral Compaction:
This has been one of the most traditional and commonly practiced obturation
techniques.
Apply the rubber dam, and sterilize the field of operation. Dry the canal
thoroughly with absorbent points.(Fig.41)
In the cold lateral condensation technique of obturation, a gutta-percha cone
called the primary or master cone is fitted to the instrumented main
canal.(Fig.42)
The primary cone is inserted into the root canal to the established working
length. It should fit snugly and should resist removal (‘tug-back”). A
radiograph is taken to determine the apical and lateral fit of the primary
cone.(Fig.43)
The gutta-percha cone is adjusted; if it protrudes through the apical foramen,
the tip should be cut off so that the reinserted primary cone fits snugly, has
“tug-back”, and seals the apical canal approximately 0.5mm short of the
radiographic apex.
If the initial fit of the primary cone is 2 to 3mm short of the apex, a new
primary cone should be measured or the canal should be re-prepared to the
corrected length and another primary cone should be fitted.
Another radiograph is taken to verify the fit of the cone. Once the primary
cone has been accurately seated in the root canal, it is removed and the canal
is dried again with the help of absorbent paper points.
Mix root canal sealer on a sterilized slab with a sterile spatula. Test for
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proper consistency.
Remove the absorbent paper point.
Pick a small amount of sealer on a lentulospiral, master cone, file, or reamer
and coat the surface of the root canal. Repeat the process.
The apical half of the primary cone is coated with the sealer and is carefully
replaced in the canal.
A hand or finger spreader is inserted short of the working length in order to
ensure lateral compaction of the apical third of the master gutta-percha
point(Fig.44)
The spreader is disengaged from the cone by rotating it between the
fingertips or, when using a long-handled spreader, by rotating the handle in
an arc.
Once disengaged, the spreader can be removed without disturbing the seated
gutta-percha.
An accessory cone is inserted in the space previously occupied by the
spreader. This manoeuvre is done by positioning the (secondary, lateral)
accessory cone parallel to the spreader blade and inserting it immediately
into the opening created by the removal of the spreader.
A cement coating is not mandatory for secondary cones. This process is
repeated until the entire canal is filled with a well-condensed gutta-percha
filling.(Fig.45)
The size of the spreader is determined by the width of the prepared canal and
the lateral fit of the primary cone; the greater the space between the canal
wall and the butt end of the gutta-percha, the larger (wider) the spreader
used.
Care should be taken to reach within 1-2mm of the working length in order
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Limitations:
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Schilder described the step in cleaning and shaping of the root canal in
preparation for obturation by the vertical condensation method. The
requirements are that:
A continuous tapering funnel should be present from the root canal
orifice to the root apex.
The root canal should be prepared so that it flows with the shape of
the original canal.
The shape of the apical foramen should not be changed or moved.
The apical foramen should be kept as small as practical, so that
excess gutta-percha will not be forced through it during vertical
condensation.
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Lifshitz and colleagues used the scanning electron microscope to determine the
effectiveness of the vertical condensation method of sealing root canals in
conjuction with a sealer. The investigators found a wall-to-wall adaptation of the
gutta-percha in the apical area, as demonstrated by a solid interface among dentin
sealer and gutta-percha.
In an in vitro study, Goodman and associates have shown that the maximum region
temperature to which gutta-percha is subjected during the vertical condensation
method is 80C, and the temperature in the apical region is between 40 and 42C.
Advantages:
Disadvantages:
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With type II canals the master cones are placed in both canals before
compaction.
A hand plugger is used to stabilize the cone in one canal while the other is
being obturated.
Filling the space left by the plugger can be accomplished using a
thermoplastic injection technique (Obtura II or Ultrafil 3D
[Colene/Whaledent, Inc.]) or by fitting an accessory cone into the space with
sealer, heating it, and compacting with short applications of heat and vertical
pressure.(Fig.52)
One study evaluated internal and external temperature changes with the
System B unit with varied tips and temperature settings of 200°C, 250°C,
and 300°C. At 6 mm the System B unit set at 300°C with the fine-medium
plugger produced the highest mean internal temperature (74°C). The authors
noted the external temperature setting never exceeded the critical 10°C rise
with any temperature setting or tip configuration.
This was confirmed in another study that measured temperature changes 2
mm apical to the cementoenamel junction and at 1.5 mm from the apex.
Results indicate temperature changes apically were negligible. The mean
change near the cementoenamel junction was 4.1°C.
Another study found obturation temperature elevations produced during
obturation with System B were significantly less (P < 0.001) than with the
warm vertical compaction. An elevation of external root surface temperature
by more than 10°C was noted with vertical compaction.
Investigators measured the root surface temperatures while using the System
B heat source at various temperature settings from 250°C to 600°C. Results
indicated that the highest temperature occurred 5 mm from the apex, and
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only this site exceeded the 10°C rise. Based on this study a temperature
setting of 250°C or greater may be potentially hazardous.
For example, investigators using a thermo-couple and simultaneous infrared
analysis of temperatures found the root surface temperature averaged 13.9°C
whereas the infrared technology indicated a 28.4°C rise at the same sites.7
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Another investigator evaluated the effects of warm lateral and warm vertical
compaction on the periodontal tissues.
Neither technique produced heat-related damage.7
Jake Collins et al used a split-tooth model with artificially created intracanal wall
defects to compare three gutta-percha (GP) obturation techniques; cold lateral,
warm lateral, and warm vertical. The techniques were evaluated and compared
based on defect replication quality as a function of defect location and size. The
obturations were evaluated on an ordinal scale, 0 to 4, based on how much each
defect was replicated. There was a statistically significantly better result with both
warm techniques compared to cold lateral obturation, while there was no
significant difference between the warm obturation techniques.52
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Obtura III:
The Obtura III system (Obtura Spartan, Earth City, MO) consists of hand-
held “gun” that contains a chamber surrounded by a heating elemnt into
which pellets of gutta-percha are loaded.(Fig.57)
Silver needles (varying gauge of 20, 23 and 25) are attatched to deliver the
thermoplasticized material to the canal.
The control unit allows the operator to adjust the temperature and thus the
viscosity of the gutta-percha.
At 6mm from the apex a study found that the highest internal temperature
with the Obtura II was 27C.
Canal preparation is similar for other obturation techniques. The apical
terminus should be as small as possible to prevent extrusion of gutta-percha.
The technique requires the use of sealer, and once the canal is dried, the
canal walls are coated with sealer, using the last file used to length or a
paper point.
Gutta-percha is preheated in the gun, and the needle is positioned in the
canal so that it reaches within 3 to 5mm of the apical preparation.
Gutta-percha is then gradually, passively injected by squeezing the trigger
of the “gun”.
The needle backs out of the canal as the apical portion is filled.
Pluggers dipped in alcohol are used to compact the gutta-percha.
A segmental technique may also be used, in which 3 to 4mm segments of
gutta-percha are sequentially injected and compacted.
In either case, compaction should continue until the gutta-percha cools and
solidifies to compensate for the contraction that takes place on cooling.
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The difficulties with this system include lack of length control. Both
overextension and underextension are common results.
To overcome this drawback, a hybrid technique may be used, in which the
clinician begins filling the canal by the lateral compaction technique.
When the master cone and several accessory cones have been placed so that
the mass is firmly lodged in the apical portion of the canal, a hot plugger is
introduced, searing the points off approximately 4 to 5mm from the apex.
Light vertical compaction is applied to restore the integrity of the apical plug
of gutta-percha. The remainder of the canal is then filled with
thermoplasticized gutta-percha injected.
Investigators studied, at 3, 6 and 12 months post-treatment, the success rate
of 236 teeth obturated with the Obtura system. Results indicated that 96% of
the cases were successful, with the highest success rate being in teeth filled
flush with the apex (97%) when compared with overextension (93%) and
filling short (93%)
Another sturdy compared lateral compaction with Thermafil (DENTSPLY
Tulsa Dental Specialities) and Obtura II in root canal models and found that
the Obtura II produced the best adaptation to the canal walls.
Other investigators found that continuous wave obturation with the Obtura II
backfill nitially produced a better bacterial seal when compared with lateral
compaction, using bilaterally matched teeth and an anaerobic bacterial
leakage model.
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Ultrafil 3D:
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Calamus:
Elements:
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HotShot:
The unit is cordless and can be used with either gutta-percha or Resilon.
Needles are are available in 20, 23 and 25 gauges.
Guttaflow:
Jose et al evaluated four techniques for the obturation of the root canal system in
the presence or absence of a smear layer. The results showed no significant
differences in the degree of leakage with and without the smear layer when the
samples were considered as a whole. However, when the groups were assessed
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separately, teeth in the lateral condensation with an accessory main cone group and
teeth in the thermoplasticized group leaked less with a smear layer present. In
contrast teeth with lateral condensation and a standardized main cone leaked more
with a smear layer present. In the vertical condensation groups there was no
difference attributable to the smear layer.55
e) Carrier-Based Gutta-Percha:
Thermafil
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Rotary #.04 and #.06 nickel titanium files may also be used to remove the
obturation materials.
The plastic carriers are composed of two nontoxic materials. Sizes #20 to
#40 are manufactured from a liquid crystal plastic. Sizes #40 to #90 are
composed of polysulfone polymer.
Both have similar physical characteristics with the polysulfone carriers being
susceptible to dissolution in chloroform.
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C), Obtura II (group D), System B 1 Obtura II (group E), and Thermafil (group F).
AH26 was used as the sealer. A greater number of simulated lateral canals were
obturated when Ultrafil, Thermafil, and System B + Obtura II were used, in
comparison with canals obturated with the hybrid technique, Obtura II, or lateral
compaction of gutta-percha. This difference was statistically significant (p < 0.05).
No statistically significant differences were found between results obtained in the
obturation of simulated lateral canals in the different thirds of the root (p > 0.05)57
Successfil:
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SimpliFill:
Elliott et al studied the cytotoxicity of two metallic and two plastic Thermafil
carrier materia, and to separately evaluate the in vitro corrosion behavior of the
two metallic carriers. Stainless-steel, Ti-64Al-4V, Polysulfone, and Vectra carriers
were evaluated for cytotoxicity using the ISO-recommended agar overlay test. The
two metallic carriers were additionally corrosion tested in 0.9% NaCl solution for
174 wk, at 37C. Elemental analyses of the corrosion solutions were periodically
conducted using inductively couple plasma-mass spectroscopy. Agar overlay
results showed that the four carrier materials were not cytotoxic to L929
fibroblasts. Inductively coupled plasma-mass spectroscopy results showed that the
metallic materials had small mass loss rates. Scanning alactron microscopy showed
no evidence of pitting or crevice corrosion.59
f) Thermomechanical Compaction:
McSpadden introduced an instrument with flutes similar to a Hedstrom file
but in reverse.
When activated in a slow speed handpiece the instrument would generate
friction, soften the gutta-percha, and move it apically.
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g) Solvent Technique:
Gutta-percha can be plasticized by solvents such as chloroform, eucalyptol,
and xylol.
Disadvantages to the solvent techniques include shrinkage caused by
evaporation, voids, the inability to control the obturating material, and
irritation to periradicular tissues.
The Callahan and Johnston technique involved dissolving gutta-percha in
chloroform and placing the mixture into the canal with a syringe.
A gutta-percha cone was then softened and placed into the canal; the mass
hardened as the solvent evaporated.
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h) Immediate Obturation:
Apical barriers may be necessary in cases with immature apical
development, cases with external apical root resorption, and cases where
instrumentation extends beyond the confines of the root.
Dentin chips, calcium hydroxide, demineralized dentin, lyophilized bone,
tri-calcium phosphate, hydroxyapatite, and collagen have been advocated for
placement as a barrier in canals exhibiting an open apex.
The barriers are designed to permit obturation without extrusion of materials
into the periradicular tissues but are often incomplete and do not seal the
canal.
Dentin chips appear to confine materials to the canal space during
instrumentation/obturation and may encourage development of a biologic
seal.
Enhanced healing, minimal inflammation, and apical cementum deposition
have been noted histologically.
A concern with this technique is contamination of the dentin with bacteria
because investigators found infected dentin adversely affected healing.
Calcium hydroxide has also been extensively used as a common apical
barrier. Calcium hydroxide has been shown to induce an apical barrier in
apexification procedures.7
Calcifications similar to dentin plugs have been noted at the apical foramen.
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