R o o t C a n al F i l l i n g

P ri n c i p l e s & Te c h n i q u e s
David E. Witherspoon
✴ Understand the general principles of root canal obturation

✴ Discuss the various option available for root canal obturation

✴ Understand the application of various root canal filling techniques

✴ Compare and contrast various root canal filling techniques

Successful Endodontics
• Cleaning & Shaping
• Bacteria
• Remove Debris
• Obturation 3D
• Creating a barrier from the oral environment
• Length of the root canal system
• Coronal seal (Restoration)
Successful Endodontics
• Cleaning & Shaping
• Bacteria
• Remove Debris
• Obturation 3D
• Creating a barrier from the oral environment
• Length of the root canal system
• Coronal seal (Restoration)
 Obturation
DEFINITION: The complete filling and closing of a
cleaned and shaped root canal using a root canal
sealer and core filling material
• Objectives:
1. Eliminate of all avenues of leakage from the oral cavity and
periradicular tissues into the root canal system
2. Seal within the system any irritants that are not fully
removed during cleaning and shaping
Ideal Obturation Material
• Biocompatible
• Bactericidal
• Seal
• Bacteria
• Bacteria by products
• Biologic
• Stability
• Workability
• Easily placed and distributed
• Reasonable setting time
• Enhance tooth structure
• Homogeneous
• Radiopaque
Obturation Techniques
United States Dental Schools
Cailleteau JG. Mullaney TP. J Endod 23:394-6, 1997

• 89.6% teach lateral compaction is the primary

obturation technique
• Most common material is gutta percha
• One school teaches core carrier system
• One school use Resilon in the undergraduate
Issues Related to Obturation
• What is the role of obturation in outcomes?
• What is an appropriate means of testing ?
• Obturation techniques
• Obturation materials
•Going RE. Myers HM. Prussin SG. Quantitative method for
studying microleakage in vivo and in vitro. Journal of Dental
Research. 47(6):1128-32, 1968 Nov-Dec.

•Wayman WH. Mullaney TP. A comparative study of apical

leakage with endodontic implant stabilizers. J Endod. 1(8):
270-3, 1975 Aug.

•The apical seals of 75 extracted teeth that were treated with

three methods of endodontic implant stabilizers were
compared with the seals of 25 teeth filled with silver cones
and 25 teeth filled with laterally condensed gutta-percha.
Apical leakage was measured with the use of methylene blue
dye solution. Statistical analysis showed that there were
significant differences between the apical leakage obtained
from the teeth treated with endodontic implant stabilizers
and those teeth filled with silver cones and with laterally
condensed gutta-percha.
What is the role of obturation in outcomes?

• Klevant FJ. Eggink CO. Int Endod J 16:68-75, 1983

• Exp grp 86 Teeth C&S - Obturation
• Control grp 336 teeth C&S + Obturation
• Over 2 years the outcome was similar
What is the role of obturation in outcomes?

• Vernieks AA. Messer LB. Calcium hydroxide

induced healing of periapical lesions: a study of 78
non-vital teeth. J Brit Endod Soc 11:61-9, 1978
• C&S ➣Ca(OH)2 ➣ 3-48 mths
• 55/78 complete healing (70.5%)
• 20/78 some healing (25.6%)
• 3/78 no healing (3.9%)
What is the role of obturation in outcomes?

• Peters OA. Barbakow F. Peters CI. Int Endod J

37:849-59, 2004
• 179 pts NSRCT
• Lightspeed + LC GP AH Plus
• ProFile .04 + LC GP AH Plus
• ProFile .04 & .06 or GT
• System B, Obtura II & Roth's 801
• 86% healing
• Outcome was not significantly affected by
instrumentation or obturation system.
What is the role of obturation in outcomes?
What is the role of obturation in outcomes?
What is the role of obturation in outcomes?

92.5%
77%

LC+ Sealapex
What is the role of obturation in outcomes?

92.5%
77%

LC+ Sealapex
•Augsburger RA. Peters DD Radiographic evaluation of
extruded obturation materials. J Endod. 16:492-7, 1990

•Abstract
•The radiographic appearance of filling material extruded into
periradicular tissues during obturation of root canals was
studied over time. Recall radiographs for up to 6 1/2 yr. were
compared with immediate postoperative films. Consistently, less
material was evident at successive postoperative periods. This
study indicated that given time, the two zinc oxide and eugenol-
based sealers studied will be removed from periradicular
tissues. It also indicated that sealer is removed from
periradicular tissues more rapidly than gutta-percha.
• Obturation is important

• Obturation is a function of cleaning and

shaping

• It is difficult to identify any one technique

as being superior
 Materials
Core + Sealer
• Gutta percha
• Core carrier Niti/SS/Plastic
• Additives or modified GP
•EndoRez system
•GuttaFlow Specialized sealer
•ActiV GP
• Silver cones
• MTA
• Resilon
• Paste
•Sealer
•
Cement/Bonding Agent
 Sealer ★Ca(OH)2
★ Not recommended with heat
★ CRCS
★ ZOE
★ Rickerts
★ Acroseal
★ Pulp Canal Sealer /EWT
★ Sealapex
★ Wach’s Sealex-Extra
★ Apexit
★ Endo-Fill
★ Sealer 26
★ MCS Canal Sealer
★ Resin
★ Iodoform
★ AH26
★ Endomet
★ Sealer 26
★ Thymol Iodide
★ AH Plus
★ Pulpdent
★ EndoREZ
★ Canals
★ Topseal
★ Canals-N
★ Silicone
★ Grossman - Type
★ Lee Endo-Fill
★ Roth 801, 811, 601, 511, 515
★ Roeko Seal Automix
★ Procosol
★ RoekoSeal
★ Endoseal
★ Not recommended with heat
★ Tubliseal /EWT
★ GIC
★ Not recommended with heat
★ Ketac-endo
★ Formaldehyde
★ ActiV GP
★ N2
★ Not recommended with heat
★ Endomethasone
★ Other
★ SPAD
★ Nogenol root canal sealer
★ Salicylic Acid
★ Not recommended with heat
 Sealer
• All GP obturation techniques routinely
preform better in leakage studies when a
sealer is used
• Evans JT. Simon JH. J Endod 12:100-7, 1986

• Tagger M. Katz A. Tamse A. Oral Surg Oral Med Oral Pathol 78:225-31, 1994

• Wu, MK; van Der Sluis, LWM Wesselink, PR Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 97:257-262,2004.

• Wu, M K; Fan, B; Wesselink, P R. Int Endod J. 33:121-5, 2000

Issues Related to Sealer
• Amount / Thickness
• Stability
• Solubility
• Dimensional change
• Adhesion
• Tissue Tolerance / cytotoxicity
• Bacteria
• Application
 Sealer Thickness
• •Kontakiotis EG. et al Int Endod J 30:307-12, 1997
2 yrs. ➣ 0.05 mm (thin layer) and 0.3 mm (thick layer)
• Roth and Pulp Canal Sealer EWT
• Thick layers of allowed more leakage
• AH26, Ketac-Endo, Sealapex
• No sig diff was found between the thin and thick layers

• •Wu MK. et al Int Endod J 28:185-9, 1995

AH26, Ketac-Endo, Tubli-Seal & Sealapex
• 1 yr. thinner was better

• •Wu MK. et al Int Endod J27:304-8, 1994

AH26, Ketac-Endo, Sealapex & Tubli-Seal ➣ thickness of 0.05, 0.25 or 3 mm
• AH26, Ketac-Endo, & Sealapex sealed better than Tubli-Seal @ 0.25 mm
• Ketac-Endo sealed better the other three sealers @ 0.05 mm

• •Hall MC. Clement DJ. et al. J Endod 22:638-42, 1996

No methods exceeded an AV of 62.5% wall coverage of sealer after obturation
• Complete wall coverage after obturation may not be possible.
 Sealer Application
• Hand File (type of file)
• Rotary file
• Forward vs. reverse
• Master cone
• Paper point
• Lentulo spirals
• Ultrasonic
• Specialized instruments
 Sealer Application
•Facer SR. Walton RE. J Endod. 29:832-4, 2003
•Distribution patterns of sealers after lateral compaction
•Roth's, Sealapex, AH 26 ➣➣ Sealer placed with a file
•No sealer group demonstrated complete coverage
•Wiemann AH. Wilcox LR. J Endod. 17:444-7, 1991
•File, lentulo spiral, ultrasonic files, and master gutta-percha cone ➣ AH26
•No statistically significant differences among the four groups.
•The greatest variation in sealer coverage was found in the apical level
•Kahn FH. Rosenberg PA. et al. Int Endod J 30:181-6, 1997
•lentulo spiral =Max-i-Probe >ultrasonic = sonic files >paper point = K file.
•Aguirre AM. el-Deeb ME. Aguirre R. J Endod. 23:759-64, 1997
•Ultrasonic and hand methods of sealer placement
•Sultan "Grossman's formula," AH-26, and CRCS.
•Ultrasonics was superior to manual placement only for CRCS.
•Method of sealer placement had no effect on apical leakage
•Stamos DE. Gutmann JL. Gettleman BH. J Endod 21:177-9, 1995
•In vivo evaluation ➣ Master gutta-percha cone or an ultrasonic file.
•Sig. more radiographically visible accessory canals ➣➣ ultrasonic
 Sealer Application
Distribution
• Hall MC. etal J Endod 22:638-42, 1996
• Curved canals
• AH26 sealer K-file, lentulo spiral, or master gutta-percha cone.
• No statistical difference in canal wall coverage
• Average of 62.5% wall coverage of sealer after obturation
• Complete wall coverage after obturation may not be possible.

• Hugh CL. Walton RE. Facer SR. Quint Int 36:721-9, 2005
• WVC, Obtura II, System B, SimpliFill, Thermafil, LC
• SimpliFill had the most samples with complete coverage in both
the coronal and the apical portions.
• No technique had sealer forming a continuous layer
➣➣between the gutta-percha and canal wall.
 Sealers
Tissue Tolerance & Bacteria
• All sealers are initially cytotoxic in the unset form
• Double edge sword
• Chemical agent that have a bacteria effect have a
tendency to be cytotoxic
• Huang FM. Etal J Biomed Mat Res 59:460-5, 2002
• Cytotoxicity ↓↓ order of N2 > Endomethasome > AH Plus > Sealapex.
• Lai CC. Etal Clin Oral Invest 5:236-9, 2001
• N2 was the most effective against the microorganisms

• The concept of Ca(OH)2 sealers

• ➣ Stimulate hard tissue formation
• Tagger M. Tagger E. Endod & Dent Trauma 5:139-46, 1989
• Sonat B. et al Int Endod J 23:46-52, 1990
• Holland R. etal Revista de Odontologia Da Unesp. 19:97-104, 1990
• Sealapex stimulated hard tissue
Sealer: Formaldehyde Release
• Cohen BI. Pagnillo MK. et al Oral Health. 88:37-9, 1998

• Formaldehyde release

• AH-Plus 3.9 ppm

• EZ-Fill 540 ppm

• AH-26 1347 ppm

• Spangberg LS. etal J Endod 19:596-8, 1993

• Spangberg L. etal OOO 36:856-71, 1973

 Sealers: E. faecalis
• Saleh IM. Etal Int Endod 37:193-8, 2004
• CFU recovered from infect RCT
• AH Plus = Grossman killed bacteria (mean CFU = 0) < Ca
(OH)2 (0.53)< RoekoSeal Automix (1.36)< Apexit (1.40) <
Ketac-Endo (1.94)

• Mickel AK. etal J Endod 29:257-8, 2003

• Zones of inhibition
•
Roth 811 (1.1 mm), > Sealapex (0.8 mm) > Kerr EWT
(0.5 mm), > AH-Plus (0.0 mm)

• Kayaoglu G. etal Int Endod J. 38:483-8, 2005

• Direct contact test, MCS = AH Plus (greatest kill) >
Grossman's sealer, > Sealapex > Apexit.
• Membrane-restricted contact test, MCS > AH Plus
>Grossman's sealer > Apexit > Sealapex
 Sealers: E. faecalis
• Sipert CR. etal Int Endod J. 38:539-43, 2005
• Sealapex and Fill Canal antimicrobial activity E. faecalis
• EndoRez no antimicrobial activity

• Fuss Z. etal Int Endod J 30:397-402, 1997

• 1-hour CRCS = Roth > Sealapex
• 24-hour, Roth best
• 7-day Sealapex best

• Shalhav M. etal J Endod 23:616-9, 1997

• Ketac Endo ➣ very potent short-acting effect
• Roth ➣ effect over 7 days after setting.
 Sealers: E. faecalis
• Sipert CR. etal Int Endod J. 38:539-43, 2005
• Sealapex and Fill Canal antimicrobial activity E. faecalis
• EndoRez no antimicrobial activity

• Fuss Z. etal Int Endod J 30:397-402, 1997

• 1-hour CRCS = Roth > Sealapex
• 24-hour, Roth best
• 7-day Sealapex best

• Shalhav M. etal J Endod 23:616-9, 1997

• Ketac Endo ➣ very potent short-acting effect
• Roth ➣ effect over 7 days after setting.
 Sealer:Solubility
• Peters DD. Endod. 12:139-45, 1986.
• Procosol + GP
• LC, WVC ,Thermomechanical, Chloroform Dip
• Sealer loss Stored in H2O for 2 yrs.
• LC >WVC >Thermomechanical >Chloroform Dip
• McComb D. Smith DC. J Endod. 2:228-35, 1976
• Only AH26 adhered to dentin
• Solubility
• Pulp Canal Sealer>Roth 801 > Procosol >
Pulpdent > AH26 = Roth 511 = Tubliseal >
Diaket
Tronstad L. et al Endod Dent Trauma 4:152-9, 1988
• Kazemi RB. etal OOO 76:766-71, 1993
• ZnOE , AH26, Endo-Fill ➣ 0-180 days
• AH26
• Little water sorption /no disintegration
• Endo-Fill
• No water sorption/ Little disintegration
• ZnOE
• Dissolved during setting
• Greatest dimensional change overtime (shrinkage)

• Sleder FS. etal J Endod. 17:541-3, 1991

• Sealapex, Tubli-Seal
• Immersed in a saline solution for 2 and 32-wk
• Linear ink penetration leakage study
• No Sig Dif
• Schafer E. Zandbiglari T. Int Endod J. 36:660-9, 2003
• AH 26, AH Plus, RSA RoekoSeal, Apexit, Sealapex, ZnOE, Ketac Endo,
Diaket
• Solubility in water or artificial saliva ➣ 30 s ➣ 28 days.
• Most sealers had low solubility
•Sealapex, ZnOE and Ketac higher solubility
•
Sealapex greatest
• AH 26, AH Plus, RSA RoekoSeal, and Diaket had low solubility
•AH Plus lowest
• McMichen FR. etal. Int Endod J. 36:629-35, 2003
• Roth 801, Tubli-Seal EWT, AH Plus, Apexit and Endion
• AH Plus was the least soluble
• Apexit was the most soluble
• AH Plus < Tubli-Seal EWT< Endion < Apexit
•Roth 801 did not set sufficiently to test soluble
• Kaplan AE. etal J Endod. 23:439-41,1997
• Ketac-Endo, Tubli-Seal, AH26
• Immersed in water for 48 h, 7d 45d
• Statistically no diff
• Ketac endo looked the worst
Sealers: Adhesion
Sealers: Adhesion
Sealers: Adhesion
Sealers: Adhesion
Sealers: Adhesion
Core Materials
• Gutta percha
• Core carrier Niti/SS/Plastic
• Additives or modified GP
•EndoRez system
•GuttaFlow Specialized sealer
•ActiV GP
• Silver cones
• MTA
• Resilon
 Silver Cones
• Corrosion
• Silver sulfides, silver sulfates, silver carbonates,
silver amine sulfate amide hydrates.
• Seltzer S. Green DB. Weiner N. DeRenzis F. J Endod 30:463-74; discussion 462,
2004

• Koren LZ.Yesilsoy C. Sinai IH. Chivian N. Oral Surg Oral Med Oral Path
66:86-92, 1988

• Zmener O. Dominguez FV. Oral Surg Oral Med Oral Path 65:94-100, 1988

• Zielke DR. Brady JM. del Rio CE. J Endod 1:356-60, 1975

• Brady JM. del Rio CE. J Endod 1:205-10, 1975

• Seltzer S. Green DB. Weiner N. DeRenzis F. Oral Surg Oral Med Oral Path
33:589-605, 1972

• Zmener O. J Endod 15:319-22, 1989.

 Gutta Percha
• Gutta percha most common root canal filling material
• ItSjogren
is not inert
• U. Sundqvist G. Nair PN. Euro J Oral Sci 103:313-21, 1995
• Fine particles evoked an intense, localized tissue response ➢ macrophages

• Sjogren U. Ohlin A. et al. Eur J Oral Sci 106:872-81, 1998

• Stimulated macrophage release PG E2 & I2

• Pascon EA. Spangberg LS. J Endod 16:429-33, 1990

• Leonardo MR. Utrilla LS. et al Int Endod J 23:211-7, 1990
• Moderate to severe inflammatory response
• No contemporary root canal filling material or
technique is impervious to leakage
• Coronal restoration➫➬ Coronal leakage
 ProRoot MTA
• Seal/Leakage/ Marginal Adaptation
• Prevents leakage
• Super EBA, IRM & Amalgam
• Sets in the presence of blood
• Marginal adaptation
• Super EBA, IRM & Amalgam
• Prevents leakage = resin based materials
 ProRoot MTA
• Cellular Response
• Histologically better than Super EBA, IRM & Amalgam
– Torabinejad et al. J Endod 1995
– Torabinejad et al. J Endod 1998
– Moretton et al. J Endod 1997 (abs)
• Appears to form cementum tissue over the root-end
filling material in the periradicular region
• Torabinejad et al. 1997
Issues Related to Obturation
• Instrument dimensions
• Ca(OH)2
• Canal drying
• Pulpal floor
• Root fracture
• Spreader / Plugger penetration
• Heat generation
• Open apex teeth
 Instrument Dimensions
• LC
– D11T spreader .34 mm  1.01
~0.04 Taper
– D11TS spreader .25 mm  1.01
~0.05 Taper
• WVC
– Smallest plugger  .33 mm .66
~0.02 Taper
– Typical plugger .40 mm  1.09
~0.04 Taper
• System B
•Tip size is 55
 Effect of Ca(OH)2
• Rococo D. Langeland K. Int Endod J 30:418-21, 1997
• Case report
• Incomplete Ca(OH)2 removal resulted in Tx Failure
• Holland R. et al Endod Dent Trauma 11:261-3, 1995
• H2O +files #40 up to #70 ➣ZnOE+GP
• Significantly less leakage Ca(OH)2
• Porker P. etal. J Endod 16:369-74, 1990
• Ca(OH)2, Calasep,Vitapex, control group
• Removed NaOCL+File ➣ZnOE+GP
• Ca(OH)2
• leakage not sig dif
• sig less than the control group
 Effect of Ca(OH)2
• Lambrianidis T. etal J Endod 25:85-8, 1999
• Saline + file+ saline
• NaOCL + file + NaOCL
• NaOCl + file + EDTA
• None of the methods efficiently removed all Ca(OH)2
• 25-45% of canal walls had Ca(OH)2
• Caliskan MK. etal. Int Endod J 31:173-7, 1998
• NaOCl + K file ➣ CRCS, Diaket sealer +GP
• Diaket + Ca(OH)2 leaked the least
• Margelos J. etal J Endod 23:43-8, 1997
• NaOCl
• NaOCl+file
• NaOCl +EDTA +file ➣Removed the most Ca(OH)2
• ZnOE +Ca(OH)2
• Rapid set reaction at the interface
➣brittle granular
 Effect of Ca(OH)2
• Lambrianidis, T. Kosti, E. etal Int Endod J 39:55-61,2006.
• NaOCL+EDTA -/+ size 10 H-file
• Ca(OH)2+CHX) (gel), Ca(OH)2+CHX (sol) and Ca(OH)2+saline
• None of the techniques removed all Ca(OH)2
•File helped
• Hosoya N. etal Int Endod J 37:178-84, 2004
• Calcipex,Vitapex,Calkyl,Ca(OH)2
• Canals, Canals-N, Ketac –Endo, Sealapex
• Removed NaOCL H2O2
•Working time decreased in all except Canals+Calcipex
•Sealapex extremely variable
•Sealing ability of all four sealers was affected
•Sealapex improved with all combinations
• Sevimay S. Oztan MD. Dalat D. J Oral Rehab 31:240-4, 2004
• NaOCl
• NaOCl + File
• EDTA + NaOCl + File removed the most Ca(OH)2
• AH 26+GP➣ Ca(OH)2 had no effect on coronal leakage
 Effect of Ca(OH)2
• Kim SK. Kim YO. Int Endod J 35:623-8, 2002
• NaOCl + EDTA + files
• NaOCl + files
• ZnOE+ GP
• Ca(OH)2 leaked more than no Ca(OH)2
• No sig dif between removal method
• Goldberg, F. etal J Endod. 28:99-101,2002
• NaOCl + File
• Difficult to remove Ca(OH)2 from lateral canals
• Calt S. Serper A. J Endod 25:431-3, 1999
• NaOCl alone
• Did not completely remove Ca(OH)2
• EDTA + NaOCl
• Completely removed Ca(OH)2
•Engel GT. Goodell GG. McClanahan SB. J Endod. 31:620-3, 2005
•Leakage or sealer penetration
•Final rinse 70% isopropyl alcohol, Peridex, 6% NaOCl
•Roth's 801 lateral compaction
•No significant differences between groups for microleakage or sealer penetration
•Hosoya N. Nomura M. etal J Endod. 26:292-4, 2000
•Grp 1,one paper point, Grp 2, four paper points, Grp 3 four paper points+ gentle
burst of warm air, Grp 4 four paper points, + internal 200 degrees C heat probe.
•Zinc oxide-eugenol sealer vs glass ionomer sealer
•Glass ionomer sealer appeared more susceptible to moisture
•Group 4 Best
•Horning TG. Kessler JR. J Endod 21:354-7, 1995
•Procosol, Sealapex, Ketac-Endo
•Saline as a moisture contaminant
•Procosol <Sealapex <Ketac-Endo.
•No significant difference in the amount of dye penetration after 9 months
•Wilcox LR. Wiemann AH. J Endod. 21:256-8, 1995
•Alcohol or NaOCl
•lentulo spiral or file
•AH26 laterally
•no significant differences among the four groups
•all areas had sealer present middle and apical thirds showed the most variability
•Kuhre AN. Kessler JR. J Endod. 19:277-80, 1993
•Apical seal of laterally condensed gutta-percha
•Proco-Sol root canal cement
•Prior to obturation
•Dried
•NaOCl
•Saliva
•No significant differences were found among the groups.
 Pulpal Floor
• Accessory canals in the furcation region
• Gutmann JL. J Period 49:21-6, 1978
• 29.4% mandibular molars
• 27.4% maxillary molars
• Haznedaroglu F. Ersev H. et al Int Endod J 36:515-9, 2003
• 24% maxillary first molars
• 16% maxillary second molars
• 24% mandibular first molars
• 20% mandibular second molars
• Blaskovic-Subat V. Acta Stomat Croatica. 24:85-95, 1990
• 32.0% of all furcations
 Pulpal Floor:Sealing
Barrieshi-Nusair KM. Hammad HM. Quint Int 36:539-45, 2005
de Souza FD. Pecora JD. Silva RG. Oral Surg Oral Med Oral Path Oral Radiol & Endod 99:125-8, 2005
Shindo K. Kakuma Y. et al Dent Materials J 23:419-23, 2004
Wells JD. DH. et al. J Endod. 28:443-7, 2002
Zaia AA. Nakagawa R.et al Int Endod J. 35:729-34, 2002
Kijsamanmith K. Timpawat S. et al Int Endod J 35:833-9, 2002
Belli S. Zhang Y. Pereira PN. Pashley DH. J Endod. 27:521-6, 2001.
Wolcott JF. Hicks ML. Himel VT. J Endod. 25:589-92, 1999
Pisano DM. DiFiore PM. et al J Endod. 24:659-62, 1998
Chailertvanitkul P. Saunders WP. Saunders EM. MacKenzie D. Int Endod J. 30:318-22, 1997
Saunders WP. Saunders EM. Int Endod J. 23:28-33, 1990

• In all studies a second seal was beneficial

• Intraorifice vs pulpal floor
• 2-4 mm
• Little difference
• Sealing the entire pulpal floor is easier
• Flowable adhesive materials may be better
• Bond to pulpal floor weaker  coronal dentine
• Teeth should be restored as quickly as possible
• Super Bonder • IRM
• Single Bond • Super-EBA
• Protect Liner F • Coltosol
• Panavia F • Vidrion R
• DC core-Light cured • Scotch Bond
• DC core-Chemically cured • MTA
• Principle • Glass ionomer
• C&B Metabond • Ketac
• Clearfil SE Bond
• One-Step • Vitrebond
• Cermet cement • GC America
• Cavit • Ketac-Bond
• Amalgam
Compaction of Gutta-percha

• Cold compaction
• Compaction of heat-softened gutta-percha
Non-injected
Injected
Core carrier
• Mechanical compaction
 Lateral Compaction:Technique
• Master cone selection

• Fits to or within 0.5 mm of the working length

• Snugness of fit in the apical 1 to 3 mm

• Radiograph space lateral to the master cone in mid and coronal third

• Spreader selection

• Sealer placement

• Compaction

• Spreader place lateral to the master cone to within 0.5-1 mm of WL

• Accessory cone is lightly coated with sealer

• Add accessory cones until the spreader can penetrate only 2 to 3 mm

 Spreader selection
• Spreader needs to be 1-2 mm of WL
• Walton RE Johnson WT 1996

• Johnson WT Gutmann JL 2006

• Spreader needs to reach WL

• Gutmann JL Witherspoon DE 2002

• Spreader needs to be 2 mm of WL with GP in place

• Allison DA. Michelich RJ. Walton RE. J Endod 7:61-5, 1981
 Spreader Diameter
1 mm from the Tip

• RCS3 0.35 • RCSGP2 0.24 • S20 0.23

• RCSD11 0.50 • RCSGP3 0.30 • S25 0.30
• RCSD11S 0.28 • RCSMA57 0.22 • S30 0.33
• RCSD11T 0.34 • RCSW1S 0.36 • S40 0.44
• RCSD11TS 0.25 • RCSW2S 0.39 • S50 0.42
• RCSGP1 0.24 • RCS30 0.30 • S60 0.55

Need To Shape to Accommodate the Spreader

RCSD11T 0.34
RCSD11TS 0.25
Lateral Compaction: Spreader Penetration
• Spreader penetrate more tapered canal systems
• Dulaimi, S. F. 1; et al Int Endod J 38:510-515, 2005.

• Finger spreaders appear to be better than hand spreaders

• Simons J. Ibanez B. etal J Endod 17:101-4, 1991

• Niti Vs stainless steel

• Sobhi MB. Khan I. J College Phys & Surg Pak 13:70-2, 2003

• In vivo curved root canals.

• Nickel-titanium finger spreader was significantly deeper
• Stainless steel penetration decreased with increasing angle
of curvature of the canal.
• Berry KA. Loushine RJ. et al. J Endod 24:752-4, 1998

• NiTi spreaders penetrated to a significantly greater depth

than SS spreaders in curved canals
 Lateral Compaction: Spreader Force
NiTi vs Stainless Steel; Hand Vs Finger Spreaders
• Gharai SR. Thorpe JR. et al J Endod 31:198-200, 2005
• Curved canals NiTi finger spreaders produce sig less force than SS finger spreaders
• No significant difference in microleakage between spreaders
• Blum JY. Esber S. Micallef JP. J Endod 23:340-5, 1997
• Warm vertical compaction lateral condensation thermomechanical compaction
• Vertical forces WVC, 2.5 +/- 0.4 kg, LC 1.1 +/- 0.3 kg, and TMC 1.65 +/- 0.2 kg
• Lateral forces WVC, 0.85 +/- 0.2 kg, LC 0.35 +/- 0.1 kg, and TMC 0.5 +/- 0.2 kg
• Lertchirakarn V. Palamara JE. Messer HH. J Endod 25:99-104, 1999
• Max loads and strains generated by finger spreaders were sig lower than D11T
• Joyce AP. Loushine RJ. West LA. Runyan DA. Cameron SM. J Endod 24:714-5, 1998
• Stress in canal walls
• Stainless-steel spreaders created three areas of concentrated stress
• Nickel-titanium spreaders stress spread out along the surface of the canals
• Dang DA. Walton RE. J Endod 15:294-301, 1989
• D11 spreaders or B-finger pluggers
• D11, produced vertical root fractures and caused greater root distortion
• Schmidt KJ. Walker TL. et al. J Endod 26:42-4, 2000
• Nickel-titanium spreader ➣ sig less force than a stainless-steel spreader
Spreader Loads:Vertical Root Fracture
Holcomb JQ, Pitts DL, Nicholls JI. J Endod 13:277-284; 1987
Lindauer PA. Campbell AD. Et al J Endod 15:345-9, 1989

• Force required to cause vertical fracture during LC

• DIIT spreader
• Smallest fracture load was 1.5 kg (3.31 lb.)
• Mainly buccolingual direction
• Incomplete fracture was seen in 26%.
• Positive linear correlations were found between fracture load and root
width, canal width, canal taper, ratio of canal width to total root width,
and number of accessory cones placed.

• Obturated using forces ➣ 1 to 3 kg or 4.5 to 7.5 kg.

• 3 teeth obturated using 7.0 to 7.3 kg of force demonstrated
vertical root fractures.
• Up to 4.9 kg are safe
• Chloroform, methychloroform, halothane,
rectified white turpentine and eucalyptol
• Dip ➣ softened paste of gutta-percha
(chloropercha Kloropercha)
• Removal of the excess solvent with alcohol
• Dimensional change
• Compact GP within 15 - 30 sec
• Dissipation of the chemical solvent
• Irritation / toxicity of solvent
• Barbosa SV. Burkard DH. et al. J Endod. 20:6-8, 1994
• Cytotoxicity of chloroform, halothane, or turpentine
• All solvents were toxic
• Turpentine > halothane >chloroform

• Allard U. Andersson L. Endod Dent Trauma 8:155-9, 1992

• Chloroform - Kloroperka ➣ open medical cups
• Exposure levels close to the accepted limit values in Sweden, more then one
NSRCT per day may lead to unacceptably expose
• Evacuation significantly reduced expose
• McDonald MN.Vire DE. J Endod. 18:301-3, 1992
• FDA banned drugs & cosmetics containing chloroform
• No negative health effects to the dentist or assistant and air vapor levels well
below OSHA mandated maximum levels.

• Chutich MJ. Kaminski EJ. Et al J Endod. 24:213-6, 1998

• Chloroform, xylene, or halothane.
• Residual volume of solvent expressed through the apex during Re:Tx was well
below the permissible toxic dose.
• Pose negligible risk to the patient.
 SimpliFill
• Recommend for Lightspeed prep
• Trial fit an GP Plug™, 2 mm short of WL
• Bind
• Place Sealer in the apical 1/3
• AH Plus
• Advance the GP Plug to WL
• Disengage GP plug at WL
• Rotate Counter Clockwise
• Backfill
• Available in GP and Resilon
Warm Vertical Compaction
• Pluggers
• Pre-fitted non-binding
• Smallest plugger within ~ 4 mm of WL
• Incrementally fit larger plugger
• Non-standardized gutta-percha cones
• F, FM, M, ML
• Fitted 0.5-2 mm short of WL
• Heat source
Warm Vertical Compaction
• Pluggers
• Pre-fitted non-binding
• Smallest plugger within ~ 4 mm of WL
• Incrementally fit larger plugger
• Non-standardized gutta-percha cones
• F, FM, M, ML
• Fitted 0.5-2 mm short of WL
• Heat source
Continuous Wave: Concept
System B
GP Simultaneously

Thermoplasticized

Compacted
System B: Distance to WL

• 4 to 6 mm from WL
• 5 to 7 mm from WL
• Buchanan LS. Endod Prac 1998; 1: 7–10, 13–6, 18.

• Buchanan LS. Dent Today 1994; 13: 80–5.

 System B

• 2 to 4.5 mm from WL
• Guess GM. et al J Endod 29:509-12, 2003

• Villegas JC.Yoshioka T. et al Int Endod J 38:218-22, 2005

• Jung IY. Et al Oral Surg Oral Med Oral Path Oral Radiol &
Endod 96:453-7, 2003
 System B Tip Dimensions

.04 Taper /30 .04 Taper/30

.06 Taper/55 .06 Taper/40
.08 Taper/55 .08 Taper/50
.10 Taper/55 .10 Taper/60
.12 Taper /55 .12 Taper/70
30 prep to .06 taper
25 prep to ~.08 taper 92
 ULTRAFIL®
• GP cannulas 22 Gauge needle 21 mm long
• Low viscosity material
• Regular set ➪ 30 min
• Firm set ➪ 4 min
• High viscosity material
• Endo set ➪ 2 min
• Heating unit preset to 90 C°
• Injection syringe
• GP flows for ~ 45-60 sec
 Inject-R Fil
• GP backfill in a system
• Single use device made with a stainless-
steel carrier that is packed with GP
• Heating unit
• Heat-R remains at a constant 150°C
• Prepare up to six Inject-R Fills
Core Carrier Techniques

• Thermafil
• Soft-Core
• Successfil
 C o r e C a r r i e r Te c h n i q u e
• Select obturator to match the C&S technique
• GT
• Protaper
• Profile
• SizeConfirm
verifiers
• canal size before placement of core carrier
• Fine adjustments to apical prep
• •Sealer ➣➣ canal walls ➣➣ carrier insertion
AH Plus
• File or paper point
• Heated obturator inserted into canal system
• Pre-determined length ➣➣ ~ WL
• Cool for 2-4 min
• Remove excess with prepi bur
 Successfil
• SuccessFil® Syringe must be warmed 3-10 min
• SuccessFil® Titanium Cores
• Implant-grade titanium alloy
• Non-cutting tips highly flexible
• 25 mm lengths ➣ ISO sizes 20-80
• Notch the core with a fissure bur where severing
along the shaft is desired
Thermo-Mechanical Compaction

•McSpadden Compactor
• Microseal Condenser
• Quick-fill
 Microseal System
• Spreader within 2-3 mm of WL
• Avoid sealer effected by heat
• Place a cone to WL
• Microseal Spreaders
• NiTi engine spreaders 350 rpm
• Microseal Condensers
• NiTi engine condensers ➣ reverse-helix design 5000-6000 rpm
• Load with Microseal Low-fusing GP
• Place in space made by engine spreader
• Activate
 Quick-Fill™
• Thermo mechanical
• Alpha phase GP on an inverted ‘K’ type file
• Two sizes smaller than the last file used to WL
• 1 mm short of the apex
• Lightly coat or dip Quick-Fill™ in sealer of choice
• Position the Quick-Fill™ at the orifice of the canal
• Clockwise rotate @ 3000-6000 rpm, and
• Apply light pressure
Heat Generation: Obturation Systems
• Warm vertical
• System B
• Touch n Heat
• Injection systems
• Thermo-mechanical compaction
• Ultrasonic
• Rotary
• Core carrier systems
 Heat
Eriksson A, Albrektsson T, et al. Int J Oral Surg 11:115, 1982.
Eriksson AR, Albrektsson T, J Prosthet Dent 50:101, 1983.
Eriksson AR, Albrektsson T, et al. Acta Orthop Scand 55:629, 1984.
Eriksson RA, Albrektsson T, et a. Scand J Plast Reconstr Surg 18:261, 1984.
Matthews LS, Hirsch C, J Bone Joint Surg Am 54:297, 1972.

• Heating bone to 117 to 122 F (47 to 50 C) for 1 min

• Reduces bone formation
• Irreversible cellular damage
• Fatty cell infiltration
• Increased blood flow
• Stagnation
• Deactivation alkaline phosphatase

• Temperature increase and length of increase

• 117 F (47 C) for 1 min = 118 F (48 C) for 30 sec
• Temps > 127 F (53 C) for < 1 sec adversely affect osteogenesis
Heat Generation: Core Carrier Systems
• Lipski M. J Endod. 30:441-3, 2004
• Thermafil 3.87 C°
• Soft-Core 3.67 C°
• Ultrafil 2.14 C°
• Trifecta low-temperature 2.03 C°
• Behnia A. McDonald NJ. J Endod. 27:203-5, 2001
• Thermafil Plus
• Mean temp rise of the external root surface
• 4.26 - 4.87 C°
 Heat Generation: Warm Vertical
Lee FS.Van Cura JE. BeGole E. J Endod. 24:617-20, 1998

• System B (SB) Touch 'n Heat (TH) Flame-heated carrier (FH)

• Mx incisor, premolar, and Md incisor

• 2 mm below the cementoenamel junction

• SB temperature rise < 10 C for all teeth

• TH temperature rise

• < 10 C Mx incisors and premolars

• > 10 C Md incisors

• FH temperature rise < 10 C for all teeth

 Heat Generation: System B
• Floren JW. Weller RN. et al J Endod. 25:593-5, 1999
• 250, 300 , 350, 400, 450, 500, 550 , and 600 C°.
• 5 mm from the apex temperatures ➡ 8.85-12.06 C°

• Romero AD. Green DB. et al J Endod. 26:85-7, 2000

• Temperature at the apex and 5 mm from the apex
• Av temperature ↑ ~1 C° at the apex and ~2 C° at 5 mm
• Lipski M. OOOOE. 99:505-10, 2005
• Mx central incisors and canines temperature ↑< 10 C°
• Md central incisors temperature ↑ by more than 10 C°
• Sweatman TL. Baumgartner JC. et al J Endod. 27:512-5, 2001
• Highest mean internal temperature 74.19 C° at the 6 mm from WL
• FM set at 300 C°
• Lowest mean internal temperature change was 2.09 C° at WL
• F set at 200 C°
• Did not ↑ external root surface 10 C°
Heat Generation: Injection System
• Donley DL. Weller RN. et al. J Endod. 17:307-9, 1991
• Obtura ➠ Mean temperature of the extruded GP was 137.81 C°
• Ultrafil ➠ Mean temperature of the extruded GP was 62.88 C°
• Weller RN. Koch KA. Int Endod J. 28:86-90, 1995
• Obtura II set at 160, 185, and 200 C°
•mean intracanal temperatures ➠ 40.21 to 57.24 C°
•mean root surface temperatures ➠ 37.22 to 41.90 C°
• Weller RN. Koch KA. Int Endod J. 27:299-303, 1994
• Obtura II @ 160, 185, and 200 C° intracanal temp ➠ 38.52 C°- 61.58 C°
•GP decreased heating chamber ~ 20 C°
•Extruded GP was ~ 100 C° < GP in the heating chamber
• Sweatman TL. Baumgartner JC et al. J Endod. 27:512-5, 2001
• Obtura II did not ↑ external root surface 10 C°
• lowest mean internal temperature change was 5.22 C° at WL,
• highest mean internal temperature change was 26.63 C° at 6 mm from WL
 Heat Generation: In Vivo
• Slight inflammatory reaction
• Does not appear to be at clinically deleterious levels
• No long-term effect
• Temperature
•
↑ mid-point on the root
Castelli WA. Caffesse RG. et al. Oral Surg Oral Med Oral Pathol 71:333-7, 1991
• Molyvdas I. Zervas P. et al. Endod Dent Trauma. 5:32-7, 1989
• Gutmann JL. Rakusin H. et al. J Endod. 13:441-8, 1987
• Gutmann JL. Creel DC. Bowles WH. J Endod 13:378-83, 1987

• Hand RE. Huget EF et al Oral Surg, Oral Med Oral Pathol 42:395-401, 1976

• Saunders EM. Int Endod J. 23:263-7, 1990

• No sig diff between temperature ↑ recorded in vitro and in vivo.
• Temperature elevations dissipated more rapidly in vivo than in vitro
 Heat Generation:
Thermomechanical Compaction
• Lipski M. J Endod. 31:297-300, 2005
• Mean ↑ temp LC + Engine Plugger ➡ 23.8 ± 9 C°

• Mean ↑ temp Microseal ➡ 5.5± 3 C°

• Bailey GC. Cunnington SA. et al. Int Endod J. 37:447-54, 2004

• Ultrasonic power setting 5 for 15 s
• Temperature ↑ > 10 C° mid-root level

• Sweatman TL. Baumgartner JC. et al J Endod. 27:512-5, 2001

• Ultrasonic lateral compaction ➡ ↑ external root surface not > 10 C°

• lowest mean internal temp change ➡5.01 C° WL

• highest mean internal temp change ➡ 28.95 C° 6 mm from WL

• McCullagh JJ. Biagioni PA. et al Int Endod J. 30:191-5, 1997

• Thermomechanical obturation ➡ Gutta Condensor
• Surface root temperature rises of > 97 C° were recorded during all three speed

• Saunders EM. Int Endod J. 23:268-74, 1990

• Thermomechanical compaction of gutta-percha ➡ Ferret canine @ 24 hrs, 20d & 40d.
• PDL damage in a minority of the experimental specimens 20 and 40 days
 EZ-Fill®

• Bi-Directional Spiral Filler

• EZ-Fill Epoxy Root Canal Cement ➣ AH plus
• Single cone of GP
 EZ-Fill®
• Fit a single GP cone to WL ➣ binds apically
• Fit EZ-Fill bi-directional spiral 1 mm short of WL
• Coat the bi -directional spiral with the cement
• Place into the canal
• Run at ~ 1000 RPM
• Use a slow up & down circular motion
• For approximately 5 seconds
• Seat the pre-fitted GP cone
• Sear off the end of the Gp with a heated plugger
• How too articles
Ez-Fill
• Weathers AK. Denti Today. 23:100, 102-3, 2004

• Musikant BL. Cohen BI. Deutsch AS. The evolution of instrumentation and obturation
leading to a simplified approach. Comp Cont Edu Dent 21:980-6, 988, 990, 2000

• Musikant BL. Cohen BI. Deutsch AS. Rethinking endodontics: attaining total obturation
of the root canal system with a simplified system. Gen Dent 47:73-82, 1999

• Musikant BL. Cohen BI. Deutsch AS. Report of a simplified endodontic technique.
Comp Cont Edu Dent. 20:1088-90, 1092-4, 1999

• Seidman D. A general dentist's viewpoint of two new endodontic techniques. Comp

Cont Edu Dent. 20:921-4, 926, 928 passim; quiz 934, 1999

• Musikant BL. Cohen BI. Deutsch AS. Simplified obturation of tapered canal
preparations. Comp Cont Edu Dent. 19:1152-5, 1998

• Musikant BL. Cohen BI. Deutsch AS. A two-and-a-half year perspective on simplified
endodontic techniques Comp Cont Edu Dent. 24:46-8, 50, 52 passim, 2000

• Musikant BL, Cohen BI, Deutsch AS. Traditional, modern and post modern
endodontics: part two. Endod Prac March:6-17.
 Ez-Fill: leakage
• Cohen BI. Pagnillo MK. et al Gen Den 46:618-23,1998
• Lateral compaction EZ Fill sealer
• Thermafil with Thermaseal
• EZ-Fill Bi-directional spiral EZ Fill sealer
• No sig diff
• Hata G, Imura N, et al; J Endod 28[absPR31]:261, 2002
• EZ-Fill
• System B
• Lateral compaction
• EZ-Fill technique showed the least dye penetration.
Additives or Modified GP

• GuttaFlow®
• EndoREZ System
• Activ GP™ System
 GuttaFlow®
• RoekoSeal Automix silicon-based sealer
• Contains gutta-percha particles < 30 µm as a filler
• Approximately 50 % gutta-percha and 50 % sealer
• Nano-silver
• Flowable and sets within 10 min
• Material expands slightly on setting
• Cannot be dissolved with chloroform
• Thoroughly rinse with sterile water or alcohol
• Dry with paper points
• Remove all residues of NaOCl, H2O2
 GuttaFlow®

• Elayouti etal. J Endod 31:687-90, 2005

• GuttaFlow completely filled the prepared
root canal, but small voids were frequently
present within the core of the filling
material.
 EndoREZ System
• Resin Coated Gutta Percha Points
• Polybutadiene-diisocyanate-methacrylate
• Resin coating bonds chemically to EndoREZ
• Standard ISO-sized points
• Resin sealer EndoRez
• Create a “monoblock” in the canal
• Works with all resin-based sealers
 EndoREZ Sealer
• Dual cure; self-priming; hydrophilic sealer
• Methacrylate-based resin
• ~30% Urethane dimethacrylate
• Radiopacity similar to as gutta percha
• ~ 50 wt% filled;contains bismuth oxychloride, calcium
lactate pentahydrate, silicon dioxide as fillers
• Peroxide-based lubricants and NaOCl effect bond
• EDTA final rinse
• Sets
resin
harder than ZOE but not as hard as restoratives

• There is no chemical solvent

 EndoREZ System
• Endorez sealer
• Injected into the root canal via a 30-gauge Tip
• 2 to 3 mm short WL
• Place pre-fitted master cone
• Passive place multiple 0.02 taper resin-coated GP
accessory cones
 EndoREZ
• Bouillaguet S. etal Eur J Oral Sci. 112:182-7, 2004
• Cytotoxicity & leakage
• Kerr PCS, RoekoSeal, TopSeal and EndoREZ
• All cytotoxic ➣ particularly when freshly mixed
• Roeko Seal
•Least cytotoxic
•More effective in sealing root canals against LPS
• Kardon BP. etal J Endod. 29:658-61, 2003
• Leakage
• EndoRez + single cone of GP > AH Plus + single cone
of GP = WVC + AH Plus
 EndoREZ
• Bouillaguet S. etal Eur J Oral Sci. 112:182-7, 2004
• Cytotoxicity & leakage
• Kerr PCS, RoekoSeal, TopSeal and EndoREZ
• All cytotoxic ➣ particularly when freshly mixed
• Roeko Seal
•Least cytotoxic
•More effective in sealing root canals against LPS
• Kardon BP. etal J Endod. 29:658-61, 2003
• Leakage
• EndoRez + single cone of GP > AH Plus + single cone
of GP = WVC + AH Plus
• Sipert CR. etal Int Endod J. 38:539-43, 2005
• EndoRez does not have antimicrobial activity
• Eldeniz AU. etal J Endod. 31:293-6, 2005
• Bond strength Diaket, AH Plus and Endo-REZ
• AH Plus ➣ highest bond to dentin +/- smear layer
• Sevimay S. Kalayci A. J Oral Reh 32:105-10, 2005
• LC and either AH plus vs EndoRez
• AH Plus leaked less
• AH plus ➣better adapted to dentine
• Zmener O. Pameijer CH. Amer J Dent. 17:19-22, 2004
• 145/180 patients LC+ EndoRez
• 91%. overall success rate ➣ NSRCT adequately filled WL
• 6.9% Extruded sealer
 Activ GP™ System
• Glass ionomer particles incorporated into the GP
• 8%
• Adhesive coating of particles to the surface of GP
• 2 microns
• Activ GP glass ionomer sealer
• Working time 15 min if use a chilled glass slab
• Highly radiopaque
• Cones match to the Endosequence
• Single Cone Technique
• Sever with heat
PULPDENT PRESSURE SYRINGE
• Fit needle snugly 1-2 mm from the apex
• Turn the screw plunger 1/4 turn clockwise.
• Wait 5 seconds
• This fills the 1-2 mm at the apex.
• disposable needles 18, 22, 25, 27 & 30 gauge
• Pulpdent Root Canal Sealer
Open Apex Obturation
 Open Apex Obturation

• Gutta-percha
–Apexification with Ca(OH)2
• MTA
Pulp Necrosis:Apexification

A method of inducing a calcified apical

barrier or continued apical
development of a an incompletely
formed root in which the pulp is
necrotic.
 Ca(OH)2 : Non Setting Form
• Calyx
• Calasept
• Pulpdent
• Tempcanal Methyl Cellulose
• Hypo-Cal
+ or - Water
• Reogan
• Ultracal
• Self Mixed
 Apexification: Ca(OH)2
Kinirons MJ Srinivasan V et al Int J Paed Dent 11:447-51,2001
• Barrier formation in apexification
• Effect of the frequency of change of Ca(OH)2
–  barrier detection times
• Retrospective study
• 107 teeth
• Barrier detection
– Earlier with frequent change in Ca(OH)2
• Barrier detection time of less than 9 mths
– 60.7% were changed more frequently than every 3 mths
– 39.1% with longer change times
• mean time of barrier detection  43.3 weeks
 Apexification: Ca(OH)2
Chosack A. Sela J. Cleaton-Jones P. Endod Dent Traum 13:211-7, 1997

• Single packing of Ca(OH)2 paste

• Replacement of the Ca(OH)2 paste at 3 months
• Replacement of the Ca(OH)2 paste monthly
• 48 non-vital maxillary incisors from 12 monkeys
– Killed after 6 months
• Histomorphometric evaluation of the volume of
new primary osteocementum showed no
significant difference between the three groups
 Issues: Ca(OH)2
Apexification
• Temporization
– Long-term
• Patient compliance
– Multiple appointments
• Predictability
• Radiographic interpretation
 Long-term Ca(OH)2
Fracture Strength
• Andreasen, JO etal Dent Trauma 18:134-137, 2002
– In Vitro
– Ca(OH)2 ➣ 0.5, 1, 2, 3, 6, 9, or 12 mths
– Tested for fracture strength
– ↓↓ in fracture strength with ↑↑↑ time
 Technical Application:
Apexification
• NSRCT
– Moderate curve ➬Size 40 & up
• Plugger fit
– Similar to warm vertical compaction of GP
– ~ 0.5 - 1 mm short of WL
• Mixing
• Compaction
– Enhanced with an ultrasonic
 Obturation:MTA
Lawley GR. Schindler WG. Walker WA 3rd. Kolodrubetz D. J Endod 30:167-72, 2004

• 4 mm, +\- ultrasonic vibration

– Composite resin or GP
• Bacterial leakage at 90 days
– 6 / 18 in the non-ultrasonic MTA
– 2 / 18 in the ultrasonic MTA
– 1 / 18 in the ultrasonic MTA-composite group.
• no significant differences
• significant differences @ 45 days
• Fracture resistance
– Intracanal composite resin demonstrated a significantly greater
resistance to root fracture than MTA followed with GP + sealer
• Aminoshariae A. Hartwell GR. et al J Endod 29:679-82, 2003
– Hand condensation vs ultrasonic condensation
– Hand condensation resulted in better adaptation to the tube walls and
less voids than the ultrasonic method.
 Obturation:MTA
• MTA more resistant to human saliva
leakage than vertically condensed
gutta-percha and sealer
• Al-Hezaimi K. Naghshbandi J et al J Endod 31:453-6, 2005

• 4-5 mm apical MTA plug

• Matt GD. Thorpe JR. et al. J Endod 30:876-9, 2004
• Lawley GR. Schindler WG. Et al J Endod 30:167-72, 2004

• Case reports + how too articles

• Castellucci A. Dent Today. 24:78, 80, 82 passim; quiz 87, 2005
• Villa P. Fernandez R. Dent Trauma 21:306-8, 2005
• Tait CM. Ricketts DN. Higgins AJ. Brit Dent J. 198:609-17, 2005
• MTA + dentine bonding agents and composite resin
• Linsuwanont P. Aust Endod J 29:45-9, 2003
• Steinig TH. Regan JD. Gutmann JL. Aust Endod J 29:34-42, 2003
• Lynn EA. Einbender S. New York State Dent J 69:30-2, 2003.
• Giuliani V. Baccetti T. et al Dent Trauma 18:217-21, 2002
• Levenstein H. SADJ. 57:270-3, 2002
• Bishop BG. Woollard GW. Gen Dent. 50:252-6; quiz 257-8, 2002
• Witherspoon DE. Ham K. Prac Proc & Aesth Dent 13:455-60; quiz 462, 2001
 Clinical Experience
• 60/169 pts
• Ave recall 595 days
• 43/60 (71.7%)healed
– Ave. recall 714 days
• 16/60 (26.6%)healing
– Ave. recall 281 days
• 1/60 (1.7 %) persistent disease
– Ave. recall 62 days
165
 Thank You
H15060340I
 SB .04 .06 .04 .06 GT B GT R GT G SX F1 F2 F3
0 30 30 30 35 35 20 20 20 19 20 25 30
1 35 34 36 39 41 32 30 28 23 27 33 39
2 40 38 42 43 47 44 40 36 27 34 41 48
3 45 42 48 47 53 56 50 44 33 41 49 57
4 50 46 54 51 59 68 60 52 39 46 55 64
5 52 50 60 55 65 80 70 60 48 52 61 71
6 54 54 66 59 71 92 80 68 59 58 67 76
7 56 58 72 63 77 104 90 76 73 63 72 81
8 58 62 78 67 83 104 100 84 90 69 78 68
10 62 68 90 75 95 104 100 100 111 80 89 96
12 66 76 102 83 107 104 100 100 115 91 100 106
14 70 84 114 91 119 104 100 100 119 102 111 116
16 74 92 126 99 131 104 100 100 119 113 120 120
FM @ tip= 55 @ 8mm = 95 @ 12mm = 105
M @ tip= 55 @ 8mm =111 @ 12mm = 139