Obturation Techniques: Castelucci

Hollow tube theory:

In 1931, Rickert and Dixon 125 formulated the “hollow tube theory,”
according to which an empty space within a living organism tends to fill
with tissue fluids in a short period of time. This theory was based on the
observation of an inflammatory reaction around the ends of hollow steel and
platinum anesthetic needle fragments implanted in experimental animals.
This reaction did not occur if the implant was made of a solid, non-porous
material.

Anachoresis:

Coolidge arrived at the conclusion that, just as within unfilled or underfilled

root canals, fluids that accumulate within empty spaces are rapidly colonized
by bacteria which reach these spaces by means of a phenomenon of
“anachoresis”. In other words, bacteria transported by the blood circulation
(bacteremia) colonized these areas, where they remained sheltered from
phagocytosis by the organism’s defenses.

The irritating substances derived from the breakdown of the organic material
contained in the tissue fluid and from the products of the bacterial
metabolism were supposedly the cause of the surrounding inflammatory
reaction.

There are more recent studies, therefore, strongly invalidate the previous
“hollow tube theory” and make it possible for us to conclude that empty
spaces within a living tissue are not necessarily accompanied by
inflammation or tissue destruction; on the contrary, they can be associated
with physiological repair.

Three dimensional obturation:

If, however, the root canal system is completely obturated in its three
dimensions, any remaining microorganism will be entrapped within the
dentinal tubules between the cementum on one side and the canal filling
material on the other, with no possibility of survival. Confirming Morse’s
findings, Moawad has demonstrated that such bacteria entrapped within a
completely filled root canal are nonviable within five days after root canal
filling.

The physical obturation of the canal system, withholding from bacteria their
sources of nutrients and limitating the space for multiplication. In
conclusion, obturation with gutta-percha and sealer during the first
appointment, after chemo-mechanical cleaning and disinfection with sodium
hypochlorite, also deprives the remaining microorganisms their nutrition and
leaves them no space to multiply to sufficient numbers to cause or maintain
disease.

Requirements for the ideal root canal filling material:

John West states that the ideal material must:

 be capable of being fully adapted to the prepared root canal walls

 be dimensionally stable
 be non-resorbable for an indefinite period of time
 be non-irritating
 be bacteriostatic, or at least should not encourage bacterial growth
 prevent discoloration of teeth
 preferably be semi-solid upon insertion and solid afterward
 be capable of sealing canals laterally as well as apically
 be impervious to moisture
 be radiopaque
 be sterile or sterilizable
 be easily removable from the root canal, if necessary
 be easily manipulable
 stick to the canal walls
 be a non-conductor of thermal changes
 be slightly expandable after placement
 set in a reasonable period of time.

Types of obturating material:

Apart from solid or semisolid materials (silver cones and gutta-percha

cones), root canal filling materials can be divided into cement-sealers,
cements, and non-setting pastes, on the basis of their method of application
and their setting characteristics in the root canal.

The cement or “sealer” must be used in absolutely minimal amounts, since it

must only improve the adaptation to the canal walls of the other, more
important, filling material, the gutta-percha.

The use of cements containing paraformaldehyde (just as, until a short time
ago, were N-2, Rocanal, and Endomethasone) is therefore unacceptable,
especially if used as the sole canal filling material as they are cytotoxic.