REFERENCE:

ENDODONTICS PRINCIPLES AND PRACTICE (M. TORABINEJAD) 4TH EDITION

CHAPTER 17 - Pg: 298-307
 Topics
* Definition of Obturation
* Causes of Obturation - related failures
1. Apical Seal
2. Coronal Seal
3. Lateral Seal
4. Length of obturation (overfill, Apical puff, underfill)
5. Vertical fracture
• Other Causes of failure

* Core Obturating Materials

* Desirable Properties
* GuttaPercha, Resilon, Silver Cones, Pastes “Semisolids”
* Sealers
* Desirable Properties
* Zinc oxide-eugenol , Ca(OH)2, Plastics, GIC Sealers
 Learning Objectives

After this lecture, The Student should be able to:

1. Describe the purpose of obturation and the reasons why

inadequate obturation may result in treatment failure.
2. List the criteria for the ideal obturating material
3. Identify core obturating materials and sealers most commonly
used and list their constituents and physical properties.
4. Describe the advantages and disadvantages of each core
material & sealers
5. Discuss the indications and contraindications for obturating
with each core material
 Definition

• Obturation of the root canal system is defined as

the three dimensional filling material create a
complete seal along the length of the root canal
system from the coronal opening to the apical
termination (cemento-dentinal junction)
 Causes of Obturation -
related failures
1) Apical Seal
(Irritants Remnants in Canals)

• Prevent the bacteria left in the canals from escaping

into the peri-radicular tissues via the apical foramina,
lateral, and accessory canals

• Some Sealed bacteria loss viability , because of lack

of substrate, Other bacteria remain dormant.
 Causes of Obturation -
related failures
2) Coronal seal
(Irritants from Oral Cavity)
• Seal the pulp chamber and canal system from leakage
via the crown in order to prevent passage of irritants
from oral cavity (Including substance in Saliva such as
bacteria, food, chemicals ….etc) into the canal system
and subsequently into the peri-radicular tissue

• Dissolution of sealer and leakage happened over a

short period of time.
 Causes of Obturation -
related failures
3) Lateral Seal

Seal lateral canals; a potential communication for

irritants from canal to lateral periodontium.

- Not as critical as the

Apical and coronal seal
but important.
 Causes of Obturation -
related failures
4) Length of obturation
* Overfill
o Undesirable , either Sealer or Gutta-Percha “GP”
o Failure increase with time.(if primary material extruded )
o Obturating Materials :
- Irritating (toxic),
- increase inflammation.
- increase Post-pain.
o Lack of Apical Seal Secondary
to Overfill is more important than
irritation from the materials

overfill = Absence of an apical matrix or barrier

Massive over-extension of RC2B (paste contains paraformaldehyde) into
inferior alveolar canal. Patient suffered permanent paresthesia.
Maxillary occlusal film demonstrates that the sealer is located into
maxillary sinus. Correction without surgery is impossible
 ‘Apical Puff’ Or ‘Button’

A B

Minor overextension of sealer (arrow) can be absorbed by the Peri-radicular

tissue; A: directly after obturation
B: 4 months recall. Notice also the complete healing of the peri-apical lesion
 Causes of Obturation -
related failures
* Underfill
- When both preparation and obturation are short of the desired
working length or when obturation does not extend to the
prepared length .

- PA inflammation depends on the volume of

irritant (unclean area) or balance established

between irritant and the immune system.

- Vital vs necrotic

- Underfill vs Overfill
 Causes of Obturation -
related failures
5) Vertical fracture
• Lateral forces exerted
during obturation or post
placement are major
etiologic factors
• radiographic findings, show
that bone loss and soft
tissue lesions
• usually requires removal of
the tooth or fractured root.
NOTE:

Persistence development of
periapical pathosis may not be evident
for months or even years.

Failure related to obturation are long

term failure .
* Other Causes Of Failure
• loss of or inadequate coronal seal
• Inadequate debridement and disinfection
• Missed canals
• Significant periodontal diseases
• Coronal fracture
• Poor aseptic technique
• Procedural errors ( zipping, ledge, perforation….)

Obturation is important but not Only

the most important factor for success
 Core Obturating Materials
• Desirable properties of obturating material
▄ Be easily introduced into the canal.
▄ Seal the canal laterally, as well as apically.
▄ Not shrink after being inserted.
▄ Be impervious to moisture.
▄ Be bactericidal or at least discourage bacterial growth.
▄ Be radiopaque.
▄ Not stain tooth structure.
▄ Not irritate periapical tissues or affect tooth structure.
▄ Be sterile or easily sterilized.
▄ Be easily removed from the root canal.
At this time, no material satisfies all these criteria.
 Core Obturating Materials
Gutta Percha
• This material was first used in dentistry in the late 1800s as a
temporary restorative material and then to obturate root canal systems.
• It is derived from the Taban tree (Isonandra perchas).
• Gutta-percha undergoes phase transitions when heated from beta to
alpha phase at around 115° F (46° C). At a range between 130° to 140°
F (54° to 60° C) an amorphous phase is reached. When cooled at an
extremely slow rate the material will recrystalize to the alpha phase.
• Gutta-percha is soluble in chloroform, eucalyptol, halothane and less
well in turpentine.
 Core Obturating Materials
Gutta Percha

Composition of GP cone

65% Zinc oxide – main ingredient

20% GuttaPercha
10% radiopacifiers
5% plasticizers
 Core Obturating Materials
Gutta Percha
Advantages
1. Plasticity ( Adapt with compaction to irregularities )
2. Easy to manage
3. Easy to remove
4. Minimal toxicity
5. Radiopacity
6. Sterilizing (1% NaoCl for 1 minute)

Disadvantages
1. Lack of adhesion to dentine .
2. Elasticity – causing rebound –pulling away from the canal wall.
3. Shrinkage
 Core Obturating Materials
Gutta Percha
Shapes
 Standardized
 Conventional (non –standardized )

Conventional
Standardized
 Core Obturating Materials
Resilon
o The Resin cone resembles gutta-percha and can
be placed using same techniques

o After drying the canal a self-etch primer followed

by bonded resin sealer are used. The canal is
then obturated using the appropriate technique

o The main advantage of this system is the

bonding to the canal walls (monoblock) which
enhance the apical and coronal sealing
Core Obturating Materials
Resilon
 Core Obturating Materials
Silver Cones
Advantages:
easy to place and to control length due to their rigidity

Disadvantages:
* No adaptability (not fill the irregularity in the root
canal system
* When silver points contact saliva or tissue fluids they
corrode. The corrosion products are cytotoxic
* Retreatment or post space preparation are difficult

In summary, silver cones are no longer

recommended as an obturating material.
 Core Obturating Materials
Silver Cones

A B
A: radiograph of maxillary central incisor obturated with silver cone
B: tissue discoloration indicating corrosion and leakage
Core Obturating Materials
Silver Cones

Corroded silver point

 Core Obturating Materials
Silver Cones

The difference between gutta-percha and silver points

 Core Obturating Materials
Pastes “Semisolids”
Why don’t we fill the canal with past or cement
that can be mixed in a liquid or putty form ?
Advantages :
 Fast, easy, simple equipment needed, single material.
Disadvantages
1. Length control –Overfill or underfill
2. Toxicity
3. Shrinkage –cause micro leakage .
4. Large voids
5. Past solubility in oral or tissue fluid.
 Sealers
A basic concept is that sealer is more
important than the core obturating
material

Sealer accomplishes the objective of providing

a fluid- tight seal.
 Sealers
Desirable properties of Sealer

1- Biocompatible (not irritating to Periradicular tissue):

(No tissue destruction/no cell death/no Toxicity)
2- Adequate working & Setting time
3- Adhesiveness (between core material and dentin)
4- Radiopacity ( must be radio-opaque )
5- No Staining (silver particles, heavy metals )
6- Possibility for removal –for post or retreatment.
7- Bacterial properties ( bacteriostatic or at least does
not encourage bacterial growth)
8- High Sealing ability
9- No Solubility
 Types of Sealers
I. Zinc oxide-eugenol
It has a history of successful use over an extended period of time
Advantages
a. It has an antimicrobial activity
b. It will resorb if extruded into the periradicular
tissues
Disadvantages
a. They exhibit a shrinkage on setting, solubility
b. Non-adhesive sealer.
c. They exhibit a slow setting time
d. They can stain tooth structure if not completely
removed
Commercial products
- Grossmans sealer (staining) and Roths sealer (nonstaining)
 Types of Sealers
II. Ca(OH)2 sealers
Is incorporated with a ZnOE or plastic base.

Advantages
- They supposedly have biologic properties that stimulate a calcific barrier
at the apex; however, these properties have not been proved yet

- Solubility is required for release of calcium hydroxide and sustained

activity .

Disadvantages
Questionable long-term stability. They are highly soluble material

Commercial products Sealapex ™

 Types of Sealers
III. plastics sealers (Resin)

AH26 ™ consists of an epoxy resin and not contain eugenol.

Advantages
Good sealability, adhesion, and antimicrobial
action, long working time and easy mixing.

Disadvantages
-Dentin staining, some toxicity when unset, and
ability to release formaldehyde
 Types of Sealers
III. plastics sealers (Resin)

A recently introduced AH-Plus ™ has similar

physical properties, but better biocompatibility
because it releases less formaldehyde and a
supposed decrease in dentin staining by elimination
of silver from the formula
Commercial products

AH26 ™ and AH-Plus ™

 Types of Sealers
IV. Glass ionomer sealers
- They have been introduced recently
Advantages
- high Dentin bonding properties (good apical and
coronal seal)
Disadvantages
- Their hardness make retreatment and post space
preparation difficult,
- They have minimal antimicrobial activity
Commercial product

- Ketac-Endo ™
 Placement of sealer

• By paper point , files ,ultrasonic ,

• lentulo spiral drill .

• File covered with sealer , and inserted

and spun counterclockwise to coat

canal walls.
lentulo spiral drill
 Summary
Causes of
Core Obturating
Obturation - related Sealers
Materials
failures
• Apical Seal • Desirable • Desirable
• Coronal Seal Properties Properties
• Lateral Seal • GuttaPercha, • Zinc oxide-
• Length of Resilon, Silver eugenol ,
obturation Cones, Pastes Ca(OH)2, Plastics,
(overfill, Apical “Semisolids” GIC Sealers
puff, underfill)
• Vertical fracture
• Other Causes of
failure
Quizzes
Thank You