OBTURATION OF CURVED CANALS

Roots usually have a curvature in the last 5-mm of the root. Only 2,7% of the canals are completely straight
(Perez et al, 1986). Preparation and obturation of curved canals may be accompanied by specific problems.
Most problems start with preparing, by which obturation is complicated. Even obturation of a perfect
prepared curved canals is difficult assigmnent/task. Filling curved canals is contended with three important
stumbling blocks: i. Lack of material control (over- and underextension); ii. Obturation of irregularities due to
apical transportation; iii. Stripping of the carrier though gutta-percha (core fillers, like Thermafil).

Length control in obturation of curved canals

Only a few articles were published concerning obturating curved canals. For the most part,
thermoplasticized gutta-percha and cold lateral condensation were compared. As mentioned before,
material control by using thermoplasticized gutta-percha is a great problem. This problem seems even
greater concerning curved canals. A greater discrepancy between the desired filling length and the ultimate
filling length is statistically significant, if straight and curved canals are compared (Mann and McWalker,
1987). These differences are significant greater for thermoplasticized gutta-percha.

No extrusion (0%) was perceived using cold lateral condensation and underextension did occur in 20% of
the cases. Lack of material control of warm gutta-percha was equally divided into under- (25%) and
overextension (25%) (Mann and McWalker, 1987). Possible explanation could be that the injection needle
does not reach the apex within 5 mm, because of the curvature. Though fast initial setting, the gutta-percha
mass cannot flow apically, so underextension is the result. This may also occur, if the injection needle
breaks off as result of constructive pressure- (building) within the canal. The pressure could also be
responsible to the overextension that occurs sometimes.

These results, regarding overextension, are in contrast with other investigators (Dummer et al, 1994). They
claimed no difference in extrusion neither in curved canals nor in straight canals for cold lateral
condensation and warm gutta-percha. Although another warm gutta-percha technique had been used
(Thermafil), these results are in contradiction with many other investigators who evaluated over-extension
of Thermafil and in contradiction with our former conclusions (overextension of the root canal filling, page
27). Unfortunately, in this research no attempt was made to evaluate underextension, so unequivocal
comparison cannot be made with the results of Mann and McWalker, 1987.

Obturation of canals with apical transportation

All used file techniques result in stretching of files in the root canal as well during the active movements of
the file as during insertion and taking out (Weine et al, 1975) Therefore, each instrument shifts more off the
centre of the original canal in direction to the outside border of the root. Because of apical transportation, a
completely funnel shaped preparation is not attained. The smallest level is named elbow, whereas the
upside down flared, more apically part, is named the zip (Weine et al, 9975). Good flared preparation
coronally, initially to apical preparation, apical transportation can be decreased (Cohen and Burns, 1997).
Obturation of curved canals with apical transportation, can be difficult in several ways (Gutmann et al,
1997):

1. Failure to seat the master gutta-percha cone or carrier to full working length, because of ledging
coronally to working length and lack of proper taper due to apical transportation, mostly in the middle and
apical part (cold or warm lateral condensation, core-fillers);

2. Failure to achieve "tugback" due to zipping and other irregular preparations; these tear drop apical
shape may result in an improper fitting of the master cone (cold and warm lateral condensation);

3. Failure to achieve adequate apical density or radiographic voids due to irregularities resulting in
poor adaptation in the middle and apical part (cold and warm lateral and vertical condensation);
4. Overfilling of canals or overextension of obturating material due to zipping, strips and perforations
(all techniques);

5. Stripping of the carrier through gutta-percha (core-fillers).

When we evaluate-these problems for curved canals, we may assume that created irregularities in curved
canals may be better filled with thermoplasticized gutta-percha. Probably, this is the result of the excellent
flow capacity of warm gutta-percha.

Stripping of the carrier through gutta-percha in curved canals

Because endodontic files tends to straighten within the curved canals, it seems (Weine et al, 9975)
speaking for itself, that the carrier of Thermafii may also stretch and therefore stick out through the
gutta-percha. In the only study in this way (Juhlin et al, 1993), it indeed seems that this is the case. Both the
stereomicroscope as the S.E.M. give the results below.

Cross-section Carrier Carrier partially Carrier only G.p. only (No

completely encased in g.p. (No g.p.) carrier) (%)

encased in g.p. (%) (%)
(%)
Cervical (n=40) 23 77 0 0
Middle (n=40) 17 83 0 0
Apical (n=40) 83 17 0 0
Near apex (n= 20) 5 40 10 45
At the apex 70

OTabel 1 Evaluation of the carrier (Juhlin et al, 1993)

When we look better to the results, it looks like the problems of preparing curved canals, concern the
centration of the carrier in the gutta-percha too. Owing curved canals preparing with files, it is reasonable
apical transportation is occurred. Near the apex, normally an elbow can be observed. So it is likely that
because of this narrowing the carrier is not completely encased with gutta-percha, because the carrier
takes off in the outside curve.

At the apex, it seems the carrier also suffers under the apical transportation. In 70 percent of the cases
carrier is observed without guttapercha (Juhlin et al, 1993). Perhaps a more flexible carrier can decrease
stretching of the carrier (for example a plastic of or a titanium carrier). Which material will be chosen,
stretching will always occur. Even though resin blocks is used in this study and therefore, the results can
not just applied in the clinical situation, it seems that Thermafil undergoes the same apical transportation as
various preparation techniques. Stripping of the carrier can be the result, especially in the apical part. It is
likely that this is the result of the inflexibility and stiffness of the carrier material in relation with the softened
gutta-percha.

Controlling the apical part, especially for over- and underextension with proper preparation, is considered to
be easier with cold lateral condensation. Stripping of the carrier, especially in curved canals and in the
apical part, seems to be a disadvantage of core fillers (Thermafil).
Conclusions

1. Length control in curved canals is a greater problem than in straight canals;

2. In curved canals, over- and underextension occur for warm guttapercha, because the insertion of the
injection needle or plugger is limited by the curvature of the root canal;

3. Irregularities and deviation of shape due to apical transportation may be better sealed by using
thermoplastiziced gutta-percha rather than cold gutta-percha;

4. Tendency of straightening of the carrier of Thermafil in curved canals results in a carrier which is not
completely encased with gutta-percha.