OBTURATION

TECNIQUES

DR. SAGAR KHANNA

PROFESSOR
CONSERVATIVE DENTISTRY
AND ENDODONTICS
CONTENTS
Definition
Historical Perspectives
Introduction
Ideal requirements of Obturating materials
Gutta percha
Classification
-Common types
Obturation Techniques
-Cold & warm Lateral compaction
-Warm vertical condensation
Thermoplasticized injection techniques
Carrier based guttapercha
Thermomechanical compaction
Chemically plasticized guttapercha techniques
Apical third filling materials
Pastes & cements as filling materials
DEFINITION

‘The three-dimensional filling of the entire root

canal system as close to the cementodentinal junction as
possible.’

American Association Of Endodontists (AAE) 1994

HISTORY
200 B.C. – Oldest known root canal filling bronze wire found in the
root canal in the skull of a Nabatean warrior

1757- Carious teeth were extracted ,filled with gold/ lead & replanted
again

 1825- Gold foil by Edward Hudson

1843- Sir Jose d Almeida – First introduced guttapercha to Royal

Asiatic Society of England

John I. Ingle, Leif. K Barkland, Endodontics;5th edition;Elsevier;2002.

 Edwin Truman- 1st introduced guttapercha to dentistry as a temporary filling
material

1847- Hill developed new restorative material known as ‘Hill’s stopping (mixture
of bleached gutta-percha + carbonate of lime and quartz)

1848- Was patented and introduced in dentistry.

1867-C. A.Bowman, 1st use of gutta percha for canal filling in an extracted first
molar
1883-Perry claimed the use of
 Pointed gold wire wrapped with some soft gutta-percha
 Gutta percha rolled into points and packed into the canal
 Chemical softening of shellac coated gutta percha using alcohol

 1887- S.S. White Company began to manufacture gutta percha points

 1893-Rollins introduced new type of gutta percha to which he added vermilion

(pure oxide of mercury)
1914-Callahan - softening and dissolution of gutta percha to serve as
the cementing agent through the use of rosins- diffusion technique.

1930- Elmer A. Jasper introduced silver points

1953- Acerbach – filling with silver wires

1959- Ingle & Levine – standardization of root canal instruments &

filling materials

1961- Sampeck- use of stainless steel files & sealer

1967- Schilder popularized vertical condensation technique.

1977- Yee. et al introduced the injectable thermoplasticized gutta-percha technique

1978- W. Ben Johnson described a technique of obturation with gutta percha coated endodontic
file (forerunner of Thermafil)

1979- Mc Spadden introduced a special compactor for softening gutta percha by friction

1984- Michanowicz introduced a low temperature (70C) injectable thermoplasticized gutta-

percha technique- Ultrafil

1994- James B. Roane - Inject R-Fill technique

1996- Steven Buchanan developed a new method of vertical compaction of warm gutta percha -
continuous wave of condensation technique (System B)

2003 – Martin and Ray introduced Resilon

INTRODUCTION
Objectives of obturation:

• Total debridement, try to get a fluid tight seal

• Total obliteration of canal space
• Stops coronal leakage
• Entombs surviving bacteria
• Stops influx of periapical tissues and release of bacterial
elements
• Overfilling- total obstruction of pulp space with excess material
extruding beyond apical foramen.

• Overextension- extrusion of filling material beyond the apical foramen

but with the fact that the canal has not been adequately filled and apex
has not been sealed.
• The commonly used term “hermetic seal” is not accurate.
“Hermetic” is defined as “airtight by fusion or sealing.” Air is not
the problem at the periapex—fluid is the problem. “Impermeable” is a
more accurate term.
Fluid Impervious, Fluid Tight , Bacteria Tight Seal – appropriate to
use .
Why to obturate????
• To achieve TOTAL OBLITERATION of the root canal space to prevent
the ingress of bacteria and body fluids into root canal space

• To attain fluid tight seal so as to prevent bacterial microleakage

• To replace the empty root canal space with an inert filling material to
PREVENT RECURRENT INFECTION

• It creates a FAVOURABLE BIOLOGICAL ENVIORNMENT for the

process of tissue healing to take place.
When to obturate????
• Canal must be dry

• No excessive exudate from the canal

• Absence of weeping canals

• Lack of periapical sensitivity

• Tooth should ideally be asymptomatic

• Negative culture
IDEAL REQUIREMENTS OF
OBTURATING MATERIAL (GROSSMAN)
• It should be easily introduced into the canal

• Should seal the canal laterally as well as apically

• Should not shrink after being inserted

• Should be impervious to moisture

• Should be bacteriostatic or at least not encourage bacterial growth

• Should be radiopaque

• Should not stain the tooth structure

• Should not irritate periradicular tissue

• Should be sterile or easily and quickly sterilized immediately before insertion

• Should be removed easily from the root canal if necessary

Gutta percha
• Derived from words getah-pertza meaning gum
and name of the tree respectively in malay
language.
• It is a dried coagulated product of plants of
PALAQUIN , BLANCO genus of sapotaceae
family
• Natural habitant of south east Asia , Indonesia and
malaysia.
OBACH’S TECHNIQUE

• Obtained pulp mixed with water and heated to 75 degrees

• Released GP threads cooled to 45 degrees

• Mixed with cold gasoline below 0 degrees

• Dissolved in water again at 75 degrees

• Residual greenish-yellowish solution bleached with clay and steamed to

remove gasoline
Prakash R, Gopikrishna V, Kandaswamy D;guttapercha an untold story; international journal of
therapeutic applications (2015); 20; 20-24.
• By Friedman et al (1975)

MATRIX GUTTAPERCHA 20% Organic

FILLER Zinc oxide 66% Inorganic
RADIO- Heavy metal 11% Inorganic
OPACIFIERS sulfates

PLASTICIZERS Waxes or resins 3% Organic

COLOURING Erythrosin
AGENT
 BETA heated ALPHA heated
PHASE AMORPHOUS
PHASE 420C to 490C 540C to 600C
High molecular molten melt
weight
Cooled at a rate of 0.50C / hr

Normal cooling
Available as:-
• GUTTA PERCHA POINTS

• GREATER TAPER GP POINTS(4%, 6%, 10% )

• GP PELLETS/ BARS

• PRECOATED CORE CARRIER GUTTA PERCHA

• SYRINGE SYSTEMS

• GUTTA FLOW

• MEDICATED GP
• CONVENTIONAL SIZES ARE STANDARDIZED ARE

• Extra fine ISO 2% from 15-140

• Fine fine greater taper4% and 6%
• Fine variable taper
• Medium fine
• Fine medium
• Medium
• Large
• Extra large

Louis I. Grossman.Endodontic practice. 11th edition.

• Gutta percha becomes brittle with age, a process hastened with warmth and
delayed when refrigerated .

• This was described by SORIN and OLIET and introduced a technique to

rejuvenate the aged brittle material by momentary immersion in hot tap
water 55 degree Celsius followed by instant cooling

• Siquera et. al. - GP can be sterilized by placing in 5.25% sodium

hypochlorite for 1 minute – eliminate Bacillus Subtilis spores – rinse in
hydrogen peroxide/ ethyl alcohol to remove crystalized sodium
hypochlorite.
SOURCE

• GP is a dry coagulated sap of a peculiar species of tropical plants.

• It was first obtained from Sapotaceae family of trees, which are abundant in the
Malay Peninsula (South East Asia).
• There are many species of Palaquium genus that yield GP of which four are found
in India:
1. P. obovatum-Assam
2. P. polyanthum-Assam
3. P. ellipticum-Western ghats
4. P. gutta-Lalbagh Botanical garden, Bengaluru, Karnataka.

Vishwanath V, Rao HM. Gutta-percha in endodontics - A comprehensive review of material science. J

Conserv Dent. 2019 May-Jun;22(3):216-222.
 CHEMICAL PHASES OF GUTTA-PERCHA

• C.W Bunn ;1942

• “trans” isomer of polyisoprene

• The “alpha” form occurs in the tree, which is the natural form.

• The commercially available products are in the “beta” form.

Vishwanath V, Rao HM. Gutta-percha in endodontics - A comprehensive review of material science. J Conserv
Dent. 2019 May-Jun;22(3):216-222.
Alpha (α) form Brittle at room temperature
Gluey, adhesive and highly flowable when
heated (lower viscosity)
Example: Thermoplasticised gutta-percha used
for warm condensation obturation technique

Beta (β) form Stable and flexible at room temperature

Less adhesive and flowable when heated (high
viscosity)
Example: Commercially available gutta-percha
used for cold condensation obturation
techniques
 PHYSICAL AND THERMO-MECHANICAL PROPERTIES
• Thermoplastic and viscoelastic material which is temperature sensitive.

• oxidation – brittle

• soft at 60°C and it melts around 95°C–100°C with partial degradation.

• The transformation temperatures are 48.6°C–55.7°C for the β-to the α-phase
transition, and 59.9°C–62.3°C for the α-to the amorphous phase transition,
depending on the specific compound; heating dental GP to 130°C causes physical
changes or degradation
PHYSICAL PROPERTIES AVERAGE VALUES

Yield strength 1000-1300 psi

Resilience 40-80 in/lb

Tensile strength 1700-3000 psi

Elastic modulus 15,500-28,000 psi

Flexibility 0.07-0.12 in/lb

Elongation (%) 170-500

PHYSICAL FORMS OF GUTTA-PERCHA

1.Solid core GP points

Available as standardized and non-standardized points (beta phase).
Standardized points: Correspond to instrument taper and apical gauge
Nonstandardized points: Variable taper, the tip of point to be adjusted after apical
gauging to obtain an optimum fit and apical seal.
Used with cold lateral condensation with warm vertical compaction.

2.Thermomechanical compactable GP
3.Thermo plasticized GP:
Available in injectable form (alpha phase). Special heaters are provided in the
systems to attain flowable temperature of GP. The apical seal is accomplished with
the plugging of master cone and then the injectable GP is backfilled.

4.Cold flowable GP.

It is self-polymerizing filling system in which the gutta percha in powder form is
combined with a resin sealer in one capsule. It exhibits viscoelastic property of
thixotropism and therefore has a better flow under shear stress which, in turn,
provides good sealing ability.
MODIFICATIONS OF GUTTA PERCHA
 SURFACE MODIFIED:-

 Resin coated - A resin is created by combining diisocyanate with hydroxyl-

terminated polybutadiene, as the latter is bondable to hydrophobic polyisoprene (PI).
This is followed by the grafting of a hydrophilic methacrylate functional group to
the other isocyanato group of the diisocyanate, producing a GP resin coating that is
bondable to a methacrylate-based resin sealer

 Glass ionomer coated-Results in a true single cone monoblock obturation. Glass

ionomer creates an ionic bond with the dentin, is nonresorbable.
 Bioceramic coated- Bioceramic materials are incorporated and coated onto GP points
which are available in specific sizes. They enhance the quality of obturation along
with specific hydrophilic bioceramic sealers. These materials are in the form of nano
particles (calcium phosphate silicates) to increase their activity and to bring about
better sealing by taking advantage of the natural moisture of dentin. These kinds of
obturation bring about slight expansion rather than the usual shrinkage, which
actually is beneficial to seal the canals.

• Nonthermal plasma- Argon and oxygen plasma sprayed to GP improve the wettability
of GP by the sealer, favoring adhesion. Argon plasma led to chemical modification
and surface etching while oxygen plasma increased surface roughness.
• MEDICATED:-
 Iodoform: IGP contains 10% iodoform (CHI3), a crystalline substance, which is
soluble in choloroform and ether but low solubility in water. They interact with cell
walls of microorganisms causing pore formation or generate solid-liquid interfaces
at the lipid membrane level, which lead to loss of cytosol material and enzyme
denaturation. It is said to inhibit the growth of Staphylococcus
aureus, Streptococcus sanguis, Actinomyces odontolyticus, and Fusobacterium
nucleatum, but not Enterococcus faecalis, Escherichia coli and Pseudomonas
aeruginosa
• Calcium hydroxide: Calcium hydroxide Gutta percha (CGG) points combine the
efficiency of calcium hydroxide and bio-inertness of GP to be used as temporary
intracanal medicaments. The action is directly correlated to the pH which is
influenced by the concentration and rate of release of hydroxyl ions. When used as
an intra-canal medicament in endodontic therapy, moisture in the canal activates the
calcium hydroxide and the pH in the canal rises to the level of 12+ within minutes.
The resultant antimicrobial effects may be evident within 1–4 weeks
 Chlorhexidine: Chlorhexidine (CHX) is a broad-spectrum anti-infective agent
which is a synthetic cationic bis-guanide. It acts by the interaction of the positively
charged CHX molecule and negatively charged phosphate groups on microbial
cell walls causing a change in osmotic equilibrium. CHX is both bacteriostatic
(0.2%) and bactericidal (2%) and can penetrate the microbial cell wall by altering
its permeability. Chlorhexidine impregnated GP points (Activ points) are known to
be effective against E. faecalis and Candida albicans.
• Tetracycline: Tetracycline Gutta percha (TGP) contains 20% GP, 57% zinc oxide,
10% tetracycline, 10% barium sulfate, and 3% beeswax. They remain inert pending
contact with tissue fluids; gets activated and become available to inhibit any
bacteria that remain in the root canal or those that enter the canal through leakage.
The greatest antimicrobial effect was seen on S. aureus and less on E.
faecalis and P. aeruginosa.
• Cetylpyridinium chloride (CPC): CPC, a quaternary ammonium compound and a
cationic surfactant, has been used in antiseptic products and drugs. Although the
antimicrobial mechanisms of CPC are not well understood, it appears to damage
microbial membranes, thereby eventually killing microbes. Addition of CPC
improved the antimicrobial property of GP in proportion to the amount added.
However, this GP is not commercially available yet
• NANO PARTICLE ENRICHED :-
• Nanodiamond-gutta-percha composite biomaterials

• Nanodiamond-GP composite embedded with nanodiamond amoxicillin conjugates was developed which could
reduce the likelihood of root canal reinfection and enhance the treatment outcomes. NDs are carbon
nanoparticles that are roughly 4μ - 6nm in diameter. It is a biocompatible platform for drug delivery, and they
have demonstrated antimicrobial activity. Due to the ND surface chemistry, a broad-spectrum antibiotic, such as
amoxicillin, can be adsorbed to the surface facilitating the eradication of residual bacteria within the root canal
system after completion of obturation. The homogeneous scattering of NDs all through the GP matrix increases
the mechanical properties, which enhance the success rate of conventional endodontic therapies and reduce the
need for additional treatments, including retreats and apical surgeries.
• Silver nanoparticles coated gutta-percha
• Silver (Ag) ions or salts possess sustained ion release, long-term antibacterial
activity, low toxicity, good biocompatibility with human cells and low bacterial
resistance. Dianat and Ataie have introduced nanosilver gutta-percha in an attempt
to upgrade the antibacterial effect of GP, where the standard GP is coated with
nanosilver particles. It demonstrates a significant antibacterial effect against E.
faecalis, Staphylococcus aurous, Candida albicans, and E. coli.
Disinfection of gutta-percha

• NaOCl at 5.25% concentration is an effective agent for a rapid high disinfection

level of GP cones.
• 2% CHX kills all vegetative forms in a short period but did not eliminate Bacillus
subtilis spores within the times tested.
• 2% peracetic acid solution is effective against some microorganisms in biofilms on
GP cones at 1 min of exposure.
• Herbal extracts such as lemon grass oil, basil oil, and obicure tea extract, are
probable alternatives for chairside disinfection of GP cones and have shown good
results.
• Ethanolic extracts of Neem, Aloe vera, and Neem + Aloe Vera have been seen to
be successful in decontaminating GP cones against E. coli and S. aureus (common
contaminants of GP cones).
MERITS AND DEMERITS OF GUTTA PERCHA

Merits Demerits
Compactible Lacks rigidity
Inert Lacks adhesive quality
Can be softened Does not bond to sealers by itself
Dimensional stability Easily displaced by pressure
Tissue tolerant Lack of length control
Radiopaque
Easily removed
Antibacterial
Readily sterilizable
OTHER USES OF GUTTA-PERCHA

• Assessment of pulp status

Rickoff et al. showed that GP used as above-increased pulp temperature only <2°C for

<5 s of application – a temperature change that is unlikely to cause pulp damage

• Tracing sinus tract

Studies have indicated that GP is beneficial as a diagnostic adjunct and can be precise

within 3 mm from the lesion. A medium-sized cone (size 25–40) has been found

satisfactory due to its stiffness and ease of placement.

• Temporization

After intra coronal tooth preparation and for double seal during endodontic
interappointment periods

• Markers for orthodontic and prosthetic implant placement

To aid in the determination of the ideal site for the implant, guides with markers are
useful.

A material to be used as a guide during a computed tomography scan, should contain no

metal to eliminate the possibility of scatter.

Since GP fulfills this criterion, possesses radiopacity and can be formed to a desired
shape, it is the material of choice for this purpose
• Manual dynamic irrigation

GP points are used for manual agitation of irrigants in the root canal to improve

the cleansing ability of debriding and disinfecting solutions to remove the smear

layer.

• Assessment of intracoronal tooth preparation

to check undercuts in tooth preparation requiring indirect intracoronal

restorations.
•

•
OBTURATION TECHNIQUES
ACC. GROSSMAN

1. Cold lateral condensation

2. Warm vertical condensation (warm guttapercha)
3. Continuous wave compaction technique
4. McSpadden thermomechanical compaction
5. Thermoplasticized gutta-percha injection
6. Carrier-based gutta-percha
• Thermafil thermoplasticized
• Simplifil sectional obturation
7. Chemically plasticized gutta-percha 8. Custom cone
ACC. COHEN

• Cold compaction method

• Heat softened gutta-percha compaction

• Injectable gutta-percha techniques

• Obtura II technique

• Core carrier technique

• Thermafil technique

• Thermo-compaction technique
ACC. INGLE

I. Solid Core Gutta-Percha with Sealants

A. Cold gutta-percha points
1. Lateral compaction

2. Variations of lateral compaction

B. Chemically plasticized cold gutta-percha
1. Essential oils and solvents
a. Eucalyptol
b. Chloroform
c. Halothane
C. Canal-warmed gutta-percha

1. Vertical compaction

2. System B compaction

3. Sectional compaction

4. Lateral/vertical compaction

a. Endotec II

5. Thermomechanical compaction

a. Microseal System, TLC, Engine-Plugger, and Maillefer Condenser

b. Hybrid Technique

c. J.S.-Quick-Fill
D. Thermoplasticized gutta-percha

1. Syringe insertion

a. Obtura

b. Inject-R-Fill, backfill

2. Solid-core carrier insertion

a. Thermafil and Densfil,

b. Soft Core and Three Dee GP

c. Silver points
II. Apical-Third Filling

A. Lightspeed Simplifill

B. Dentin-chip

C. Calcium hydroxide

III. Injection or “Spiral” Filling

A. Cements

B. Pastes

C. Plastics

D. Calcium phosphate
Lateral Compaction of Cold Gutta-percha

• Gound et.al
• spreader size determination,
• primary point and accessory point size determination,
• drying the canal,
• mixing and placement of the sealer

John I. Ingle, Leif. K Barkland, Endodontics;5th edition;Elsevier;2002.

SPREADER SELECTION
• within 1.0 to 2.0 mm of the true working length
to match the taper of the preparation

PRIMARY AND ACCESSORY POINT DETERMINATION

(1) visual test,
(2) tactile test,
(3) patient response,
(4) radiographic test.
VISUAL TEST:-
• Grasped at 1 mm short of the prepared length of the canal
attempt to push it apically
 TACTILE:-
• some degree of force should be required to seat the point, and, once
it is in position, a pulling force should be required to dislodge it. This
is known as “tugback.”

• if the point is loose in the canal, the next larger size point should be
tried, or the method of cutting segments from the tip of the initial
point, followed by trial and error positioning, should be used.
PATIENT RESPONSE:-

• Patients who are not anesthetized during the treatment of a nonvital

pulp or at the second appointment of a vital pulp may feel the gutta-
percha penetrate the foramen.

• Adjustments can then be made until it is completely comfortable.

• This is a good test when the position of the foramen does not appear to
be accurately determined by the radiograph or by tactile sensation.

• Pulp remnants from a short preparation will cause a sensation of much

greater intensity than periapical tissue.
RADIOGRAPHIC TEST:-

• After the visual and tactile tests for the trial point have been completed, its
position must be checked by the final test—the radiograph.

• The film must show the point extending to within 1 mm from the tip of the
preparation.

• Radiographic adaptation is a better criterion of success than either the visual or

tactile method.

• The trial point radiograph presents the final opportunity to check all of the
operative steps of therapy completed to date.
• Occasionally the radiograph shows the point forced well beyond the apex. If this is the
case, an incorrect working length has been used during instrumentation, and the
operator may have wondered why the patient complained of discomfort.

• The overextended point should always be shortened from the fine end and then
carefully returned to proper position.

• It should never be just pulled back to a new working length, in which case it would be
loose in the canal.

• In this new position, it should again pass the tactile and radiographic tests of trial points.

• It should never be manipulated so that it just appears to fit in the film. It must fit tightly
and come to a dead stop.
• Sometimes the initial point will not go completely into place even
though it is the same number as the last enlarging instrument. This
condition may arise because

• (1) the enlarging instrument was not used to its fullest extent,

• (2) there was a larger than standard deviation between the sizes of
instruments and gutta-percha,

• (3) debris remains or was dislodged into the canal, or

• (4) a ledge exists in the canal on which the point is catching.

In any case, the problem can be solved by one of two methods:

• selecting a new file of the same number and re-instrumenting the

canal to full working length until the file is loose in the canal, or

• selecting a smaller size gutta-percha point. Trial and error will

determine when the point is seated.

PREPARATION OF THE INITIAL POINT:-

• After the initial point has passed the trial point tests, it should be
removed with cotton pliers that scar the soft point or snipped with
the scissors at the reference point.
DRYING THE CANAL:-
• While preparations are being made to cement the filling point, an absorbent
paper point should be placed in the canal to absorb moisture or blood that
might accumulate.
• Larger paper points are followed by smaller paper points until full length is
achieved.
• To determine the presence of moisture in the canal, one must remove the
absorbent point and draw the tip along the surface of the rubber dam. If the
point is moist, it will leave a mark as it removes the powder from the dam.
When this procedure has been repeated with fresh points that no longer streak
the dam, the final paper point is left in place to be removed just as the sealer is
to be introduced.
• Any bleeding should be stopped, the blood irrigated from the canal, and care
taken to avoid penetrating beyond the apex with the final paper point.
• Excess moisture or blood may affect the properties of the sealer, although fluids
may be completely displaced during condensation and not affect the seal.
Mixing-
A sterile slab and spatula are removed from the instrument case or are
sterilized by wiping with a gauze sponge soaked in germicide and dried with a
sterile sponge.
One or two drops of liquid are used and the cement is mixed according to the
manufacturer’s directions.
The cement should be creamy in consistency but quite heavy, and should string
out at least an inch when the spatula is lifted from the mix.
Benatti et. Al. concluded that ideal consistency is achieved when the mixture
can be held for 10 seconds on an inverted spatula without dropping off and will
stretch between the slab and spatula 2 cm before breaking.
Ideal consistency permits ample clinical working time and minimal dimensional
change.
Sealer should not be mixed too thin, but on the other hand, it must not be so
viscous that it will not flow between the gutta-percha points or penetrate
accessory and lateral canals or the dentin tubules.
Placement-
• Sealer can be place in abundance to ensure thorough canal wall contact
because the technique will displace all excess sealer coronally.
• Root canal cement/sealer may be placed in a number of ways. Some
clinicians “pump” the sealer into the canal with a gutta-percha point.
Some carry it in on a file or reamer, which is twirled counterclockwise,
pumped up and down, and wiped against all the walls.
• Some use rotary or spiral paste fillers turned clockwise in one’s fingers
or very slowly in a handpiece
• If powered by a handpiece, they can be easily locked in the canal and
snapped off . Twirling them in the fingers is safer, and Lentulo spirals are
now being made with regular instrument handles.
• rotary-powered Lentulo spirals comes from “whipping up” the cement
in the canal and causing it to set prematurely
• powered Lentulo spiral consistently caused sealer extrusion.
• A San Antonio group also found the Lentulo to be the most efficient in
coating the walls: 90.2%, compared with using a K-file at 76.4% or using
a gutta-percha point at 56.4%. They suggested that complete coverage
may not be possible.
• A more recent method is to place the cement with an ultrasonic file—
run without fluid coolant.
• with the Lentulo spiral-placement, they found that ZOE cement set
within a few seconds when ultrasonically spatulated in the canal. Heat
generated by ultrasonics can accelerate ZOE sealers. However, they
used AH-26 successfully.
PLACEMENT OF THE MASTER CONE:-

• The premeasured primary (or master, or initial) point is now coated with
cement and slowly moved to full working length.

• The sealer acts as a lubricant.

• The patient may experience some minor discomfort from this procedure
as air or sealer is evacuated from the canal through the foramen.

• If the resistance form has been correctly prepared so that a “minimal

opening” exists at the foramen, no more than, and usually not as much
as, a tiny puff of cement will be forced from the apex.
Multiple-Point Obturation with Lateral Compaction:-
• When the fit of the cemented primary point is ensured, the butt end,
extending into the coronal cavity, should be removed with a hot
instrument or scissors to allow room for visualization and the spreader
that is to follow.
• The premeasured spreader is then introduced into the canal alongside
the primary point, and with a rotary vertical motion is slowly moved
apically to full penetration, marked on the shaft with a silicone stop
• Weine recommends that the initial spreader be left in place a full
minute to allow the primary gutta-percha time to reconform to this
pressure.
• One must know that, along with the lateral force of spreading, a
vertical force, albeit less, is also exerted.
• If the spreader does not reach the premeasured length within the
apical 1 mm, firm apical pressure can be applied with the knowledge
• If full penetration is still not achieved, a spreader that is a size smaller
can be used, which will bind apically to the previous spreader.
• The master point may appear to elongate slightly coronally as it
stretches to plasticity at the point of condensation.
• The spreader is then removed with the same reciprocating motion and
is immediately followed by the first auxiliary point inserted to the full
depth of the space left by the spreader.
• Selecting auxiliary cones that are the same size or smaller in diameter
or taper than the spreader is done.
• This point is followed by more spreading and more points, more
spreading and more points, until the entire root cavity is filled.
• To ensure a cohesive filling, additional sealer should be added with
each point as a lubricant to facilitate full penetration.
• Obturation is considered complete when the spreader can no longer
penetrate the filling mass beyond the cervical line.
• At this time the protruding points are severed at the orifice of the canal with a hot
instrument.

• Vertical compaction with a large plugger will then ensure the tightest possible
compression of the gutta-percha mass and provide a more effective seal against
coronal leakage.

• All of the sealer and guttapercha should then be removed from the pulp chamber
and a final radiograph taken.

• After an intraorifice barrier is placed, either a final or temporary coronal filling

should follow.
Stress and Fractures from Lateral Compaction:-

• Hatton and his associates found they could adequately seal root canals with as little as 1 kg of
spreader pressure. They applied up to 2.5 kg and suggested that excessive forces could produce
fractures.

• The Iowa group found 3 kg to be the average lateral condensation pressure exerted by six
endodontists. Although they found the incidence of immediate vertical root fractures to be low
at 3 kg, they speculated that a buildup of root distortion, “stored” in the root, could well be
released later as a fracture.

They also concurred with the Iowa group when they noted that lateral condensation may lead to
incomplete root fractures and that these fractures may later lead to full vertical fractures under
the stresses of restoration or mastication
• At Melbourne University researchers compared load and strain using hand

versus finger spreaders and found “that strains generated by finger spreaders

were significantly lower than hand spreaders.”

• Blum described the intracanal pressure developed during condensation as

the “wedging effect” and measurements graphed from a force analyzer

device showed that gutta-percha deformation occurs at only 0.8 kg for lateral

condensation.

• Researchers at the University of Washington found it took 7.2 kg (15.8 lbs) to

fracture a maxillary central incisor.

However, 16% of their maxillary anterior teeth fractured at loads under 10

kg. They felt that 5 kg (11 lbs) were a “safe load” for these husky teeth.

When this same group tested mandibular incisors, they produced fractures

with only 1.5 kg (3.3 lbs) of load, and 22% of their lower incisors fractured

at loads less than 5 kg, in marked contrast to the maxillary incisors and

canines. In the lower incisor sample, fractures occurred when only three

accessory points were compacted.

They speculated that “vertical root fractures might not be detected clinically
• The relationship between tooth reduction and vertical fracture was studied to show that
vertical root fracture did not occur in maxillary anterior teeth under a constant force of 3.3 kg
for 15 seconds until 40% of the total canal width was reduced and was always preceded by
visible craze lines.

• From Greece, Morfis condemned lateral condensation and long post placement as responsible
for root fractures. He reported 17 (3.69%) vertical fractures of 480 endodontically treated
teeth.

• The University of Georgia, stated that “the force of the spreader is apparently transmitted 1
to 2 mm beyond the spreader tip and molds the points and sealer against the walls as it forces
them apically.” Essentially the same thing was noted at the University of North Carolina.
VARIATIONS OF LATERAL CONDENSATION
• Curved canals
• Immature canals and apices
• Tubular canals
tailor made gutta percha
• Chloroform dip technique
Warm vertical condensation
• Schilders technique
• 3 prefitted pluggers:-
• widest 10 mm
• medium 15mm
• narrowest 3-4mm
• Heating device
• First heat wave:- 5to8 degree (42to45degree)
• 3 to 4 mm for 2to3 seconds
•
SYSTEM B : Continuous wave of condensation
Buchanan technique
Sectional g.p technique

“Chicago” technique
since it was widely promoted by Coolidge,
Blayney, and Lundquist, all of Chicago.
It was also the favorite technique of Berg of Boston.
ENDOTECH II
BY HOWARD MARTIN & FISCHER

Consists of :-
Endotec Handpiece- cordless
Battery
Plugger/Spreader
- adjusted to any access angulation
Temperature – 315.5 - 343.9 C
- 170 C apical 16mm in 5 sec
- takes 2 sec to cool down
It combines ease of lateral condensation and superior density gained by
vertical compaction of warm g.p
 Thermomechanical Compaction of Gutta-percha

MCSPADDEN COMPACTOR 1979

It fit into a latch-type handpiece and was
spun in the canal at speeds between
8,000 and 20,000 rpm.

At these speeds, the heat generated by

friction softened the gutta-percha and
the design of the blades forced the
material apically.

Fragility and fracture of the instruments,

along with overfilling because of the
difficulty in mastering the technique, led
to its demise
Master cone is dipped into the endodontic sealer and introduced into the canal
NiTi microseal spreader is advanced to within 1-2mm from the working
length and is rotated.
Ist spin:- Guttapercha cartridge is heated
-condenser is introduced ;
-cover 5-6mm of the instrument with warm guttapercha.
The condenser is removed after rotating with a gentle stroking motion against
canals walls ( 6 secs)
2nd spin- carries additional GP
 Thermo mechanical Solid-Core Gutta-percha Obturation.

Introduced as the J.S. Quick-Fill (J.S. Dental Co., Sweden/USA).

This system consists of titanium core devices that come in ISO sizes 15 to 60, resemble
latch-type endodontic drills, coated with alpha-phase gutta-percha.
Operates in regular slow-speed handpiece.
Friction plasticizes gutta-percha.
No preheating or open flames.
 ULTRASONIC PLASTICIZING GP

First suggested by Moreno from Mexico

Used a Cavitron ultrasonic scaler with a PR30 insert,
Used only in the anterior teeth.
Moreno placed gutta-percha points to virtually fill the canal.
Insert the attached endodontic instrument into the g.p mass,
activated the ultrasonic instrument -plasticized the gutta-percha
by friction.
Final vertical compaction could be done with hand or finger
pluggers.
More homogeneous compaction
 Less stress and less apical microleakage
 THERMOPLASTICIZED
INJECTABLE GUTTA PERCHA
OBTURATION
 Obtura System
Technique :
Canal is prepared, dried and the walls are coated with sealers.

GP is preheated in the gun and the needle is positioned in the canal so that it reaches
within 3-5 mm of the apical preparation.

GP is passively injected by squeezing the trigger of the gun.Needle backs out of the
canal as the apical portion is filled.

Pluggers dipped in alcohol are used to compact the GP when it gets cooled.
First commercially available thermoplasticized guttapercha
Introduced in 1977 at Harvard Institute ( Harvald/Forsyth )

OBTURA
( Unitek Corp. U.S) – 1st generation
-Obtura Gun (“GUTTA GUN”)
-Pistol Grip Syringe
- GP pellets loaded into chamber of Obtura gun
- soft & flexible silver needles
- no digital display
Needle size -- 20 gauge (equal to a size 60 file)
23 gauge (equal to a size 40 file).
OBTURA II
2nd generation instrument
Improvements:-
- pistol-grip syringe made of stronger heat resistant plastic
- highly polished chamber & well-fitting round plunger
-digital display of temperature reading
-safe circuit with precise temperature control
- better designed & fitted disposable silver needles
Silver needles – 20,23,25 gauge
Temperature: 160- 200 C
Highest internal temperature (after 3 min
– 27 degree C)
OBTURA III
Newest 3rd generation
Heated to 150-200 deg C
Available with different viscosites of GP
- Regular Flow
 Inject-R fill back filling technique

By James B. Roane at University of Oklahoma(1994)

Consists of miniature metal tube with GP
Canal orifice – min 2mm diameter
Results similar to warm vertical compaction
Apical segment of canal can be obturated using any technique
Heated in a flame or an electronic heater
Coronal surface of the gutta-percha - should be warmed using heated
instrument.
Burner is used -- sleeve is waved through the flame until gutta-percha
begins to extrude from the open end.
warmed unit -placed into the orifice
canal orifice must be at least 2 mm in diameter.
handle pushed - injects the heated gutta-percha into the canal.
Pre-fitted hand or finger pluggers used to compact the gutta-percha.
CARRIER BASED OBTURATING MATERIAL
 Thermafil Obturators
( Tulsa Dentsply )

Concept by W.B. Johnson ( 1978)

Popular- simplicity & accuracy
Consists of basically: flexible central carrier
guttapercha ( 2mm beyond carrier)
alpha
THERMAPREP OVEN:
Heating temperature- 115 C
3-7 min depending on carrier size
GP sets in 2-4 min
Thermoplasticized alpha-phase gutta-percha carried into the canal on an
carrier thermafil obturator.
 TITANIUM SS PLASTIC

ISO Standard With Colour Matching

Sizes -20-140
Plastic carrier – liquid crystal plastic ( 25-40)
- polysulphone polymer ( 45 & above)
2nd generation
Thermafil plus obturators:
slight groove along 60deg of circumference
-allows backflow of excess GP
- pilot point for carrier removal in retreatment

Thermaprep oven:
17-45sec
APICAL THIRD FILLING
 Simplifill

Developed by SENIA
Available with GP and Resilon apical plug
SimpliFill is a relatively new two-phased
obturation method
Use of a stainless steel carrier to place
Compact a 5 mm segment of gutta-percha into the
apical portion
Once placed, the carrier is removed by counter
clockwise rotations, leaving a plug of gutta-percha.
Backfill canal.
 Conserves Dentin
 Simple to use

 Requires no expensive equipment

 Requires no heat

 Leaves no carrier in canal

 Saves time when post space is required

 Simplifies cleaning and shaping

 Dentin Chips Apical Plug Technique
• Forms a BIOLOGICAL SEAL
• Stimulates Osteo-cementogenesis
• Filling apical 1mm with dentin chips
• H file or GG used to produce dentin chips from coronal 2/3rd

File

Gates Glidden Paper Point butt end Blunt end

110
 COLD PLASTICIZED GP

GuttaFlow is the first Non-Heated Flowable Obturation Material for

root canals which combines Gutta-Percha and Sealer in One product

+ =

GP Powder Sealer GuttaFlow

 Works at room temperature
 Excellent Seal
Excellent Seal
 Easier and Faster  No Heat - NoNoShrinkage
Heat - No Shrinkage
 Gutta-Percha and Sealer in One  Expands slightly by 0.2% percent
Expands slightly by 0.2% percent
 No condensation needed  Insoluble and dimensionally
Insoluble stable
and dimensionally stable
working time of 15 minutes and it  Easily removed – post
Easily placement.
removed – post placement.
111
cures in 25 to 30 minutes.
COMPOSITION:-

Matrix - Polyvinyl siloxane

Filler - GP- fine ground powder(less
than 30mm)
Silicone oil
Paraffin oil
Zirconium dioxide
Platinum catalyst
Nano-silver – preservative
Colouring agent
 Hydraulic condensation using bioceramic
sealer
 CONCLUSION
Satisfactory root canal filling can be achieved in well prepared canal with GP and
sealer compacted by variety of cold and warm techniques

Although there is a little evidence currently of improved outcomes, it is rational to

assume that techniques better able to obliterate three dimensionally the pulp canal
space are preferable

Whilst the GP and sealer still remains the gold standard and alternatives are
justifiably gaining acceptance in a variety of techniques.
REFERENCES
• John I. Ingle, Leif. K Barkland, Endodontics;5th edition;Elsevier;2002.
• Prakash R, Gopikrishna V, Kandaswamy D;guttapercha an untold story;
international journal of therapeutic applications (2015); 20; 20-24.
• Louis I. Grossman.Endodontic practice. 11th edition.
• Vishwanath V, Rao HM. Gutta-percha in endodontics - A comprehensive
review of material science. J Conserv Dent. 2019 May-Jun;22(3):216-222.
THANK YOU!!!