OBTURATION TECHNIQUE

OBTURATION TECHNIQUES
 OBTURATION TECHNIQUE

I. Introduction

The final step in endodontic treatment has been stated to be the sealing of the apical foramen at the
cemento-dentinal junction and all portals of entry to the periapical tissue with an inert material.
Root canal obturation is defined and characterized as “the three-dimensional filling of the entire root
canal system as close to the cementodentinal junction as possible. Minimal amounts of root canals sealers,
which have been demonstrated to be biologically compatible, are used in conjunction with the core filling
material to establish an adequate seal”.
Achieving the ideal seal however is complex as the anatomy of the root canal system itself. So a well
prepared root canal to receive the filling is an absolute necessary without which the canal cannot be filled
properly.

II. HISTORY

► 200 B.C. – oldest known root canal filling bronze wire found in the root canal in the skull of a Nabatean
warrior

► 1825- Gold foil by Edward Hudson

► Other materials
 Lead
 Paraffin
 Amalgam
 Wood points
 Oxychloride of zinc
 Ivory
 Orangewood sticks

► 1847- Hill developed first gutta –percha material known as Hill’s stopping
 Consisted of bleached gutta-percha carbonate of lime and quartz

► 1848- was patented and first used as insulation for undersea cables

► 1867-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

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 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)

► 1898- Gysi introduced a formaldehyde paste- Gysi’s Triopaste

► 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

► 1946- Sommer provided the technical essentials of application of the lateral condensation technique

► 1953- Berg- essentials of vertical condensation technique

► 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 endonotic 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)

III. PURPOSE, RATIONALE, AND IMPORTANCE OF OBTURATION

According to Ingle, the preliminary objectives of operative endodontics are:

- total debridement of the pulpal space,
- development of a fluid-tight seal at the apical foramen, and
- Total obliteration of the root canal.

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By the same token, one must not overlook the importance of a coronal seal.

(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.)

According to Cohen the purposes of obturating the prepared root canal space are as follows:

1. To eliminate all avenues of leakage from the oral cavity or the periradicular tissues into the root canal
system, and
2. To seal within the system any irritants that cannot be fully removed during canal cleaning and shaping
procedures.

The rationale for these objectives recognizes that microbial irritants (e.g., microorganisms, toxins,
metabolites) and products of pulp tissue degeneration are the prime causes for pulpal demise and its
subsequent extension into the periradicular tissue. Failure to eliminate these etiologic factors and to prevent
further irritation via continued contamination of the root canal system are the prime causes for failure of
nonsurgical and surgical root canal treatment.
The importance of three-dimensional (3-D) obturation of the root canal system cannot be overstated.

IV. EXTENSION OF THE ROOT CANAL FILLING

The anatomic limits of the pulp space are the dentinocemental junction apically, and the pulp chamber
coronally.
- Debate persists, however, as to the ideal apical limit of the root canal filling. Canals filled to the apical
dentinocemental junction are filled to the anatomic limit of the canal. Beyond this point, the periodontal
structures begin.
- The dentinocemental junction is an average of about 0.5 to 0.7 mm from the external surface of the
apical foramen, as clearly demonstrated by Kuttler, and is the major factor in limiting filling material to
the canal

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- Two terms, overfilling and overextension, are often used interchangeably. This is not correct.

- Overfilling denotes “total obturation of the root canal space with excess material extruding beyond the
apical foramen.” Note the emphasis on “total obturation.”
- Overextension, on the other hand, may also denote extrusion of filling material beyond the apical
foramen but with the canal has not been adequately filled and the apex has not been sealed.

 A number of dentists disagree with the contention that the terminus of the filling should be at the
dentinocemental junction. They prefer instead to fill to the radiographic external surface of the root or
just beyond. They seek to develop a small “puff” of overfilling.
 Purposely overfilling to produce a periradicular “puff” is advocated primarily by the proponents of the
diffusion technique or the softened gutta-percha technique. Ostensibly, the “puff” or “button” is
designed to compensate for shrinkage of the filling by pulling down tightly against the apex.
 Although no proof exists that this is true, the advocates of softened gutta-percha fillings interpret the
apical “puff” as an indicator that the gutta-percha has been densely packed into the apical preparation
and that all of the aberrations, as well as the lateral and accessory canals of the root canal system, have
been cleansed and filled. No accounting is given of postoperative discomfort.
 Many authors believe that filling just short of the radiographic apex is greatly preferred to overfilling.
Filling short of the apex following Pulpectomy is especially recommended by Nygaard-Østby, Blayney,
and most recently Strindberg.

 Despite all of this, a high degree of success is still achieved if overfilling occurs.
 Fortunately, most of the root canal sealers currently used, as well as the solid-core filling materials, are
eventually tolerated by the periradicular tissues once the cements have set. The tissue reaction that does
occur can be a fibrous walling off of the foreign body. On the other hand, fewer stormy postoperative
reactions can be expected if canal instrumentation and filling are limited by the narrowest waist of the
apical foramen

V. WHEN TO OBTURATE THE CANAL

For many years most authorities agreed that four conditions must be satisfied:
(1) Negative culture test,
(2) No excessive exudate from the canal,
(3) Absence of foul odor, and
(4) Lack of periapical sensitivity.

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This list has undergone periodic revision and several of the conditions have been given more credence from
time to time. Presently, however, at least one condition— gaining of a negative culture—has been eliminated
from the list

Problems Stemming from Reliance on Negative Culture

This was a dominant criterion for many years for two major reasons. First, it was the only criterion that
was completely objective. The culture test was either positive or negative, and no degree of "slightly" positive
was possible in such a qualitative test. Second, the pioneers of endodontics were aware of the potential dangers
of bacteria in the apical portions of the canal and the periapical tissues.
The reliance on the negative culture test decreased when important studies indicated that false negatives
could give an inaccurate assessment of the microbial population in the critical areas. In addition, even a positive
culture did not vouch for the potential pathogenicity of the offending microorganisms. Even more serious was
the fact that some of the most pathogenic organisms were grown only with great difficulty by the culture
methods then in vogue.
This is not meant to infer that a contaminated canal should be filled with impunity. On the contrary, the
presence of bacteria due to a faulty temporary seal or frank intracanal infection on opening the canal is an
obvious contraindication for completion.

Significance of Foul Odor

For many years, it was common practice for dentists to smell the paper points when it was removed from
a canal being treated, particularly as a substitute for culturing. The absence of odor supposedly was an
indication that no infection was present and that the canal could be filled.
Grossman reported a poor correlation between canal odor and culture results—positive cultures were
found in canals free of odor. In addition, foul odor has been associated with anaerobic growth, which was very
difficult to verify with the routine culture methods then in vogue. For these reasons, absence of canal odor is
rarely considered as an indication for filling.

No Excessive Exudate
In regard to the finding of exudate, the word excessive presents a problem of semantics. A tooth with a flaring
apex is almost impossible to rid of tissue fluids without resorting to caustic chemicals that might cause
periapical inflammation. On the other hand, the presence of even a slight purulent exudate may indicate the
possibility of an incipient exacerbation.

Lack of Periapical Sensitivity

- Because the previously discussed criteria may be difficult to assess, the lack of periapical sensitivity retains
the strongest cogency.
- The amount of sensitivity is determined by lightly tapping the treated tooth with the butt end of a mouth
mirror and by digital manipulation of the buccal and lingual plates of bone surrounding the tooth.
- In a tooth ready for filling, the result should be the same as for an adjacent or a contralateral nontreated
tooth.

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- The presence of sensitivity indicates retained inflammation in the periodontal membrane space, most
frequently as a result of overinstrumentation.
- If the canal is filled before the inflammation has dissipated, the additive inflammation that normally results
from the packing of the canal with filling materials and sealer will often cause an extremely painful episode,
which may prompt the patient to insist on an extraction or require heavy administration of pain relievers.
- Unless tissue resistance is strong enough to overcome this considerable increase of inflammatory potential,
an area of periapical inflammation (granuloma) will result or a previously existing lesion will be
perpetuated.

OBTURATION TECHNIQUES

CLASSIFICATION OF OBTURATION TECHNIQUES BY GUTMANN AND WHITHERSPOON

(2002)

I. Solid core Gutta percha with sealants

A. Cold Gutta percha points
► Lateral compaction
► Variations of lateral compaction

B. Chemically plasticized cold gutta percha

 Essential oils and solvents
 Eucalyptol
 Chloroform
 Halothane
C. Canal warmed gutta percha
 Vertical compaction
 System B compaction

 Sectional Compaction
 Lateral / vertical compaction
 Endotec II
 Thermomechanical compaction
 Mc Spaden, TLC, Engine-Plugger, Maillefer Condenser
 Hybrid technique
 J.S. Quick-Fill
 Ultrasonic plasticizing

D. Thermoplasticized gutta percha

 Syringe insertion
 Obtura

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 Ultrafill

 Solid – core carrier insertion

 Thermafil and densfil
 Soft core and three Dee GP
 One step obturator
 Alphaseal
 Sucessfil

E. COMBINATION TECHNIQUES (Core carrier + Syringe insertion)

 TRIFECTA SYSTEM (Coltene Whaledent)

II. Apical third filling

 Light speed SimpliFill
 Fiberfil obturator
 Dentin – chip
 Calcium hydroxide

III. Injection or “Spiral” filling

 Cements
 Pastes
 Plastics
 Calcium phosphate

COLD LATERAL COMPACTION

Ralph Sommer provided the essentials of this technique 1946

 Is the technique most commonly taught in and used by practitioners and has long been the standard
against which other methods of canal obturation have been judged.
 This technique encompasses first placing a sealer lining in the canal, followed by a measured primary
point, that in turn is compacted laterally by a plugger-like tapering spreader used with vertical pressure,
to make room for additional accessory points
 An apical stop must be created to resist apically directed condensation

Spreader Size Determination.

 fit the spreader to reach to within 1.0 to 2.0 mm of the true working length and to match the taper of the
preparation.

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 Therefore, a spreader of the same apical instrument size or one size larger is chosen so that it reaches to
within 1.0 to 2.0 mm but will not penetrate the apical orifice.
Primary Point Size Determination.
 the primary point should be selected to match the size of the last instrument used at the apex and should
be tested in place and confirmed radiographically.
 The accessory gutta-percha cones must be smaller in diameter than the spreader/plugger

 The four methods used to determine the proper fit of the primary point are as follows
(1) visual test
(2) tactile test
(3) patient response
(4) radiographic test

 The premeasured primary (or master, or initial) point is now coated with cement
 Once the fit of the cemented primary point is ensured, 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.

 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.

 This point is followed by more spreading and more points. 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 followed by vertical compaction with a large plugger

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► Advantages
► Simplicity & ease
► Speed
► Disadvantage
► Does not achieve a dense homogenous mass
► Filling of lateral and accessory canals not achieved
► Cannot adapt to canal wall irregularities
► Chances of stress development and fracture
► 1.5kg – 5kg

CHEMICALLY PLASTICIZED GUTTA PERCHA TECHNIQUE

 In an effort to ensure that the primary gutta percha point will better conform to the aberrations in apical
canal anatomy a modification of the lateral compaction technique involves the use of a solvent to soften
the apical portion to develop a master cone.
 The principal solvent used in this technique is chloroform. It is preferred because it is more volatile than
other solvents, and no solvent adhering to the cone is desired during condensation.
 Other solvents such as eucalyptol, halothane, xylene, methylchloroform and rectified white turpentine
have been evaluated as substitutes for chloroform.

Technique

 In this technique the primary point is blunted and fitted 2.0mm short of the working length or a slightly
oversized master cone is used.
 The apical 2 to 3 mm is placed in the solvent for about 3 to 5 seconds, removed and placed into the canal
with slight apical pressure, held for a few seconds until the working length is achieved with a good
apical fit
 If a correct preparation has been made, the cone will assume a pointed tip, and striations will be noted
along the lateral portion, recapitulating the canal interior.
 To begin the obturation by lateral compaction, one must immediately position the customized master
point to its full measured length and then spread it aside to allow the softened gutta percha to flow.

 If the canal is so large that the largest gutta percha point is still loose in the canal; a tailor made point
must be used as ‘a primary point’.
 The cones are softened with a small amount of solvent until they become tacky and
adhere to each other
 The softened, gutta percha points are arranged butt to tip, butt to tip on a sterile glass slab.
 The cones are rolled and fused together with spatula or between two glass slabs to the
desired shape and taper.

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Main disadvantages
1. Dramatic shrinkage of the solvent softened material.
2. High incidence of overfilling.
3. Potential toxicity of these materials.

CANAL WARMED GUTTA PERCHA TECHNIQUES

1) WARM VERTICAL COMPACTION

USING TRADITIONAL HEAT CARRIER

SCHILDER’S BOSTON TECHNIQUE

► Three dimensional technique
► Herbert Schilder, 1967

Technique of warm gutta-percha/vertical compaction:

 Master gutta-percha cone fits tightly to radiographic apex. Marked at incisal edge to
establish length reference.
 Master cone cut back 0.5 to 1.0 mm at tip and retried in canal. Trimmed incisal
reference remains same.

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 Largest plugger prefit to coronal third of canal.
 Midsize plugger prefit to midcanal without touching walls.
 Smallest plugger prefit to within 3 to 4 mm of radiographic apex. Remains free in canal.

 Kerr Sealer deposited in midcanal with Handy Lentulo spiral.

Apical third of master cone is lightly coated with sealer and
gently teased to place. Incisal reference checked.

 Surplus gutta-percha removed with heat

carrier down to canal orifice.
 Largest plugger compacts warmed gutta-
percha into bolus. Midroot lateral canal being
obturated.

 Heat carrier transfers heat 3 to 4 mm into middle

 third of mass. Wiping carrier against walls softens excess gutta-percha.
 First selective gutta-percha removal.
 Midsize plugger compacts heat-softened gutta-percha apically. Second lateral canal appears as obturated.

 ,Heat transfer instrument warms apical gutta-percha.

Second selective removal of material.
 Smallest plugger compacts apical mass into apical
preparation and accessory canals now appear obturated as well.
 Plugger folds surplus gutta-percha around walls into
flattened
 central mass. Radiograph confirms total obturation of apical third
 of canal. If a post is to be placed, obturation is complete

 If gutta-percha gun (Obtura II) is used for backfill, the needle is inserted to the apical segment and then
backed out, leaving deposit.

 Plasticized gutta-percha is compacted to complete obturation to canal orifice.

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 Final compaction of backpack done with largest plugger.

 Gutta-percha and sealer are removed to below free gingival level, crown is thoroughly cleansed, and
final restoration is placed in the coronal cavity.









 Advantages
► Merging of gutta percha into a dense homogenous mass
► Dense three dimensional fill
► Obturation of lateral and accesssory canals
 Disadvantages
 Many steps involved
 Time consuming
► Uncontrolled heat with heat carriers
► Heat carriers heated over a flame can reach an average temperature of
321.20C
 Requires a wide tapering preparation

USING ELECTRIC HEAT CARRIER

I. SYSTEM B
II. TOUCH N’ HEAT

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SYSTEM B TECHNIQUE

► by Stephen Buchanan in 1996

► Also called the “Continuous wave of obturation Technique”
► Variation of warm gutta percha vertical compaction techniques
using an electrical heart carrier

Consists of
 System B Heat source: It has continuous / touch mode
 Temperature - 200°C
 Period of time - determined by the operator

► Handpiece
 Holds the tips
 connected to the heat source by a cord
 Has a ‘ring switch’ which is pressed to activate the
handpiece
► Pluggers / Tips
 available in standardized sizes as well as non standardized
sizes
► medium system B tip 0.06 taper
► medium /fine system B tip 0.04 taper

Technique: done in 3 stages

► Cone fit + plugger fit in

► Down pack technique
► Backfill technique

► Cone fit
► Appropriate sized gutta percha cone selected
 Must fit in last 1 mm and to full length
 Minimal cutback of 0.5 mm of apical tip of gutta percha cone

► Plugger fit in
 Plugger must stop at about 5-7 mm short of working length (binding point)
 Stop attachment adjusted at coronal reference points
 Plugger removed and attached to heat sources

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► Down pack technique:

► Primary point coated with sealer and pushed to place

► Heat source preset at 200°C (power dial at 10)

► The tip is activated by pressing the ring switch on the hand piece
► Cone is seared off at orifice
► Preheated plugger driven smoothly through gutta percha to within 3-4 mm of binding point in
2 sec
► Heat switch is released
► Plugger continues to more apically
► Cold plugger held for additional 10 seconds under sustained pressure
► To remove plugger
► Heat switch activated for 1 second followed by 1 second pause
► Cold plugger then quickly withdrawn
► Radiographic confirmation

► Back fill technique:

 same gutta percha cone coated with sealer and positioned in back fill space
► System B with the same plugger
► insert at 100°C for ¼ second only
► cut heat
► immediately plunge plugger into backfill cone and hold in place for 3-5
seconds
► another cone placed and procedure repeated
► final plugging with a large cold regular plugger
 Obtura II gutta percha gun

 Requirements

► a smooth tapering funnel

► a apical construction
► appropriate master cone adaptation

► Advantages:
 Clinician can control the amount of heat in the heat carrier by use of thermostat
 Temperature at the tip of heat carrier plugger is monitored
 Heat once activated is constant and is concentrated at the tip
► Hence can soften gutta percha and apply vertical pressure in one continuous motion (continuous
wave of condensation)
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 Faster than traditional warm vertical compaction

 Disadvantages:
► Potential for extrusion
► Potential for thermal damage to periodontal ligament and supporting alveolar bone

System-B/Elements Obturation Unit (SybronEndo)

► A newer generation System B Unit

► Coupled with a motor driven extruder handpiece that makes the backfill
easy
► Buchanan Pluggers are available in tapers of .04, .06, .08, .10 and .12,
to correspond with the shapes created by GT Files
► Advantages
► Combines downpack to backfill
► Takes only 1/3 the space

TOUCH N’ HEAT

 BY Clifford J. Ruddle
 An electronic device specially developed for the warm
gutta - percha technique
► Battery or AC models are available
► Consist of
► Control unit
► Heat Carrier
► connected to the unit by a cord
► tips are interchangeable with those of
system B

► Uses:
► heat carrier
► sear off excess gutta percha
► preparation of post space
► pulp testing tool for a response to heat

 Disadvantages

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 Heat produced excessive (0 - 8160C)

 Twice as high as that produced for an open flame
 Might lead to overheating the gutta percha
 may damage periodontal ligament in teeth with narrow roots such as mandibular anteriors

 Spreader not uniformly heated to the same temperature throughout its entire length ( Jurcak et al
1992)
 Connected to the unit by a cord

2) LATERAL / VERTICAL COMPACTION

ENDOTEC (L.D Caulk / Dentsply Milford DE)

 Developed by Howard Martin and Fisher
 Designed to compensate for the voids created during the “cold welding” of cones
during lateral compaction
 It consists of
 Endotec handpiece
► Cordless handpiece with an activator
button
► Battery operated
 Endotec tips
► quick changes tips
► 21mm long
► 2 sizes
 larger tip (No.45)
 small tip (No.30)
► Autoclavable
► May be adjusted to any access angulation

► TECHNIQUE

 Heated plugger moved in a clock wise motion with activator button

pressed
 Activator button is then released
 Plugger is allowed to cool

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 Removed from the gutta percha with a counter clockwise motion

► USES
 Warm lateral compaction
 Gutta percha removal during retreatment or post preparation
 Elimination of voids created during normal lateral condensation

Zap and tap technique

► For obturating mandibular molars with C –shaped canals
► Technique
 Preheating Endotec plugger for 4-5 seconds
 Insertion (Zap)
 Then moving the hot instrument in and out in short continuous strokes (Taps) 10-
15 times
 Plugger removed while still hot
 Followed by insertion of a cold spreader
 Insertion of additional accessory points
► ADVANTAGES
 Combines the best of the 2 techniques
► Lateral compaction – relative simplicity (ease and speed)
► Vertical compaction – superior density
 Tip can be used as both a plugger or spreader
 Heated tip is able to advance apically with minimum exertion
► Creates less stress on root structure than does cold lateral compaction
► DISADVANTAGES
 Increased time needed for obturation
 Spreader breakage and kinking
 Heaviness of the handpiece
 High heat
► Decomposition of gutta percha

3) SECTIONAL COMPACTION / SECTIONAL GUTTA PERCHA

TECHNIQUE

► By Coolidge 1946
► Also called “Chicago technique”
 (as it was promoted by Coolidge, Blayney and Lundquist – Chicago dentists)
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► One of the earliest modification of vertical compaction method
► Technique:

 Plugger should fit the prepared tapered canal loosely and extend to within 3 mm of the working
length
 Primary gutta percha point is blunted and carried to place, to fit 1 mm short of working length
 3 mm of the tip of the point is clearly excised with a scalpel
 This small piece is then luted to the end of the warmed plugger
 Canal lined with sealer
 Gutta percha tip is warmed by passing through alcohol flame and then carried to place
 Vertical compaction

► Variations
 Soften in chloroform or halothane
 Backfilling – using thermoplasticized gutta percha

4) THERMOMECHANICAL COMPACTION

► introduced by McSpadden in 1978

► Principle
 Automated rotary device
 heat generated by friction softened the gutta-percha
 design of the blades forced the material apically

THERMOMECHANICAL COMPACTION USING COMPACTORS

USING COMPACTORS AND GUTTA PERCHA CONES

► McSpadden Compactor

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 resembled a reverse Hedstroem file, or a reverse screw
design
 made of stainless steel
 fit into a latch-type handpiece
 speeds between 8,000 and 20,000 rpm
 Used with regular beta phase gutta percha cones

► Advantages
 Canals could be filled in seconds
 Ability to fill very irregular spaces and teeth with resorptive defects
 Gave a dense fill
 Conservative use of gutta percha
► Disadvantages
 Fragility and fracture of the instruments
► In canals less than size 50
► Curved canals
 Overfilling
 Void formation
► ‘popcorn appearance’ of gutta percha
 Poor seal
► Use of speeds higher than recommended
 Difficulty in mastering the technique

 Gutta-Condenser (Maillefer)
► Blunt tipped
► Flute depth reduced
► Less likely to fracture

 Engine Plugger (Zipperer)

► more closely resembles an inverted K-file
 K file design with a reverse twist

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 TLC / Thermal Lateral Compactor (Brasseler, Savannah, Georgia)

► Less aggressive
► Less prone to fracture
► Reduce the possibility of extrusion through the apex

Common disadvantages

► Cutting / gouging of dentin

► Breakage of compactors
► Potential for generation of excessive heat levels on external root surfaces
► Overfilling / extrusion of filling material

USING COMPACTORS COATED WITH GUTTA PERCHA

NT Condenser

► By McSpadden 1993
► Modification of the original McSpadden compactor
► Made of Ni-Ti
 Flexibility
 Can be used in curved canals
► Blunted blades and tip
 Prevents gouging
► Also called
 Microflow compactors
 Pac Mac compactors
► Supplied as
 Engine driven
 Hand powered
► Used in a Ni-Ti Matic handpiece
 slower speed
► 1000 – 4000 rpm

► Used in a ‘Multiphase Technique’

 Principle

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 OBTURATION TECHNIQUE
► slower-speed, lower-temperature plasticized gutta-percha
► can be placed with less stress to the tooth
► yet provide optimal obturation

 Different phases of gutta percha syringes

► Phase I
 Beta phase gutta percha
► Phase II
 Alpha phase gutta percha

► Heated in a Phase II gutta percha heater

► Technique

 Coat canal with sealer

 NT Condenser coated with heat softened Phase I and Phase II
gutta percha
 Coated with sealer
 ‘triple coated compactor’ placed in canal and rotated
 Flings gutta percha laterally and vertically

USING PRECOATED COMPACTORS COATED WITH GUTTA PERCHA

J.S. Quick-Fill

► Uses precoated compactors

 titanium core devices
► resemble latch-type endodontic drills
 in ISO sizes 15 to 60
 coated with alpha-phase gutta-percha

► Advantages
 Does not need to be heated
 Neat
 Easy to use
► Disadvantages
 Tendency for voids

► Technique
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 OBTURATION TECHNIQUE
 fitted to the prepared root canal
 spun in the canal with a regular low-speed, latch-type handpiece
► compacted to place by the design of the Quick-Fill core
 After compaction two choices
► the compactor may be removed and final compaction completed with a hand plugger
► the titanium solid core left in place and separated in the coronal cavity with an inverted
cone bur

THERMOMECHANICAL COMPACTION USING AUTOMATED PLUGGER

Canal Finder Plugger (Laser Medical technology Inc. U.S.)

► Stepwise flexible plugger shaped much like a telescope

► Used in a Canal Finder Handpiece
 Delivers a rapid vertical stroke that varies between 0.3mm and 1.0mm

► Telescopic design catches in gutta percha and compacts it apically

► Accessory points are added in lateral voids produced

THERMOMECHANICAL COMPACTION USING ULTRASONIC PLASTICIZING

► first suggested by Moreno from Mexico,1976

 Cavitron ultrasonic scaler
(Dentsply/Caulk;Milford, Dela.) with a PR30
insert
 it could be used only in anterior teeth
► Technique
 place gutta-percha points to virtually fill the canal
 then insert the attached endodontic instrument into the mass
 activate the ultrasonic instrument (without the liquid coolant)
 the gutta-percha is plasticized by friction and advanced to the measured root length
 final vertical compaction with hand or finger pluggers
► Concerns about the heat generated by this technique
 Cavitron PR30
► very little heat rise: 6.35°C in 6.3 seconds
 Enac ultrasonic unit (Osada Co.; Los Angeles, Calif. and Japan)
► a 19.1°C rise in temperature
► took 141 seconds to plasticize the mass
 Energized Spreading Technique
 Enac ultrasonic unit (Osada) with an attached spreader
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 OBTURATION TECHNIQUE
 no attempt to plasticize the gutta-percha
 the spreader more easily penetrates the mass of gutta-percha than did the finger
spreaders
 more homogeneous compaction of gutta-percha with less stress and less apical
microleakage

5) LASERS
► To warm gutta percha by laser heat energy
 Argon
 Nd:YAG
 Carbon dioxide

► Anic and Matsumoto (1995)

 Sectioned gutta percha segements
 Pulsed nd: yag laser
 Vertical condensation
Disadvantages
► Required to much time
► Significant temperature increases on the external root surfaces

THERMOPLASTICIZED GUTTA- PERCHA TECHNIQUES

1) SYRINGE INSERTION

Syringe insertion with gun

 Using Beta Phase

Obtura
Obtura II

 Using Alpha Phase

Ultrafil

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 OBTURATION TECHNIQUE
 This was later patented and made commercially available as Obtura (Unitek Corp U.S) in 1983

► Obtura gun
► Also called “gutta gun”

 a pistol grip syringe

 Uses pellets of gutta percha which were loaded in a chamber of the Obtura gun
 It used silver needles
► more flexible
► retained heat to keep the gutta percha soft

► This was later modified and commercialized as Obtura II (Texceed Corp. U.S) 1991

Obtura (Unitek Corp.U.S) Obtura II (Texceed Corp U.S)

► no digital display ► digital display of temperature

reading
► Disposable silver needles
► Syringe made of stronger heat
resistant plastic material
► Highly polished chamber and well-
fitting round plunger

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 OBTURATION TECHNIQUE
► Temperature

 160°C- 200°C
 depends on the gauge of the needle (smaller the
gauge of the needle higher the temperature needed)
 extruded gutta percha has temperature of 62 o - 65 oC
 remains soft for 3 min
 at the right consistency and temperature extruded
gutta percha
► Strings out
► Viscous and sticky
► Not uncomfortable to touch

 Gutta percha pellets

► available as b phase gutta percha pellets

► variations in consistency of the gutta percha to improve flow and
regulate viscosity
 REGULAR-FLOW GUTTA PERCHA
 ESAY-FLOW GUTTA PERCHA

► Regular –flow gutta percha

 Homogenized formulation with superior flow characteristics
 Cools rapidly and hardens within 1 minute

► Easy –flow gutta percha

 has longer working time (10-15 seconds more than regular)
 less viscous, higher flow form
 Softens at a lower temperature
► Used with 25 gauge needles
 Indications
► Complex cases which require extensive compaction
► Small curved canals
► Inexperienced clinician

TECHNIQUE :
► requires a minimum, size 40 preparation in body of canal
► continuously tapering funnel from the apical matrix to the canal orifice
► needle and pluggers should reach within 3.5 to 5mm of the terminus (binding point) and fit loosely at
that point

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 OBTURATION TECHNIQUE
► compaction necessary
 to close space and gaps
 compensates for shrinkage as gutta percha cools

USES:
► Complete or primary obturation
 Total
 Segmental
► Backfilling (sectional techniques)
► Managing canal irregularities
 fins
 webs
 cul de - sacs
 internal resorption
 accessory /lateral canals
 arborized foramina
► Combination techniques
 Master cone + Obtura injection around the point

DISADVANTAGE
 Gross overfilling of root canal, known as “SPAGHETTI PHENOMENON”

OBTURA SPARTAN
► Newer version of Obtura
► Compact control unit
► Ergonomic handle
► Availability of different viscosities of gutta percha
 Regular Flow
 Flow 150

ULTRAFIL

► Is a ‘low heat’ injectable gutta percha system

► Introduced by Michanowicz and Czonstokowsky in 1984
► Consists of
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 OBTURATION TECHNIQUE
 heating unit
 Metal syringe
 Cannules prefilled with gutta percha

► METAL SYRINGE
 Also called peripress syringe
 Does not have a heating element

► HEATING UNIT
 Has slots to receive the needle
 Used to warm the cannules
 It is pre-set to 90 0C

► CANNULES
 Prefilled with gutta percha
 Has attached needles of 22 gauge (0.7 mm diameter)
 Disposable
 Contains enough gutta percha to fill at least one molar
 Available in 3 types

► REGULAR SET (white)

 Setting time – 30 min
 Low viscosity, compaction not required

► FIRM SET (blue)

 Setting time – 4 min
 Condensation possible but not required

ENDOSET (green)
 Setting time – 2min
 Highest viscosity
 Must be condensed

► TECHNIQUE
► Cannule is chosen and needle may be bent on the barrel of the syringe
► Cannule is placed in the preset heater at 90 0C for 15min
► Cannule is placed in injection syringe during which time it loses heat rapidly and drops to 70 0C
– ready for injection
► Has a 1 minute working time
► Material is injected into the preparation at 420 – 450C
► If required the cannule with the gun can be returned to the heater for further softening
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 OBTURATION TECHNIQUE
 if unused at one sitting may be reheated
► If left in the heater for more than 4 hours should be discarded
► Injection procedure is technique sensitive
 trigger should be squeezed slowly and steadily
► Excessive pressure can
 Fracture the cannule
 Extrude gutta percha through back of the cannule

► ADVANTAGES
► Versatile (varied viscosities)
► Can be compacted (Vertically & laterally)
 Requires minimal pressure during compaction
► Increased patient comfort (thermoplasticized at low temperature)
► Disposable cannules
► Can be used for back filling
► Flows into canal irregularities (moldable)
► Can be used for different cases
 Large canals
 Retrograde filling
 Internal resorption
 Perforations
 Lateral canals
 Ledges
 Open apex

► DISADVANTAGES
 Requires a wide middle 1/3 preparation (to at least size 70)
 The filling can be pulled out if the injector is removed prematurely

2) SOLID –CORE CARRIER INSERTION

Pre coated carriers

Thermafil and Densfil
Soft core and Three Dee GP
One Step Obturator

Operator coated
AlphaSeal
SuccesFil

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 OBTURATION TECHNIQUE
► PRINCIPLE
 Was given by W. Ben Johnson in 1978
 To combine the advantages of gutta percha and silver cones
 Gutta percha
 Superior to silver cones for sealing
 Better tolerated by the body

 Silver cones
 Ability to traverse through small canals more easily
 Better length control

 Original hand made gutta-percha obturator

 Thermoplasticized alpha-phase gutta percha on an endodontic file

3. THERMAFIL

► Then in 1989 it was commercialized in the form of THERMAFIL

 A patented endodontic obturator
 Consisting of a flexible central carrier uniformly coated with a layer of refined and tested
alpha-phase gutta percha
► Carriers
 Made of
► Stainless steel (initially)
► Titanium (later)
► Plastic
 Have ISO standard dimension with matching color coding
 Comes in sizes of 20-140

 Plastic carrier
► Made of special synthetic resin
 Liquid plastic crystal
 Polysulphone polymer

 Liquid plastic crystal

► To make sizes 25-40
► Stiffer material
► Resistant to solvents

 Polysulphone polymer
► To make sizes 45 and above
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 OBTURATION TECHNIQUE
► Can be dissolved in most organic solvents

 Both plastics are

► Non toxic
► Highly stable polymers
► Well tolerated by the body

 Advantages of plastic core

► Allows post space to be made more easily
► Retreatment of larger sizes performed more easily

 Plastic carrier is cut off

► Heated instrument
► Long shank diamond stone
► Inverted stainless steel bur
► Prepi bur

► Alpha phase gutta percha

► The gutta percha normally covers the first two or three gradation
marks at 18, 19, 20mm and must be cut away if required
► The gutta percha coating extends beyond the length of the carrier by
1-2mm
► Previously the gutta percha was molded into
 a non standardized thick parallel sided point
► More recently gutta percha
 shaped into a tapering cone

► Size verifiers
 Disadvantage of Thermafil oburators
► Cannot check by radiograph to test if master cone fits
properly
 Size verification kit
► Collection of plastic obturators
 without the gutta percha portion
► Size verifier of same as the master apical file is chosen

Heat Source
► Initially metal obturators
 Heated over a Bunsen burner
 Rotated in the blue zone of the flame
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 OBTURATION TECHNIQUE
 Until a shiny coat developed on the gutta percha

► Disadvantages
 heat is not controlled
 If not heated sufficiently
► obturator did not go to place
► metal would push through the gutta percha
► made the entire unit unusable
 If overheated
► Causes gutta percha to conflagrate
► Becomes unusable

► Therma prep oven

► Was especially needed with introduction of plastic carrier
► Advantages
 Enables operator to have a consistently reliable
temperature of the obturator
 Better chance for smooth complete placement
► Consists of
 On / off button
 Dial
 Heater
► Heating temperature
 1150 C (constant)

► Heating time
 3-7 min depending on size of carriers
 Time was operator controlled
 Gutta percha sets in 2-4 minutes

SOFT-CORE OBTURATORS
► Similar to Thermafil carriers except the handle is attached to a removable metallic insertion pin
 Advantage
► Length of the carrier can be adjusted
► Can also be bent for use in areas of difficult access

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 OBTURATION TECHNIQUE
o Metal pin is 9 mm in length
o Hollow plastic core is 24 mm in length

► Soft-Core oven consists of a halogen lamp

► Plastic size verifier is also available

ONE –STEP OBTURATORS

► Cores
o Soft plastic
o Does not have a handle
► Special tweezer
o Helps hold the obturator
o Also acts as a cutter
 thus eliminating the need for a separate cutting bur

► One-step oven
o halogen oven
o Temperature 1100C
► Technique
o Tweezer holds the obturator at the working length
o Holding the obturator with the tweezer it is carried to the oven
o It is then placed into the canal to full working length
o The tweezer is then gently withdrawn
o Once the gutta percha is cooled the tweezer holds the obturator at the desired position and
twisted to one side to snap off the protruding plastic core

ALPHA SEAL

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 OBTURATION TECHNIQUE
► Provides a-phase guttapercha in a syringe which is heated in a special oven
► This system uses conventional K files or similarly sized carriers as the carrier
► Similar in concept to the Thermafil system but in contrast the clinician does the “coating” of the carrier

► Advantages
 Is more effective in resisting slippage and displacement of the gutta-percha than pre-coated
carriers
► Use of master apical file or similarly sized titanium
carrier
 Ability to try in the carrier prior to obturation
 Ability to precurve the carrier prior to coating

SUCCESSFIL

► Consists of
 SuccessFil solid-core carriers
► Titanium cores
► Radiopaque plastics

 SuccessFil syringes
► Contain high viscosity alpha phase gutta percha
► Heated in special heater oven
► It sets in 2 minutes

 SuccessFil heater

► Technique
 The gutta percha syringe is warmed
 The carriers are inserted to the measured depth into the gutta-percha in the syringe and then
extruded by forcing the plunger
► Rapid withdrawl
 Creates a tapered shape
► Slower withdrawl
 creates a cylinder shape
 Inserted into the canal
 Core is separated by holding the handle and severing the core shaft 2mm above the orifice

AlphaSeal (The Cutting Edge, SuccessFil (Hygienic corp, Akron, OH)

Chattanooga, TN)
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 OBTURATION TECHNIQUE

Uses conventional K-files Uses its own titanium cores

Alpha phase of the gutta percha is Alpha phase of the gutta percha in
processed through heat fractionization processed through extensive milling

COMBINATION TECHNIQUES (Core carrier + Syringe insertion)

1. TRIFECTA SYSTEM
A method to block the apex and prevent extrusion
 A plug of gutta percha at the apical foramen
► SuccessFil
 remainder of canal
► Ultrafil

► Technique
 2-3mm of warm, plasticized gutta-percha is retrieved from a SuccessFil syringe on the tip of a
sterile endodontic file one size smaller than the last enlarging file used at the apex

 File rotated counterclockwise and retrieved

 Plugger is used to compact

 Sectional injections of Ultrafil is used to fill the rest of the canal and compacted

2. APICAL THIRD FILLING

WITH GUTTA PERCHA WITHOUT GUTTA PERCHA

Lightspeed Simplifill obturator Dentin chips

Fibrefill obturator Calcium hydroxide
Mineral Trioxide aggregate

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 OBTURATION TECHNIQUE

3. SIMPLIFILL

► Originally developed by Senia at Lightspeed Technology

 to complement the canal shape created using Lightspeed instruments
► The Apical GP Plug size is the same ISO size as the Lightspeed “MasterApical Rotary”
(MAR)
► use of a stainless steel carrier to place and compact a 5 mm segment of gutta-percha into the
apical portion of a canal

Technique

 Trial fit an Apical GP Plug, without sealer, to ensure a correct apical fit.
 Use a GP Plug the same size as the LIGHTSPEED Master Apical Rotary
(MAR).
 Set the rubber stop 2 mm short of working length (WL) and slowly advance the
GP Plug apically without rotating the handle
 The Plug should advance without resistance until just reaching the length at
which the rubber stop is set (WL minus 2 mm)

 Place Sealer in the apical 1/3 of the canal using a LIGHTSPEED

instrument smaller than the MAR, or a paper point
 Re-set the rubber stop on the Carrier to the WL and coat the GP Plug with
sealer
 Slowly advance the GP Plug until resistance is felt. Then, condense (push) it
vertically to WL without rotating the handle

 After the Apical GP Plug is in place, release the plug from the Carrier using a
Counter Clockwise rotation
 Do not push or pull while rotating the handle
 Obturation is now complete if a post will be used

 Load syringe with sealer

 Insert the tip of the needle as far as possible into the canal to eliminate air
bubbles in the backfill
 Slowly withdraw syringe while injecting sealer until the canal is filled to the
orifice

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 OBTURATION TECHNIQUE

 For the Backfill Cone, select a standardized (ISO/ADA) cone the same size
as the Apical GP Plug
 Advance the Backfill Cone apically until it contacts the
Apical GP Plug
 Fill any remaining space with an accessory cone(s)
 Remove excess gutta percha to the level of the canal orifice

► Advantages
► helps conserves dentin because of the Lightspeed instrumentation
technique (less flaring)
► it eliminates additional internal forces since no spreader or plugger is used to compact the apical
plug
► it is simple to master
► no carrier is left in the canal

FIBREFILL OBTURATORS

► A combination obturation technique

 Combines a post and obturator in a single unit
 Apical 5 to 8 mm is gutta percha
► Attached via a thin, flexible filament
► For negotiation of moderately curved canals
 Coronal two thirds is a resin core post comprised of unidirectional fibers in an organic resin
matrix
► Fibrefill obturation system consists of
 Fibrefill obturators
 Fibrefill Root Canal Sealant
► Dual cure resin sealer
 Fibrefill primer and bonding agent

► Advantage
 can be bonded to the tooth, dramatically reducing coronal leakage

► Disadvantage
 Difficulty of retreatment

DENTIN CHIP APICAL FILLING

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 OBTURATION TECHNIQUE
► Based on premise
 dentin fillings will stimulate osteo or cementogenesis
► Advantages
 Prevents overfilling and confining the irrigating solutions and filling materials to the canal space
(El Deeb et al)
 lead to quicker healing, minimal inflammation, and apical cementum deposition, even when the
apex is perforated (Oswald et al)
► Disadvantage
 dentin chips, if infected, are a serious deterrent to healing (Holland et al)

► Dentin Chip Technique

 the canal is totally debrided and shaped

 Gates-Glidden drill or Hedstroem
file is used to produce dentin powder in the
central position of the canal
 These dentin chips may then be pushed
apically with the butt end of a paper point
and then the blunted tip of a paper point
 They are finally packed into place at the
apex using a premeasured file one size
larger than the last apical enlarging
instrument

 One to 2mm of chips should block the foramen

 Completeness of density is tested by resistance to
perforation by a No. 15 or 20 file
 The final gutta-percha obturation is then compacted
against the plug

CALCIUM HYDROXIDE APICAL FILLING

► Cementogenesis, which is stimulated by dentin filings, appears to be replicated by calcium hydroxide as

well
► calcium hydroxide resorbs away from the apex faster than do dentin chips

► Method of Use

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 OBTURATION TECHNIQUE
 Calcium hydroxide can be placed as an apical plug in either a dry or moist state
 Dry calcium hydroxide powder
► May be deposited in the coronal orifice from a sterilized amalgam carrier
► The bolus may then be forced apically with a premeasured plugger
► Tapped to place with the last size apical file that was used
► One to 2 mm must be well condensed to block the foramen
► Blockage should be tested with a file that is one size smaller

 Moist calcium hydroxide

► can be placed in a number of ways
 amalgam carrier and plugger
 Lentulo spiral
 injection from one of the commercial syringes loaded with calcium hydroxide
► Calasept (J.S. Dental Prod., Sweden/USA)
► TempCanal (Pulpdent Corp.; Boston Mass.)

► calcium hydroxide deposit should be thick enough and well condensed

 serve not only as a stimulant to cemental growth but also as a barrier to extrusion
of well compacted gutta-percha obturation

NEWER TECHNIQUES

GuttaFlow
► is a new self-curing filling system for root canals that
combines two products in one capsule
 gutta-percha in particle form (less than 30 µm)
 Sealer
► Injectable system
 time-saving obturation
► The capsule
 is activated by compression
 mixed for only 30 seconds in a standard
triturator
 is designed for single use mixing
► one capsule can fill up to 3- 4 canals
► Reduces risk of contamination
► Advantages
 Easier and faster to use

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 OBTURATION TECHNIQUE
► no condensation required
 Radiopaque
 Dimensionally stable
► No heat – No shrinkage
► Better seal
 Biocompatible
 Easily removed for retreatment or post preparation, no plastic carriers
 Economical
► no heating unit required

CONCLUSION

 During the past 15 years, great efforts have been made to enhance the manipulative properties of gutta-
percha by either thermoplasticizing the rubber like material before its insertion or thermo softening the
gutta percha once it has been cemented in the canal “cold”.
 As a result obturation systems have evolved that use heat softened gutta-percha delivered via injection or
in a carrier; and that deliver heat to cold gutta percha cones cemented in place.
 Two important principles must be realized about obturation techniques.

 No filling method will be effective without proper cleaning and shaping of the root canal system.
 “The obturation is in essence an impression of what the canal looks like after it has been instrumented”
 S.I. Kratchman 2004

 There is no single technique that can fulfill the requirements of all cases and hence success requires that
in addition to proper case selection, one is familiar with as many if not all techniques, to use either singly
or in combinations.

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 OBTURATION TECHNIQUE
 Although some of the systems may appear rather simple to use. They do in fact require a thorough
understanding of the respective principles and a rather long learning curve in order to achieve
predictable outcomes.

 Gutta percha has been the standard material for almost 100 years. As endodontic success rates continue
to increase, research has begun to focus on coronal seal and to the endodontic – restorative continuum.
Although the clinician has a variety of obturation techniques to choose from today, one should keep in
mind that there is no method that produces a leakproof seal.
 In light of this, perhaps one of the biggest challenges that faces endodontics in this millennium is to find
a gutta-percha replacement; a material that actually bonds to the dentin of the canal walls and form a
leakproof seal, a material that is bioinductive and promotes regeneration or a “smart” material that can
adapt to the everchanging microenvironment of the canal systems.

REFERENCES

1. D. Ricucci, : Apical limit of root canal instrumentation and obturation part I. Literature review.
International Endodontic Journal (1998) 31:384-393.
2. Endodontics - 5th edition. John I. Ingle Leif K Bakland. Chapter - 11 - Obturation of the radicular
space.
3. Pathways of the Pulp by Stephen Cohen, Richard C. Burns 8th Edition
4. Endodontic therapy by Weine 6th edtn
5. Endodontic practice by Louis Grossman, 11th edition
6. Endodontics - Science and Practice. A text book for student and practitioner by - Andre Schroeder
1981.Chapter 5 : Root canal filling : Procedures and materials.
7. Color Atlas and text of Endodontics (2nd edition) Christopher J. Stock, Kishore Gulabiyala, Richard
T. Walker, Jane R. Goodman. Chapter - 9. Obturation of the root canal system.

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