OBTURATION OF ROOT

CANAL SYSTEM
Definition

 The three-dimensional filling of the entire root canal system as close to the
cemento-dentinal junction as possible.
 Obturation is the method used to fill and seal a cleaned and shaped root canal
using a root canal sealer and core filling material.
Objectives

 Substitution of an  To eliminate all

inert filling in the avenues of leakage 
To seal within the
space previously from the oral cavity
system any irritants 
occupied by the pulp or the peri-radicular To adequately seal
that cannot be fully
tissue tissues into the root iatrogenic causes
removed during canal
canal system such as perforations,
cleaning and shaping
ledges and zipped
procedures
apices
Obturation timing

 When the canal is cleaned and shaped to an optimum size

 Tooth is asymptomatic

 When the culture is negative

 The root canal is reasonably dry

 An exception is the presence or persistence of exudation from the canal. Obturation of the canal which cannot be dried is

contraindicated.
REQUIREMENTS FOR AN IDEAL
ROOT CANAL FILLING MATERIAL

 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
 Bacteriostatic
 Radiopaque
 Should not stain the tooth structure
 Should not irritate periradicular tissue
 Should be sterile, or easily & quickly sterilized before insertion
 Should be easily removable, if necessary
Classification

Solid Semi-Solid Paste

• Silver points • Gutta percha • ZOE and Ca(OH)2 Paste
• Thermoplasticized Gutta Percha • Mineral Trioxide Aggregate
• Thermomechanical compaction
of Gutta Percha
• Carrier- Based Gutta Percha
• Resilon
Composition of Gutta-Percha

 18-22% Gutta Percha –Binder

 59-76% Zinc Oxide –Filler
 1-4% Waxes and Resins- Plasticizers
 1-18% Metal Sulfates- Radio-opacity

 Newer Gutta Percha with iodoform as antimicrobial agent- MGP medicated gutta percha
 The solid mass alpha-phase
It is a trans-isomer of
On heating the material, gutta-percha melts at a
polyisoprene and exists in
the beta phase changes into temperature above 65°C
sap of rubber trees of genus alpha (α) and beta (β)
the alpha phase which is and turns into the beta
Palaquium gutta. crystalline forms. The
tacky and flowable under phase on slow cooling. This
material is solid in the beta
pressure. exhibits less shrinkage and
phase and does not shrink.
more dimensional stability
 STERILIZATION OF GUTTA PERCHA CONES
 5.25% or 5% NaOCl for 1 min
 Disinfected by
 1% NaOCl – 1min
 0.5% NaOCl – 5min
 After disinfection, gutta percha cones must be rinsed in ethyl alcohol to remove crystallized
NaOCl before obturation
Instruments

Paper Points Spreader

Color - coded Plugger
Pre-marked Endodontic Plier
Varied taper Lentulospiral (Paste
Use: To remove residual carrier)
moisture following
irrigation and before
obturation of the root canal
SPREADER

Is a tapered and pointed instrument

Used to laterally displace gutta-percha cones in

the lateral compaction technique

Materials used - Stainless steel

Nickel titanium

Available as - hand held instruments

finger held instruments
HAND HELD SPREADERS

 Usually single ended instruments

FINGER HELD SPREADERS

 Advantages  Available as

 Greater control of compaction process (as fingers are  Stainless steel

close to the tip of the instrument)  NiTI spreaders
 Lesser risk of vertical root fractures

 Easier to use throughout the mouth

 Available as

 non- standardized

 standardized
 PLUGGER

 Is a tapered and blunt ended instrument whose main

component of force during use is vertical rather than
lateral
LENTULOSPIRAL / PASTE CARRIER

 Small flexible instrument used to place materials in canal.

 Fits into conventional hand piece
 Use it with caution can easily broken
 Different size available.
SEALERS

Basic requirement  Insoluble in tissue fluids

 Should be tacky,  Bacteriostatic
 Radiopaque,  Non-irritating to periradicular tissue

  Slow setting
Provide excellent seal
when set  Easily mixed and removed if
necessary
 Adequate adhesion
 Non-staining
 Dimensionally stable
ZINC OXIDE-EUGENOL

 E.g. Grossman cement, Kerr root canal sealer, tubliseal

Powder Parts

 Zinc oxide, reagent 42

 Staybelite resin 27

 Bismuth subcarbonate 15

 Barium sulfate 15

 Sodium borate, anhydrous 1

Liquid - Eugenol
 Zinc Oxide Eugenol Containing Sealer
 It again divides into eugenol based and non-eugenol-based sealer. Zinc oxide is the main ingredient of
all ZOE based sealers. Some of the ZOE based sealer consist of medicated agent like paraformaldehyde,
corticosteroids, and heavy metals-
 Eugenol Based Sealer
Rickert’s formula, Grossmans cement, Wach’s cement, Endomethasone, N2
 Non-Eugenol Based Sealer Kloropercha N-0, SPAD
EPOXY RESIN BASED SEALER

 AH-26 AND AH- PLUS

Calcium Hydroxide Based Sealer

 Calcium hydroxide in endodontics first introduced by Herman in 1920. Calcium-hydroxide based sealer
used as a sealer as it has good osteogenic and cementogenic properties. It is also helpful in case of
periapical lesion as it fastens the periapical healing- Sealapex, Apexit, Apexit plus, Vitapex., Calcibiotic
root canal sealer.
OBTURATION TECHNIQUE

 Lateral condensation

 Vertical condensation (Warm gutta-percha)

 Sectional condensation

 Compaction method (McSpadden technique)

 Thermo-plasticized gutta-percha technique

 Chemically plasticized gutta-percha

COLD LATERAL CONDENSATION METHOD

 Uses spreaders and pluggers to force GP to flow Primary or master cone inserted to the
laterally and apically established working length. Should fit snugly and
resist removal.
 PROCEDURE
 Dry the canal
 Radiograph taken to determine
Walls of the canal and apical Primary cone is carefully
apical and lateral fit
half of primary cone coated placed in the canal
with sealer
 Spreader  Spreader inserted in the the entire canal
inserted along removed without space occupied is filled with well
side the primary disturbing seated by the spreader condensed GP
cone and pressed Gutta-percha
apically.
Spreader must
reach 1-2mm of
working length.

 Process is
 Accessory cone repeated until
Advantage

 Deep spreader penetration: minimize apical leakage/ percolation.

 Positive dimensional stability of the root canal filling.
 Less likelihood of carrying filling material beyond the root apex.
Disadvantage

 Does not achieve a dense homogenous mass.

 Filling of lateral and accessory canals not achieved.
 Cannot adapt to canal wall irregularities.
 Time consuming.
 Chances of stress development and fracture
 1.5kg – 5kg
II. WARM COMPACTION METHOD (WARM GUTTA-PERCHA)
1. Warm Vertical Compaction

 Indications
• As an alternative to the cold lateral compaction technique
• When the fitting of a conventional master cone to the apical portion of a canal is impossible, as when
there is a ledge formation, perforation, or unusual canal curvatures,
 internal resorptions, or large lateral canals
 A primary nonstandardized or greater taper gutta-percha cone corresponding to the last instrument (MAF)
used is fitted in the canal in the usual manner.
The canal wall is coated with a thin layer of root canal sealer. The primary gutta-percha cone or master cone
is inserted up to the working length.
 The coronal end of the cone is cut off with a heated instrument. Warm vertical compaction technique can be
divided into two clinical steps:
 Step 1: Down packing
■ A “heat carrier,” such as a root canal plugger is heated to redness and is immedi-ately pushed into 3–4
mm of the coronal third of the gutta-percha.
 ■ The heat carrier is deactivated and removed after a pause of 2–3 seconds inside the canal. The sheared
gutta-percha gets removed along with the heat carrier.

 This process of “down packing” or compacting of thermoplasticized gutta-percha segmentally using the
alternate application of heat carrier and condenser is repeated until the smallest plugger compacts the gutta-
percha to about 5 mm distance from the working length.
1. Step 2: Back filling

 Once the down packing is completed, the next step is to fill the remaining canal with thermoplasticized
gutta-percha.
 Warm vertical compaction technique: (a and b) Master cone adaptation in the prepared root canal. (c) Severing of the coronal
portion of the master cone with a heated instrument. (d) Compaction of the master cone. (e) Sequential segments removed with
the heat carrier followed by compaction. (f–h) Once the apical third is reached, the canal is backfilled with heated segments of
gutta-percha followed by compaction with suitable pluggers.
If GP gun (Obturator) is used for backfill

 Needle is inserted to the apical segment and then backed out.

 Plasticized GP is compacted to complete obturation to canal orifice.

 Final compaction done with largest plugger.

 GP removed to below free gingival level

Warm vertical condensation

 Advantages  Many steps involved

 Irregularities & accessory canals better filled.
 Excellent seal of the canal laterally & apically.
 Time consuming
 Uncontrolled heat with heat carriers
 Heat carriers heated over a flame can reach an
average temperature of 321.20C
 Can transmit a temperature of 140.70C
 Requires a wide tapering preparation

 Disadvantages
SYSTEM B TECHNIQUE (Analytical
Technology)

Also called the “Continuous wave of obturation Technique”

 Variation of warm gutta percha vertical compaction techniques using an electrical heat carrier
Consists of
 System B Heat source:
 It has continuous / touch mode
 Temperature - 200C
 Pluggers / Tips
 available in standardized sizes as well as non standardized sizes
 Touch n’ heat  System B
THERMOPLASTICIZED GUTTA- PERCHA
TECHNIQUES

 OBTURA Also called the “ High heat technique”  This was later modified and commercialized as
 Obtura gun Obtura II

 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
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
Gutta percha pellets
Technique
SECTIONAL METHOD

 Plugger preselected to fit loosely and extent to within 3mm of working length.
 Master GP fitted to within 1mm
 Confirm by radiograph
 3mm of apical point are excised
 Plugger warmed and point is luted to plugger
 GP coated with sealer and carried to place
 Plugger rotated to loosen and then used for compaction.
COMPACTION METHOD
(McSpadden)

 Uses heat to decrease GP viscosity and

increase its plasticity.

 Heat is created by rotating a compacting

instrument in a slow speed contra-angle handpiece
(8,000 to 10,000rpm)

 Compactor – spiraled 90° flutes, similar to

H-file, but in reverse.

 Canal enlarged to atleast file size 45

 GP inserted in the prepared canal.

 Compactor blade selected according to
width and length of the canal
 With rubber stop, the rotating tip of
blade is guided to within 1.5mm of root apex.
 The reversed flutes push the softened
GP forward and sideways M.
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
 Poor seal
 Use of speeds higher than recommended
 Difficulty in mastering the technique
CHEMICALLY PLASTICIZED GUTTA-
PERCHA

 GP is plasticized by chemical solvents e.g. chloroform, eucalyptol or xylol.

 Eucapercha has replaced chloropercha

 Eucapercha is made by softening the surface of GP in warm oil of eucalyptus.

 GP cone is inserted and compressed with pluggers.

 DISADV – Inability to control over filling periapical tissue reaction, shrinkage of filling
 Long essays:

1. Classify obturating methods. Describe lateral condensation method of obturation of root canal..

 Classification

 Acc to Grossman:

1. Lateral

2. Vertical

3. Sectional

4. Compaction ( McSpadden technique)

5. Thermoplasticized gutta percha

6. Chemically plasticized gutta percha

1. What are the Hill’s stopping?
a) Silver cones
b) Silver paints
c) Gutta-percha
d) Eugenol
1. When sealing a root canal with gutta percha the master cone should be coated with sealer in
A. Apical 1/3rd
B. Till middle 1/3rd
C. Tip of cone
D. Entire cone
1. Which of the following sealers is found to release formaldehyde when setting?
a) Sealapex
b) AH-26
c) AH plus
d) None