Obturation of the Root Canal

System
By
Dr. Amr Abdelwahab bayoumi
Lecturer of endodontics
Faculty of dentistry, Al azhar university
Obturation of
Root Canal
System
 Outline
Objectives of Obturation
 Basic Principles of Root Canal Filling
 Extension of the Root Canal Filling
Timing for Obturation (When to Obturate the Canal)
Materials Used in Obturation
Definition
Three dimensional filling of the entire root canal system and all complex
anatomic pathways with a nonirritating hermetic sealing materials

core filling material

+
Sealer

which acts as an interface between the core material and the dentin walls
Failure
3 questions must be answered

• I- Why we do obturation ?

• II-When we do obturation ?

• III -How we do obturation ?

Objectives of Obturation

• Development of a fluid tight seal along the whole length of the root

canal from the coronal opening to the apical termination.

Objectives of Obturation

• Total and three dimensional obliteration of the root canal system in

order to;
• Prevent fluid percolation

• Prevent canal re-infection

• Allow healing of the preapical tissues

Basic Principles of Root Canal Filling

• The central core acts as a piston on the flowable sealer, causing it to spread, fill

voids and to wet and attach to the instrumented dentin wall.

 Extension of the Root Canal Filling

• The anatomical limit of the root canal is CDJ

(0.5-1 mm from the radiographic apex).

 Extension of the Root Canal Filling

• It represents the narrowest diameter of the apical foramen

and called the apical constriction (Minor diameter).

Extension of the Root Canal Filling
Extension of the Root Canal Filling
Overfilling

• Total obturation of the root canal space with excess

material extruding beyond the apical foramen.
Overextension
is extrusion of filling material beyond apical foramen but
the canal may not have been filled completely.
Underfilling

• Underfilling results when both preparation and

obturation are short of the desired working
length

• or when the obturation does not extend to the

prepared length.
When to Obturate
the Canal ??????
 Timing for Obturation
(When to Obturate the Canal)

• When canal is correctly cleaned and shaped to an optimum size

• Asymptomatic tooth or mild discomfort present

• No pain

• No tenderness to percussion

• No swelling

• No foul odour

• No sinus tract
 Timing for Obturation
(When to Obturate the Canal)

• The canal is dry after using paper points

• The temporary filling remains intact between the appointments

• Negative culture obtained.

 III-Procedure of obturation
Materials & Techniques
• Materials :-
• Core materials:

• Plastics: Gutta-percha, resilon

• Solids or metal cores: Silver points, Gold, stainless steel, titanium.

• Cements and pastes:

– zn/oxide
– resin based
– Calcium hydroxide-based
– glass ionomer based
– bioceramics
I. Core Obturating Materials

• Semisolids ------------------------ Gutta-percha

and Resilon
• Solids
• Semi-rigid ------------------ Silver points
• Rigid ----------------------- Endodontic implants
 What are the ideal
requirements of the
obturating material ????
 I. Core Obturating Materials

• Ideal requirements of root canal filling material

(According to Grossman):

1. It should be easily introduced into a root canal.

2. It should seal the canal laterally as well as apically.

3. It should not shrink after being inserted.

 I. Core Obturating Materials

4. It should be impervious to moisture.

5. It should be bacteriostatic or at least not encourage bacterial growth.

6. It should be radiopaque.

7. It should not stain tooth structure.

I. Core Obturating Materials

8. It should not irritate periradicular tissue.

9. It should be sterile or easily and quickly sterilized immediately

before insertion.

10. It should be removed easily from the root canal if necessary.

 Gutta-percha
is derived from two words:
“GETAH”—meaning gum
“PERTJA”—name of the tree in Malay language

oComposition:

– It is a natural product that consists of the purified

coagulated exudate of mazer wood trees .

– Chemically, gutta-percha is a type of rubbers.

 Gutta-percha

oComposition:

– Gutta-percha and rubber have the same chemical structure

while the difference in the physical properties only.

 Gutta-percha
oComposition:
– The commercial components of gutta-percha points :
Constituent Percentage Function
Gutta-percha 18-22 % Matrix
Zinc oxide 60-75 % Filler

Waxes / Resins 1-4 % Plasticizers for handling properties---so the

material becomes more compactable

Barium sulphate 1-18 % Radiopacifiers

Colouring agent <1 for visual contrast
 Phases of gutta-percha
Chemically pure gutta-percha exists in two different crystalline forms,
that is, α and β
Natural gutta-percha coming directly from the tree is in α-form while
the most commercially available product is in β-form.

These phases are interconvertible.

• α-Form
• •• Brittle at room temperature

• •• Becomes tacky and flowable when heated (low viscosity)

• •• Thermoplasticized gutta-percha for warm compaction technique is in α-form

• β-Form
• •• Stable and flexible at room temperature

• •• Becomes less adhesive and flowable when heated (high viscosity)

• •• Gutta-percha points used with cold compaction are in β-form

 Gutta-percha
oChemical properties: Alpha Form

Heated above 65 º C

Amorphous structure

Cooled routinely Cooled slowly 0.5 º C/hr

Beta Form Alpha Form

 Gutta-percha
oPhysical properties:

1. Effect of heat on the volumetric change of gutta-percha

(Expansion and shrinkage).

2. Effect of condensation forces (Compactability).

 Gutta-percha
oPhysical properties:

3. Gutta-percha points become brittle as they age,

probably through oxidation.

Storage under artificial light also speeds up their

deterioration.
Brittle gutta-percha can be rejuvenated by
immersion in hot water (55°C) for 1 or 2 s
and then immediately immersed in cold
water for few seconds
 Gutta-percha
oBiological properties:
• Slight antibacterial activity; Medicated Gutta-Percha (MGP).
Calcium hydroxide, iodoform, or chlorhexidine

• Gutta-percha promotes a degree of tissue irritation, due to the high content

of zinc oxide.
 Gutta-percha
o Configuration (Availability):

• Conventional (non-standardized) form: (XF-FF- MF- F-M-Coarse)

• Standardized form: (ISO)

Nonstandardized (top) and standardized (bottom) cones

What are the advantages
of gutta-percha??????
 Gutta-percha
oAdvantages:
1. Compactable material and adapts excellently to the irregularities.

2. Inertness.

3. Dimensional stability.

4. Tissue tolerance (nonallergenic).

 Gutta-percha
oAdvantages:
5. Radiopaque

6. Solubility in organic solvents.

7. It can be easily removed from the canal when necessary.

8. It does not support bacterial growth.

9. It can be easily sterilized by immersion in 1% (or greater 5.25%)

sodium hypochloride for 1 minute. Then, rinsed in hydrogen

peroxide or ethyl alcohol to remove crystallized NaOCl before
obturation
What are the disadvantages
of gutta-percha?????
 Gutta-percha
oDisadvantages:

1. Lack of rigidity.

2. Lack of adhesive quality.

3. Lack of length control.

 Gutta-percha
o Indications:

1. Filling of;
− Irregular and non circular canals
− Wide and funnel shaped canals
− Root canals with lateral, accessory canals and
− multiple apical foramina
− Root canals with internal resorption

− Root canals with ledges and /or perforations

 • Resilon is a thermoplastic synthetic polymer-

based root canal filling material based on

Resilon
polymers of polyester and contains bioactive

glass and radiopaque fillers.

 It is available like gutta-percha in
conventional and standardized forms.

It utilizes Resilon root canal sealer,

Resilon which is a dual cured resin sealer.

It depends on the monoblock

concept.
 Resilon
Monoblock
 Activ GP
• It consists of gutta-percha cones impregnated on the

external surface with glass ionomer

• Single cones are used with a glass ionomer sealer.

• Available in .04 and .06 tapered cones

 Silver Points
It is a semi-rigid (flexible) obturating material

Constituents Percentage
Silver 99.8 -99.9 %
Nickel 0.04 – 0.15%
Copper 0.02 – 0.08 %
 Silver Points

• Properties:

• Hardness: (dentin grip).

• Oligodynamic property: (bacteriocidal effect)

• Corrosive effect
 • Advantages:

 Rigidity

 Easy of placement

Silver Points  Control of the length

 Ability of precurving the points

 Ability of forcing the sealer into the root canal

irrgularities

 Radiopaque
 • Disadvantages:

 Inadaptable to the root canal walls

Silver Points  Insoluble in common solvents

 Irritation of the tissues

Clinical case filled with
silver point
3 questions must be answered

•I- Why we do obturation ?

•II-When we do obturation ?
•III -How we do obturation ?
 oCold gutta-percha points:
• Single cone technique
• Lateral compaction
Different • Variations of lateral compaction
Obturation
oChemically plasticized cold gutta-percha:
Techniques • Chloroform
• Eucalyptol
• Halothane
Different Obturation Techniques
oCanal-warmed gutta-percha:

• Intra-canal warmed gutta-percha:

• Vertical compaction
• Continuous wave compaction( System B)
• Sectional compaction
• Lateral/vertical compaction (Endotec II)
• Thermomechanical compaction
Different Obturation Techniques
o Canal-warmed gutta-percha:

• Extra-canal warmed gutta-percha:

• Thermoplasticized injectable GP:(Syringe insertion)

• Solid-core carrier insertion

 Cold gutta-percha points:

Single cone technique

• It depends on matching a single

cone to a prepared round canal.
• Advantages:
• Simple and rapid technique
• Disadvantages:
• Lack of complete seal of the
root canal.
 Cold gutta-percha points:
Lateral compaction
• It is the most common technique for obturating the root canal space.

• Advantages:
− Simple technique.

− Good length control during compaction.

− Less amount of sealer left in the canal after obturation.

− Good sealing ability and adaptation to the canal walls.

− Easy of retreatment.
 Cold gutta-percha points:
Lateral compaction

• Disadvantages:

− Non-homogenous filling of the root canals.

− Cold GP does not conform to canal irregularities.

− Presence of unfilled areas "voids" with resultant microleakage.

Cold gutta-percha points:
Lateral compaction

• Steps :
1. Spreader size determination
2. Drying the canal

3. Mixing and placement of the sealer

4. Placement of the premeasured primary (master or initial) point

5. Placement of accessory (auxiliary) gutta-percha points

Cold gutta-percha points: • Steps :
1. Spreader Size Determination;
Lateral compaction − The spreader must reach to within 1 to 2 mm of the working length.
− Hand versus finger spreaders.
− A spreader of the same apical instrument size or one size larger is chosen.
Cold gutta-percha points :

Lateral compaction
• Steps :

2. Drying the Canal

− Absorbent paper point.

− Larger paper points are followed by smaller paper points

until full length is achieved.

Cold gutta-percha points:

Lateral compaction
• Steps :

3. Mixing and Placement of the Sealer

− The cement should be creamy in consistency.

− Sealer should paint all the canal walls.

 Cold gutta-percha points:

Lateral compaction

• Steps :
3. Mixing and Placement of Sealer
• Methods for sealer placement;
− File or reamer.

− Sealer carrier instrument (Lentulo spirals)

− Ultrasonic file.
 Cold gutta-percha points:

Lateral compaction

• Steps :
4. Placement of the Premeasured
Primary (Master or Initial) Point

−The primary point is coated with

sealer and slowly moved to full
working length.
Selection of the Master Point

1. Visual Test:
• Checking the working length and
width.
• Checking the apical stop:
Selection of the Master Point

2. Tactile Test: (Tactile sensation of the clinician)

It depends on the preparation of the apical 3 to 4 mm

of the canal with parallel walls “tugback”.

Selection of the Master
Point

3. Patient Response:

Gutta-percha penetrating the apical foramen

Selection of the Master
Point
4. Radiographic test: the
radiograph shows;
 Whether the working
length of the tooth was
correct

 Whether instrumentation
followed the curve of the
canal
Cold gutta-percha points:
Lateral compaction

• Steps :
5. Placement of Accessory GP Points
− Use the premeasured spreader
alongside the primary point with a
rotary vertical motion.

− Remove the spreader with a

reciprocating motion and is followed
by inserting the first auxiliary point.
Cold gutta-percha points:

Lateral compaction

• Steps :
5. Placement of accessory gutta-percha
points
− Obturation is completed when the spreader can no
longer penetrate the filling mass beyond the cervical
line.
− Severing the GP at the level of the orifice.
− Vertical compaction with a large plugger.
Remove Remaining Cement
.• Use cotton to remove any remaining cement from the inside of
the chamber by wetting small cotton pellet and wiping the
chamber clean.
Complete technique
• Lateral compaction
Cold gutta-percha points:
Variations of Lateral compaction

1. Inverted point technique

• Indication: in tubular canals
• Technique:
− Cut off the colored end of a gutta-
percha point.
− The point is inverted and tried in
the canal.
Cold gutta-percha points:
Variations of Lateral compaction
1. Inverted point technique
• Technique:
− It should fulfill the following criteria;

• Go to the full working length

• Exhibit “tugback” on removal

• The pt. may complain of discomfort due to air evacuation

 Cold gutta-percha points:
Variations of Lateral compaction

2. Tailor made (Customized) gutta-percha technique:

• Indication:
• In tubular canals (while the largest inverted
point is still loose in the canal).
• Technique:
• Roll a number of GP points.
• The rolled GP should be checked for
tugback and radiographically.
Tailor made GP
Chemically plasticized cold gutta-percha:

• Concept:

− It involves use of a chemical solvent to soften the primary

gutta-percha point to conform to the canal anatomy.

Chloroform customized
master cone.
Chemically plasticized cold gutta-percha:

• Steps:
− Cut off 2.0 mm short of the working length from the master point.

− Dipping it in the solvent (chloroform) for 1 second.

− Insert it to full measured length.

− Insert the spreader.

− Completing the obturation using lateral compaction technique.

Chemically plasticized cold gutta-percha:

• Advantages:

− Smooth, homogeneous, well-condensed obturation.

• Disadvantages:

− Leakage that may occur due to solvent evaporation.

− Irritation.
Different Obturation Techniques
o Canal-warmed gutta-percha:

• Extra-canal warmed gutta-percha:

• Thermoplasticized injectable GP:(Syringe insertion)

• Solid-core carrier insertion

Different Obturation Techniques
oCanal-warmed gutta-percha:
• Intra-canal warmed gutta-percha:
• Vertical compaction
• Continuous wave compaction( System B)
• Sectional compaction
• Lateral/vertical compaction (Endotec II)
• Thermomechanical compaction
• Ultrasonic
 All these techniques requires:
1. Tapered canal preparation.
2. Well defined apical constriction or seat.
 Extra-canal warmed gutta-percha:
Thermoplasticized injectable GP:(Syringe insertion
Obtura injectable technique

• Principle:
− Using injection gun in which the GP is warmed to temperatures ranging
from 160°C to 200°C and delivered into the canal through either;
−20 gauge needle (equal to a size 60 file) or
−23 gauge needle (equal to a size 40 file)
− The gutta-percha leaves the needle at approximately 70ºc.
 Extra-canal warmed gutta-percha:
Thermoplasticized injectable GP:(Syringe insertion
Obtura injectable technique

• Advantages:
• In wide canals with an apical stop
 Internal resorption
• Disadvantages:
− Lack of length control .
− Shrinkage of the GP during cooling may result in voids.
 Extra-canal warmed gutta-percha:
Solid-Core Carrier Insertion
Thermafil

• Principle:
− It consists of a flexible central carrier (stainless steal, titanium or plastic)
that is sized and tapered to match variable tapered endodontic files and
is uniformly coated with GP that is heated in a special (Thermafil) oven.
Extra-canal warmed gutta-percha:
Solid-Core Carrier Insertion
Thermafil
• Advantages:
− Simple and fast technique.
− Suitable for greater tapered instruments.
− Rigid insertion of the central core coated with GP to
flow into lateral and accessory canals.
− Control of the temperature of the coating GP.
Extra-canal warmed gutta-percha:
Solid-Core Carrier Insertion
Thermafil
• Disadvantages:
− Difficult post placement( when using the metallic core)

− Difficult in re-treatment procedures

− The gutta-percha may be stripped from the carrier.

− Liability of overfilling and sealer extrusion.

 Canal-warmed gutta-percha:
Intra-canal warmed gutta-percha:
Vertical compaction

• Concept:
− Gutta-percha is warmed inside the canal and compacted vertically with
sufficient vertical pressure to force it to flow into the root canal system,
including accessory and lateral canals using pluggers.
Vertical compaction

• Indications
− In general, vertical condensation can be used in the
same situations as lateral condensation.
− It is preferred in a few circumstances such as;
 Long , narrow, curved canals

 Internal resorption.

 In presence of lateral and accessory canals.

Vertical compaction
• Advantages:
1) Homogeneous filling throughout the root canal.
2) Better adaptability of the warmed / softened GP to
canal irregularities.
3) The root canal space is obturated with a maximum
amount of GP and a minimum amount of sealer.
Vertical compaction
• Disadvantages:
1) Difficulty of length control.
2) A more complicated procedure.
3) More instruments are required.
4) A larger canal preparation is necessary to allow
manipulation of the instruments.
5) Liability of root fracture may be due to excessive
vertical pressure.
Vertical compaction

• Contraindications;

− When there is a possibility for overfilling.

− When there is a possibility for root fracture due to

excessive vertical pressure.

Vertical compaction

• Steps:
1) Dryness of the canal with paper points.

2) Fitting the master GP cone ( key of success)

3) Plugger size selection

Vertical compaction

• Steps:
4) Sealer placement

5) Use of heat Transfer Instrument

6) Trimming off the master cone

Touch ’n Heat
Vertical compaction

• Steps:
7) Heat waves of vertical compaction (Apical down-pack)

8) “Backpacking” of the remainder of the canal

9) Removal of excess GP
 Intra-canal warmed gutta-percha:

Continuous wave compaction System-B

• Concept:
• It is based on the principle of vertical compaction technique but with
advancement in heat source using the System-B and associated
pluggers

• It controls the temperature at the tip of heat carrier pluggers,

thereby delivering a precised amount of heat
 Continuous wave compaction (System B)

• Advantages:
− It is faster and more accurate technique.

− It controls the temperature at the tip of the heat-carrier pluggers.

Continuous wave compaction (System B)
Intra-canal warmed gutta-percha:
Sectional compaction

• Concept:
− It is a modification of the vertical
compaction technique including
the use of small warmed pieces
of GP ( sectional obturation
technique).
• Advantage:
− Apical seal for post insertion.
• It is also described as → Chicago
technique.
Intra-canal warmed gutta-percha:
Lateral/Vertical Compaction (Endotec II)

• Concept:
− Endotec II is a cordless
battery powered, heat-
controlled
spreader/plugger that
ensures complete thermo-
softening of any type of GP.
Lateral/Vertical Compaction (Endotec II))

• Advantage:
− It has the best advantages of both lateral and
vertical compaction techniques i.e.
The ease and speed of lateral
compaction as well as
The superior density of the obturation
gained by vertical compaction of warm
GP.
 Intra-canal warmed gutta-percha:
Thermomechanical compaction
Mc Spadden compaction technigue

• Concept:
− The GP is plasticized by frictional heat and compacted by means
of a Mc Spadden compactor that forces the GP apically.

− The compactor is an engine operated instrument resembling a

reverse Hedstroem file.
Thermomechanical compaction

Thermomechanical solid core GP

obturation technique
(J.S.-Quick-Fill)

• Concept:
− Generating a frictional heat inside the
canal to soften alpha-phase GP that is
coating a titanium core devices.

− These solid core carriers come in ISO

sizes 15 to 60 resemble latch-type
endodontic drills and coated with
alpha-phase gutta-percha.
 Ultrasonic plasticizing:

• plasticizing gutta percha in the canal with an ultrasonic instrument.

• A special insert like a spreader is used in a Cavitron ultrasonic scaler.
• The sealer and the gutta percha points are placed inside the canal → the
endodontic instrument attached to the Cavitron is then inserted into the mass and
activated without the coolant to plasticize gutta percha by friction.
• Final vertical compaction could be done with hand or finger pluggers
 • Functions:

1. Fill in the discrepancies between canal

walls and filling cone.

2. Luting action between canal filling and

dentin wall.

SEALERS 3. Lubrication.

4. Antibacterial at the time of insertion and

shortly after.

5. Filling patent accessory canals and

multiple foramina.
 Root Canal Sealers:

• Ideal requirements of a root canal sealer (Grossman):

1. It should be tacky when mixed to provide good adhesion.
2. It should make a hermetic seal.
3. It should be radiopaque.
4. The particles of powder should be very fine for easy mix.
5. It should not shrink upon setting.
6. It should not stain tooth structure.
 Root Canal Sealers:
• Ideal requirements of a root canal sealer (Grossman):
7. It should be bacteriostatic or at least not encourage bacterial growth.
8. It should set slowly.
9. It should be insoluble in tissue fluids.
10. It should be soluble in solvents.
11. It should be tissue tolerant (non-irritant to periradicular tissue).
12. It should be neither mutagenic nor carcinogenic.
Root Canal Sealers:

• Types:
1) Zinc oxide based sealers
2) Resin based sealer
3) Combination(ZOE & resin) sealers
4) Calcium Hydroxide based Sealers
5) Glass-ionomer sealer
6) Polycarboxylate cements
7) Medicated sealers
8) Bioceramic sealers
 1) Zinc oxide based sealers
一 Powder: Zinc oxide. Liquid: Eugenol.
二 The silver added for radio-opacity causes discoloration of teeth.
三 All ZnO/E cements have extended working time, but set faster in the tooth due to  the body
temperature and humidity.
四 Advantages: Plasticity.
Slow setting time in absence of moisture.
Good sealing potential due to its little volumetric changes on setting.
一 Dis-advantages: Decomposed by water through a continuous loss of eugenol.
This makes the cement weak, unstable and limits its use
Modifications: Nogenol:
一 Developed to overcome: The irritating quality of eugenol.
The decomposition by water.
一 The base is zinc oxide with other ingredients mixed with vegetable oil.
2. Resin sealers

Example AH – plus:
•An epoxy resin sealer

•It sets slowly in 24 – 36 hours.

•It is not sensitive to moisture and

will even set under water.
3. Combination sealers
Tubli seal:
•Based on combination of ZnO/E and resin.

•Quick and easy to be mixed.

•Its use is recommended in case of periapical

surgery due to its short setting time.

•Its dis-advantages are:

Rapid setting and Tissue irritation.
4. Calcium hydroxide sealers:
•Calcium hydroxide has been added to root canal sealers for → its
osteogenic effect.
•So, the calcium hydroxide should be released from the hard cement to
stimulate cementum and/or bone formation.
•The question remains → if these cements are soluble for the calcium
hydroxide to be released → what about the sealing ability of these sealers.
5. Glass ionomer sealers
Ketc-Endo:
•form an adhesive bond with dentin.

•They have good flow and setting abilities.

•The greatest problem is their removal

from the canal when there is a need for
re-treatment as there is no solvent for
glass ionomers.
6. Polycaroxylate cement

•It is a zinc oxide and polyacrylic acid.

•It sets very hard.

•Adheres well to dentin.

•It is insoluble in water.

•Not recommended to be used due to: Its viscosity.

Rapid setting time.

Difficulty to be removed.
7. Medicated sealers
N2, SPAD, Endomethasone:

•Paraformaldhyde and sometimes corticosteroids are added

to ZnO/E cements.

•The one common component of these medicated sealers is

→ formaldehyde in one form or another.

•It is claimed that → these sealers constantly release anti-

microbial formalin.

•The release of formalin breaks the seal and leads to

destructive chemical behavior to the tissue → so; these
sealers are listed as number one irritant.
Testing of the quality of the
mix
• 1. String out test:
• The flat surface of the spatula is placed on
the top of the sealer mix and then lifted
slowly. The sealer should string out at least
an inch without breaking.
• 2. Drop test:
• The soft sealer mix is gathered onto the
spatula, which is then held edgewise. The
sealer mass should not drop of the spatula’s
edge in less than 10-12 seconds.
•
 EVALUATION
OF OBTURATION

Evaluation
Well condensed homogenous filling
Absence of voids or spreader tracks
Underfilling or overfilling
proper coronal level of gutta percha
Good quality of radiograph