University of Jordan

Dentistry 019

Endodontics
َ‫شل‬
Written by: ‫ح‬ ‫ميرا‬
Corrected by: asma alqaisi
Doctor: Sanaa Aljamani
Sheet #6

1|Page
 Obturation of root canal system

*we are going to talk about the obturation as a procedure we do in endo ,theory path of it ,composition
of the materials.

*the lecture informations from the doctor in blue.

Learning objectives
• Understanding the aims of obturation ,why we do obturation as a procedure? .
• The requirement to perform obturation ,what do we need to have before we get to the obturation
stage ,because as you know the root canal treatment is a procedure that needs a steps ,so each
step depend on the previous one.
• Identify the desirable properties of obturation material .(dental material part of the obturation)
• Identify the different techniques of root canal obturation ,we done one technique in the lab but in
real life in Endodontics we have different ways to obturation.
• Understand the flaws and overcomes during obturation .

Aims of obturation (why do we do obturation?)

1. Prevent microorganism growth in the root canal space.
*because it is an empty space that we created, we have to close this space and
prevent any microorganism to go inside it .
*any empty space has oxygen ,leakages and fluid exist ,make the bacteria to grow
again ,so we have to make sure that this dead place is completely blocked ,no
oxygen or nutrients from blood supply or from leakage of the restoration .

2. Prevent regrowth of any residual microorganisms that have survived the

debridement and disinfection stages of the root canal treatment.
*so when we clean the tooth we remove the bacteria to prevent them from
regrow again we obturate this material to occupy the space with something
solid or at least semisolid .
*sometimes when we do irrigation ,we still don’t guarantee 100% of cleaning
,that’s normal because we have a lot of bacteria which sometimes miss
getting the irrigation to the apical part of the tooth ,but at least when we clean 75% lets say from the
biofilms and then obturate ,we prevent the regrowth again because there is no space to this bacteria .

3. Prevent leakage into the root canal space from by sealing the spaces.
we close all holes and spaces so we don’t have leakage for any fluids in the oral cavity

2|Page
 Requirements
1. Biomechanical preparation to a standard size.
*access cavity by the mechanical preparation, irrigation, step-back technique .

2. No symptoms or complaint from the patient regarding to the treated tooth

*no pain ,no tenderness ,no swelling from the tooth
* when you clean the teeth you give it chance to be healed →symptom free.
*NEVER obturate when the patient is in pain .

3. Dry canals. No exudates from periapical tissue. (in inflammation).

*weeping canals: un dry canal ,we get wet paper point more times (inflammation +
infection at the periapical tissue )

4. No sinus or swelling associated with the treated tooth.

*no swelling either intraorally or extraorally

5. Master cone (cone fit) Radiograph with satisfactory results.

Characteristic of ideal root canal filling

Brownlee 1900 Grossman 1940
• Inserted easily • Easily introduced

• Mouldable ,we can bend it easily • Liquid or semisolid , because the canal sometimes has
irregularities and tapering or curvature
• Fill and seal apex ,not flowy . • Seal apical and lateral

• Neither expand/contract ,dimensionally stable • Not shrink

,prevent make spaces ,never get shrinkage . ‫ما بتتأثر‬
‫بالحرارة‬

• Impermeable ,does not have pours ,prevent things to • Impervious to moisture ,does not be degraded .
pass through it.

• Antiseptic ,does not attract the bacteria • Bacteriostatic

• Easily removed • Easily removed

• Chemically neutral ,to prevent the reaction and • Not irritant

irritation with the tooth in case it escape out of the
tooth, in the worst scenarios .

• Durable ,can be used in prolonged time • Sterile

• Not discolor tooth ,its not desirable if it discolor the • Radio-opaque

tooth

*gutta percha: not the ideal but it is most close one ,staining is possible so we must overcome this.
3|Page
Root canal filling materials (core)
1.Gutta-percha
*comes in different colors ,most common is pink

2.Acrylic point
*with resin ,they are not very friendly to use ,they stop use them.

3.Resilon (resin based)

*at certain time they leave the gutta percha to develop things and try to use the
resilon but eventually they come back to use gutta percha because it is safer.

4.Silver point.
*they can bent ,but also cause corrosion ,problems and irritation to the tissues .
*very diffecult to remove

Gutta percha composition

*origin : from taban tree ,the final outcome went
throw purification and modification processes .
• 19-22% gutta percha ,raw material .
• 59%-75% zinc oxide
• Wax, colouring agents, antioxidants and metallic salts ,radio-opacity elements (basement oxide)which makes it
radio opaque .

Ideal Sealer
*comes around the root canal filing
*why we use them ? to make the filing(gutta percha) adhere to the
walls(dentinal walls) and to adhere gutta percha to each other ,seal the
micro spaces
*easily flow ,it can goes to the canal spaces (spaces that we cannot reach
them with preparation)

*desirable physical properties:

• Good adhesion to canal wall
• Good adhesion to filling material
• Slow setting ,within the working time .but when I want to insert it in the canal it
should get hard and dry
• Easy mix
• Easily removed
• No leakage
• Not toxic ,because it can easily go out from the root canal compared to the gutta percha (fluid)
• Bio-compatable , when it is near to the tissue it does not cause irritation to them .

4|Page
*we have different types of seales depends on the material in it

*it is important to know the sealer that you deal with from which category

*in the lab we use a sealer that is resin based or calcium hydroxid based (more resin beside the calcium hydroxid)

*glass ionomer based : mixed powder and liquid

*calcium hydroxid :two pastes

*silicone-based : it is been used in the past

*calcium silicate : we will talk about if in details ,new sealer ,freindly with the soft tissues

*read the table

Carrier based systems

Obturation techniques:
• Modified single cone

• Cold lateral condensation

• Warm lateral condensation

• Vertical condensation
*obturate with a gun ,has a soft gutta percha ,should be heated.
• Thermo-plasticized Gutta-percha

• Carrier based systems

• Thermo-mechanical compaction
*very risky ,we put a file with the gutta percha and keep
rotating until the material melt ,so we fill it in a thermal way .

5|Page
*obturate the small and lateral canals
-refer to the video for more clarification.22:43.

Cold lateral condensation

1.Master apical cone & sealer
• Identical size to MAF

• Good fit at working length ‘tug back’ resistance that you can feel

(GP>WL)➔If GP passes full length adjust (to get the tug back) by cutting tip 1 mm to WL
or use large GP

(GP<WL)➔If GP does not go to length, use MAF to length irrigate & dry (recapitulation),
debris accumulate . Or, you may use smaller size GP that fits to WL with tug back.

Spreader selection
2.Finger spreader
• Sizes A, B, C, D matches the MAF

• Bind 1-2mm from working length

• Firm pressure in apical direction ,to make sure that you seal the apex with a
master cone.

• Slight lateral pressure , to make space for another accessory cones.

Accessory cones
• Used in lateral condensation to fill the gaps between the Master cone
and the dentinal wall

• The spreader helps creating a uniform space for the accessory cones.

• Careful handling is required as the GP material is easily bend.

• Comes in different sizes.

*there is different types of accessory cones ,fine F ,medium fine MF, fine fine FF.

*the place you insert the spreader in , it is the same place where you insert the accessory cone ,once you creat this
space definitly the accessory cones will get in nicely and smoothly .

*now we do the obturation ,we always dip the accessory cones and the master cone with the sealer to make sure
that those small spaces are being obturated or filled with a sealer .

6|Page
Spoon excavator
• Remove the excess 1 mm below Cemento-Enamel Junction.

➔Heat with a lighter or alcohol torch for firm and Clean GP cut.

*in real life we have a heated instruments that we cut with it ,it is small metal tip
you just press on it ,and become very hot ,then cut the GB ,and then when you lose your finger on the
sensor it goes cold quickly .
*be careful when you use the alcohol torch

➔Condense warm GP and remove excess.

•do Not leave RF(root filing) coronally (stain risk )
*GP→ radio-opaque caused by basement oxide
- basement oxide which is component of GP cause discoloration when it
REACT with a sealer

• Increased space helps achieve better seal with coronal restoration

*you have to leave a space for the restoration .

➔Seal root canal with small amount of Vitrebond /Vitremer

*when we finish root canal ,and leave a small nice dot of GB on the bottom of our access cavity we
normally seal it with vitrebond or vitremer or a temporary filling .
*just a small flowable composite on top to seal that area ,making sure that after a GP we have a cover on
the top of it ,1-2 mm of resin filled material or composite restoration or glass ionomer cements (gic).
*so sealing the orifices is very important .
• Temporary/definitive restoration
• Remove rubber dam
• Take radiograph

• Put the spreader in one side laterally ,we don’t put it every where .
• Moving or condensing the GB to one side ,otherwise we will have spaces
and lines “black and white” in radiograph image .

7|Page
*different techniques to doing root canal treatment, which might in the future make you more optimistic.

Modified single cone obturation technique:

• we do it when we do preparation with a rotary ,resopricating way of root canal, put a file in a motor and get to the
full length and prepare different parts of the root canal
• Expensive + if you do it in a wrong way they can stab easily ‫بتكسرو بسرعه‬
• Standard taper preparation (Rotary file system preparation) ,easier and faster
• Standard GP point with larger taper +thicker than the ISO 02, because it goes to the corresponding file of
preparation
• Bioceramic sealer
• Heated instrument to cut the GP.
• Matchtou pluggers to condense the GP.

BioRoot RCS
• Calcium silicate based root canal filling materials for permanent canal
obturation
*calcium silicate sealer is a material that is based on tricalcium silicate ,it is
an empty a based material, mineral trioxide aggregate (‫)هاي الجملة مش فاهمتها‬
*its properties are very friendly to the tissues ,it can be bioactive .

•High pH (~11) stops bacterial growth and alleviates risk of intracanal

reinfection ,antibacterial effect as a material we use as a sealer
*does not shrink , high PH ,enhances more building up of periapical tissue:
tooth with infection and bone lose, after obturation this material invite the bone cells to rebuild again at the apical
part of the tooth .

• Biocompatible and resin-free

• Leakage resistance, does not shrink ,dimensionally stable compared to other sealers

Modified single cone obturation

Master cone size = MAF (f1,f2,..)

• Identical size to MAF ( rotary file)

• Good fit at working length ‘tug back’

• Take a master cone radiograph to confirm length and the fit. (same as the conventional technique)

• Mix the sealer and apply into the root canal (RCS Root)
*huge amount of a sealer then we dip the GP inside of it ,only one GP ,no shrinkage of sealer ,GP already filing the
place and we cut it without any lateral condensation
*this does not happen with any kind of sealer ,you have to use bioceramic sealer as it has different properties from
the sealers we use in the labs
• Insert the master cone and ensure it goes to length
• Cut the excess coronal part to the level of the root canal orifice with a heated instrument
• Vertically condense the coronal third of the root canal with Machtou pluggers
• Place a RMGIC into canal orifice to seal it

8|Page
Problem solving
Too short master cone
Why? Check with your MAF /Canal blocked with dentine mud
Action: Irrigate, gently file canal to apex(MAF) , irrigate again

Still no good? Why? Poor size match between files & GP?
Action: Try smaller GP point

Too long?
Why? Canal over-prepared - no apical stop Poor size match between files & GP
*you destroy the apical stop by excessive screwing
Action: Try larger GP point / cut 1mm from tip (making GP tip wider)

*so always you GP should be 2 mm from the apex on the radiograph .

• as we almost finishing the obturation should I use a smaller

spreader ? no we have to use the same spreader all the time for
one reason : you are getting out of the canal ,and the canal is
getting larger.
• Important note: the file does not touch all the wall, maximum,
65% of the canal walls being touched by the files
• ‫بنحاول نستخدم تقنية بناء على القناة‬
• If it is a molar ,small canals ,your preparation will be very fine
,single cone technique will be ok.
• This in blue represent 2mm of resin materials ?????-------------→

Post Obturation Radiograph

🡺 Take radiograph after you place temporary

*it is very important to take a post obturation radiograph

*in the picture we see a premolar ,has two canals .

*always look for the reflection on the radiograph ,can tell how do
you see the obturation ,there is any voids? The length ok? The
taper ok?

*so how do the doctor comment in your biomechanical

preparation ? according to the image of obturation

*if the biomechanical step back is not done well enough and tapered enough that will affect the mark of obturation
etc. “PRACTICAL NOTE”

*so be careful .

9|Page
Single vs multiple visits?
• Radiographically: no difference in the effectiveness between single vs multiple visits. (short and long term
complications are almost the same)

→complications like: reinfection again, pain, lose of the tooth , discoloration .

*we can do a single visit in one scenario ,the root and the tooth should be dry, patient should be asymptomatic

*if you have a patient with very huge swelling ,then we finish the cleaning with him, but we cannot do the obturation
in the same visit ,we have give him medications ,if there is any abscess we have to drain it + intercanal medications .

*but if he has a periapical lesion with dry canal then I would to obturate WHY? Because of a possible leaking of the
temporary restoration (which is put between visits ) that we put it on top of the canal and accumulation of every
thing in his oral cavity get in to the tooth ,you are encouraging bacteria to get in

*the quicker that you obturate the tooth and seal it ,it will become less risky to have reinfection.

Obturate with →no symptoms ,no weeping canal , no exudate .

<<<<<< open ,clean ,irrigate ,obturate.>>>>>>>

• The likelihood of swelling after root canal therapy is more frequently associated with single root canal treatment.
(high intake of pain killers)

Refer to the video for more clarification + students’ questions at the end.

10 | P a g e