Endodontic

obturation
techniques

Dr. M. Rokaya
Associate professor of endodontics
 Endodontic obturation techniques

1) Cold gutta percha Points.

a) Lateral condensation.

b) Single cone technique.

1) Chemically plasticized Cold gutta percha technique.

2) Warmed gutta-percha technique.

3) Ultrasonic plasticizing.

4) Thermo-plasticized Injectable gutta percha obturation.

5) Solid core carrier insertion.

 Selection of the master cone

▪ Adjusted length is sufficient to reach the

end of the canal. i.e. not be able to be
forced beyond the working distance

▪ The apical 1/3 of gutta percha completely

fill the apical 1/3 of the prepared canal.
I.e. primary point has the same size of the
file that prepared the apical 1/3 & it will fit
exactly.
Methods used to determine the
proper fit of the primary point
1) Visual test.
2) Tactile test.
3) Patient response.
4) Radiographic test.
 1) Visual Test
-The master cone is measured & grasped with a tweezer at a
position equal to the working length.
-The point is then carried in the canal until the tweezer
touching the external reference point.
- If the working length is correct:
This mean:
▪ The master cone will go completely to its position & visual
test is finished.
 If the point extend beyond the apex
This mean:
-The apical foramen was originally large.
-The working length is incorrect & the
apical foramen
has been perforated.
So the problem can solved by either:
1- The next larger size point should be tried.

Or

2- The original point is used by

cutting1or 2mm of the tip ,as
each time the tip is cut the
diameter becomes larger.
 If the point will not go completely into
place even though it is the same
number as the last enlarging
instrument
This mean:
-The enlarging instrument was not use to its full extent
(working length ? ? ? ? ).
-Debris remain in the canal.
-A ledge exists in the canal upon which the point is catching

So the problem can solved by either:

1) Dry reaming by master apical file. Or
2) New file and re-instrumentation the canal to full working
length until the file is loose in the canal.
 2) Tactile Test
-If the apical 3-4mm of the canal is prepared with
parallel walls:
▪ the cone bind in the apical portion of the canal
▪ tug back action achieved i.e. :
▪ Some degree of force to seat the point.
▪ it not be able to be forced beyond the working distance
▪ Some force is necessary to withdraw it.
-If the point loose in the canal so :
▪ Next larger size is tried.
▪ Cutting the tip of the master cone.
 3) Patient response.
- Patients may feel the gutta-percha penetrate the foramen.
• not anesthetized during the treatment.
- Adjustments can be made until it is completely
comfortable.
• This is a good test when the position of the
foramen does not appear to be accurately
determined by the radiograph or by tactile
sensation.
- Pulp remnants from a short preparation will
cause a sensation of much greater
intensity than periapical tissue
 4) Radiograph Test
- It is the final test after visual &tactile test.
-The film must show the point extending to
within 1 mm from the tip of the
preparation or radiographic apex.
 If the radiograph shows the point forced
beyond the apex
- The overextended point should be shortened from the
end & then carefully inserted.
or
- The next larger size used.

A) cone fit to radiographic terminus B) Cone is cut back 0.5mm

 Variation of Master Points
Immature Canals and Apices

The apical opening

A non /(little) constrictive A flaring foramen of a
terminus of a tubular canal blunderbuss shape.
 1-Inverted Cone Technique:
▪A coarse gutta percha cone is selected.
▪A serrated But end of the point carefully
removed with a scalpel.
▪The point is inverted & tried in the canal, where
it should:
▪ Visibly go to full working length.
▪ Tug back when it is removed .
▪ Optimum position in radiograph.
 2-Tailor Made (custom cone)Gutta Percha Technique

Indication:
-If the tubular canal is so large that the largest inverted point
is still loose in the canal, a tailor made point must be used
as primary pint.
Technique:
- Prepared by heating a number of large (Coarse) gutta
percha cones & combining them butt to tip on a glass slab
until a roll has been developed to match the size & shape
of the canal.
Fabrication of a custom cone
-Gutta-percha should be cooled with ethyl
chloride spray or ice water to stiffen gutta
percha before it is fitted

-Trial point testing of tailor-made roll in the canal

by Tug back &Radiograph:

• if it goes to full depth easily but is too loose:

- more gutta percha must be added then forced to the
proper position in the canal .

• If is only slightly too large:

- the outside of the gutta percha can be flash- heated
over the flame and the roll forced to proper position
in the canal
or
- flash dipping the point in chloroform or halothane. By
repeating this method or exercise, an internal
impression of the canal is secured.
- Alcohol be used to stop the action of this solvent
Techniques Of Root Canal Obturation
 Endodontic obturation techniques

1) Cold gutta percha Points.

a) Lateral condensation.

b) Single cone technique.

1) Chemically plasticized Cold gutta percha technique.

2) Warmed gutta-percha technique.

3) Ultrasonic plasticizing.

4) Thermo-plasticized Injectable gutta percha obturation.

5) Solid core carrier insertion.

I- Cold gutta percha Points:
Lateral condensation.
.
Spreader
sharp tip
spreader
 Spreader Size Determination
▪ The appropriate spreader need to reach to
within 1.0 to 2.0 mm of the true working
length and to match the taper of the
preparation

▪ The appropriate spreader should not

penetrate the apical end.
 Master cone Size Determination
▪ Visual test.
Select Master Cone
▪ Tactile test.
size that corresponds
▪ Patient response.
to your MAF size.
▪ Radiographic test.
▪ The MC should have a definite apical
resistance when MC is placed to
FWL.
▪ The MC should exhibit
▪ “tugback” or
▪ resistance to removal.
 Drying the Canal
▪absorbent paper points
▪excess moisture or blood may affect the
properties of the sealer
Mixing of the Sealer
ideal consistency
• mixture can be held for 10-12
seconds on an inverted spatula
without dropping off

• mixture can stretch between the

slab and spatula 2 cm before
breaking.
 Placement of the Seale
- “Pump” a gutta-percha point into the
canal .
- Carry the sealer in on a file or reamer,
which is rotated counterclockwise,
pumped up and down, and wiped
against all the walls
-Use rotary or spiral paste fillers turned
clockwise in one’s fingers or very
slowly in a handpiece
 Placement of the Master Point
▪ The pre-measured primary (or master, or initial)
point coated with cement

▪ Slowly moved to full working length minus 0.5-

1mm“apical stop.’’

▪ Spreader is inserted to full depth with rotary

• vertical motion , slowly moved apically to spreader
master cone
full penetration.
0.5-1mm
▪ Spreader acts as Lateral compaction
technique a wedge to squeeze the gutta-
percha laterally under vertical pressure .
▪ The spreader is removed by
rotation and is immediately
followed by the first auxiliary
point inserted to full depth of
the space left by the spreader.

▪ This point is followed by more

spreading & more points until
the entire root canal is filled.

▪ Obliteration is considered
complete when the spreader
can no longer penetrate the
filling mass beyond the cervical
line.
Lateral Compaction

▪ Do this until the

canal is obturated to
the cervical line.
▪ Take a radiograph at
this time and
evaluate fill.
▪ This confirms
adequacy of the
obturation.
 Lateral Compaction

▪ If the obturation is satisfactory, the excess gutta

percha should be cut to the CEJ level (bucco-
lingual).

▪ If obturation is not dense, or if voids are

present, remove all the cones and redo the
obturation process.
Final Radiograph

▪ Remove the rubber

dam, cand take the
radiograph.

*In a real
patient, a
temporary
restoration is
placed before
rubber dam is
removed.
 Efficacy of Lateral Compaction

Advantage :
• Excellent length control

Limitations:

➢ may not fill canal irregularities.

➢ Gutta-percha cones never merge

into a homogeneous mass, and are
frozen in a sea of cement.
 Radiographic evaluation of good obturation
➢ Radiolucencies:
No Voids within the body or
at the interface of obturating material and dentin wall represent incomplete obturation.

➢ Density:
Material should be of uniform density from coronal to apical aspects. The margins of
gutta-percha should be sharp and distinct with no fuzziness, indicating close adaptation.

➢ Length:
The material should extend to the prepared Length.

➢ Taper:
The gutta-percha should reflect the canal shape;
that is, it should be tapered from coronal to apical regions.

➢ Restoration:
Whether permanent or temporary, the restoration should ensure a coronal seal.
 Variations of lateral compaction technique:

Sometimes the wide variations in the root canal shape require

variations in the master point technique.
1- Inverted point technique.
2- Tailor-made gutta-percha technique.
The apical opening
A non /(little) constrictive A flaring foramen of a
terminus of a tubular canal blunderbuss shape.
1-Inverted Cone Technique:
▪A coarse gutta percha cone is selected.
▪A serrated But end of the point carefully
removed with a scalpel.
▪The point is inverted & tried in the canal,
where it should:
oVisibly go to full working length.
oTug back when it is removed .
oOptimum position in radiograph.
2 -Tailor Made Gutta Percha Technique
Indication:
-If the tubular canal is so large that the largest inverted point
is still loose in the canal, a tailor made point must be used
as primary pint.
Technique:
- Prepared by heating a number of large (Coarse) gutta
percha cones & combining them butt to tip on a glass slab
until a roll has been developed to match the size & shape
of the canal.
-Gutta-percha should be chilled with ethyl
chloride spray or ice water to stiffen gutta
percha before it is fitted .

-Trial point testing of tailor-made roll in the canal

by Tug back &Radiograph:

• if it goes to full depth easily but is too loose:

- more gutta percha must be added then forced to the
proper position in the canal .

• If is only slightly too large:

- the outside of the gutta percha can be flash- heated
over the flame and the roll forced to proper position
in the canal
or
- flash dipping the point in chloroform or halothane. By
repeating this method or exercise, an internal
impression of the canal is secured. Alcohol be used
to stop the action of this solvent
B- Single cone technique.

▪Using a special taper gutta percha 4%, or 6%

which in the same size of the master apical file
used. And there is no space for auxiliary cones.
II- Chemically plasticized Cold gutta
percha technique:
This technique is a modification of
the lateral compaction technique
involving a solvent to soften the
master point in an effort that it better
conforms to the irregularities in the
apical canal anatomy.
Solvents used:
▪ Chloroform:
Chloropercha . (carcinogenic )
▪ Halothane :
Halopercha /gutta percha dissolved
in halothane (biocompatible agent )
▪ Eucalyptol oil:
Eucapercha.
Callahan-Johnston technique:( Old method(

where too much of solvent is chloroform which is

used to dissolve small pieces of gutta percha to form
a creamy mix which was laced into the canal with
syringe.
Disadvantage:
A creamy mix of chloro-perecha had volume 3
times greater than the original gutta percha
material, as chloroform evaporates:
1) The 2/3 of the root canal become empty.
2) it produces 24% shrinkage toward the mass breaking the
sealing integrity of the filling (leakage).
3) Gutta percha lose the adhesive quality .
4) Irritation to periapical tissue.
 • Solvent Dip technique:
▪ The master point is blunted and fitted 2 mm short of the working length.
The apical 2-3mm is the dipped in the solvent for 3 seconds then the
softened cone is inserted into the canal with slight apical pressure till the
working length is reached.

▪ Care should be taken to moisten the canal with irrigation to avoid the
sticking of soft gutta-percha to the canal walls.

▪ A radiograph is taken to verify the fit and correct working length of the
cone. The cone is then removed, the canal coated with sealer, the cone
is cemented in the canal, THEN continue with lateral compaction
technique.

▪ The principal solvent used in the technique chloroform which was

claimed to be carcinogenic. Other solvents, such as eucalyptol and
halothane, became as substitutes for chloroform.
The shape of the control
zone is evident on the
fitted gutta-percha cone
on the left side of figure
III. Warmed gutta-percha technique:
 Indication
▪In root canal with:
▪ internal resorption.
▪ ledge formation .
▪ unusual curvature (C-shape canal) .
 Vertical compaction technique.

•Schilder in 1967.

•Heated gutta-percha has been shown to flow extremely well

into all canal irregularities.
 steps
▪ A suitable gutta-percha cone is chosen and placed in the canal to reach
the apical terminus of the canal.

▪ The cone is removed and slightly cut back short (1-2 mm) of this length.
This allows heat molding of the round cone into the apical constriction and
minimizes sealer-tissue contact.

▪ When the guttapercha cone is warmed and compacted, it fills the critical
parts of the canal including the shaped and cleaned apical constriction.
Schilder pluggers come in a variety of sizes :
#8 =0.4 mm,
# 8.5 = 0.5 mm,
etc., for sizes #9, # 9.5, #10, #10 .5 #11, #11.5 #12 = 1.2 with
increasing diameter. The instruments are marked vertically at 5-mm
intervals.
A heat carrier, an instrument designed much like a spreader, is used to transfer
heat from a heat source, e.g. flame, to the gutta-percha. It is heated "cherry-red",
immediately carried into the canal, penetrated into the gutta-percha and left there
for 2-3 seconds to allow heat transfer.
It is then withdrawn in a slightly circular wiping motion. Some of the gutta-
percha will be attached with the heat carrier.
Vertical compaction immediately follows.
▪ To complete obturation of remainder canal by placing 5mm
precut segments of gutta percha in canal, cold welding
them with the appropriate plugger to the apical material,
warming them with heat carrier, and then compacting it to
apical filling.
▪ An electronic device specially developed for the warm gutta-percha
technique is called "Touch'n Heat“ and System B. It exhibits the
same thermal profile as the original heat carrier but has the
advantage of generating heat automatically at the tip of the
instrument.

"Touch'n Heat
▪ A, The System B unit.
▪ B, System B plugger with a nonstandard cone of similar taper (#.04, #.06, #.08, #.10, and
#.12 tapered stainless steel pluggers, each with a tip diameter of 0.5 mm).
▪ C, System B pluggers. Compaction of obturating materials occurs at the levels simultaneously
throughout the momentum of heating and compacting instrument apically.
Advantages:
filling of canal irregularities and
accessory canals.
Disadvantages :
-The risk of vertical root fracture.

- Less length control than in lateral

compaction

-Warm vertical compaction is difficult in

curved canals where rigid pluggers are
unable to penetrate to the necessary depth.
Ultrasonic plasticizing:
▪ This technique depends on plasticizing
gutta percha in the canal with an
ultrasonic instrument.
▪ ultrasonic cavitron used in anterior teeth
only because it's design .
▪ Gutta percha points are placed to virtually
fill the canal then the attached endodontic
instrument inserted into the mass.
▪ Activated(vibration)the ultrasonic
instrument without the liquid coolant,and
as it plasticized(warmed) the gutta percha
by friction,advanced it to the measured
root length.
▪ Final vertical compaction done with hand
or finger pluggers.
Thermoplasticized Injectable gutta percha obturation:
(Syringe insertion):

Obtura II heated gutta percha system.

Obtura II heated gutta percha system:
▪ Plasticized gutta percha will flow
through
o 20 gouge needle (equal to # 60
file ) or
o 23 gouge needle (equal to # 40
file ),
these needles are fitted to gutta
percha gun for injection into the
canal.

▪ The temperature of gutta percha

exerted from Obtura II system is
137 c.
Technique:
▪ Needle is fit loosely in the canal, reach within3.5-5mm of
terminus.

▪ Insert Master apical cone into canal followed by

plasticized gutta percha around it, this producer is better
to ensure apical closure without overfilling.
Advantages:

➢ Easy and less time consuming

➢ 3-D obturation
➢ Enhanced apical and coronal
seal
➢ Useful in C-shaped, irregular
and complex root canals

Disadvantage:

➢ Risk of overfilling
➢ Not suitable for canals with open
apices
Thermoplasticized gutta percha:
(Solid core carrier insertion):
Carrier Based Obturation Techniques
Thermafil System .
Thermafil System
 Solid core carrier or obturator.

▪ Central carrier sized & tapered to match the standard

endodontic files(size of carrier range from #20 to #140 ) .
 Selecting the obturator

▪ Select the thermafil obturator corresponding to the verifier

which adapts itself passively to the working length.

▪ Silicon stop must used to determine the distance of the

working length.
 Heating obturator in ThermaPrep Plus Oven

• heating the core or carrier by placing

it in a preheated Therma prep oven
for 15 sec.

• Then remove it by sliding forward

not pulling up .
• The heating time varies depending on
obturator size from 17 to 45 seconds
and is regulated automatically.
Hang the carrier in the oven handle from the
plastic handle and not from the stopper.
Thank you