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JOURNALOF ENDODONTICS
Copyright © 1997 by The American Association of Endodontists
Analysis of the Forces Developed During
Obturation: Warm Vertical Compaction
Jean-Yves Blum, DDS, Eric Parahy, DSO, and Jean-Paul Micailef, PhD
The aim of this work was to measure and analyze
the forces applied by endodontists during an ob-
turation. This was achieved by devising a system of
force transducers linked to acquisition software.
The software allowed us to study the obturation
forces in real time or to store them. In this initial
study, the forces developed by endodontists and
students during a warm vertical compaction were
analyzed. The vertical and frontware backware
horizontal direction forces were first stored.
Graphs of the compaction forces were then gen-
erated, permitting the analysis of the obturation
method, indeed, two cases of obturation failure
were analyzed from these graphs. The mean values
for the vertical forces applied by the endodontists
and students were, respectively, 2.5 + 0.4 kg and
1.9 +- 0.9 kg; the mean values for the lateral forces
were, respectively, 0.85 - 0.2 kg and 1.4 +- 0.6 kg.
This device permits the analysis of compaction
forces and may thus be highly useful in obtaining
improvements in obturation techniques.
The new endodontic techniques often use gutta-percha, the most
acceptable and widely used filling material. Warm vertical com-
paction, as described by Schilder (1), is a technique that produces
an homogeneous and dimensionally stable mass of gutta-percha.
By a succession of heating and compaction, a wave of softened
gutta-percha is gradually pushed down into the root canal system.
Because of its overall efficiency, this technique has never been
greatly modified. Indeed, only the heating procedure has been
improved by new technology. The original heat carrier, heated by
an open flame, has now been replaced by the Touch 'n Heat 5002
model instrument (2). In contrast, compaction is still performed by
manual pluggers. The use of these instruments, in association with
a suitable preparation, produces a tridimensional obturation.
Schilder et al. (3) reported that pressure is necessary to adapt
gutta-percha to the walls of the canal. Their research further
showed that gutta-percha is not compressible, but that dimensional
variations result from transitions in the gutta-percha's phases.
These findings were later confirmed by Marciano and Michailesco
(4). To perform warm vertical condensation, the endodontist has to
91
Printed in U.S.A.
VOL. 23, No. 2, FEBRUARY1997
heat the gutta-percha to decrease the pressure of compaction. But
to prevent destruction of its properties, too-high temperatures must
be avoided (4).
Excessive compaction pressures may cause root fracture. Using
strain gauges, Saw and Messer (5) demonstrated that root canal
obturation is the major cause of vertical root fracture because of the
wedging effect generated in the canal by the compaction strain.
Ricks-Williamson, et al. (6) studied the stress induced by obtura-
tions with finite-element analysis. They reported that vertical con-
densation produces more detrimental stresses throughout the root
than lateral condensation. Other studies have analyzed the stresses
induced by obturations by means of different experimental meth-
ods, such as the Instron testing machine (7) and photoelastics (8).
To date, no investigation has studied the pressure applied during
warm vertical compaction obturation. The aim of this study was to
determine and display the vertical and lateral forces developed
during an obturation using the warm vertical compaction tech-
nique.
M A T E R I A L S AND M E T H O D S
A computerized recording system was developed to record the
forces applied during obturations. The system was composed of
two force transducers (Captels, St. Mathieu de Treviers, France),
electronic amplifiers, an analog-to-digital converter, a PC-compat-
ible computer, and acquisition software. The sensitive component
of the force transducers was a Wheatstone bridge of strain gauges.
All strain variations were transformed by this bridge into electrical
voltage variations in application of Poisson's hypothesis, i.e. a
linear relation existed between a given pressure and the level of the
corresponding electrical signal. The two transducers for the force
measurement (Fig. 1 and 2) were disposed perpendicularly, with
the end of one fixed on a frame and the other connected to a cupule
in which the tooth was embedded (Fig. 3). The forces were mea-
sured in the vertical and frontward and backward horizontal direc-
tions. The sensors were connected with data acquisition software
(LAPS) developed by INSERM (Unit 103, Montpellier, France)
(Fig. 4). The electrical gain of amplification was first set at 1000
to obtain a voltage range between - 2 . 5 V to +2.5 V. The signals
were then digitilized by an analogic-digital converter connected to
the RS232 port of the PC. The sample frequency of the inputs was
800 Hz.
The software gave access to the following functions:
92 Blum, et al.
FIG. 1. Frontal photograph of the device.
FrG. 2. Frontal view of the device: (1) transducers forming a right
angle; (2) cupule; (3) support frame; (4) to the Wheatstone bridge; (5)
gutta-percha; (6) tooth; and (7) plugger.
Configuration: selection of port (COM 1 or COM 2) on the
computer and the band rate of transmission (9600 to 110 K bands).
Identification: identification of the channels to acquire num-
bers, names, frequency of the sampling, and duration of the ac-
quisition.
Journal of Endodontics
FiG. 3. Tooth embedded into the cupule (with light silicone).
F v = T v + Rv
F u - Tn - R~
FiG. 4. Description of the recorded forces (Fv, Fh). The vertical forces
are transmitted (Fv = Tv + Rv). Only the resultants of the horizontal
forces are transmitted (Fh = Th-Tv). (1) Plugger; (2) Gutta-Percha;
and (3) Tooth.
Acquisition: three modes were available: storage and visual-
ization, storage without visualization, and numerical storage.
Disk access: for save and loading.
Visualization: shows a graph in function of time.
Oscilloscope: on-line visualization of data without storage.
Transfer to Excel: transfer of the LAPS files to Excel's format.
Protocol
Fifty freshly extracted human central maxillary incisors were
selected for similarity in size, shape, and root canal anatomy. Teeth
were stored in an environment maintained at 37°C and 100%
moisture. A standardized preparation was performed (1). A #45
gutta-percha cone was fitted as master cone and adjusted to give a
tug back and to be, radiographically, 1 mm shorter than the canal
length. Warm vertical compaction was performed using four finger
pluggers (Hu Friedy, Chicago, IL). The first was set to the entry of
the canal, the second at the halfway point, and the third and fourth
at, respectively, 9 and 7 mm short of the root length. A Touch 'n
Heat device was used to heat the gutta-percha cone. The power
setting was 8 and the device was used in discontinuous mode. The
heating time was 8 s. The compaction was considered to be
finished when the last plugger reached 7 mm from the apex. The
remainder of the canal was completely filled using a MacSpadden
compactor (10). Ten practitioners participated in this study. Five
Vol. 23, No. 2, February 1997 Warm Vertical Compaction Forces 93

3.5 I A I peaksof compaction]

3

2.5

2
A
==
" 1.5
ito
1 number of session
FiG. 6, Mean values of number of compactions during successive
0,5 sessions,

-05 3

Time (ran)

-~ 2 I,..do~oo,~=I
0.8 -B w ~ students l
,2o
0.6
1
1
°' 3
0
0,2 3 2 3 4 5
number of session
!0 FIG. 7. Mean values of vertical forces during successive sessions.

-0.2 3~

43,4

2 B verticalforces
43.6 Illatera forces J
Time (ran)
1
F~G. 5. Typical graphs generated by the warm vertical compaction
technique. Line represents the tracing from gauge over time. (5A)
Vertical forces. (5B) Horizontal forces. (1) First pushing phase; (2)
Last compaction; and (3) Mac-Spadden compaction.
1 2 3 4 5 6 7 8
were endodontists, and five were dental school students. The teeth number of compaction

were embedded in the cupule with Night silicone (Coltex Fine,
Pierre Rolland, France) (Fig. 3). The operators performed five
sessions of four successive warm vertical compactions. During the
obturations, the screen of the PC was occluded, but forces were
stored. Off-line, the stored files were loaded and the graphs of the
forces exerted during the obturations were analyzed as a function
of time (Fig. 5A and 5B). The choice of teeth and operators was
randomized. After the first session, the practitioners viewed their
graphs. The plots of force versus time generated by the endodon-
tists and students were analyzed and a new session of obturations
was then performed. Between all sessions, graphs were analyzed in
the same manner.
RESULTS
An analysis of variance was performed for all results. When the
A N O V A F ratio was significant, a contrast test was used. The
FIG, 8. Comparison of mean values of vertical and lateral forces
during successive sessions.
mean number ( + sem) of compactions for one obturation was 8 -+
1 for the endodontists (Fig. 6). The mean value of the vertical
forces was 2.5 _+ 0.4 kgF (Fig. 7). No significant difference was
found for the forces exerted over the course of the obturation. The
mean value of the lateral forces was 0.85 +- 0.2 kgF (Fig. 8). The
mean duration of compaction was, respectively, 2.03 +_ 0.13 min
for the apical packing and 5 + I s for filling of the remainder of
the canal. Duration between two compactions was I l + 5 s (Fig.
9). The mean duration of one compaction was 6 -+ 3 s except for
the last, which lasted 15 + 3 s. During the last compaction, the
exerted force was never constant but instead showed a decrease
from beginning to end (i.e. 2.8 _+ 0.2 kgF to 2.0 -+ 0.1 kgF) (F =
14.6, p < 0.05). For the students, the number of compactions was
11 -+ 5 for the three first sessions and 8 + 2 for the last two (Fig.
94 Blum, et al.
~o]
" I ill
. !! , ,
number of session
,
FiG. 9, Mean values of time between two compactions. Variations
over the successive sessions.
6). T h e difference between these results was significant (F =
121.3, p < 0.01). During the three first sessions the mean values
of the fc,rces exerted by the students were significantly lower than
those ,.ff the endodontists (F = 13.5, p < 0.05). In contrast, the last
two sessions showed no difference in either number or force of
compaction between the two groups (Fig. 7). The lateral forces for
the students were always greater (1.4 ± 0.6 kgF) than those of the
endodontists (F = 13., p < 0.05). Moreover, the time between two
compactions was also always greater (F = 14.6, p < 0.001) (Fig.
9).
DISCUSSION
The measurement device allowed the storage of the forces
developed during warm vertical compactions performed by end-
odontists and students. Details of compaction were revealed on
graphs (Figs. 5A and 5B).
In the horizontal plane, the recorded forces were not true int-
racanal forces but only the resultant forces (Fig. 4). Recording
revealed an imbalance in the intracanal forces, which may produce
highly detrimental lateral forces. Our results were in agreement
with those of Ricks-Williamson et al. (6) who reported that warm
vertical compaction produced more detrimental stresses than other
techniques such as lateral condensation. The imbalance of the
students' forces was initially very great. In contrast, that of the
endodontists was always very low. This indicates the difficulty of
producing a balanced vertical force during obturation.
The recorded forces did not agree with the results of Telli et al.
(11) who used a 2-D-study design, nor with those of Gimlin (9)
who used a 2-D finite-element method. They reported that gutta-
percha needed to be vertically condensed with a load of 4.5 kg. In
our study, the recorded forces never exceeded 3 kg. This difference
may be due to differences in the heating and pushing sequences.
However, as this study is the first to our knowledge to present
visual information on the sequence durations, it is impossible to
analyze our results in comparison with those of other studies.
Nevertheless, our comparatively low value is in agreement with the
concept of the softened wave developed by Machton (12).
The choice of pluggers, which ensured that there were no
interferences between the walls of the root canal and the instru-
ments, prevented the wedging effect described by Ricks-William-
son et al. (6). Indeed, the depth of penetration by the pluggers was
controlled by a stop that bad been fixed on the plugger.
Journal of Endodontics
35 A
3t _ oo,.o,,od ,, II.,
i- 5o'-
-05
lj,,,tllll I
. . . . .
Time (Inn)
0.6- B
0.5
[ 2
0.4
0,3
i 0.2
0.1
0
-0.1
-0.2
43.3
Time Iron)
FIG. 10. Typical graphs of failure in compaction due to underesti-
mated master cone. (10,4)Vertical forces; and (10B) Lateral forces.
(1) lack of vertical forces; and (2) lack of last compaction.
Schilder (1) described the importance of the last compaction,
which is performed to reduce the final cooling dimensional vari-
ations. This last compaction should last 15 _+ 4 s (14). The graphs
show that the endodontists always performed this compaction.
They were unable, however, to exert a constant force. At the
beginning of the study (Fig. 10A and 10B) the students did not
produce this last compaction, whereas Figures 1 IA and 11B) show
the improvement in the last two sessions.
From its inception, warm vertical compaction has been consid-
ered to be a very difficult technique (15) because of the inability to
monitor forces and heating time. The only accessible observation
has been the radiograph of the tooth after treatment. One of the
advantages of the device developed for this study is the potential
for on-line monitoring of forces and heating and compaction se-
quences during obturation. Evaluation and correction zre possible
in real time, offering, for the first time to our knowledge, a
bio-feedback method for improving technique. Two kinds of eval-
uation are possible. Sequences between heating and compaction
can be studied, with corrections made on-line or off-line of the
operating act. The applied forces may also be studied by direct
analysis during the obturation itself (on-line) or by comparison to
mean force values (off-line), i.e. corrections can be made in ref-
erence to stored graphs.
Perhaps the greatest advantage of the graphs is for the detection
Vol. 23, No. 2, February 1997 Warm Vertical Compaction Forces 95

3 A peaks of compaction] The graph shows a lack of sufficient vertical force; with no
reaction force opposed to the compaction forces, sliding of the
cone resulted. The increase in the diameter again blocked the cone
2.5.- 1 and thus the forces again appeared normal. The graph indicates
on-line the failure of the obturation.
2.- During this study, the students involuntarily produced these
2 failures but were able to analyze their errors following a brief
1.5-- explanation of the graphs. This monitoring of their obturations
permitted the students to progress (Figs. 6 and 7). Indeed, perhaps
.o
,? 1 -- the most interesting analysis was the comparison between the
working techniques of the students and the endodontists. The result
0.5 of this comparison was a modification in the applied forces and the
sequences of heating and compaction. Instead of assessing the
0 L ,~, ~ .f~ ,/Lu~ quality of their work by radiograph of the treated tooth, students
I- L ~

r--'~Vl ~ 4 5 were able to focus their analysis on the individual compactions

-0.5 Iv- forces and sequences.
It also appeared that each endodontist had his own work pro-
Time (ran) tocol for the heating and compaction phases. The force values were
O,5
not exactly the same between the different endodontists but seemed
B 1 peaks of compactionI to be uniform for each individual endodontist. Thus, each graph
0,4 could be considered as a signature.
In conclusion, the device developed for this study appears to

JAj,
0,3 have potential for research and teaching. As our results show, it
allows the analysis of the forces and sequences of warm vertical
0,2 compaction. Other obturation techniques may also be studied.
==
A

0.1
The authors thank INSERM, Unit 103, for the use of their LAPS acquisition
o software and Catherine Scott Carmeni for technical assistance.
0
1.==, ~ ..~. .
Address requests for reprints to Dr. Jean-Yves Blum, 12 rue de I'Aubier,
34130 St. Aunes France.
-0.1

-0.2

-0,3
Time (mn)
FiG. 1 1. Typical graphs of failure in c o m p a c t i o n due to underesti-
mated apical diameter of master cone. (11A) Vertical forces; (11B)
Lateral forces. (1) Normal forces; (2) Lack of sufficient forces (sliding
of master cone); and (3) last c o m p a c t i o n .
and analysis of failure, as the following examples show. Figures
10A and 10B show the specific obturation graph of an underesti-
mated cone. This failure appeared as a lack of sufficient vertical
force in the beginning of the obturation. The pluggers pushed into
the canal to a length of approximately 6 mm from the entry without
any opposition, and obturation proceeded without reaction forces.
As a result, the root canal system was filled but not three-dimen-
sionally obturated. Moreover, because the coronal plug was not
performed, accidental withdrawals of the master cone occurred
during the student obturations, indicating the importance of the
choice of master cone, as described by Schilder (1) and Machtou
(12).
The procedure may also fail because the master cone is not
adapted to the apical constriction. The tug back is thus obtained,
not at the apical constriction level but on the walls of the canal. As
Figures 11A and 11B show, initially the obturation appeared as
normal, but when the coronal plug was eliminated, the compaction
forces pushed the cone through the apex into the periodontium.
References
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