LEC 6 ‫ مصطفى رشاد‬.

‫د‬

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Obturation of the root canal system

Objectives of canal obturation

I. Prevents percolation of periapical exudate into the root canal space.
2. Prevents reinfection of the root canal during transient bacteremia.
3. Creates a favorable biologic environment for the process of tissue healing to
take place.

Criteria for root canal obturation

 The tooth is asymptomatic.
 The canal is dry
 There is no sinus tract.
 There is no foul odor.
 A negative culture is obtained.

Root filling techniques for gutta-percha

There are various methods for delivering and packing gutta-percha in root canals and
they can be divided into solid core and softened core techniques. Solid core techniques
imply that unsoftened gutta-percha cones are fitted to the instrumented canal(s) and
cemented to the canal walls with a root canal sealer. Techniques exist whereby either a
single cone or multiple cones are placed in the root canal space. In softened core
techniques gutta-percha is plasticized either prior to or after insertion in the root canal
by solvent or heat. These techniques also often make use of a sealing agent to
supplement the filling.

The single-cone technique consists of matching a cone to the prepared canal. For this
technique a type of canal preparation is advocated so that the size of the cone and the
shape of the preparation are closely
matched. When a gutta-percha cone fits
the apical portion of the canal snugly, it is
cemented in place with a root canal sealer.
Although the technique is simple, it has
several disadvantages and cannot be
considered as one that seals canals
completely. After preparation, root canals
are seldom round throughout their length, except possibly for the apical 2 or 3 mm.
Therefore, the single-cone technique, at best, only seals this portion.
In lateral compaction techniques additional secondary points are inserted and compacted
laterally around the master cone to reduce the thickness of the sealer layer. In this
technique, after cementing the master cone in position, specially designed spreaders –
long, tapered, pointed instruments – are placed in the canal as far apically as possible
and the master cone is laterally compacted against the wall. Next, the spreader is
removed and the first auxillary point forced fully into place. The canal is filled in this
way until it is not possible to place another accessory cone further than 2–3 mm into the
root canal. Excess gutta-percha is then removed with a heated instrument at the canal
orifice and final compaction is completed by vertical pressure with a plugger or
condenser – an instrument with a flat apical tip.

The advantage of the lateral compaction technique in comparison with the single-
cone technique is that it reduces the amount of sealer left in the canal. Because the
relation between the butt end of the cones and the reference point of the preparation can
be monitored during the filling procedure, the length control of the filling is quite good
and usually no filling material is extruded beyond the foramen. The seal is good in
comparison with other techniques.
The disadvantage of the lateral compaction
method is that the root filling consists not of a
homogeneous mass of root filling material but rather
of a large number of individual points tightly pressed
together and joined by the frictional grip of the
cementing substance.
Procedure of Master cone selection (the cone that
occupies most of the root canal parts).
1- The master cone selected should have the same
size of the M.A.F. & it should have the same length
of the full working length.
2- The master cone should need some force to be seated inside the canal & some force
is required to dislodge the master cone from the canal. This is called Tug back. This
resistance of removal of the master cone enhances the sealing ability at the apical area
of the root canal
3- If the master cone goes to the full working length but it’s loose inside the canal, we
take a larger gutta percha cone or we remove 1 mm from the apical end of the master
cone to increase the width of the master cone.
4- Verify the master cone position with a radiograph to ensure the optimum fitness.
5- Mix the sealer & coat the wall by picking up sealer on M.A.F & spin it counter-
clockwise. Once the M.A.F. is rotated, there will painting of the walls with the sealer.
6- Dip the tip of master cone in the sealer & seat it in the root canal.
7- By the use of the spreader, the master cone is pushed laterally & apically providing
room for auxiliary gutta percha point.
The spreader should rotate 180o (to the right & left) until it becomes loose & pushed
out-side.
8- The spreader should penetrate the apical 1/3 (a rubber stopper should be placed to
mark the length of penetration 2-3 mm. In spite of this criticism, the technique has
been used for many years with considerable success and appeared clinically to be an
improvement over the single-cone technique.

In an attempt to overcome the deficiencies of the cold lateral compaction technique,

heat and solvents have been applied to render gutta-percha plastic. Gutta- percha is then
compacted to create a homogeneous root canal filling of greater density throughout the
canal than solidcore techniques can provide. In recent years several modes of utilizing
heat have been developed to soften gutta-percha. In principle, heat softening can be
carried out inside the root canal or outside: the latter in the form of injecting preheated
gutta-percha and the former by applying heat after insertion of unsoftened cones.

Solvent-softened gutta-percha:
Chloropercha method, Chloropercha is made by dissolving gutta -percha in
chloroform; this paste is used as a sealer in conjunction with a well-fitted primary
cone. The technique is useful in perforation cases and in filling unusually curved
canals or canals with ledge formation.
Technique. The canal is dried with paper points. It is then flooded with chloroform
solution for 2 to 3 minutes. A suitable gutta-percha cone is inserted and
compressed laterally and apically with a stirring motion of the plugger until the
gutta-percha is entirely dissolved in the chloroform solution. Additional points are
inserted, one at a time, and dissolved in the same way. A plugger is used to apply
lateral and vertical pressure to force the chloropercha into the accessory canals
and multiple foramina. Care must be taken to prevent overfilling, because freshly
prepared chloropercha is toxic before evaporation. As chloroform from the
chloropercha evaporates, it causes a significant dimensional change of the filling
and a possible loss of the apical seal. Therefore, a sufficient time is allowed for
the chloroform to evaporate in the course of the filling operation and the gutta-
percha is compressed to form a homogeneous mass.
4
 Filling large canals. A customized cone is fashioned and fitted with the
chloroform technique. Three or more gutta-percha cones are warmed together over
a flame and are pressed and twisted together into a bundle. The slightly warmed
cones are rolled between-two sterile glass slabs held at an angle to make a
cone with a dia meter approximately the size of the canal. ' -
After the cone is allowed to cool and harden, the apical end - is softened
superficially in chloroform then the cone is inserted very slowly in the canal.
Slow insertion of the customized cone will allow time for the cement to flow
back coronally.

Warm lateral compaction:

This technique evolved as a compromise between lateral compaction of cold gutta-
percha and the vertical compaction of warm gutta-percha. The technique is similar to
lateral compaction of cold gutta-percha but here a heated spreader is initially advanced
into the mass of gutta-percha cones placed in the canal. Following its removal a cold
spreader is inserted, and the space thus obtained is filled up with accessory cones. The
process is repeated until the canal is completely filled. Originally, it was advised to
insert a heated spreader after every accessory cone. In practice, the gutta-percha mass is
usually heated after every three to four accessory cones and the compaction is continued.
 The advantage of warm lateral compaction is that it leads to a homogeneous mass
that, permitted significantly less leakage than cold lateral compaction.
 A distinct disadvantage is that the softening of the gutta-percha may lead to
overextension of root filling material.

Warm vertical compaction:

The objective of this technique is to obliterate the canal with a filling material softened
by heat and packed with sufficient vertical pressure to force it to flow into the root
canal system, including accessory and lateral canals. A non-standardized master cone is
selected and adjusted so that it is loose in the coronal and the middle third, fits to the
apical terminus of the preparation and is snug in its apical extent. The canal is lightly
coated with sealer. The cone is plasticized with a hot instrument. Next, the soft gutta-
percha is compacted with a cold plugger in an apical and lateral direction.
 The advantage of the warm vertical compaction technique is that it results in a
homogeneous mass of guttapercha, well-adapted to the canal wall, that requires a
minimum of sealer.
 The disadvantage is that the technique almost consistently leads to extrusion of
filling material.

Thermomechanical compaction:
In this technique gutta-percha is plasticized by frictional heat and inserted by means of
a compactor that forces the material apically. The compactor is an engine-operated
instrument resembling a Hedstrom file, but with the blades directed toward the blunt-
tipped end, and operates on the principle of the reverse turning screw.
 The advantage is that it is a very
fast technique leading to a
compact mass of gutta-percha
that, in wide canals, resulted in
less Leakage than lateral
compaction.
 The disadvantage is that the
technique requires a lot of
practice to get consistent results.

Injection technique:
Gutta-percha is thermoplastically molded and ejected out of a needle into the canal. The
Obtura system uses a pressure syringe in which the gutta- percha is warmed to 200°C
and expressed into the canal through a needle as fine as 25 gauge (0.5 mm diameter).
The gutta-percha leaves the needle at approximately 70°C. Pluggers are prefitted to
ensure that they match the middle portion of the canal while not contacting the dentin
wall.
 Advantages of the injection technique are similar to those of warm vertical
compaction. It also is useful in wide canals with an apical stop and in cases of

internal resorption.
 The disadvantage is the difficulty of controlling the level of the root filling, with
a possible under- or overfill as a result. Shrinkage of the gutta-percha during
cooling may cause voids, which may make it necessary to use continuous
compaction with pluggers during the cooling phase. For this reason a segmental
filling technique where small portions are injected and compacted with pluggers
is advocated.
Core carrier technique:
A metal or resin core coated with gutta-percha is used (Thermafil, Soft core). After root
canal preparation the correct size of the cone is selected and heated in a special oven for
45 s. After heating, the cone is pushed with pressure into the canal that is coated with
sealer. Next, the coronal part is removed from the core that remains in the canal and the
gutta-percha is then compacted in the canal orifice with a hand plugger.
 The advantage of this technique is that, once the cone is properly heated in the
oven with this system, the canal can be well obturated in all its dimensions within
a short time.
 The disadvantage of the system is that, especially in curved canals, there is a risk
for gutta-percha to be stripped off, thus, the core material will only become
cemented apically.