ERRORS IN

OBTURATION & ITS

PREVENTION
Pawan Pathak
Roll NO.: 17
BDS Final Year
Contents:
• Introduction
• Overfilling
• Underfilling
• Apical third of canal not adequately filled
• Middle third of canal not adequately filled
• Coronal third of canal not adequately filled
• Improper lateral compaction
• Pulp chamber not adequately cleaned after root canal filling
• Vertical root fracture
• Nerve paresthesia
• Conclusion
• References
Introduction
• Obturation errors are the endodontic mishaps that we encounter in
between or post treatment in the patient because of preventable
mistakes on the part of clinician while performing endodontic
treatment.
• These may lead to failure of endodontic treatment which might often
lead to necessity of extraction.
Overfilling
• Defined as filling materials beyond
radiographic apex.
• When a filling material is forced into
radiographic apex, a chronic inflammation
occurs with prolonged pain.

Causes:
• Overzealous instrumentation of the root
canal with the destruction of the natural
apical stop, i.e. Apical perforation.
• The use of smaller size master cone when
obturating the canal.
Consequences
• Inflammatory reaction
• Immediate pain
• Foreign body reaction
• Infection
• Post-operative pain
• Higher failure rate
Diagnosis:
• Clinical
• Radiograph

Correction:
• Removal of old filling
• More difficult
• Successful if the entire GP is removed in one tug
Depends on:
• Canal length
• Density of filling
• Curvature of the canal
It is best removed in a crown manner (first coronally, then middle
third & finally apical third)
• The removal of the filling : Heat or chemically
GP is removed till the middle third by rotary files in the
presence of solvents.
A new H-file is then heated & inserted into the GP (in the apical
third of the canal).
The file is withdrawn gently after the GP cools, which brings the
overextended GP along with it.
• The correction of the apical stop
• The use of proper size master cone in relation to the prepared canal.
• If symptoms persist - Periapical surgery.
Over-filling vs Over-extension
Over-filling: When the canal is totally obturated with the excess
material extending beyond the apical foramen.

Over-extension: When the canal is not filled properly & material

extrudes beyond the apical foramen.
Underfilling
• It means that a portion of canal is left unobturated.
• This predisposes a case of failure from continued
breakdown of pulpal elements: which may not
have been effectively removed during
instrumentation or from retention of periapical
exudates into this space with subsequent
degeneration of the exudate & irritation to
periapical tissue.
Causes:
• Loss of WL or incomplete preparation of root canal.
• Improper recapitulation/irrigation.
• Improper selection of (use of larger) master cone.
Diagnosis:
Correction:
• Removal of old filling
Technique: GP can be softened either by heat or chemically.
• Preparing the canal to properly determined WL according to the
principles of root canal preparation.
• Proper adjusting & fitting of the master cone before obturation.
Prevention of over/under obturation
• Proper knowledge of root canal morphology
• Pre-procedural radiograph
• Use of proper size master cone
Poor lateral compaction
• May get way for transmission of
infection.

Consequences: Periapical lesion

Prevention: Proper lateral compaction.

Apical third of canal not adequately filled
• This can be seen as a void in the apical third of the canal. Since we
can’t evaluate 3D adequacy of the canal fillings R/G, whenever we see
an obvious void in the apical third, we must consider it as an unfilled
portion of the canal.

Cause:
• Improper condensation of the root canal filling.
Middle third of canal not adequately filled
• Seen as void in middle third of filled canal

Cause:
• Improper compaction in middle third of canal
• Failure to condense properly due to altered morphology of canal
Coronal third of canal not adequately filled
• Occurs due to: lack of obturation in the coronal areas.

Causes:
• Poor condensation of GP in coronal third of canal.
• Insufficient cement around coronal third of silver point.
Prevention for improper compaction:
• Proper knowledge about anatomy of root canal.
• Proper lateral condensation
• Radiograph between each steps of endodontic therapy

Correction of improper condensation:

• Same as over/underfilling.
Pulp chamber not adequately cleaned after
cleaning & shaping
i. Cement although it does not cause discoloration can change the
color of the crown when the labial tooth structure of anterior teeth
is particularly thin because the cement is darker & in most cases,
more yellow than tooth structure.
ii. Cement left in a pulp chamber can interfere with the marginal seal
of a final filling by preventing union or adequate approximation of
the filling material with the prepared dentinal access margin.
Vertical root fracture
Split root during condensation
• This is due to exerting unnecessary pressure by the spreaders
during condensation of the root canal.
• As a result of excessive widening of the root canal by intracanal
instruments.
Investigation:
• Clinical
• Teardrop radiolucency
• Exploratory surgery is good way to visualize but deep pd pocket in
long standing RCT cases is most suggestive.

Correction:
• In most cases, extraction is the only treatment option.
Nerve Paresthesia
Causes:
• Over extensions / over instrumentations
• Injury to inferior alveolar nerve

Note: Loss of sensation / nerve damage can be transient / permanent

Symptoms
• Loss of sensitivity of lips and gingiva
• Numbness
• Tingling sensation
• Dryness of the affected mucosa often preceded by intense pain in the
affected area
• Inflammatory edema with resulting ischemia, that compresses and
compromises blood supply to soft tissues and nerves in confined
spaces such as the inferior alveolar canal. - Compartment syndrome
Correction
• Non-intervention and observation
• Systemic prednisolone
• Surgical decompression
Prevention
• Identify radiographically the neural structures and the sinuses in order
to clearly understand the proximal risk.
• Use obturation materials that are well tolerated
• Careful shaping strategies and take serious precaution against over-
instrumentation.
• When using thermoplastic techniques, it is important to respect the
flow characteristics of the material.
• Caution in use of paste fillers and syringes for applying endodontic
sealers.
• Creating a clean dentin plug or material barrier at the patent apical
terminus when there is risk of extrusion.
Conclusion
• Obturation is one of the most important event in performing
endodontic treatment.
• We must be very careful while performing obturation to avoid
obturation mishapes/errors.
• We should have proper knowledge about root canal morphologies, its
alterations, good radiographic access, proper knowledge of
radiographic interpretation, well known to use of all endodontic
materials, methods, techniques along with possible failures & errors.
References:
• Textbook of Endodontics – Ingle
• Principles & Practice – Walton & Torabinejad
• Problem Solving in Endodontics - Guttmann
• Pathways of the Pulp – Cohen
• Textbook of Endodontics – Nisha Garg
• Endodontic practice - Grossman References
• Internet resources