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Francis prathyusha
WHY OBTURATE???
Coronal seal
Lateral seal:
Apical seal
WHEN TO OBTURATE ??
• Tooth is asymptomatic, or very mildly
symptomatic with definite, ongoing symptom
resolution
• Canal preparation dries completely to its
terminus
• Canal is relatively “free” of bacteria
• No foul odor is noted upon canal system entry
• Temporary restoration intact and
uncompromised
• No sinus tract is present (debatable)
• No signs of active infection
•
IDEAL REQUIREMENTS OF ROOT CANAL
FILLING MATERIALS
Grossman’s Criteria
(1940)
OBTURATING MATERIALS
ANSI/ADA ANSI/ADA
Specification No.78 Specification No.57
(ISO No. 6877) (ISO No. 6876)
Endodontic obturation Sealing materials
points
vType I : Core standardized points to be
used with sealer & cement
Tantalu
m
Calcium
Titanium
phosphate
Amalga
cement (CPC)
m
MTA
SILVER POINTS
Ø Introduced by Jasper in 1933
Ø Pure silver molded in a conical
shape – same diameter & taper as
files & reamers
Ø Advantages
vStiffer than gutta-percha
vEasier to insert in very
narrow/ fine tortuous canals
Ø Disadvantages
vPoor lateral seal.
Ø
Corrosion of silver cones due to:
Presence of small amounts of
other trace metals (e.g. 0.1%
to 0.2% of copper and
nickel)
Presence of metal restorations
or posts in the tooth
Loss of integrity of coronal
restoration and exposure to
saliva
Canal
Zielke DR, Brady JM, del Rio CE. irrigants
Corrosion
of silver cones in bone: a scanning electron microscope and microprobe
analysis. J Endod 1975;1:356–60.
Zmener O, Dominquez FV
Corrosion of silver cones in the subcutaneous connective tissue of the rat: a preliminary
scanning electron microscope, electron microprobe, and histological study. J Endod
1985;11:55–61.
STAINLESS STEEL FILES
Ø Introduced by Sampeck in 1961
Ø Used to fill
ØFine, tortuous canals
ØHeavily calcified dilacerated narrow
canals
Ø Used instead of silver cones
Ø Involved cementing one file & cutting off
handle with a high-speed hand piece, 3-
4mm below occlusal surface
Ø Advantages
More rigid than silver cones
Inserted into canal with greater ease
Less susceptible to corrosion
Ø Disadvantages
Cannot independently seal the root
canal, needs a cementing medium
Excess sealer collects in the flutes of the
instrument rather than being forced
against canal walls
DISADVANTAGES OF METAL CORE
MATERIALS
Tantalu
m
Calcium
Titanium
phosphate
Amalga
cement (CPC)
m
MTA
GP/SEALER
OBTURATION TECHNIQUES
• Lateral compaction (old term
–“condensation”)
• Vertical compaction
• Thermo mechanical
• Thermoplasticized
• Hybrid (thermo- and non
Thermoplasticized combined)
• Master apical impression
•
LATERAL COMPACTION
Advantages
• Long track record
• Replicates canal adequately
• Seals well
• Inexpensive
• Requires little armamentarium
Disadvantages
• Moderately time consuming
• Can vertically fracture roots
• May leave vertical voids
VERTICAL COMPACTION
Disadvantages
• Most time consuming technique
• Requires significant flaring for deep
condensation
• Requires increased number of
instruments
THERMOMECHANICAL COMPACTIBLE GP:
•
• Disadvantages:
• Extrusion of material
• Instrument fracture
• Inability to be used in curved canals
• Heat generation
• Void formation; poor seal
Thermomechanical Compaction
Indications
• Canal irregularities
• C-shaped canal systems
• Internal resorption
•
Conti.
Advantages
• Replicates the canal space better
than other techniques
• Seals well
• Fills internal defects
• Best method for accessory canal
obturation
• Fastest technique
•
Conti..
Disadvantages
• Extrusion of GP and sealer is common
- Poor apical control
- Apical matrix required.
• Expensive equipment
• Poor tactile feedback during injection
• Requires increased preparation flare for
applicator tip (inappropriate for many
curves)
•
Apical seal comparison of low-
temperature thermoplasticized gutta-
percha technique and lateral
condensation with two different
master cones
1: Carrier system
2: Gutta-percha
3: Sealer
4: Dentin wall
2/MIDDLE THIRD
1: Carrier system
2: Gutta-percha
3: Sealer
4: Dentin wall
3/APICAL THIRD
Advantages
• Able to combine the best of several
methods
• Potential for excellent replication, seal
and reduced extrusion
Disadvantages
• Expensive equipment
• Still tends to extrude sealer
• Short track record
•
Hybrid Methods :
SimpliFiL ( Hygenic corp, Akron, OH)
The percentage of gutta-percha-
filled area in simulated curved
canals when filled using Endo
Twinn, a new heat device source
3 4
1)Stainless steel
2)Ultrasonics
3)NiTi
4)Cutting spoon tips.
AIM
–
–
–
–
• Seal dependent on penetration of
hydrophilic sealer into dentinal
tubules & lateral canals
•
• Resin tags were demonstrated
impregnating canal walls, but
interfacial leakage was not prevented
•
The regular ActiV GP System includes gutta-percha points
that are manufactured in a traditional design, with the
further enhancement of being impregnated and coated with
glass ionomer. The other choice, ActiV GP Plus, has a
different cone design. It employs calibration rings for easy
depth measurement and a convenient handle that facilitates
easy insertion into the canal
• The core
• The sealer is a dual-cure sealer.
• In addition the system comes with a self-etching primer.
Resilon Pellet
Transverse cross-section of the root canal obturated with Resilon-Epiphany system. Sealer (U)
adheres tightly to dentine (Z) and Resilon (R), sealer tags are visible in dentine
tubules (arrow). Magnification 3000x
• Transverse cross-section of the root canal obturated with Resilon-Epiphany
system: a) A 1,2 m wide gap visible between sealer (U) and Resilon (R)
(arrow). Magnification 2 500x
Visible is the sealer (U) adhering to dentine (Z) as well as gaps between the sealer and
Resilon (R) (arrows), a likely result of root cutting. Magnification 3 000x
Abstract
The purpose of this study was to compare the
sealing ability of gutta-percha and AH Plus sealer
versus Resilon and Epiphany Resin Root Canal
sealer using three different final irrigants with the
fluid filtration model.
Result
• Two-way ANOVA analysis indicated
significantly less leakage using Resilon with
Epiphany sealer compared to gutta-percha
and AH Plus sealer. There was no statistical
significance between any of the irrigants
used for either obturation group
Limited Ability of Three Commonly
Used Thermoplasticized Gutta-Percha
Techniques in Filling Oval-shaped
Canals
•Gustavo De-Deus, DDS, claudia Reis, DDS, MS,Sidney Paciornik,
DsC
Abstract
The aim of the study was to evaluate the adaptation
and quality of root fillings achieved by the lateral
condensation, vertical condensation, Thermafil,
Ultrafil and Obtura II techniques..
figure1
figure2
figure3 figure4
RESULT
•
Abstract
The aim of this study was to evaluate the ability of three
obturation methods to seal root canals prepared using
0.06 taper rotary instruments.
System B technique Negative
with 0.06 taper standardised
control . gu
cess was
49sealed
teeth with casting wax and the entire root surface was
teeth Experimental
4System control group
B technique with non-standardised MF gu
ed for 10 days in a humid chamber at 37°C to allow for c
24,extracted max CI
Results
Radiographic evaluation of quality of obturation
of simulated internal resorptive cavities
Aim: to analyse the gp filled area of c shaped molar teeth root
filled with the modified microseal tchnique with reference to
the radiographic features and c shape canal configuration
Type 2
Type 1
saline at 4 °C
TYPES
show an increment in the sealer the good adaptation of the root canal
area; observe the division of the filling in the mesio-lingual canal.
distal canal
shows a C-shaped symmetrical type canal
Disadvantages
üSealing ability questionable
• üConcerns of tissue toxicity by the unset
material
üAbsorption of the root filling material
with time
üLack of homogeneity
üNot stiff enough to reinforce roots
üClinical use – proved unsatisfactory
Hydron versus gutta-percha and sealer:
A study of endodontic leakage using the
scanning electron microscope and
energy-dispersive analysis*
James R. Murrin, DDS, MS ,Al Readex Dennis, F. Michael Beck,
DDS, Journal of Endodontics
Volume 11, Issue 3 , Pages 101-109, March 1985
Tantalu
m
Calcium
Titanium
phosphate
Amalga
cement (CPC)
m
MTA
N2 / SARGENTI PASTE
Ingle
• The prominent endodontic textbook, Endodontics,
by John Side Ingle, Leif K. Bakland, states, "The
Sargenti method has become a cult and, like most
cults, is based more on testimonials than on
facts.... [Dr.] Sargenti himself indicated a double
standard of endodontic treatment when he
publically stated 'If I had endodontic problems
myself, and I wished to have an exact endodontic
treatment, I would certainly ask Dr. Herbert
Schilder to treat me'". Dr. Schlider was an expert
on endodontic treatment and did not use Sargenti
Paste.
• Sargenti paste always contains paraformaldehyde and
sometimes contains lead and mercury.
• Paraformaldehyde is a powder form of formaldehyde and is
highly toxic. It can cause severe and irreversible damage
to tissues, nerves, and bones that can be detected
immediately after the procedure or months later.
• The formaldehyde emits gasses that can escape from the
confines of the tooth. It enters the blood stream during the
root canal procedure. If the paste is extruded out
the bottom of the tooth (called an overfill) or seeps out of
the porous structure of the tooth, it can cause severe and
devastating results, often becoming permanent life-
altering conditions and even fatal.
N2 / SARGENTI PASTE
• Term coined by Angelo Sargenti
– To describe the “second nerve”
– Coincided the color of the filling material
(red) to the color of the pulp
• Formaldehyde containing zinc oxide – eugenol
paste
• Introduced by Sargenti and Ritcher in 1954
• Used as a core filling material - known as
‘Sargenti technique’
• Also used as a sealer with core
• American counterpart : RC2B
•
Ø Properties:
Very toxic
– Causes coagulations
necrosis of tissues in
less than 3 days
• Tissues
irreversibly
altered
•
– Irreversibly inhibits
nerve tissue -
paresthesia
–
– Loses substantial
volume when exposed
Anaphylactic shock during endodontic
treatment due to allergy to
formaldehyde in a root canal sealant.
Abstract
A 41-yr-old patient experienced an anaphylactic shock reaction
caused by formaldehyde in a root canal sealant during endodontic
treatment. The clinical events, positive skin tests, and a high level
of immunoglobin E to formalin RAST (class 4) suggest the
involvement of immunoglobin E-dependent mechanisms toward
formaldehyde. This very infrequent observation in endodontic
therapy focuses attention on the different pathological
manifestations related to formalin, their mechanisms, and the
prevention possibilities in dentistry.
• PMID: 11199795 [PubMed - indexed for MEDLINE]
•
J Endod. 2000 Sep;26(9):529-31.Haïkel Y, Braun JJ, Zana H, Boukari A, de Blay F.
Dental Faculty, University Louis Pasteur, Strasbourg, France.
RESORCINOL – FORMALDEHYDE (RF)
RESIN THERAPY
Ø Called as “Russian Red” cement
Ø Used primarily in Eastern Europe, Russia,
China
Ø Consists of
– Formaldehyde / alcohol - liquid
– Resorcinol - powder
– Sodium hydroxide – catalyst
– Zinc oxide / barium sulfate –
radiopacifier (optional)
•
Ø When 10% sodium hydroxide is added to the
mixture, polymerization occurs
Ø Forms a brick – hard red material that has no
known solvent
Ø Disadvantages
– Retreatment is difficult
– Contains 2 potentially toxic components
• Formaldehyde
• Resorcinol
– Shrinks on setting
– Resorcinol discolors tooth structure
•
CALCIUM PHOSPHATE CEMENTS (CPC)
– Toxicity
• Composed of:
– 75% Portland cement
– 20% Bismuth oxide
– 5% gypsum
–
• Mainly used for obturation of apical third
– Open apex cases
–
• Orthograde obturation with MTA as apexification
material represents a contemporary version of the
primary monoblock - attempt to reinforce immature
tooth roots
Ø Advantages
– Excellent sealing ability
(dye/fluid/bacterial/endotoxin leakage
studies)
– Good marginal adaptation
– Extremely biocompatible
• Least cytotoxic
• Cemento conductive
• Osteo inductive
Ø Disadvantages:
– Poor handling characteristics
– Long setting time – 3hrs or more
ØMTA as Primary Monoblock:
1.Bondability:
Volumetric shrinkage of PC :
0.1% on setting
– But MTA not bonded to
dentin – no shrinkage
stresses at interface
• High bond strength of MTA
(38-40 Mpa) in push-out bond
strength tests despite no
dentin bonding due to 2
reasons
JOE Vol 33(4) 2008)
2.Root Reinforcement ability:
•
• Fracture resistance of MTA treated
immature sheep teeth tested
– no difference b/w saline & MTA
groups
(Andreasen et al, Dent Traumatol 2006: 154-6)
–
• No benefit in root strengthening by
MTA due to:
– Lack of dentin bonding
– Low strength in tension
• Sealing ability of orthograde MTA root
canal filling against human saliva
•
– Both gray & white MTA – more resistant
to human saliva leakage than vertically
condensed GP/sealer
(JOE 2005; vol 31, no 6)
Polycarboxylate
Calcium phosphate
cements
Articles
Zinc oxide Eugenol sealer(fill canal)
99 teeth
Result
Glass ionomer sealer(Ketac-Endo)
AH plus showed less leakage than other seal
Epoxy resin(AH-Plus).
ability of root canal sealers. Indian J Dent Res.2002 Jan-Mar;13(1):31-6.
WHICH TECHNIQUE IS GOOD AND
WITH WHICH SEALER IS GOOD??
EFFECT OF OBTURATION TECHNIQUE
ON SEALER CEMENT THICKNESS AND
DENTINAL TUBULE PENETRATION
M. V. Weis, P. Parashos & H. H. Messer
School of Dental Science, University of Melbourne,Australia