Obturation

Basic concepts of why we have to fill the root canal space.

The complete filling and closing of a cleaned and shaped root canal space using a root
canal sealer and core filling material.
Main concept, why is it that we have to put a filling in there; theory is we take out
bacteria in canal space, why pack rubber etc into canal itself? Cannot ever sterilize root
canal space, there will always be bugs in there. Constantly bacteria in there, thats the
key. Only reason we do it:
To seal out fluid from entering the root canal system (if it leaks, bacteria that we cannot
clean out will have a food substrate, they will start to multiply and cause reinfection)
To seal in any irritants that can not be removed from the root canal system.
Reason why we cant get bacteria out: size is a micron, dental tubules can be up to .5 to 3
microns. Tons of bacteria in each tubule that we cannot get out.
Smear layer removal, before we obdurate. Smear layer is gunk, a surface film of debris
retained on dentin after instrumentation with files; consists of dentin particles, remnants
of vital or necrotic pulp tissue, bacterial components and retained irritant. Infected
surface.
Top right, SCM of surface of canal of root. Holes with dentin tubules open, to the left its
after its cleaned and shaped.
With 17% EDTA. Once you do cleaning and shaping, dry canal, EDTA is a weak acid
like acid etching, that removes little bits of peritubular dentin and widen the tubule. After
a minute, put in hypochloride and that can go into the tubules. Bad thing is if you havent
sealed it well, created a nice channel for bacteria to go in and out of.
Ideal properties of obturation materials. Filling materials are sealer and gutta percha.
The ideal properties: minimally irritant, not shrink, provide a fluid tight seal, moldable,
bacteriostatic (sealers are), easily removed (root canals fail and have to redo them), not
stain tooth.
Bacteriostatic, stops them from propagating, bacteriocidal it actually kills them.
Problems with obturation are usually due to cleaning and shaping. Sealers. When we put
a filling into a tooth, use a rubber, quite viscous. Doesnt go into nooks and crannies.
Surface tension is too high. Something more fluid. Only thing that does the sealing is
the sealer but we want the minimal amount of sealer in the canal.
Types of sealers. Know the base constituents. Can group them into types of sealers.
Zinc oxide eugenol (best tested, stood the test of time), calcium hydroxide (osteogenic,
may have osteogenic potential, but that doesnt work out, as calcium leaches out of the
sealer, sealer breaks down), glass ionomer (stick to the tooth well, good seal, flows well,

trouble is that its not easily removed), resin (doesnt come out easily either) or
paraformaldehyde (cant touch, highly toxic to tissues, if you spin it into bone, go into
nerves, nerve paralysis and degeneration, shouldnt touch it).
They are all cytotoxic, if you put an incision under the skin, put in the sealer, watch it,
cytotoxicity is the level of inflammation and tissue destruction it will cause. Almost any
material we put in the body does that. Titanium is one of htem and so is MTA. Other
than that almost every single thing is cytotoxic. All sealers are cytotoxic when freshly
mixed but this greatly reduces on setting. Most sealers are resorbable when exposed to
tissues and tissue fluids (over time the body gets rid of it). Want to minimize pushing the
sealer out the apex. That determines how you clean and shape.
Slears: clinical tips. Mix consistencystring an inch.
Method of placementlentulo, buttering master cone
Post op painextrusion, free eugenol
This is what you need for obturating, powder and liquid, sealer, master cone, accessory
cone, gutta percha, cotton pliers, mixing spatula and spreader.
All sealers tend to shrink, therefore iti s necessary to minimize the amount in the canal by
using a central core of GP. Every material on setting either contracts or expands. Cannot
put it completely in the canal and leave it, dont fill the whole canal with it. Put a big
core of GP that shrinks less to take up all the space and then have thin layer of sealer all
around, so when sealer shrinks, proportion doesnt affect it as much. (classic test
question).
Gutta percha. 20% gutta percha, zinc oxide eugenol mainly (60-75%), metal sulfates (217%), wax/rexin 1-4%. Even GP causes cytotoxicity, mainly because of zinc oxide.
Metal sulfates stop it form being too brittle, same with wax.
We used to say lateral condensation, now we say lateral compaction. Condensation
means you can compress the material, in fact gutta percha is less compressible then water.
By compressing bring molecules closer together, the only thing we are doing is
compacting it, taking out voids placed there during manufacturing process. Want to
decrease voids. Its lateral compaction.
The reason we go through cytotoxicity is that you send GP and sealer out the other end.
How much post op pain? It is a big deal, but by the 15th day, not that much effect. Of all
the materials we use, GP is a material that is an inert material, a relatively non toxic
material.
Gutta percha types. Have to know. ISO, and non standardized are the main ones to
know. Up until the 50s, there was no standard system. Did it for the filing system and
gutta percha. ISO is that the tip is measured to the size of a 15 file or 20 or 25. non
standardized is what was used before.

ISO standardized. Tip diameter corresponds to file tip. Know going in what size it is a
the apex. Taper of this, doesnt widen out.
Non standardized come in many sizes, start from extremely skinny, cut it off to
correspond to prep size. See the taper increases significantly.
Importance of sealer. The bulk of filling material is the GP, but most important is the
sealer.
Obturation techniques. Lateral compaction is the only thing you will be using in the
clinic.
To do this, you need your GP, the spreader, heat source, something to sera off the gutta
percha with, and plunger to squash it.
Fit the master cone, measure to see how deep. Already know the length from cleaning
and shaping, measure it out, fit it in.
Has to fit with three things; apical gauging (corresponded the diameter of apex of prep
and GP, 35 file, 35 GP cone, or else too skinny and goes out the end or too big and wont
get to the end), length confirmation, and tug back on removal (means that its a snug
fit, when you pull up, there is some resistance).
Spreader penetration considerations, once the master cone is in place. Once gp is in place
,squash with spreader, then try to get another GP cone to go down the hole you created
with the spreader.
Hand spreaders, tapered, metal, rubber stopper, go to a mm short of working length.
More force, can crack root.
Finger spreaders are like files, they do the same thing, but use less force, less chance of
fracture.
Next, put in accessory cones. They are much skinner, go to same length the spreader
went to, go in and put in spreader again, it wont go in all the way this time, more GP.
Keep pushing it down, putting another cone in, until spreader is sequentially backed out.
Point of this is that the spreader reaches to mm or two of the working length, thats the
hard part to obturating. That will cause voids in root canal filling. The main reason
spreader wont go down there is cleaning and shaping. Without a good flare or taper, or
too constricted at top, cant get the spreader down. If it starts to get parallel, not flared,
obturation process becomes difficult.
Quality of apical seal is directly related to depth of spreader penetration. The best seal
achieved when spreader reaches to 1 mm of working length.

Heat up and sear it off. Then with plunger you pack it down. Heat will travel 3 or 4 mm
down the GP. Once you condense, you will compact it down a little bit. The hard part is
not the obturation, thats fairly simple, the hard part is what prep size should you take
each mm as you go along. If you create continuous taper, it becomes easy. What the
obturation reflects is not the obturation but the cleaning and shaping. When you look at
an x-ray, judging the cleaning and shaping.
The ideal fill. Should be a continuous density. Silver cones (dont use them anymore),
rods of silver, single cone with sealer around it, cannot get it to flow into nooks and
crannies, short, and there are lesions around it.
Continuous taper, want flow, so each mm is a little wider as you go up. Straight line
access.