OBTURATION

Francis prathyusha
 WHY OBTURATE???

• Dr Herbert Schilder – first to publish classic

article on filling root canal space in 3
dimensions
 (DCNA 1967:723-44)

– Final objective of endo therapy: “total

obturation of root canal space”
– “ sealing of complex root canal system from
periodontal bone ensures health of
attachment apparatus against breakdown
of endodontic origin ”
–
Commentary on: Filling Root Canals in Three Dimensions
Harold E.–Goodis, DDS
copyright
 © 2006 by the American Association of Endodontists.
doi:10.1016/[Link].2006.02.029
 DEFINITION

 The three-dimensional filling of the

entire root canal system as close as
possible to the cementodentinal
junction


 American Association Of Endodontists (AAE), 1994


 OBJECTIVES OF
ENDODONTIC OBTURATION
• When obturation objectives are met, we help
to produce an optimal environment for
periradicular tissue healing and health,
and thus for successful endodontic
therapy.
 These objectives are
• Replicate ,
• Seal ,
• Control.
•
 RATIONALE FOR OBTURATION
• “ Bacteria are the primary source of
persistent periradicular inflammation
and endodontic failure”
 ( Ingle & Bakland, 5 th Ed )


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)


vEasily introduced vRadiopaque

vSeal laterally as well as vNot stain tooth
apically vNot irritate
vNot shrink after being periradicular tissue
inserted vSterile or
vImpervious to moisture sterilizable
vEasily removed
vBacteriostatic
 CLASSIFICATION
According to Grossman


OBTURATING MATERIALS

Core materials sealers

vMetals vPlastics
vPlastics vCements
vPastes/ Cements vPastes
 ANSI/ ADA CLASSIFICATION:


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

vType II : Auxiliary (conventional or

accessory points) of non standardized taper
 CORE FILLING MATERIALS
vMetal vPlastics
vPastes/ Cements:
Silver N2 – Sargenti
Stainless GP
Hydr technique
steel files
Gold on Resorcinol –
Iridiopla Resil formaldehyde
tinum on resin (Russian
Red 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


• Require an absolutely circular canal preparation

• Often bind in one or two places in the root canal
wall, giving a false sense of fit
• Radiographically are deceptive because they give
a dense appearance to the root canal fill
• Corrode when in contact with either periradicular
tissue fluids or oral fluids
• Corrosion products are highly cytotoxic
• Cannot obturate the canal system three
dimensionally - requires a sealer
•
 CORE FILLING MATERIALS
vMetal vPlastics
vPastes/ Cements:
Silver N2 – Sargenti
Stainless GP
Hydr technique
steel files
Gold on Resorcinol –
Iridiopla Resil formaldehyde
tinum on resin (Russian
Red Cement)


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

Vertical compaction of warm gutta-percha. Fitting

the master gutta-percha cone. The cone is fit to the
radiographic terminus.
 Advantages
• Replicates well
• Seals well


 Disadvantages
• Most time consuming technique
• Requires significant flaring for deep
condensation
• Requires increased number of
instruments

THERMOMECHANICAL COMPACTIBLE GP:

• GP plasticized by frictional heat in root

canal
• McSpadden Compactor
– Used with regular β phase GP cones
– H-file design (pushes GP apically)
–
–


•
• Disadvantages:
• Extrusion of material
• Instrument fracture
• Inability to be used in curved canals
• Heat generation
• Void formation; poor seal
 Thermomechanical Compaction

Compactor + Gutta Operator coated

percha cone compactors
Precoated Compactors

vMc Spadden compactor Multi – phase technique

Multi – phase II Pac Mac
vGutta Condenser Beta phase GP cone
compactors
vEngine Plugger +
‘triple coated compactor’
NT Condenser coated with alpha
0.02 or 0.04 taper compactor
USE phase gutta percha
coated with
Beta phase GP cone Multiphase I (beta phase GP)
+ Microseal system &
Stainless steel Multiphase II (alpha phase GP)
Alpha phase GP cone
compactors +
+
Sealer
Microseal condenser coated with
alpha phase GP
THERMOPLASTICIZED
 Heat softened GP is injected into
the canal or carried inside on a
carrier.


 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

Mercedes Pérez Heredia1, Javier Clavero González 1, Carmen María

Ferrer Luque 2, María Paloma González Rodríguez 3
(1) Graduate in Dentistry
(2) DDS, MD, PhD: Associate Professor
(3) DDS, PhD: Assistant Professor. Department of Dental Pathology and
Therapeutics. School of Dentistry. University of Granada (Spain)
 AIM:
• To compare the apical sealing in mesio-buccal
canals of extracted molars obturated with low-
temperature thermoplasticized gutta-percha or
cold lateral condensation techniques using a .06
or a .02 mm/mm tapered gutta-percha master
cone.
• The secondary aim was to evaluate the depth
of spreader penetration in root canals using a .
06 or a .02 mm/mm tapered gutta-percha master
cone.
MATERIALS AND METHODS
•
 RESULTS:
• There were no differences among the three
group, which showed a very similar mean
microleakage .
• The difference in spreader penetration between
the groups filled by cold lateral condensation
was significant
•
CONCLUSION OF THE STUDY
• The Ultrafil® 3D system and cold lateral
condensation techniques with .06 or .02
tapered master cones were equally effective
in the apical sealing of curved canals.
• The spreader penetrated deeper using a .02
mm/mm tapered gutta-percha master cone.
 HEROFILL:
A THIRD GENERATION OF
ROOT CANAL FILLING

Assistant, Department of Dental Medicine, EPS Farhat Hached Sousse, Tunisia

** Professor, Department of Dental Medicine, EPS Farhat Hached Sousse, Tunisia
DENTAL NEWS, VOLUME XII, NUMBER III, 2005
 Abstract
• Tremendous progress has been made in the last
quarter of a century in understanding the
nature of root canal system and obturation
material. New techniques and materials are
expected to increase the already high success
of NITI rotary canal preparation. Adapted
obturation is required for such cases.
• This article reviews the specificity of HEROfill
system and how this procedure based on a
plastic core coated with thermoplastic gutta-
percha has evolved.
• Recently herofill was introduced by MicroMega
Corporation to replace classic gutta-percha.
• HEROfill system is a 3rd generation endodontic
obturator which was developed to give the
practitioner a fast and reliable means of
obturating a root canal, and is based on the
principle of a solid plastic core coated with
thermoplastic gutta-percha.
• The enhancements created in this system
comparatively to other similar generation such as
THERMAFIL, QUICKFILL,
 ADVANTAGES
• Detachable handle, that can be pre-bent up to
90° for a better angle in restricted access
canals.
• Adjustable working length.
• Easy control by HEROfill® Verifiers.
• No preheating of oven, short heating times.
Four obturators can be heated at the same
time. In addition, we can save an obturator
even heated if we decide not to use it.
• Hollow core in the coronal part of the carrier.
• Natural GP free of any toxic components
 DISADVANTAGES

• Under preparation of the canal space could

cause “stripping” of the gutta-percha from
the carrier as it was forcefully placed in the
canal.
• The result - basically a single cone - metal or
plastic carrier obturation in the apical
portion – is undesirable. So like Warm
vertical compaction, this too was
“technique-dependent”.
• Retreatment and surgical procedure difficult
• Retreatment of these cases required removal of
the carrier prior to re-cleaning and repacking
of the canal.
• Surgical treatment of these cases was more
difficult than normal due to complications
caused by metal carriers.
SCHEMATIC ILLUSTRATION SHOWING
HEROFILL TECHNIQUE STEPS:
 SEM observation :
1/CERVICAL THIRD

Fig. 1: Marginal adaptation of Fig. 2: No space between

gutta-percha with presence of sealer gutta-percha and dentin wall

1: Carrier system
2: Gutta-percha
3: Sealer
4: Dentin wall
 2/MIDDLE THIRD

Fig. 3: Penetration of sealer inside Fig. 4: Interface dentin/obturator

surface dentin; better seal HEROfill™: good adaptation

1: Carrier system
2: Gutta-percha
3: Sealer
4: Dentin wall
 3/APICAL THIRD

Fig. 5: Acceptable marginal adaptation Fig. 6: Acceptable fitting at dentin wall

1: Carrier system
2: Gutta-percha
3: Sealer
4: Dentin wall
 CONCLUSION
• HEROfill obturation is considered among the
fast, reliable and easy obturation methods. It
can be used in the same situations as the
lateral condensation; it is however preferred
in many circumstances, such as with internal
and root end resorption.
• Its main advantage is the ability to adapt the
warmed and softened gutta-percha to the
irregular root canal system
 HYBRID OBTURATION
TECHNIQUES (COMBINATION
OF THERMO- AND NON-
THERMOPLASTICIZED)

• Lateral compaction and Obtura II®

• Continuous wave of condensation
• A technique combining thermoplastic and non-
thermoplastic GP is preferred over
thermoplastics alone. This combines the best
features of several techniques, including better
apical control (than thermoplasticized alone)
and better canal replication (than lateral
compaction alone).
• Obtura II® is the most popular
thermoplasticizedGP system. The “hot glue gun”
approach keeps GP molten for injection.
• Prefit proper applicator tip near the junction of
the coronal and middle thirds
Prefit compactors to lengths required (using
stops or instrument graduations)
 Conti..

• Fit and select master cone

• Use of sealer is essential
• Insert master cone (laterally compact 1-2
accessory cones if necessary)
• Sear off at 2-3 mm from canal terminus and
vertically [Link] inject Obtura
II® GP
• Segmental addition
• Compact each increment immediately
following injection
•
 CONTINUOUS WAVE OF
CONDENSATION
• The non-standardized master cone is heat
softened in place, using the System B®
heat source and down-packed with a
Buchanan plugger. Various sizes of heating
tips and pluggers needed. The GP is
alternately seared and down-packed, going
deeper into the canal each time, until
within 3-4 mm of the canal terminus. The
middle and coronal canal space is
backfilled with incremental Obtura II®
injection and compaction.


 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)


– 5mm apical plug of GP or Resilon +

metal carrier
– Carrier removed after apical plug is
placed
– Backfilling with injectable
thermoplasticized GP or post given
 Trifecta System


– Blocks the apex & prevents extrusion



– A plug of gutta percha at the apical foramen

• SuccessFil (carrier based)
•
– Backfilling
• UltraFil (thermoplasticized injection)
•



 The percentage of gutta-percha-
filled area in simulated curved
canals when filled using Endo
Twinn, a new heat device source

[Link],L GIACHETTI etal

INTERNATIONAL ENDODONTIC JOURNAL , VOL 39 ISSUE 8 Pgs 610-
[Link] 2006,
 2
1

3 4

1)Stainless steel
2)Ultrasonics
3)NiTi
4)Cutting spoon tips.


 AIM 


 To compare the percentage of gutta-percha-filled

area (PGP) in simulated root canals when varying
the penetration depth and function of the pluggers
(heat versus heat plus vibration) using Endo
Twinn

RESULTS 
•


• At the 1.25 mm level PGP was significantly greater

using the vibration function .
• At the 2.5 mm level the PGP was greater in the
canals with 0.8 taper compared with a 0.4 taper
with or without vibration
• In 0.4 taper canals the PGP was greater when the
vibration function was activated.
• At the 4 mm level in 0.8 taper canals there was no
significant difference in PGP with or without the
vibration .
CONCLUSION OF THE STUDY  

• 0.8 taper canals had significantly greater PGP

than 0.4 taper canals. At the 1.25 mm level
there was significantly greater PGP when the
vibration function was activated
•
 MEDICATED GP:
 Iodoform Containing GP

• Calcium Hydroxide Containing GP
•
 Chlorhexidine – Impregnated GP
 Tetracycline Containing GP
FLOWABLE GUTTA PERCHA (GUTTA FLOW):

Gutta-Flow with single gutta percha

master cone creates an apical seal that is
equivalent to GP/AH Plus with warm
vertical compaction
Brackett et al, JOE 2006; 32(12): 1188-90

Non-heated/Cold flowable obturation

material
Combines GP & Sealer in one product
Consists of polydimethylsiloxane based
sealer used with single /multiple cone
obturation
 COATED GUTTA PERCHA

 EndoRez Points (Ultradent Products, South Jordan,

UT)
• GP coated with proprietary resin coating
• Polybutadiene-diisocyanate-methacrylate resin
coated GP


–
–
–
–
• 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
•

Tay et al, JOE 2005; 31: 659-664)

 Management of Open Apex Situations,
including Master Apical
Impression Technique
– Preparation of “tailor-made” gutta-percha roll.
A: Number of heated, coarse, gutta-percha points are

arranged butt to tip, butt to tip on sterile glass.

B: Points are rolled with spatula into rod-shaped mass

C: By repeated heating and rolling, the roll of gutta-percha

is formed to approximate size of canal to be filled. No

voids should exist in mass.
D: Before trial point testing of tailor-made roll, gutta-percha

should be chilled with ethyl chloride spray.


  Activ GP (Brasseler USA, Savannah, GA)


• Marketed as “monoblock” sytem

• Gutta percha cones are surface coated
 with glass ionomer fillers


• Helps achieve a stiffer GP cone –

 Transforms it into a GP core/cone
– Acts as filling cone +
– Carrier core



 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

ActiV GP Plus cones come with a handle and depth

ActiV GP Precision Obturation System. markings to expedite insertion into the canal
 A hermetic seal can be created
if there is a monobloc between
the canal wall, the sealer, and
the master cone.

A NEW MONOBLOC MATERIAL AND TECHNIQUE

Resilon system
 New technology in endodontics
– the Resilon-Epiphany system
for obturation of root canals
Pawińska M1*, Kierklo A2, Marczuk-Kolada G3

1 Department of Conservative Dentistry, Medical University of

Białystok,Poland,2 Department of Dentistry Propaedeutics,
Medical,University of Białystok, Poland,3 Department of
Paedodontics,Medical University of Białystok, Poland

Advances in Medical Sciences · Vol. 51 · 2006 · Suppl. 1 ·

 REALSEAL (RESILON/EPIPHANY)

• The core
• The sealer is a dual-cure sealer.
• In addition the system comes with a self-etching primer.

Resilon can be placed as single cones, warm vertical

compaction thermoplastic injection, or lateral
compaction.

Advances in Medical Sciences · Vol. 51 · 2006 · Suppl. 1 ·

 #35, 0.04 tapered cone bent to show the
Resilon cones
flexibility of the cones

Resilon Pellet

Thermoplastic ResilonMaterial through an

Obtura gun (150°C)
Primer and Sealer
• During the cleaning and shaping procedures,
alternating rinses of EDTA and sodium
hypochlorite remove the smear layer and open
the dental tubules for penetration of the
resinous sealer. Because resins will not set in
the presence of oxygen, the oxygenating agent
sodium hypochlorite should not be the last
irrigant before the resin sealer is introduced into
the canal. The last irrigant should be EDTA,
followed by sterile water or 2% chlorhexidine
solution.
Mono block
 Material and methods

5 men 16 women Endodontically treated 48 root canals(24teeth)

(5 incisors, 1 canine, 6 premolars and 12

molars)
Aged 14-55,

Advances in Medical Sciences · Vol. 51 · 2006 · Suppl. 1 ·

Immediately after the treatment One year after the treatment
 Laboratory evaluation – 4 extracted tooth

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

Resilon-Epiphany system has yielded positive outcome both

in clinical and microscopic examinations.
Micrograph demonstrating intimate
contact of sealer and Resilon.
SEM demonstrating microgaph SEM demonstrating intimate
formation with AH 26 epoxy contact with methacrylic sealer and
sealer due to polymerization Resilon, and dentinal tubula
shrinkage. (ES - epoxy sealer; D - penetration of the sealer. (RS -
dentin) methacrylic sealer; D - dentin)
 A Fluid Filtration Comparison of Gutta-
Percha versus Resilon, a New Soft Resin
Endodontic Obturation System
Ryan K. StrattonMichael J. Apicella, DDSPete Mines, DDS
Journal of Endodontics Volume 32, Issue 7 , Pages 642-645, July 2006

 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

 Journal of Endodontics,volume 34, Issue 11 , Pages 1401-1405, November 2008

 Result

• Thermafil system, wave of condensation, and

thermomechanical compaction produced
significantly higher PGFAs than lateral
condensation
  Comparative Study of Five Different
Obturation Techniques

 Lumnije Kqiku (1), Andreas Weiglein (2), Peter Städtler (1)
 1 - Department of Operative Dentistry, University Dental Clinic, Graz, Austri

 Available online: March 25, 2006



 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

 Radiographic evaluation of material adaptation

• The quality of obturation obtained with the five
techniques was compared with the Kruskal-Wallis test
and the Mann-Whitney U-test. Overall, there were no
significant differences in the radiographic quality
• In the overall radiographic obturation quality the
techniques showed good adaptation in the apical middle
and coronal third of the root canal .
  CONCLUSION
•
•
 All the thermoplastic filling systems tested
demonstrated acceptable root canal filling and
good adaptation to the root canal wall with no
statistically significant difference between them
and in comparison to lateral condensation.
•
•
 In vitro Evaluation Of Three
Techniques To Obturate 0.06 Taper
Canal Preparations
• By Solaiman M. Al-Hadlaq, BDS, MS, PhD1 and Abdulmohsen A. Al-Rabiah,
College of Dentistry, King Saud [Link] , Saudi Arabia.
• AUSTRALIAN ENDODONTIC JOURNAL VOLUME 31 No. 2 AUGUST 2005

•
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

The positive control group, no casting wax or nail varnish was

cold lateral condensation technique using standardised 0.02 tap
 RESULT
• The positive control teeth showed complete dye
penetration, whereas negative control group
teeth showed no dye leakage.
• Two teeth, one from the 0.06 taper gutta-percha
group and one from the MF non-standardised
gutta-percha group, were excluded from the
final sample due to vertical root fractures.


Group 1 < Group2 < Group3

 Obturation of internal resorption
cavities with 4 different techniques:
An in-vitro comparative study

Professor and Head,

Deptt. of Conservative Dentistry and Endodontics,
Saveetha Dental College and Hospitals,
Chennai, India.
Materials and methods

24,extracted max CI
 Results
Radiographic evaluation of quality of obturation
of simulated internal resorptive cavities

Groups Samples Total Partial

obturation obturation
1 6 2 4
2 6 6 0
3 6 3 3
4 6 6 0
Table II : Stereomicroscopic evaluation of
nature of predominant filling material in the
simulated internal resorption cavities.
GROUP-1 Group-2 Group-3 Group-4
Type- 3 0 2 0
1(sealer)
Type-2 (GP) 1 5 1 5
Type-3 2 1 3 1
(sealer+Gp)
• Conclusion
• Results with Thermafill and lateral
condensation were inferior compared to
Obtura and ultrasonic condensation technique
for obturation of internal resorption cavities.
• Therefore, the later two techniques are
recommended to be used to obturate the
defects of internal resorption cavities in
clinical practice
Analysis of the gutta-percha filled area in C-
shapedmandibular molars obturated with a
modified MicroSeal technique
Ordinola-Zapata , Bramante CM et al
Department of Endodontics, Dental School of Bauru, University of São Paulo, Brazil.


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

International Endodontic Journal

Volume 42, Issue 3, pages 186–197, March 2009 
PMID: 19228207 [PubMed - indexed for MEDLINE
Type 3 

Type  2 

Type 1 
saline at 4 °C
 TYPES

Type I merging Type 2 Type 3 asymmetrical

symmetrical
Radiograph of an obturated Merging type C-shaped
molar

a complete C-shaped pulp chamber

middle third C1 configuration - good

adaptation of the α and β gutta-perch
in the distal and mesial canal

shows a void Increment of the sealer area -in a more apical

Proximal radiographic view of an obturated
asymmetrical C-shaped molar

A complete C-shaped pulp chamber

Middle third section shows a good

adaptation of the a and b gutta-percha
in the distal canal and accessory
points are
visible in the large isthmus

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

An incomplete C-shaped pulp chamber

C3 canal configuration -coronal sec

C1 canal configuration is evident in the apical Gutta-percha is absent in the isthmuses -

section partially filled with sealer and debris
communication between the middle and apical
third

An incomplete C-shaped pulp chamber

C2 large distal canal with an

isolated mesio-lingual canal

C1 canal configuration gutta-percha is evident in the isthmus

 Conclusion
• The percentage of area filled with gutta-
percha was similar in the three
radiographic types and canal
configuration categories of C-shaped
root canal systems of mandibular second
molars;
• The percentage of the gutta-percha filled
area was lower in the apical third.
• These results reflect the difficulty of
achieving predictable filling of the root
canal system when this anatomical
variation exists.
 HYDRON (HYDRON TECHNOLOGIES, FL, USA)

Ø First described by Wichterle and Linn (1960)

– For use as a biocompatible implant material
Ø Introduced as a root canal filling in 1978
– By Goldman and associates
Ø Rapid setting hydrophilic plastic material used as
sealer without core – first attempt at Primary
Monoblock
Ø Polymer of hydroxyethyl-methacrylate (poly
HEMA)
Ø Hydrophilic acrylic resin
– Injected into canal to set in situ
– Undergoes polymerization in aqueous envirnt
•
Ø Properties:
– Self polymerizing
– Rapid setting : 8-15 mins
– Radiopaque – barium sulfate



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

 Abstract :This in vitro study compared the

apical sealing efficacy and permeability of
Hydron with laterally condensed gutta-
percha and Grossman's sealer.
 Result

• Hydron was found to be significantly more

permeable to managanese ions than
gutta-percha with Grossman's sealer.
 CORE FILLING MATERIALS
vMetal vPlastics
vPastes/ Cements:
Silver N2 – Sargenti
Stainless GP
Hydr technique
steel files
Gold on Resorcinol –
Iridiopla Resil formaldehyde
tinum on resin (Russian
Red Cement)


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):[Link]ïkel 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)

• Introduced by W. E Brown and L. C Chow

(1985) for complete canal obturation


• 2 calcium phosphate powders

– Acidic – Dicalcium phosphate
dihydrate / anhydrous dicalcium
phosphate
– Basic – Tetracalcium phosphate

• When mixed with water sets into a hardened
mass - hydroxyapatite
• Sets within 5 minutes
– By adding glycerin to mixture, setting time
can be extended
– Can be extruded from a 19-gauge needle
• Final set cement
• Nearly all-crystalline
– As radiopaque as bone
– Nearly insoluble in water, saliva and blood
– Readily soluble in strong acids
– Porosity in direct proportion to amount of solvent
(water) used
• Excellent resistance to leakage – only 0.15mm dye
penetration
•
Ø Disadvantages Of Paste Fills


– Toxicity


– Porosities in paste fills



– Most pastes resorb in time resulting in

leakage, percolation and strong
possibility of ultimate endodontic failure


– Antigenic chemical components – causing

immunologic response


– Apical control difficult

•
MINERAL TRIOXIDE AGGREGATE (MTA)
• Introduced by Mahmoud Torabinejad in 1993
at Loma Linda University


• 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:

[Link]:
 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)
[Link] Reinforcement ability:


• Portland cement modulus of

elasticity:
• 1700MPa at early set
• increases to around 30,000
Mpa after 14 days (in w:p
ratio of 0.33)


– Theoretically – MTA can

reinforce roots


•
 • 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)


– Lamb et al - Minimum 3mm thickness for

adequate sealing


– Thickness of MTA barrier - no significant

difference in microleakage (dye
penetration)
 ROOT CANAL SEALERS
 CLASSIFICATION
Type I Materials: used with
 Type II Materials:
core material with or without core
 material
– Class 1 – powder and
liquid that set Class 1 - powder and
through a non liquid that set through
polymerizing process a non polymerizing
process
– Class 2 – two pastes Class 2 – 2 pastes that
that set through a set through a non
non polymerizing polymerizing process
process Class 3 – metal
– Class 3 - polymer and amalgams
resin systems that set Class 4 - polymer &
through resin systems that set
polymerization through polymerization

 2. According to Composition by Messing:
A. Eugenol B. Non Eugenol C. Medicated
 Silver ii. Silver Free
containing
  

Rickert’s Procosol Non- Diaket Diaket-A

formula/ staining cement AH 26 N2

Kerr’s Sealer AH Plus Endomethasone

Grossman’s

Hydron SPAD
Procosol sealer Chloropercha Iodoform paste

Radiopaque Eucapercha Riebler’s paste

silver cement Tubliseal


Nogenol Calcium

Endofil hydroxide paste

Wach’s paste
Glass ionomer Biocalex

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).

[Link] Almeida [Link], Evaluation of apical sealing of three

Endodontic sealers. IEJ 2000; 33:25-27.
 Other study


 In a study they compared the sealing ability of AH-

26/silver free,a modified version of AH26,a resin based
sealer was compared with tubliseal ,a zinc oxide eugenol
based sealer using methylene blue dyepenetration method.


 AH-26/silver free showed superior sealing ability.



Suprabha BS,Sudha P,Vidya M .A comparitive evaluation of sealing




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

International Endodontic Journal, 37, 653–663, 2004

•
Abstract
Aim To compare the average sealer cement film thickness
and the extent and pattern of sealer penetration into
dentinal tubules in association with four obturation
techniques in curved root canals.
CROSS-SECTIONS OF EACH OF THE FOUR-
OBTURATION TECHNIQUES 3 MM FROM
WORKING LENGTH
Mean sealer
thickness at the
gutta-percha core
and canal wall
interface at the 1,
3 and 5 mm levels
for each of the
four obturation
techniques.
 RESULTS
• Thermafil demonstrated superior GP adaptation at all
levels with a mean overall sealer cement thickness ,
followed by lateral compaction , continuous wave and
SimpliFill .
• SimpliFill also demonstrated the highest frequency of
voids . Sealer cement penetrated dentinal tubules as
far as the outer one-third of dentine, with greater
penetration observed buccally or lingually.
• Penetration was not significantly affected by obturation
technique, but on average was deeper and more
frequent at the 3 and 5 mm levels than at the 1 mm
level.
•
 CONCLUSION

• Sealer thickness was strongly dependent on

obturation technique. Assuming that minimal
sealer thickness and fewer voids are good
measures of long-term sealing ability,
Thermafil resulted in the best outcome.
•
 BEST ??
• It is quite possible that after 100 years, gutta-percha will
suffer its demise as an endodontic filling material, as it
did for golf balls. In its place we may well see modern
chemical compounds as the obturating material of the
future. Today, Resilon ,thermoplastic cones, soluble in
Resilon – ephiphany
chloroform system-
but not in water. striaght
Pellets of canals
Resilon may even
Thermoplastized
be heated and expressedtechinique
through an Obtura gun.
• Curved orthec polyester
In addition, or complexpoints anotomy
are sealed to place with a
resin-based composite sealer, Epiphany or RealSeal.
• These sealers have the advantage of bonding chemically not
only with the polyester cones but the dentin walls as well
= monoblock that seals the canal and the tubuli.
 CONCLUSION

Continuous efforts are being made to develop better

sealer and core obturation materials & techniques but
till date none of the materials & techniques have
safely reached the highest biologic and technical level.
There is no universally accepted ideal root canal
filling material and technique.

e for further research and development remains