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Root Canal
Obturation &
Sealers
Thilanka Umesh Sugathadasa
Thilanka Umesh Sugathadasa
Purpose of Obturation
1. To achieve total obliteration of the
root canal space so as to ingress of
bacteria & body fluids in to root
canal space as well as egress of
bacteria which are left in the
canal.
2. To attain fluid tight seal
3. To prevent recurrent infection
4. To seal the root canal space as
well as to have coronal seal for
long term success of root canal
therapy.
Timing of Obturation
1. Patient symptoms
-If patient present with
sensitivity on percussion, It
indicates inflammation in
periodontal ligament space, Canal
should not be obturated before
the inflammation has subsided.
Also in case of irreversible pulpitis
the obturation can be completed
in a single visit.
2. Pulp & periradicular status
- Teeth with vital pulp can be
obturated in same visit.
- Teeth with necrotic pulp may
be completed in as single visit if
tooth is asymptomatic.
- Presence of even a slight
purulent exudate may indicate
possibility of exacerbation.
Extent Of Obturation
Obturation should be done at the
level of the Dentinocemental
junction.
We should prevent overfilling &
overextension.
Overfilling – is complete
obturation of root canal system
with excess material extruding
beyond apical foramen.
Overextension – Is extrusion of
filling material beyond apical
foramen but the canal may not
have been filled completely.
Thilanka Umesh Sugathadasa
Characteristics
1. Easily introduced in to the canal.
2. Seal the canal laterally & apically.
3. Dimensionally stable after being
inserted.
4. Impervious to moisture.
5. Bacteriostatic or at least should
not encourage bacterial growth.
6. Radio opaque.
7. Non staining
8. Non irritating
9. Nontoxic /Non allergic
10. Ability to sterilized easily
11. Remove easily from the canal if
required.
Materials
1. Plastics –
Gutta-percha
Resilon
2. Solid or metal cores –
Silver points
Gold
Stainless steel
Titanium
3. Cements & pastes -
Gutta flow
MTA
Hydron
Composition of commercially
available GP
Organic
Matrix(GP) - 20%
Filler(ZnO) - 66%
Inorganic
Radioopacifiers (Heavy metal
sulfates) - 11%
Plasticizers(Waxes or Resins)
- 3%
A- Resilon
B- Matching sealer
Thilanka Umesh Sugathadasa
Different forms of GP
Alpha form
Pliable & tacky at 560C-640C
Available in form of bars or
pellets.
Used in thermo plasticized
obturation technique
Beta form
Rigid & solid 420C – 440C
Used to made GP points & Sticks.
Amorphous form
Exist in molten stage.
Phases of GP
These phases are interconvertible.
α – Runny , Tacky & sticky
β – Solid , Compactable &
Elongatable
γ – Unstable form
On heating GP expand, which means
increased volume of materials. Then GP
shrinks when it returns to the normal
temperature, So vertical pressure should
be applied in all warm GP technique to
compensate for the volume changes
during cooling.
Aging of GP causes brittleness
Because of the oxidation process. GP
cannot be heat sterilized. For
disinfection of GP points, They should be
immersed in 5.25% NaOCl for one
minute, Then GP points should be rinsed
in Hydrogen Peroxide or Ethyl alcohol,
The aim of rinsing is to remove
crystallized NaOCl before obscuration, as
these crystallized particles impair the
obscuration.
Cold lateral condensation
Thermoplastic condensation
GP should always be used with
sealers & cement to seal root canal
space as GP lacks adhering quality. GP is
soluble in solvent like chloroform.
Current Available Forms Of GP
1. GP points –Standards cones are
same size & shape as that of ISO
endodontic instruments.
Thilanka Umesh Sugathadasa
2. Auxiliary points – Non
standardized cones
3. Greater taper GP points –
Available in 4%, 6%, 8%, 10%
tapers.
4. GP pellets / bars – They are used
in thermoplastisized GP
obturation system.(Obtura
system).
5. Precoated core carrier GP points –
Here using stainless steel,
Titanium or plastic carriers are
precoated with alpha phase GP for
use in canal (Thermafil).
6. Gutta flow – GP powder is
incorporated in to resin based
sealer.
7. Syringe system – Low viscosity GP
(α)
8. Medicated GP – Chlorhexidine
diacetate, Calcium hydroxide,
Iodoform containing GP
9. GP sealers like chloropercha – GP
is dissolved in chloroform.
Advantages
Compactability
Inertness (Non-reactive)
Dimensionally stable
Tissue tolerance
Radio opacity
Plasticity(become plastic when
heated)
Dissolve in some solvents
Disadvantages
Lack of rigidity(Difficult to use in
smaller canals tend to bend)
Easily displaced by pressure
Lacks adhesive quality
Medicated GP
Calcium hydroxide containing GP
Advantages
Ease of insertion & removal.
Minimal or no residue left.
Firm or easy insertion.
Disadvantages
Short-lived action.
Radiolucent.
Lack of sustained release.
Iodoform containing GP
Free iodine releasing & these
are showing antibacterial effects.
Chlorhexidine diacetate containing
GP
Thilanka Umesh Sugathadasa
Obturation Technique
Can mainly divide
1. Use of cold GP
Lateral compaction technique
2. Use of chemically softened GP
Chloroform
Halothane
Eucalyptol
3. Use of heat softened
Vertical compaction technique
Lateral cold condensation
Armamentarium for Obturation
Primary or accessory GP
Spreaders & Pluggers
Absorbent paper points
Lentulospiral
Scissors for cutting GP
Endo guage for measuring length
of the GP
Endo block for measuring GP
points.
Endo Organizers to arranging the
GP & accessory points in various
sizes.
Heating device
Heating instrument
Lateral compaction technique
1. Select the master GP. One should
feel the tugback with master GP.
Master GP is notched at the
working distance analogous to the
level of incisal or occlusal edge
reference point.
2. Check the fit of cone
radiographycally.
- If found satisfactory, remove
the GP from the canal & place it in
the Sodium hypochlorite.
- If cone going beyond the
working length cut the GP or
select the larger no.
3. Select the spreader. It should
reach the 1-2mm of true working
length.
4. Dry the canal with paper points.
5. Apply sealers in the prepared root
canal.
Thilanka Umesh Sugathadasa
6. Now premeasured cone is coated
with sealer & placed in to the
canal. Then do lateral compaction
using spreader.
7. After placement remove spreader
from the canal by rotating it back
& forth movement.
8. Accessory cone is placed & above
procedure is repeated. until the
spreader can no longer penetrate
beyond the cervical line.
Advantages
1. Can be used in most clinical
situation.
2. Decrease the chance of over
filling.
Disadvantages
1. May not fill the canal irregularities
efficiently.
2. Does not produce homogenous
mass.
3. Spaces may exist between
accessory & master cones.
False
tugback
Thilanka Umesh Sugathadasa
Variation Of Lateral Compaction
Technique
For tubular canals.
1. Tubular canals are generally large
canals with parallel walls.
2. Since these canals don’t have
apical; constriction, The main
criterion of obturation is to seal
the apical foramen in order to
permit the compaction of
obturation materials
3. These cases can be obturated by
tailor made GP or with GP cone
Which has been made blunt by
cutting at tip.
For curved Canals
1. Canals with gradual curvature are
treated by same basic procedure
which includes the use of more
flexible(NiTi) spreader.
2. For these canals, Finger spreaders
are preferred over hand spreader.
3. For canals with severe curvatures
like bayonet shaped or dilacerated
canals, thermo plasticized GP
technique is preferred.
Blunderbuss/Immature Canals
1. Blunderbuss canals are
characterized by flared out apical
foramen. So a apical procedure
like apexification is required to
ensure apical closure.
2. For complete obturation of such
canals, tailor made GP or warm GP
technique are preferred.
Chemical Alterations of GP
GP is soluble in Chloroform,
Eucalyptol,etc
This property of GP is used to adapt it in
various canal shapes.
Teeth with blunderbuss canals
Root ends with resorptive defects
Teeth with internal resorption.
So in these cases following methods are
using.
Root canal cleaned & shaped
properly.
The cone is held with the plier &
adjusted to the working length.
The apical 2-3mm of cone is
dipped for a period of 3-5s dish
containing solvents.
Thilanka Umesh Sugathadasa
Softened cone inserted in the
canal with slight apical pressure
until the beaks of plier touches
the reference point.
Here take care to keep the canal
moistened with irrigation,
Otherwise some of softened GP
may stick to the desired canal
walls, Though this detached
segments can be easily removed
by using H-files.
Radiograph is taken to verify the
fit & correct working length. Then
irrigate with 99% Isopropyl
Alcohol to remove residual
solvents.
After this canal is coated by sealer,
cone is dipped again in the solvent
2-3s then inserted in to the canal
with continuous apical pressure
until the plier touches the
reference point.
Use finger spreader
Accessory GP points are then
placed.
Thilanka Umesh Sugathadasa
Vertical compaction technique
Here we use heated pluggers, pressure is
applied in vertical direction to heat
softened GP which causes it to flow and
fill the canal space.
Requirements
Continuous tapering funnel shape
from orifice to apex.
Apical opening kept as small as
possible.
Decreasing the cross sectional
diameter every point apically.
Advantages
Excellent sealing of canal apically,
Lateral & obturation of lateral as
well as accessory canals.
Disadvantages
Increased risk of vertical root
fracture.
Overfilling of canal with GP or
sealer from apex.
Time consuming.
Thilanka Umesh Sugathadasa
Root canal Sealers
The purpose of sealing root canal is
to prevent periapical exudates from
diffusing in to unfilled parts of the canal,
to avoid reentry of colonization of
bacteria & to check residual bacteria
from reaching the periapical tissues.
Therefor to accomplish the fluid
tight seal, root canal sealer is needed.
Basic Functions
It lubricates & aids the seating of
the master GP cone
Act as binding agent between GP
& the canal wall
Fill the anatomical spaces where
the primary filling material fails to
reach.
As antimicrobial agent
Fill the discrepancy between the
material & Dentin wall.
Giving Radiopacity.
As canal obturation material.
As lubricants.
As binding agent
Requirements
1. It should be tacky when mixed so
as to provide good adhesion
between it & the canal wall when
set.
2. Should create hermetic seal.
3. Radiopaque
4. Should not shrink when set.
5. Ability to mix easily.
6. Should not stain the tooth.
7. Bacteriostatic
8. Set slowly
9. Good biocompatibility.
10. Nontoxic/ Non allergic
11. Insoluble in tissue fluids.
12. Should be soluble in common
solvents.
Thilanka Umesh Sugathadasa
Classification
According to composition
Eugenol
Silver containing
- Kerr sealer
- Procosol radiopaque silver
cement.
Silver free
-procosol nonstaining cement
-Tubliseal
-Grossman’s sealer
-Wach’s paste
Non Eugenol
Diaket
AH-26
Chloropercha & Eucapercha
Nogenol
Calcium Phosphate
Polycarboxylate
Endofill
Hydron
Medicated
Diaket-A
N2
Endomethazone
SPAD
Iodoform paste
Ca(OH)2 cement
According to Grossman
ZnO resin cements
Ca(OH)2 cements
Paraformaldehyde cements
Pastes
According to Clark
Absorbable
Non Absorbable
According to Ingle
Cements
Pastes
Plastics
Experimental sealers
Root canal sealer also may be divided in
to
Zinc oxide-eugenol based
Resin-based
Dentin adhesive materials(GI)
Calcium hydroxide
Combination
Thilanka Umesh Sugathadasa
ZnO Eugenol Sealers
1. Kerr Root canal Sealer
Composition
Powder
ZnO
Precipitated silver
Oleo resin
Thymol iodide
Liquid
Oil of cloves
Canada balsam
Advantages
Excellent lubricating
properties.
It allows a working time of
more than 30 minutes,
When mixed in 1:1 ratio.
Germicidal
Biocompatibility.
Disadvantages
Silver makes the sealer
extremely staining if any
material enters the dentinal
tubules.
2. Tubiseal
Slight modification has been made
in Rickert’s formula to eliminate
the staining properly. It has
marketed as 2 paste system
containing base & catalyst.
Advantages
Easy to mix.
Extremely lubricated.
Does not stain the tooth
structure.
Expands after setting.
Disadvantages
Irritant to the periapical
tissues.
Very low viscosity makes
extrusion through apical
foramen.
Short working time.
Thilanka Umesh Sugathadasa
3. Calcium Hydroxide Sealer
The pure Calcium
hydroxide powder can be used
alone or It can be mixed with
normal saline solution. The
alkalinity of the Calcium hydroxide
stimulates the formation of
mineralized tissues.
Advantages
Induce mineralization.
Induce apical closure via
cementogenesis.
Inhibit root resorption
subsequent to trauma.
Inhibit Osteoclast activity via
an Alkaline pH.
Seal or prevent leakage as
good as or better than ZnO
sealers.
Less toxicity than ZnO sealers.
Disadvantages
Calcium hydroxide contents
may dissolve, leave the voids.
No proof having about
which it having any added
advantages.
Although It’s having dentin
regenerating ability. Without vital
pulp it’s not possible.
Thilanka Umesh Sugathadasa