1. Root Canal Obturation:
Determining The Optimal Obturation Length
Dr. Ranya Elemam
BDS. Msc Endodontics
Email : Ranya_Elemam@yahoo.co.uk
9/11/2013

2. Aim
Provide an understanding in determining termination
of obturation.
Ranya Elemam
Root Canal Obturation
9/12/2013

3. Objectives
ↄ Understand The Anatomical Land Marks Of Apical
Zone Of The Root .
ↄ Know What Literatures State About The Termination
Length Of The Obturation .
ↄ Recognize The Relation Between The Obturation
Length And Endodontics Outcome.
Ranya Elemam
Root Canal Obturation
9/12/2013

4. Where to End the Gutta Percha?
Ranya Elemam
Root Canal Obturation
9/12/2013

5. Recommendation by Literatures: 1
Termination should be to the apical constriction
(Kulter et al 1955)
Kuttler Y. Microscopic investigation of root apexes. Journal of the American Dental Association (1939).
1955;50(5):544-52.
Ranya Elemam
Root Canal Obturation
9/12/2013

6. Recommendation by Literatures: 2
Obturating short of the radiographic apex 0.5–2.0 mm
(Weine 1996 )
FS W. Endodontic therapy. 6th ed. ed: MO: Mosby; 1996.
Ranya Elemam
Root Canal Obturation
9/12/2013

7. Recommendation by Literatures: 3
In presence of root and/or bone resorption
should be to even shorter length.
( Walton And Torabinejad 2002 )
Richard E. Walton MT. Principles and practice of endodontics. 3rd ed ed: Philadelphia, Pa. ; London :
Saunders, c2002; 2002
Ranya Elemam
Root Canal Obturation
9/12/2013

8. Recommendation by Literatures: 4
Apex is a more reliable reference point.
(Ricucci 2003)
5. Ricucci D, Bergenholtz G: Bacterial status in root-filled teeth exposed to the oral environment by loss of
restoration and fracture or caries—a histobacteriological study of treated cases. Int Endod J 36:787, 2003.
Ranya Elemam
Root Canal Obturation
9/12/2013

9. Recommendation by Literatures: 5
Debridement and obturation to the radiographic apex, results
in material being extruded into periradicular tissues. (Schilder
1974)
Schilder H. Filling root canals in three dimensions. Dental clinics of North America. 1967:723-44.
Ranya Elemam
Root Canal Obturation
9/12/2013

10. Ranya Elemam
Root Canal Obturation
9/12/2013

11. Anatomical Rational
Apical Anatomy
Ranya Elemam
Root Canal Obturation
9/12/2013

12. Apical Anatomy
Anatomical Apex
Radiographical apex
Ranya Elemam
Root Canal Obturation
9/12/2013

13. Anatomical Landmarks
1. Apical Construction AC (Minor Apical Diameter)
2. Cement dentinal Junction CDJ
3. Radiographic apex
Ranya Elemam
Root Canal Obturation
9/12/2013

14. AC: Apical Construction
ↄ May be more conceptual than real
ↄ Considered the part of the root canal with the smallest diameter.
ↄ The reference point clinicians use most often to terminate shaping, cleaning, and obturation
ↄ
present less than half the time, particularly when apical root resorption was a factors .
ↄ 0-2.5 mm from the apex and increases with age because of cementum deposition
ↄ believed to coincide with the cemento-dentinal junction (CDJ)
1. Buckley M, Spangberg LS: The prevalence and technical quality of endodontic treatment in an American subpopulation. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 79:92, 1995.
2. Castelli WA, Caffesse RG, Pameijer CH, Diaz-Perez R, Farquhar J: Periodontium response to a root canal condensing device (Endotec). Oral
Surg Oral Med Oral Pathol 71:333, 1991.
3. Levitan ME, Himel VT, Luckey JB: The effect of insertion rates on fill length and adaptation of a thermoplasticized gutta-percha technique. J
Endod 29:505, 2003.
1. Kuttler Y: Microscopic investigation of root apexes. J Am Dent Assoc 50:544, 1955.
Ranya Elemam
Root Canal Obturation
9/12/2013

15. Cement dentinal Junction (CDJ)
ↄ The point in the canal where cementum meets dentin and where pulp tissue
ends and periodontal tissues begin.
ↄ The location of the CDJ in the root canal varies considerably.
ↄ Estimate placed approximately 1 mm from the AF.
ↄ Based on histological section and ground specimen and cant located
precisely on radiograph
Lawley GR, Schindler WG, Walker WA, III, Kolodrubetz D: Evaluation of ultrasonically placed MTA and fracture
resistance with intracanal composite resin in a model of apexification. J Endod 30:167, 2004.
Machnick TK, Torabinejad M, Munoz CA, Shabahang S: Effect of MTAD on flexural strength and modulus of
elasticity of dentin. J Endod 29:747, 2003.
Ranya Elemam
Root Canal Obturation
9/12/2013

16. Radiographic Apex:
ↄ It is the tip of the root where as determined radioghraphicaly
ↄ location of the foramen not at the apex as deviations occurred in 92% of the roots.
ↄ Shaping to the radiographic apex is likely to produce over instrumentation with
potential clinical squeals of post treatment pain and inoculation of
microorganisms into periapical spaces.
Buchanan L: Continuous wave of condensation technique. Endod Prac 1:7, 1998.
El Ayouti A, Weiger R, Löst C: Frequency of overinstrumentation with an acceptable radiographic
working length. J Endod 27:49, 2001.
Ranya Elemam
Root Canal Obturation
9/12/2013

17. Thoughts: Imperfection !
Thought “ is out only .5-1
mm”
0.5-1 mm
http://www.endomail.com
Ranya Elemam
Root Canal Obturation
9/12/2013

18. .
Reality
Cohen KMHaS. Cohen's Pathways of
the Pulp 10th Edition ed: Mosby; 2011.
Ranya Elemam
Root Canal Obturation
9/12/2013

19. Reality
Cohen KMHaS. Cohen's Pathways of
the Pulp 10th Edition ed: Mosby; 2011.
Ranya Elemam
Root Canal Obturation
9/12/2013

20. This variable structure in the apical region presents
challenges for root canal therapy !
Ranya Elemam
Root Canal Obturation
9/12/2013

21. Pulpal And Periapical Condition ??

22. Pulpal Condition
1. Vital Pulpectomy: (Irreversible Pulpitis ) :
procedures terminate 2 to 3 mm short of the radiographic
apex.
2. Pulpal Necrosis:
procedures terminate at or within 2 mm of the radiographic
apex (0 to 2 mm).
Ranya Elemam
Root Canal Obturation
9/12/2013

23. Periapical Condition
1 mm
Ranya Elemam
1.5 mm
Root Canal Obturation
2 mm
9/12/2013

24. Other Considerations
Re-treatment
It is preferable to clean the canal to the AF in retreatment !
Wu MK, Wesselink PR, Walton RE. Apical terminus location of root canal treatment procedures. Oral surgery, oral
medicine, oral pathology, oral radiology, and endodontics. 2000;89(1):99-103.

25. Systemic considerations
There is no definitive evidence that introducing bacteria or antigens
from infected canals into the bloodstream causes systemic diseases, it
would seem prudent to avoid this situation when possible.
Debelian G, Olsen I, Tronstad L. Anaerobic bacteremia and fungemia in patients undergoing endodontic therapy: an
overview. Ann Periodontol 1998;3:281-7
Wu MK, Wesselink PR, Walton RE. Apical terminus location of root canal treatment procedures. Oral surgery, oral
medicine, oral pathology, oral radiology, and endodontics. 2000;89(1):99-103.

26. Obturation Length
And
Treatment Outcome
Ranya Elemam
Root Canal Obturation
9/12/2013

27. Obturation Length And Treatment Outcome
“ Length of root canal filling was found to influence the outcome
of the endodontic treatment.
The most successful outcomes were associated with teeth without
apical extrusion of the filling material .The overextension of filling
materials was combined with delayed healing “
Elemam RF, Pretty I. Comparison of the success rate of endodontic treatment and implant
treatment. ISRN dentistry. 2011;2011:640509.
Ranya Elemam
Root Canal Obturation
9/12/2013

28. The importance of length control in obturation relates to extrusion of
materials. Studies indicate that extrusion decreases the prognosis for
complete regeneration.
Swartz DB, Skidmore AE, Griffin JA, Jr: Twenty years of endodontic success and failure. J Endod 9:198, 1983.

29. Obturation Length And Treatment Outcome
When the therapeutic procedures shorter 2 mm from or past the
radiographic apex, the success rate for INFECTED CANALS
was approximately 20% lower than that when the procedures
terminated at 0 to 2 mm.
Ranya Elemam
Root Canal Obturation
9/12/2013

30. Obturation Length And Treatment Outcome
ↄ Periapical pathosis was found with 43% of the teeth with overfills.
ↄ An overfilling resulted in a failure rate of 37%. this was four times greater
than cases that filled short.
Buckley M, Spangberg LS. The prevalence and technical quality of endodontic treatment in an
American subpopulation. Oral surgery, oral medicine, oral pathology, oral radiology, and
endodontics. 1995;79(1):92-100.
Swartz DB, Skidmore AE, Griffin JA, Jr. Twenty years of endodontic success and failure. Journal
of endodontics. 1983;9(5):198-202.
Ranya Elemam
Root Canal Obturation
9/12/2013

31. Obturation Length And Treatment Outcome
ↄ Teeth with root canal fillings 0–2 mm from the root apex showed significantly
better periradicular conditions than teeth with either overfillings or underfillings
ↄ The success rate in group of teeth obturated from 0 to 1 mm short of the apex
was 28.9% better than group of teeth those obturated beyond the apex and 5.9%
better than group of teeth where they were obturated 1 to 3 mm short of the apex
Moreno JO, Alves FRF, Gonçalves LS, Martinez AM, Rôças IN, Siqueira Jr JF. Periradicular Status and Quality of Root
Canal Fillings and Coronal Restorations in an Urban Colombian Population. Journal of endodontics. 2013;39(5):600-4
Schaeffer MA, White RR, Walton RE. Determining the optimal obturation length: a meta-analysis of literature. Journal
of endodontics. 2005;31(4):271-4.
Ranya Elemam
Root Canal Obturation
9/12/2013

32. Obturation Length And Treatment Outcome
On the basis of biological and clinical principles, instrumentation and
obturation should not extend beyond the apical foramen.
Ricucci D, Langeland K. Apical limit of root canal instrumentation and obturation, part 2. A histological
study. Int Endod J. 1998;31(6):394-409.
Ranya Elemam
Root Canal Obturation
9/12/2013

33. Clinical determination of apical canal morphology
is difficult at best. !!!
Ranya Elemam
Root Canal Obturation
9/12/2013

34. Conclusions
The apical limit of instrumentation and obturation continues
to be the subject of major controversy in root canal therapy.
However ,the use of an apex locator in conjunction with
radiographs and sound clinical judgment makes this decision
more logical.
Cohen KMHaS. Cohen's Pathways of the Pulp 10th Edition ed: Mosby; 2011.
Ranya Elemam
Root Canal Obturation
9/12/2013

35. Remember:
A little short is better and more conducive to a
successful root canal procedure !!
Ranya Elemam
Root Canal Obturation
9/12/2013

36. Ranya Elemam
Root Canal Obturation
9/12/2013

37. Recommended Articles/books:
1. Schaeffer MA, White RR, Walton RE. Determining the optimal
obturation length: a meta-analysis of literature. Journal of
endodontics. 2005;31(4):271-4.
2. Wu MK, Wesselink PR, Walton RE. Apical terminus location of
root canal treatment procedures. Oral surgery, oral medicine,
oral pathology, oral radiology, and endodontics. 2000;89(1):99103.
3. Cohen KMHaS. Cohen's Pathways of the Pulp 10th Edition ed:
Mosby; 2011.
Ranya Elemam
Root Canal Obturation
9/12/2013

38. Ranya Elemam
Root Canal Obturation
9/12/2013

40. Question ?