obturation and obturating materials with latest advances

1. Obturation of
root canal system

2.  The American Association of Endodontist’s
Guide to Clinical Endodontics states that
“obturation of the root canal space involves the use of
biologically acceptable chemical and mechanical
treatment that can promote healing and repair of the
periradicular tissues. Root canal sealers are used in
conjunction with a biologically acceptable semi-solid
or solid obturating material to establish an adequate
seal of the root canal system.”

3. Objectives of obturating the root canal
 Elimination of all avenues of leakage
from the oral cavity or the
periradicular tissues into the root
canal system
 Sealing within the root canal system
of any irritants that remain after
appropriate cleaning and shaping,
thereby isolating these irritants.

4. EXTENSION OF THE ROOT CANAL FILLING
 The anatomic limits of the pulp space are the
dentinocemental junction apically, and the pulp chamber
coronally. Debate persists, however, as to the ideal apical
limit of the root canal filling.

5.  Root resorption is an additional factor in length
determination. Resorption is more common with
necrosis and apical bone resorption, and this can result
in loss of the constriction. On the basis of these findings
it appears that canals filled to the radiographic apex
reflect an overextension of the obturating material.
 Studies indicate that extrusion decrease the prognosis
for complete regeneration
 In another study of 1000 cases, investigators found that
overfilling resulted in a failure rate of 37%. This was
four times greater than for cases filled short.

6.  A study found that, in necrotic cases, better success was
achieved when the procedures terminated at or within 2
mm of the radiographic apex.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 89:99,
2000.
 Obturation shorter than 2 mm from the apex or past the
apex resulted in a 20% lower success rate. For vital
cases, termination between 2 and 3 mm was acceptable.
 Peak JD et al found that teeth obturated less than 2 mm
from the apex had a higher success rate when compared
with cases obturated more than 2 mm from the apex.
Br Dent J 190:140, 2001.

7. Timing of obturation
 Factors influencing the appropriate time to obturate a tooth include
1)The patient’s signs and symptoms
Tooth should be asymptomatic
Canal should be reasonably dry, with no “weeping” of fluids in the form of
bleeding or discharge of serous fluids
2)Status of the pulp and periradicular tissue
Vital Pulp Tissue
 At present the consensus is that one-step treatment procedures are
acceptable when the patient exhibits a completely or partially vital
pulp.
 Removal of the normal or inflamed pulp tissue and performance of the
procedure under aseptic conditions should result in a successful
outcome because of the relative absence of bacterial contamination.

8. Necrotic pulp tissue
 Patients who present with pulp necrosis with or
without asymptomatic periapical pathosis (chronic
apical periodontitis, chronic apical abscess,
condensing osteitis) may be treated in one visit,
based on the best available information.
 When patients present with acute symptoms caused
by pulp necrosis and acute periradicular abscess,
obturation is generally delayed until the patient is
asymptomatic.

9. 3) Degree of difficulty and patient management
 Procedural concerns also dictate the time of
obturation.
 Difficult cases may require more time for preparation
and can be managed more uneventfully in multiple
appointments. Patients may require multiple short
appointments because of medical conditions, their
psychologic state of mind, and fatigue.

10. Preparation for obturation
 During the cleaning and shaping process, organic pulpal
materials and inorganic dentinal debris accumulate on
the canal wall, producing an amorphous irregular smear
layer which is superficial, with a thickness of 1 to 5 μm.
 The smear layer is not a complete barrier to bacteria but
may act as a physical barrier, decreasing bacterial
penetration into tubules. This was illustrated by a study
demonstrating that Removal of the smear layer
permitted colonization of the dentinal tubules at a
significantly higher rate when compared with leaving the
smear layer in place.
JEndod 20:78, 1994.

11.  The smear layer may also interfere with
adhesion and penetration of sealers into
dentinal tubules. Evidence indicates that sealer
penetration into dentinal tubules does not occur
when the smear layer is present.
J Endod 10:558, 2004.
 The advantages and disadvantages of the smear
layer remain controversial; however, growing
evidence supports removal of the smear layer
before obturation.
J Endod 33:96,2007.

12.  Bacterial penetration in the presence of a smear layer
in canals obturated with thermoplasticized gutta-
percha and sealer has been shown to be significantly
higher than with smear layer removal before
obturation.
Proc Finn Dent Soc 88:215, 1992.
 An additional consideration is the presence of viable
bacteria that remain in the dentinal tubules and use
the smear layer for sustained growth and activity.

13.  The smear layer may also interfere with the
action of irrigants used as disinfectants.
Endod Dent Traumatol 6:142, 1990.
 When the smear layer is not removed, it may
slowly disintegrate and dissolve around leaking
obturation materials, or it may be removed by
bacterial by-products such as acids and enzymes.
Int Endod J 28:141, 1995.

14.  Method for removing the smear layer employs the use of a
mixture of a tetracycline isomer, an acid, and a detergent
(MTAD) (BioPure; DENTSPLY Tulsa Dental Specialties, Tulsa,
OK) as a final rinse to remove the smear layer.
Endod 29:233, 2003.
 MTAD removed most of the smear layer; however, some
organic components of the smear layer remained on the
surface of the root canal walls.
 The effectiveness of MTAD in completely removing the
smear layer was enhanced when low concentrations of
NaOCl were used as an intracanal irrigant before the use of
MTAD as the final rinse.

15.  Another study showed that MTAD was effective in
killing Enterococcus faecalis at 200-fold dilution,
which was more potent than NaOCl because it ceased
being active when diluted 32-fold.
J Endod 29:400, 2003
 Another method for removal of the smear layer is
generally accomplished by irrigating the canal with 17%
disodium EDTA and 5.25% NaOCl
 EDTA had no antimicrobial activity.

16.  Chelators remove the inorganic components,
leaving the organic tissue elements intact. NaOCl is
necessary for removal of the remaining organic
components.
 Fifty percent citric acid has also been shown to be
an effective method for removing the smear layer.

17. Components of root canal filling
 Core material
 Root canal sealer

18. Requirements for an ideal root canal
filling material - by Grossman
 Easily introduced into the root canal
 Should seal the canal laterally as well as apically
 Should not shrink after being inserted
 Impervious to moisture
 Bactericidal, or at least, discourage growth of microbes
 Radiopaque
 Not stain tooth structure
 Not irritate periradicular tissue or affect tooth structure
 Sterile, or easily and quickly sterilized immediately before
insertion
 Easily removable from the canal if necessary

19. Silver cone
 Jasper introduced cones made of silver, which he claimed produced the
same success rate as gutta-percha and were easier to use.
 The rigidity provided by the silver cones made them easy to place and
permitted more predictable length control; however, their inability to fill
the irregularly shaped root canal system permitted leakage . When silver
points contact tissue fluids or saliva, they corrode.
 The corrosion products have been found to be cytotoxic and produced
pathosis or impeded periapical healing.

20.  With the introduction of rigid silver cones it
became possible to easily place them to length.
This resulted in clinicians often failing to properly
clean and shape the canal before obturation.
 Treatment failures were the result of leakage and
failure to remove the irritants from the root canal
system. The use of silver cones today is considered
to be below the standard of care in contemporary
endodontic practice.

21. Gutta-Percha
 Currently most widely used filling material
 Introduced by Bowman in 1867
 Composition of gutta percha cones vary with each
manufacturer. Approximately,
 20% gutta percha (matrix)
 65% zinc oxide (filler)
 10% heavy metal sulphates (radiopacifier)
 5% waxes or resins (plasticizer)

22.  Gutta percha is a trans isomer of polyisoprene
 Exists in two phases: α and β
 In solid state, material is in β phase and does not shrink
 On heating, it changes to α phase which is tacky and
flowable under pressure. It shrinks as it sets into a solid
mass.
 The solid mass α phase gutta percha melts at a
temperature above 65 C and turns into β phase on slow
cooling. This has less shrinkage and is more
dimensionally stable than when the β phase is heated.
 α phase gutta percha is used in thermoplastic
techniques
 β phase is used in lateral condensation techniques.

23.  Gutta-percha points also become brittle as
they age, probably through oxidation.
Storage under artificial light also speeds
their rate of deterioration.
 On the other hand, they can be
rejuvenated somewhat by alternate
heating and cooling.

24. Availability of GP cones
 Available in conventional and standardized sizes.
 Conventional sizes include : extra fine, fine fine, fine,
medium fine, fine medium, medium, large, extra
large.
 Standardized sizes are designed to match the size and
taper of corrosponding SS or NiTi instruments.
 Prior to use, sterilize by placing in 5.25% NaOCl for 1
minute.

25. Activ GP
 Activ GP (Brasseler USA) consists of gutta-percha cones
impregnated on the external surface with glass ionomer.
 Single cones are used with a glass ionomer sealer.
 Available in .04 and .06 tapered cones, the sizes are
laser verified to ensure a more precise fit.
 The single cone technique is designed to provide a bond
between the dentinal canal wall and the master cone.
 A bacterial leakage study comparing Activ GP/glass
ionomer sealer, Resilon/Epiphany, and gutta-percha/ AH
Plus demonstrated no statistically significant differences
in leakage at 65 days.
J Endod 34:725,2008

26. Resilon
 Polycaprolactone core material with difunctional
methacrylate resin, bioactive glass, bismuth and barium
salts as fillers, and pigments.
 Used with a resin sealer.
 Can be used with lateral compaction, warm vertical
compaction, or thermoplastic injection techniques.
 Available in ISO sized points and pellets.
 Requires 150 C temperature for thermoplasticized
technique.
 Biodegradation of Resilon by bacterial and salivary
enzymes need further investigation before
recommending it as an alternative to GP.

27. ROOT CANAL SEALERS
Requirements for an ideal root canal sealer – by Grossman
 Provide an excellent seal when set
 Produce adequate adhesion with canal walls and filling
material
 Be radiopaque
 Nonstaining
 Dimensionally stable
 Easily mixed and introduced into the canal
 Easily removed if necessary
 Insoluble in body fluids
 Bactericidal or discourage bacterial growth
 Non irritating to periradicular tissues
 Be slow setting to ensure sufficient working time

28. Classification of Sealers
 Broadly classified according to their
composition
1. Eugenol
2. Non eugenol
3. Medicated

31. 1.Zinc Oxide Eugenol Sealers
 This sealer cement displays antimicrobial activity and will be absorbed if
extruded into the periradicular tissues.
 They however exhibit a slow setting time, shrinkage on setting, are
soluble and can stain tooth structure.
Brands Available
 Earlier formulations stain teeth.
 Include:
1. Pulp Canal Sealer (SybronEndo) and Pulp Canal Sealer EWT (extended working time):
Introduced by Rickert and Dixon.
2. Procosol (Procosol, Inc., Philadelphia, PA): modification of Rickert’s formula in which the
silver particles have been removed (zinc oxide, hydrogenated resin, bismuth subcarbonate
and barium sulfate; liquid eugenol).

32.  Grossman developed a non staining cement that meets most of the requirements
of a root canal sealer
Powder Parts
 Zinc oxide, 42
 Staybelite resin 27
 Bismuth subcarbonate 15
 Barium sulphate 15
 Sodium borate, anhydrous 1
Liquid : Eugenol
 Grossman’s cement hardens in approx. 2 hours at 37 C and 100% relative humidity.
In root canal, it sets in 10-30 min due to presence of moisture in dentin
 Tissue tolerance of this sealer is satisfactory with little inflammation and no
inhibition of repair.

33.  Formulation used in:
1. Roth’s Sealer (Roth International).
2. Tubli-Seal (SybronEndo).
3. Wach’s sealer (Balas Dental, Chicago, IL).

34. 2.Calcium Hydroxide Cement
 Zinc oxide eugenol cements modified by incorporating calcium hydroxide.
 Developed for their antimicrobial and osteogenic-cementogenic potential;
but these actions have not been demonstrated clinically.

35.  Sealapex (SybronEndo): Non eugenol, calcium hydroxide-resin root canal
sealer available in base-catalyst system
 Base contains – zinc oxide, calcium hydroxide, butyl benzene,
sulfonamide, and zinc stearate
 Catalyst contains – resin, isobutyl salicylate, barium sulphate, titanium
dioxide, and aerosol
 CRCS (calcibiotic root canal sealer) : zinc oxide type cement containing
calcium hydroxide. Set CRCS contains 14% by weight of calcium hydroxide

36. Apexit and Apexit Plus (Ivoclar Vivadent, Schaan,
Liechtenstein): consist of an activator (disalicylate,
bismuthhydroxide/bismuth carbonate, and fillers) and a
base (calcium hydroxide, hydrated colophonium, and
fillers).
Noneugenol Sealers
 3. Nogenol
 Developed from a periodontal dressing, Nogenol (GC America, Alsip, IL) is a
root canal sealer without the irritating effects of eugenol. The base
contains zinc oxide, barium sulfate, and bismuth oxychloride. Settig of
sealer is accelerated by hydrogenated rosin, chlorothymol and salicylic
acid.

37. 4.Glass Ionomer Sealer
 Glass ionomers have been advocated as root canal sealers for their dentin-
bonding ability
Brands Available
i. Ketac-Endo (3M ESPE, Minneapolis, MN)
 Enables adhesion between the material and the canal wall.
 Has minimal antimicrobial activity.
 Limitations- Difficult to remove the sealer from root canal walls during
retreatment; solvants are ineffective against them

38.  Activ GP (Brasseler USA, Savannah,
GA) glass ionomer–coated gutta-
percha points and sealer.

39.  A bacterial leakage study comparing Activ GP/glass
ionomer sealer, Resilon/Epiphany, and gutta-percha
(GP)/AH Plus demonstrated no statistically significant
differences at 65 days.
J Endod 34:725, 2008

40. 5.Medicated Sealers
 Basic ingredient is zinc oxide
 But usually they contain other contraindicated ingredients, like
paraformaldehyde
 N2 and RC2B contains 6.5% paraformaldehyde and lead
 Paraformaldehyde is highly irritating to tissues
 Lead is toxic to humans
 Endomethasone contains corticosteroid. These reduce postoperative
pain.
 Use of medicated sealer is clinically not recommended

41. 6. RESIN SEALERS
 Resin sealers have a long history of use, provide adhesion, and do not
contain eugenol.
Brands Available
i. AH Plus is an epoxy-bis-phenol resin that comes in two tubes.
 It exhibits a working time of approximately 4 hours.
AH Plus sealer is a resin formulation. (Courtesy DENTSPLY,
Konstanz, Germany)

42. ii. EndoREZ (Ultradent Products, South Jordon, UT) is a methacrylate resin
with hydrophilic properties.
When used with EndoREZ resin-coated gutta-percha cones the dual cure
EndoREZ sealer bonds to both the canal walls and the core material.
iii. Diaket, a polyvinyl resin (3M ESPE), consists of a powder composed of
bismuth phosphate and zinc oxide and a liquid consisting of dichlorophen,
triethanolamine, propionylacetophenone, and copolymers of vinyl
acetate, vinyl chloride, and vinylisobutyl ether. The material appears to
be biocompatible.

43. Brands Available
iv. Other resin-based sealers, Epiphany (Pentron Clinical Technologies,
Wallingford, CT) and RealSeal (SybronEndo), have been introduced for
use with a new core material, Resilon (Pentron Clinical Technologies).
 Advocates of these sealers propose that they bond to the canal wall
and to the core material to create a “monoblock”.

44. Monoblock Concept
 It means the creation of solid, bonded, continuous material from one
dentin wall of canal to other. Monoblock phenomenon strenthen the root
by 20%.
 Classification( Based on number of interfaces present
between core filling material and bonding substrate)
 Primary: In this obturation is done with core material for example use of
MTA for obturation in case of apexification.
 Secondary monobloock: Here bond formes between etched dentin of
canal wall impregnated with resin tags which are attached to resin cement
that is bonded to core layer e.g. resilon based system.

45.  Tertiary monoblock: In this conventional GP is coated
with resin which bond with the sealer which further
bonds to canal walls.
 For ex: Endorez and activ GP system

46. Types of Sealers
7. SILICONE SEALERS
Brands Available
i. RoekoSeal (Coltène/Whaledent, Germany) is a
polyvinylsiloxane that has been reported to expand
slightly on setting.

47. ii. GuttaFlow (Coltène/Whaledent) is a cold flowable
matrix that is triturated.
It consists of gutta-percha added to
RoekoSeal.
The material is provided in capsules
for trituration.
The technique involves injection of
the material into the canal, followed
by placement of a single master
cone.

48. GuttaFlow trituration capsule and injection syringe
(Coltène/Whaledent, Cuyahoga Falls, OH).

49. Working time:15 minutes, Setting time: 25
to 30 minutes.
Fills canal irregularities with consistency
and is biocompatible, but the setting time
is inconsistent and may be delayed by final
irrigation with sodium hypochlorite.
Sealing ability appears comparable to other
techniques in some studies and inferior in
others.

50. MTA based sealer
• MTA fillapex is a mineral trioxide aggregate-based,
salicylate resin root canal sealer.
• It is designed to provide a high flow rate and a low film
thickness for easy penetration of lateral and accessory
canals.
• It contains 13% MTA and salicylate resin for their
antimicrobial and biocompatibility properties. The
working time is 23 minutes with a complete set time is
approximately 2 hours.
• MTA Fillapex is a two-paste system and is provided in a
4 g automix syringe and 30 g tubes

51. INDICATION: MTA Fillapex is indicated for filling root canals
of permanent teeth. It can be inserted with the gutta-
percha points or with Lentulo drills. It can also be used
with thermal condensation techniques (heated gutta
percha) because the boiling point of MTA Fillapex is 150°C.
CONTRAINDICATION
In patients with hypersensitivity against the resins or other
components of the product. In perforations, resorption
sites and apical plugs (these cases must be filled with MTA
Reparative Cement (Angelus MTA)).

52. Bioceramic sealer
 In 2007, a Canadian research and product development
company (Innovative BioCeramix, Inc., Vancouver,
Canada), developed a premixed, ready-to-use calcium
silicate based material, iRoot® SP injectable root canal
sealer (iRoot® SP).
 Since 2008, these products have also been available as
EndoSequence® BC Sealer™, Recently, these materials
have also been marketed as Totalfill® BC
Sealer™(Brasseler USA Dental LLC)

53.  Bioceramic (BC) sealer is composed of zirconium
oxide,calcium silicates, calcium phosphate
monobasic, calcium hydroxide, and various filling
and thickening agents.
 The material is available in a premixed syringe with
calibrated intracanal tips.
 As a hydrophilic sealer it utilizes moisture within the
canal to complete the setting reaction and it does
not shrink on setting.
 It is biocompatible and exhibits antimicrobial
properties during the setting reaction. The
manufacturer advocates expressing the sealer into
the coronal one third to one half of the canal and

54.  BC materials have a pH of 12.7 while setting, similar to calcium hydroxide,
resulting in antibacterial effects.
 BC Sealer was shown to exhibit a significantly higher pH than AH Plus for a longer
duration.
J Endod. 2013;39(10):1281-1286.
 Alkaline pH promotes elimination of bacteria such as E. faecalis.
 . Lovato KF et al performed in vitro study and reported EndoSequence Paste
produced a lower pH than white MTA in simulated root resorption defects,and
EndoSequence Paste, Putty, and MTA had similar antibacterial efficacy against
clinical strains of E. faecalis.
J Endod. 2011 Nov;37(11):1542-1546.

55.  Bioactivity
 An in vitro study on the effects of iRoot SP root canal sealer suggested that
iRoot SP is a favorable material for cellular interaction.
J Endod. 2010;36(12):1978-1982.
 Exposure of MTA and EndoSequence Putty to phosphate-buffered saline (PBS)
resulted in precipitation of apatite crystalline structures that increased over
time, suggesting that the materials are bioactive.
Int Endod J. 2012 Dec;45(12):1127-1134
 Human dental pulp cells exhibited optimal proliferation and mineralization
on the surface of iRoot BP Plus.
Int Endod J. 2013;46(10):923-929

56.  iRoot SP exhibited significantly lower cytotoxicity and a higher level of cell
attachment than MTA Fillapex, a salicylate resin-based, MTA particles containing
root canal sealer .
J Appl Oral Sci. 2013;21(4):351-357.
 EndoSequence Sealer had higher pH and greater Ca2+ release than AH Plus30 and
was shown to release fewer calcium ions than BioDentine® (Septodont) and
White MTA.
Int Endod J. 2013;46(9):808-814
 Güven EP et al reported that MTA may provide more inductive potential and hard
tissue deposition than iRoot SP.
Int Endod J. 2013;46(12):1173-1182.

57. Recent Endodontic Sealers
ProRoot Endo Sealer:
It is a calcium silicate-based root canal sealer that is
designed to be used in conjunction with a root filling
material in either the cold lateral, warm vertical or
carrier-based filling techniques. The major components of
the powder component are tricalcium silicate and
dicalcium silicate, with the inclusion of calcium sulphate
as a setting retardant, bismuth oxide as a radiopacifier
and a small amount of tricalcium aluminate.
The liquid component consists of a viscous aqueous
solution of a water soluble polymer. Similar to other
tricalcium silicate and dicalcium silicate-containing
biomaterials, the sealer produces calcium hydroxide on
reaction with water .
{Int Endod J. 2009; 42: 34-46. doi: 10.1111/j.1365-
2591.2008.01490.x }

58. Herbal Sealer (Biosealer)
 It is a root canal sealer based on Copaifera multijuga oil-
resin.
 Trees belonging to the genus Copaifera are distributed
around northern South America, mainly in the Amazon
Rainforest.
 It is one of the most popular and promising phytomedicines
used in Brazil. The powder is composed of zinc oxide,
calcium hydroxide, bismuth subcarbonate, natural resin
(rosin) and borax, and the liquid is purified Copaifera
multijuga oil-resin
 (Int Endod J. 2010; 43: 283-291. doi: 10.1111/j.1365-
2591.2009.01678.x )

59. Nanoseal plus root canal
sealer
 A common cause of failure of root canal treatment is due to
the inability to seal the accessory canal in most cases.
 One of the newest update in endodontics is the
development of the first endodontic sealer based on
nanotechnology which actively seals the tiny gaps thereby
reducing the infection.
 It is made up of calcium phosphate hydroxyapitite
nanoparticles range from 40-60 nm. The rod shaped active
nanoparticles can penetrate the dentinal tubules & enter
accessory canals to ensure that all the spaces are effectively
sealed (Prezi.com/Nanotechnology-in-endodontics. )

60. Hybrid root seal
 It is a commercially available fourth generation
self-adhesive dual-cure sealer, available in the
powder-liquid form. It is an insoluble,
radiopaque material that can be used either
with resilon or Gutta-percha.
 The liquid comprises of 4- META,
monofunctional methacrylate monomers and
photo-initiators, while the powder consists of a
mixture of zirconia oxide filler, silicon dioxide
filler and polymerization initiators. 4-META is
able to promote monomer diffusion into the
acid-conditioned and underlying intact dentin
and produces functional hybridized dentin with
polymerization (24, 25).

61.  The formation of the hybrid dentin
is the major mechanism of bonding
and also the high quality hybridized
dentin resists acidic challenges (26).
However, polymerization shrinkage
is inherent to methacrlyate resin-
based sealers that tend to produce
debonding at the resin-dentin
interface.

62. Gutta flow 2 sealer
 This is a modification of the original Gutta flow sealer
which was available in the cartridge form. The excellent
flow of this material made it the sealer of choice.
 However, the larger armamentarium required was a
drawback. Of late, Gutta Flow 2 has been introduced
which is available in the syringe form and has an
excellent property of slight expansion after mixing which
helps in better sealing.

63. Sealer placement
 A study compared sealer placement with a K-type file, the lentulo spiral, and
using the master cone in curved canals.
 Results demonstrated no significant differences in the techniques after
obturation; no technique covered more than 62.5% of the canal wall surface.
JEndod 22:638, 1996.
 Other investigators found that ultrasonics produced the best sealer distribution
when used circumferentially.
Br Dent J 190:140,2001.

64. OBTURATION TECHNIQUES
 Cold lateral compaction
 Warm vertical compaction
 Warm lateral compaction
 Continuous wave compaction
 McSpadden thermomechanical compaction
 Thermoplasticized gutta percha insertion
 Carrier based gutta percha
 Chemically plasticized gutta percha
 Custom cone technique

65. Cold Lateral Condensation Technique
The fit of the master cone is checked using
radiograph and “tug-back” is checked
Canal dried and apical half of master cone
coated with sealer is placed in the canal
Finger spreader placed along it, 1mm
short of WL, and laterally compacted
Accessory cone inserted in space created
by spreader
Process repeated till spreader cannot be
reinserted

66.  Butt end of the GP: cut off with heated instrument
 Warm vertical compaction: coronal GP
 Chamber cleaned
 Restoration placed

67. Advantages
Limitations
 Presence of voids in between the filling
 Incresed sealer:gutta percha ratio
 Inferior seal as compared to warm compaction
technique
However, it is one of the most traditional and
commonly practiced obturation techniques
• “ Deep spreader penetration”: minimize apical
leakage/ percolation
• Positive dimensional stability of the root canal
filling
• Less likelihood of carrying filling material beyond
the root apex
JOE—Volume 32, Number 4, April
2006
Endodontic Topics 2005, 12, 2–24

68. Warm Lateral Compaction Technique
 Lateral compaction provides for length control, which is an advantage
over thermoplastic techniques.
 Endotec II, Endo Twinn, EI DownPak device is used in warm lateral
compaction.

69. Adapt master cone in the same manner
as with lateral compaction. Appropriate
size Endotec II tip is selected
Device is activated. Tip is inserted beside
the master cone to within 2 to 4 mm of
the apex using light pressure
Tip is rotated for 5-8 secs and removed
Unheated spreader is placed in the
channel created to ensure adaptation,
and accessory cone is placed
Process is continued until the canal is
filled

70.  Martin H et al compared the stress generated with lateral compaction and warm
lateral compaction, using the Endotec, and found that the warm lateral
compaction technique created less stress during obturation.
Oral Surg Oral Med Oral Pathol 70:325, 1990.

71. Warm Vertical Condensation Method
 Introduced by Schilder
Fit of master cone checked, canal wall coated
with sealer and the master cone placed in the
canal
Coronal end of the cone is cut with a heated
instrument
Heated instrument or electric heat carrier
(System B, Touch n Heat) is forced into the
coronal third of GP
Condenser or plugger of suitable size is
used to apply vertical pressure to heated
GP
Repeat till plasticized GP fills the canal
three dimensionally

73. Advantages :
1. Excellent seal of the canal apically and laterally
2. Obturation of larger lateral and accessory canals
Disadvantages :
1. More time consuming
2. Risk of vertical fracture due to undue force
3. Periodic overfilling with GP or cement
4. difficult in curved canals, where the rigid pluggers are
unable to penetrate to the necessary depth. To allow
the rigid carriers to penetrate within 4 to 5 mm of the
apex, the canals must be enlarged and tapered more, in
comparison with the lateral compaction technique;
however, excessive removal of tooth structure weakens
the root.

74.  A study compared root surface temperatures for warm vertical
obturation using the System B heat source, the Touch ’n Heat device,
and a flame-heated carrier in maxillary and mandibular incisors and
premolars 2 mm below the cementoenamel junction.
 System B and the Touch ’n Heat produced a surface temperature rise
that was less than 10° C for all maxillary incisors and premolar teeth.
The Touch ’n Heat produced a greater than 10° C rise in mandibular
incisors. The flame-heated carrier produced temperature changes
greater than 10° C in all experimental teeth.
 Because the critical level of root surface heat required to produce
irreversible bone damage is believed to be greater than 10° C the
findings suggest that warm vertical compaction with the System B
should not damage supporting periodontal structures; however,
caution should be exercised with the Touch ’n Heat and flame-heated

75. Continuous Wave Compaction Technique
 Variation of warm vertical compaction technique.
 The Continuous Wave Compaction Technique employs an
electric heat carrier , the system B unit and tapered
pluggers #.04, .06, #.08, #.10, and #.12 with a tip diameter
similar to tapered GP points.
 Electric heat source permits a variable temperature setting.
The recommended temperature setting for system B unit is
200 C.

76. Master cone
selected &
plugger prefitted:
5-7mm from WL
System set in
Touch mode:
200oC
Cold plugger
initillay placed
against GP with
firm pressure and
heat is activated
with the device.

77. Plugger rapidly
moved: 1-2 sec
within 3mm of
binding point
Heat inactivated;
firm pressure
maintained: 5-
10 sec
Cooled; 1 sec
heat application
separates
plugger

78. ppdentistry.com

79. ppdentistry.com

80. ppdentistry.com

81. McSpadden Thermomechanical
Compaction Method
 Introduced by McSpadden
 Uses heat created by rotating a compacting instrument in a slow-speed
contra-angle handpiece at 8000-10000 RPM alongside GP cones inside the
root canal.
 Compactor with spiraled 90 degrees are similar to flutes on H-files, but in
reverse, forces the softened GP apically and laterally.
 Should be used to fill straight canals as the compactor blade breaks if it
binds.

82. Canal should be enlarged to al least size
#45 instruments
Compactor blade selected according to
width and length of prepared canal
GP cone is inserted into prepared canal and
compactor placed between GP and canal
wall up to 3-4 mm from prepared length
Handpiece activated, GP is heated by
friction of rotating bur. Rotating tip is
guided to within 1.5mm of root apex
Reversed flutes on the compactor push the
softened GP laterally and apically

83.  Advantages :
1. Ease of selection and insertion of GP cones
2. Economy of time
3. Rapid filling of canals apically and laterally, including irregular spaces
within the canal
 Disadvantages :
1. Inability to use it in narrow canals
2. Frequent breakage of compactor blades
3. Frequent overfilling of the canal
4. Shrinkage of cooled, set filling

84. Thermoplasticized Injection Technique
 The technique comprises a pressure apparatus consisting of an insulated
electrically heated syringe barrel and a selection of needles ranging 18 – 25
gauge size
 Plunger is designed to prevent the backflow of GP
 The Obtura III,Calamus, Elements,HotShot, and Ultrafil 3D are available
devices
 Obtura III It heats gutta percha to 200 C & Ultrafil 3D system employs a low-
temperature gutta-percha that is heated to 90° C.

85.  Obtura III
 The Obtura III system (Obtura Spartan, Earth City, MO) consists of a hand-
held “gun” that contains a chamber surrounded by a heating element into
which pellets of gutta-percha are loaded.
 Silver needles (varying gauges of 20, 23, and 25) are attached to deliver the
thermoplasticized material to the canal.
 The control unit allows the operator to adjust the temperature and thus the
viscosity of the gutta-percha.
 At 6 mm from the apex a study found that the highest internal temperature
with the Obtura III was 27° C.

86. Suitable gauge needle is selected to be
placed at 3-5mm short of WL
Gutta percha pellet is loaded in a
chamber surrounded by heating element
Electrically heated gutta percha is
gradually injected by a hand held gun
The needle is withdrawn as the canal gets
filled apically
GP is then compacted using pluggers

87. Obtura III unit with silver tips, gutta-percha plugs, and
cleaning solution (Obtura Spartan, Earth City, MO).

88.  For this technique, the canal preparation should be tapered and restricted
apically to prevent the extrusion of gutta percha
 Appropriate vertical pressure should be combined with this technique,
otherwise the interface seal between the gutta percha and the canal wall
is weakened and voids occur in the final filling

89.  A study compared lateral compaction with Thermafil
(DENTSPLY Tulsa Dental Specialties) and Obtura in root
canal models and found that the Obtura produced the best
adaptation to the canal walls.
J Endod 23:703, 1997.
 Other investigators found that continuous wave obturation
with the Obtura backfill initially produced a better bacterial
seal when compared with lateral compaction, using
bilaterally matched teeth and an anaerobic bacterial
leakage model.
Endod Dent Traumatol8:206, 1992.

90. Ultrafil 3D
 Ultrafil 3D (Coltène/Whaledent) is a thermoplastic guttapercha injection
technique involving gutta-percha cannulas, a heating unit, and an injection
syringe.
 The system employs three types of gutta-percha cannulas. The Regular Set
is a low-viscosity material that requires 30 minutes to set. The Firm Set is
also a low-viscosity material but differs in that it sets in 4 minutes.
 The manufacturer recommends compaction after the initial set with both
materials. Endoset has a higher viscosity and does not flow as well. It is
recommended for techniques employing compaction and sets in 2 minutes.

91. The Ultrafil 3D system consists of an injection
syringe,
gutta-percha cannulas, and heating unit

92. Calamus
 The Calamus flow obturation delivery system (DENTSPLY Tulsa Dental
Specialties) is a thermoplastic device equipped.
 with a cartridge system with 20- and 23-gauge needles. The unit permits
control of temperature and also the flow rate. Pluggers are also available
for use with the system.
 The 360 degree activation switch allows great tactile sensation during use.

93. The Calamus thermoplastic unit (DENTSPLY Tulsa Dental
Specialties, Tulsa, OK) for heating and injecting gutta-percha.

94. Elements
 The Elements obturation unit (SybronEndo) consists of a
System B heat source and plugger as well as a handpiece
extruder for delivering thermoplastic gutta-percha or
RealSeal from a disposable cartridge.
 The cartridges come with 20-, 23-, and 25-gauge
needles for gutta-percha and 20- and 23-gauges for
RealSeal.

95. The Elements obturation unit (SybronEndo, Orange, CA)
for injecting and compacting gutta-percha. Note the System B heat
source.

96. Carrier-Based Gutta-Percha Techniques
 Thermafil and Simplifil are examples of carrier based obturation
technique
 Thermafil comprises of a plastic core carrier coated with α phase gutta
percha
 They are available in ISO standardized sizes as well as variable tapered
sizes suitable for NiTi instruments.
 These are used with a heating device known as Thermaprep plus Oven.

97.  As with all techniques, a sealer is required. Grossman
formulation sealers and resin sealers consistent with AH-
26 and AH Plus are acceptable; however, Tubli-Seal and
Wach’s paste are not recommended.
 Removal of the smear layer is strongly recommended and
has been shown to enhance the seal with Thermafil After
drying the canal a light coat of sealer is applied.

98. After preparation, size of canal is assessed
with a thermafil verifier . It helps in
selecting appropriate obturator
Canal dried, coated with sealer
Stopper of carrier is adjusted to WL and
carrier is loaded into Thermaprep plus Oven
for 10 seconds
Carrier is then inserted into the canal till
WL with a firm apical pressure without
rotating
Position of carrier verified radiographically,
allowed to cool for 2-4 min before
resecting the carrier at canal orifice

99. Thermafil carrier and size verifier
Thermafil oven with carrier in place
Thermafil carrier placed in the distal canal.

100.  Pro-Post drills (DENTSPLY Tulsa Dental Specialties)
are recommended if post space is required for
restoration of the tooth. The unique eccentric
cutting tip keeps the instrument centered in the
canal while friction softens and removes the
guttapercha and plastic carrier.
 When retreatment is necessary the plastic carrier
has a groove along its length to provide an access
point for placement of a file.

101.  Chloroform and hand files can be
used to remove the gutta-percha
surrounding the carrier. Rotary #.04
and #.06 nickel–titanium files may
also be used to remove the
obturation materials.
 Retreatment rotary nickel–titanium
files are available in three different
sizes to facilitate removal of

102.  Simplifil is a carrier based sectional gutta percha obturation system used
with light speed rotary instruments.
 Simplifil has an apical 5mm plug of gutta percha which performs cold
sectional obturation of root canal

103. Carrier size is chosen according to master
apical file
Canal is dried and sealant is applied
Carrier is introduced upto WL
Handle of carrier is rotated quickly in
counterclockwise direction 3-4 times to
disengage the apical GP plug
Remaining coronal space is filled with
lateral compaction or thermoplasticized
gutta percha methods

104. SimpliFill carrier and LightSpeed file
SimpliFill fitted to 1 to 3 mm from the
prepared length.

105. Chemically Plasticized Gutta Percha
Technique
 Gutta percha is plasticized by chemical sovants such as chloroform
(Chloropercha), eucalyptol (Eucapercha), or xylol
 Disadvantage : inability to control overfilling, with resultant periapical
tissue reaction and shrinkage of filling after setting, resulting in poor
apical and lateral seal
 No longer recommended

106. Custom Cone Technique
 Chair side procedure for customizing gutta percha in wide canals where
traditional master cone cannot be adapted
 Gutta percha is customized to achieve a “tug back”

107. Soften appropriate size gutta percha with
accessory cones with the help of heat and
roll together between two glass slabs
Single master cone of increased diameter is
created
Soften the tip of this cone with chemical
solvants for few seconds and insert it to the
WL
On removal, gutta percha will carry the
impression of canal
Repeat process till snug fit is achieved and
ensure GP remains semi-rigid during this
process

108. Immediate Obturation
 Immature teeth exhibiting pulp necrosis or teeth with apical resorption
traditionally were treated with calcium hydroxide to establish an apical barrier
(apexification) before obturation.
 Studies have demonstrated that teeth treated with calcium hydroxide for
prolonged periods are more susceptible to fracture. Immediate obturation is an
alternative to apexification.

109.  An apical barrier material should confine obturation
materials to the canal space and enhance healing by
inducing cementum and bone formation.
 Mineral trioxide aggregate (MTA) (ProRoot MTA;
DENTSPLY Tulsa Dental Specialties) has been successfully
employed as an apical barrier material before
obturation.

110. ADVANCES IN
OBTURATION

111. Smart Seal System
 This product is considered to exhibit smart behavior and
incorporates developments in hydrophilic polymer
plastics.
 Smartseal is a two-part system consisting of:
 1. Propoint
 2. Smartpaste/Smartpaste Bio
 Propoint: Also known as C points, these obturation
points are constructed in two parts:
 Central Core: It consists of a combination of two
proprietary nylon polymers, Trogamid T and Trogamid CX.
It is considered to provide the point with the flexibility
to allow it to easily pass around any curves in the

112. Outer Polymer Layer: It consists of a cross-linked
copolymer of acrylonitrile and vinylpyrrolidone,
which has been cross-linked using allyl
methacrylate and a thermal initiator.
This hydrophilic, hydrogel layer allows the point
to swell in order to adapt to the ramifications of
the root canal. This coating is designed to swell
laterally, thereby self-sealing the canal. It does
not swell axially so there is no length change and
radial swelling stops once a seal is created.

113. Mechanism of Controlled
Expansion The hydrophilic nature of propoints may allow the minute amount of water
present in the root canal to be absorbed by the points. This water can
hydrogen bond to the polar sites present, enabling expansion within the
polymeric chains.
 The rate and extent of this expansion is controlled as part of the
manufacturing process. The expansion occurs with a miniscule force that is
claimed to be well below the reported tensile stress of dentine and a
fraction of the force generated when using traditional techniques such as
warm vertical compaction.

114.  This gentle expansion occurs within the first 4 hours
after placing the point into the canal and allows the
point to gently adapt to any irregularities in the root
canal.
 This results in the polymer and sealer being expressed
into the dentinal tubules. The slight positive pressure
against the canal wall that is created forms a seal that is
believed to be virtually impermeable to bacterial micro-
leakage.
Smartseal DRFP Limited 2012

115. Conclusion
 The clinical success of endodontic therapy depends on proper diagnosis, access
preparation, complete chemo mechanical preparation and three dimensional
obturation of the root canal space.
 However complete obliteration of the root canal space from canal orifice to
apical constriction has been shown to be very critical to achieve success.
 The difficulties involved in totally obliterating the root canal space has led to
innovations of variety of techniques and filling materials.Gutta percha and
biocompatible sealer cement, used with cold lateral condensation method,
although not ideal, is at present the most universally accepted means to
obturate the root canal space.(Dummer 1991)1 .

116.  This root filling method is not without its drawbacks. It
produces a root filling that is not a homogeneous mass of
gutta percha but rather a number of separate cones tightly
pressed together and held with a root canal sealer.
 This technique is relatively time consuming, causes vertical
root fracture,irregularities in taper and morphology,
encourage voids or pooling of sealer(Brayton et al 1973)2
and micro leakage between individual gutta percha cones
and the canal walls contribute to failure.(Kerkes K, Tronstad
L 1979)3.

117.  Currently to achieve complete obliteration of the root canal space and to
achieve optimum results, newer methods are introduced for eg ultrasonically
energized spreaders are used as aids for lateral condensation of gutta percha
cones.
 Ultrasonic spreaders vibrate linearly and produce heat, thus thermoplasticizing
the gutta percha, achieve a more homogeneous mass with decrease in number
and size of voids and hence produce a complete three-dimensional obturation of
the root canal system.