Advances in obturation system in endodontics /certified fixed orthodontic courses by Indian dental academy

Advances in obturation system
in Endodontics

INDIAN DENTAL ACADEMY
Leader in Continuing Dental Education

www.indiandentalacademy.com

contents
Introduction

Definition

History of obturation

Requirements of obturation materials

Classification of obturation materials

Various obturation techniques

Advances in obturation systems
System B technique
Therma fil technique
UltraFil 3D
Obtura technique
Simplefil technique
Successfil technique

Resin based obturation techiniques
Resilon system
Endo rez technique
Fiber fil technique
EZ Fil Obturation system

INTRODUCTION

Obturation is the substitution of an inert filling in

the space previously occupied by the pulp tissues, to

prevent recurrent infection by way of circulation or

through a break in the integrity of the crown of the tooth.


HISTORY

Before – 1800 – Gold,bronze,silver.
1867 - Bowman Claimed first use of gutta
percha.
1883 – Perry used gold wire wrapped with
gutta percha.
1887 – S.S. white manufacturers GP points.
1893 – Rollins introduced gutta percha with
vermilion.


1914 – Challahan used chemically
plasticized gutta percha.
1977 – Thermoplasticizing device was
introduced by yee et .
1978 – Johnson introduced solid core carrier
technique.
1979 – Mc Spadden introduced
thermomechanical compaction .
1982 – Touch ‘n’ heat device was introduced
by john masreillez.
1987- System B obturation technique was
inrtroduced by Dr.L.Buchanan.
.

Obturation – “The three dimensional filling of
the entire root canal system as close to the
cementodentinal junction as possible. Minimal
amounts of root canal sealers which have been
demonstrated to be biologically compatible are used
in conjunction with the core filling material to
establish an adequate seal”.


3-D OBTURATION
Quality of cleaning and shaping
Skill of the clinician
Materials used
Coronal seal
Health of the supporting periodontium
Periradicular tissue regeneration

The clinicians must choose a path of
treatment that will result in best possible cleaning
and shaping of the root canal system coupled with
an obturation technique that provides a 3D seal
apically, laterally and coronally WITHIN the
confines of the root canal system.

PURPOSE

(1) To eliminate all avenues of leakage from the oral
cavity or the periradicular tissues into the root
canal system.

(2) To seal within the system any irritants that cannot
be fully removed.

RATIONALE

“ Microbial irritants and products of pulp tissue
degeneration are the prime causes for pulpal
demise and it subsequent extension into the
periradicular tissue”.

WHEN TO OBTURATE ?

Historically – Negative culture/cessation of signs
and symptoms

• Tooth is asymptomatic

• Canal is dry

• No sinus tract

• Intact temporary filling


REQUIREMENTS FOR AN IDEAL ROOT CANAL
FILLING MATERIAL
• Easily introduced
• Liquid or semisolid and become solid
• Seal laterally and apically
• Not shrink
• Impervious to moisture
• Bacteriostatic
• Not stain
• Not irritate periapical tissues
• Easily removed
• Sterile or sterilizable
• Radiopaque

OBTURATION MATERIALS

• Plaster of paris, asbestos, bamboo, precious metals

Contemporary material can be classified as

• Pastes : Zincoxide eugenol cements and
modifications

• Synthetic resins : Epoxy, acrylic, poly etheylene ,
polyvinyl resins, Poly carboxylate, glass ionomer
cements ,Silicone rubber


• Semisolid, solid core materials

Gutta-percha

Silver points

Gold, Iridoplatinum, tantalum

Titanium – advocated by Messing


GUTTA-PERCHA
• Introduced by Bowman (1867)
• Sapodilla family, genera payena
• Trans isomer of 1,4 – poly isoprene
Two crystalline forms

Alpha (α) Beta (β)
• Direct form • Commercial form

• Brittle • Flexible
• Low melting point
• Adhesive
• Good flow characteristics

β Phase α phase Amorphous
melt
37° C 42 – 44°C 56 – 62°C
• 1% - 2% expansion occurs but % shrinkage is
greater when cooled
• Slow cooling forms α chains, rapid cooling forms
β chains
Commercially supplied as

Cones - ISO standardized / Non standardized
Pellets / Cannulas (Injectable thermoplastic
techniques)
Heatable syringes (Thermomechanical
techniques)
Coated over cores (Plastic / metal)

Composition :
• Gutta-percha - 20% - MATRIX
• Zinc oxide - 66% - is the filler
• Heavy metal sulfates - 11% - acts as the
Radiopacifier.
• Waxes or Resins - 3% - they make the points
more pliable or compactable.
• Varies slightly with each manufacturers


PROPERTIES:

 Compactable, adaptable
 Can be softened (heat / solvents)
 Inert
 Does not stain
 Easily removed
 Lacks rigidity
 No adhesive quality
 Easily displaced by pressure


SILVER POINTS

Indications :
• Mature teeth, small well calcified round tapered
canals
• Tight fitting canals / curved canals

Contraindications:
• Large canals / Oval canals

Disadvantages :
• Corrosion (Sulfur/chlorides)


Various obturation techniques


OBTURATION TECHNIQUE

Lateral compaction

Vertical compaction (Warmgutta-percha)

Compactionmethod (McSpadden technique)

Chemically plasticized gutta-percha


Thermoplasticized gutta-percha
Technique’s


OBTURA II TECHNIQUE
“High heat technique”
• Requires tapering funnel preparation with
definite apical matrix
Device (obtura II)
• Heated delivery system (Pistol shape)
• GP heated to 185 – 200°C
• Needle gauge 20 (#60 file), 23 (#40 file)
Best used in presence of canal irregularities (fins,
webs, cul-de-sacs, internal resorption, C-shape
canals, accessory and lateral canals).

Method of use
Needle / pluggers or prefit (3-5mm from apex)

Minimum sealer placed

Gutta-percha injected passively (2-5sec)

Immediately cold compacted (within 1minute) or

Completely filled.


Variations

 Regular flow gutta-percha (homogenized, superior flow)

 Easy flow gutta-percha (Lower temp., more working
time)

 Apical closure using fitted master cone + injected gutta-
percha


System B obturation

• Introduced in 1987 by Dr.L.Stephen
Buchanan.
• He retained the principles of vertical
compaction and improved the methodology.
• Obturation is completed
• in 2 phases.
• Down pack technique.
• Back fill technique


Down pack technique

• A Corresponding size plugger is selected
and should stop at its binding point at 4-
5mm from the working length.
• Primary cone is coated with the sealer and
is placed in the canal.
• The heat device is activated and the
temperature is set at 200*c.

•The pre heated plugger is then driven
smoothly through the gutta-percha to
within 3-4mm of its binding point.

• The softened gutta percha flows to the
apical matrix and the accessory canals.

Back fill technique

• Accessory cones are added , condensed with the
preheated pluggers and obturation is completed.

• Obturation can be also completed using obtura II gutta-
percha gun.


UltraFil 3D

• Its is a thermoplastic guttapercha technique injection
technique
• Consists of cannuals , Heating unit , injection suringe.

• Cannuals come in 3 types :
• Regular set - low viscosity - 30 min
• Firm set - low viscosity - 4 min
• Endo set - High viscosity - 2 min


• Method of use :

• Obturation is done similarly to that of obtura II system.
• Each cannula has a 22 guage stainless steel needle that
can be pre curved.
• Cannula is placed in the warm heater for about 3 min.
• Sealer is applied to the canal walls
• Gutta percha is displaced into the canal with the pre
curved 22 guage needle
• Manufacturers recommend compaction using both
Regular set and Firm set followed by the Endo set


SIMPLIFILL
•Uses stainless steel carrier to place and compact
5mm segment of GP.
•Rubber stopper is set 2mm short of the W/L
•Carrier must not be rotated during insertion
•GP vertically compacted to full W/L
•GP plug is released by rotating the handle CCW


Therma Fil Obturation
• The Thermafill technique was introduced in an
attempt to bridge the "silver cone - gutta
percha void". It involved the heating of gutta
percha on a "carrier" system, first made of
metal and then later on - in plastic. When
used correctly it was also very successful.


Method of use:
• After the canal preparation,Removal of the smear
layer is recommended.
• Light sealer coat is applied
on the canal walls.
• Carrier is marked,set to
pre determined length.
• Millimeter calibration markings
are provided on the carrier
at18,19,20,22,24,27,29.


• Carrier is placed in the heating device for 10-15 sec.
• The carrier is carried and nserted into the canal.
• Gutta-percha is alowed to cool for 2-4 min.
• Excess is removed using a Round Bur.


Successfil

• Its is also a carrier based obturation system.

• Carrier is made of Titanium or Radiopaque
plastic.

• Gutta-percha comes in a syringe.


• Method of use:

• Sealer is placed on the canal walls.

• The carrier with the gutta-percha is
placed into the canal to the
predetermined length.

• The gutta-percha is then compacted
around the carried with various pluggers.

• Severing of the carrier is done with a
round bur above the orifices.

Newer systems

Each system component is resin based resulting
in a solid resin monoblock in the root that
effectively seals to the dentinal walls.


Resin based obturations


Resilon obturating system

• Resilon research ltd,LLC.
• Resilon (Trade name "Epiphany"-
Manufactured By Pentron ) - This is the most
promising material for replacement of Gutta
Percha. The Epiphany obturation system has
been shown to resist leakage significantly
better than gutta percha based obturation.
• Resilon was introduced to bond with
methacrylate sealers and produce a
monoblock with the tooth.
• Resilon system is supplied as
core + primer + resin sealer


Core material : thermoplastic,synthetic
polymer based (polyester).

Resilon points – available in ISO sizes in
0.02,0.04,0.06 tapers.


Composition :
• Polycaprolactone (50%) has low glass
transition temperature (-62ºC). the glass
transition temperature dictate whether the
Polymer is hard and brittle or soft and flexible.
• Methacrylate co-polymer(10%)helps in
bonding chemically with methacrylate based
sealers.
• Glass fillers(40%)
• Bismuth oxychloride is the radiopaque filler.


• PROPERTIES :

• CYTOTOXICITY : Resilon is same as
biocompatible as G.P.
• MELTING POINT : 60.50*C
• REMOVAL FOR RETREATMENT : heat or
solvents like chloroform can be used for
removal of the resilon points.
• DEGRADABILITY : degrades slowely in water
and can be accelerated by the enzymes.
• REINFORCEMENT OF TOOTH STRUCTURE : it
can provide 20% more that of the G.P points
provide.
• Resilon has low melting point than G.P
• Resilon has higher molecular weight that G.P
so when subjected to heat resilon exhibits
higher flowability than G.P


• Resin sealer :
• Epiphany root canal sealer is a dual cured methacrylate
resin based sealer containing a new redox catalyst that
enables optimal auto polymerisation under acidic
environment.

• Composition:
• BISGMA
• Ethoxylated BISGMA
• UDMA
• Difunctional methacrylates
• Fillers(70%) – calcium hydroxide,barium sulfate,barium
glass,bismuth oxychloride and silica


METHOD OF USE :
• After the canal preparation is done, irrigation
is done with 5.25% sodium hypo chloride
solution and final rinse is done with 17% EDTA
• Canal is dried with the paper points.
• Self-etch primer is brought into the canal by
insertion of a saturated fitted paper point.
• Excess is removed with a dry paper point.
• Epiphany resin sealer is then express into the
canal using a auto mix syringe.
• The fitted master cone was coated with the
sealer and is placed into the canal.
• Obturation is completed using Downpack and
Back fill technique.


Air Displaced Obturation

Consists of:
• A Reciprocating handpiece
• 7 Stainless steel files (3 shaping files used in hand
piece and 4 hand files for apical 3 mm)
• Irrigants and Lubricants
• Delivery tips
• EndoRez Sealer and EndoRez points


The sealer comes as a dual cure material in a skinni
syringe.

The 29G navitip cannula helps in delivary of the sealer in
the apical third region without air trapment.


• Sealer is placed in the apical third of the root
canal and the remaining canal is filled using
gutta-percha which are ovelayed with a thin
resin coat.
• The resin coat allows the Endo Rez points to
bond chemically with Endo Rez sealer.
• The coronal portion of the sealer is then light
cured and the sealer sets in 15 min time and
final set – 2hrs.

Fiberfil system
• Fiber fill (jeneric pentron,walling’sford,CT,USA.
• It simplifies sealing of a root canal both apically
and coronally.
• The Fiberfill system consists of an adhesive
bonding agent, a light-curable CaOH based
resin sealer and a fiber post with an apical
terminus of gutta percha .
• Primer included in the system is a self etching
two bottle liquid that allows the sealer to
chemically bond to the canal dentin. The primer
is a self curing adhesive.

• The Fiberfill root canal sealer (RCS) is a
radiopaque dual cure resin sealer.,
• Contains : UDMA, PEGDMA, HDDMA, and
BISGMA resins with silane treated
bariumborosilcate glasses, barium sulfate, calcium
hydroxide with initiators.
• The material comes in a two barrel automix
syringe.


• Once mixed it provides a working time of
10-12 minutes and a self cure setting
time of approximately 25 minutes. It
provides a depth of light cure of 1.7mm .

• The Fiberfill obturator is a resin and glass
fiber post with a terminal gutta percha
tip.
• The gutta percha is available either in 5
or 8mm lengths .
• The diameter of the post is available in
sizes 30, 40, 50, 60, 70 and 80.


Method of use :
• An obturator is selected that matches the final diameter of the
canal.
• The yellow Peeso reamer (included in the kit) is introduced
into the canal set either to 5 or 8mm from the working length.
• Then the blue Peeso reamer (also in the kit) is taken to the
same depth as the previous reamer.
• The canal is irrigated, disinfected and dried.
• A drop of primer A and B are mixed in a dish and applied in
the canal with the kits spiral brush.
• The brush tip is introduced to the depth made by the Peeso
reamers.


• An automix tip is placed on the Fiberfill RCS
syringe and the sealer is introduced into the canal
with a lentulo or other sealer applicator.
• The obturator is gently seated to working length
allowing excess sealer to be expressed coronally.
• The dual cure Fiberfill RCS is light cured to
stabilizer the coronal portion.
• The result is a durable restoration with a
resin/fiber reinforced root that is optimally sealed
apically and coronally


• Advantages:
• Obturation and post placement – same visit
• 80 % root strengthening
• Immediate coronal seal
• Highly radiopaque sealer


EZ Fill Obturation system
Epoxy resin sealer with bidirectional
lentulo spiral system.

Advantages:

•The cements works synergistically
with gutta-percha to assure a
complete seal.
•Lateral and vertical condensation
not needed.
•Bonds chemically and physically with
dentin and gutta-percha.
•Hydrophobic in nature.
•No shrinkage.
•Mild Expansion of the sealer
provided tightwww.indiandentalacademy.com
seal.

• A Pre-fitted gutta-percha point is selected.
• Place the spiral in a slow-speed hand piece
(the 300 rpm hand piece designed for Endo
Magic files is perfect), and coat it with the
resin cement. Insert the coated spiral into the
canal and advance slowly to working length.
• Apply two or three applications of the sealer
with a smooth in-and-out motion to coat the
canal walls and fill the canal with cement.
• Coat the apical 4mm of your pre-fitted gutta-
percha point with the resin cement, and slowly
insert it to length in the canal.
• Using a heated instrument (or an electric
device such as the Touch 'N Heat), sear off the
excess gutta-percha.


• Conclusion :

• With the newer endodontic obturation systems ,
obturation has become easy , quick and accurate ,
But even having so many obturation systems the
quest for the hermetic seal remains as a myth .


Thank you


Advances in obturation system in endodontics /certified fixed orthodontic courses by Indian dental academy

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