5- OBTURATION TECHNIQUES l Endodontics series  

 

CLINICAL RECORD IN OBTURATION

CLINICAL VIDEO IN OBTURATION

OBTURATION

Outline

1. Obturation materials (cone and sealer).
2. Obturation techniques.

• Main purpose of endodontic treatment is to remove all bacteria from pulp system, so after cleaning I need to obturate to close any spaces where bacteria can flourish again and cause failure, also as much as you depend on core material than sealer success rate will increase.
• When to obturate?

1.  You need a dry clean canal even if there is a sinus tract oozing pus, and made in a single visit.
2. No signs and symptoms.

Core materials

• Silver points (history).
• Gutta percha is a rubber material 60% zinc oxide.

Types of gutta percha:

1. Standardized (#10 to #140).
2. Not standardized (conventional) (xxf, xf, l, m, f) mainly used as auxiliaries, saves time and effort.
3. Tapered.
4. Injectable as Obtura and Gutta flow.
5. Gutta percha Thermafill.
6. Medicated gutta percha.
7. Resin coated gutta percha.
8. Bioceramic coated gutta percha.
9. Resilon, but researches stated that bacteria stick to resilon bond causing voids and leakage leading to failure, so it became history.

Sealers:

Main purpose:

1. Adhesion between cones of guttapercha together and with the tooth structure.
2. Fill all the spaces and provide hermetic apical seal.
3. Radioopaque.
4. No shrinkage to avoid formation of voids.
5. No staining to tooth structure.
6. Bacteriostatic or at least don’t encourage bacterial growth.
7. Insoluble in tissue fluids.
8. Not irritant to periapical tissues.

Types:

1. Zinc oxide eugenol based sealer: irritant to tissues, soluble, has high toxicity, bad flowablity and adhesion so cause voids, leakage and then failure.
2. Calcium hydroxide based sealer: to get the benefit of calcium hydroxide it must be soluble but this will cause voids, leakage and then failure.
3. Glass ionomer based sealer: necessary to treat surface before using it by certain material that cannot reach apical third so bonding in the apical third will be very weak, also they found that the sealer to bond with gutta percha it must be coated with glass ionomer but to make this cost too much money and time.
4. Silicone based sealer: as Gutta flow, but it is expensive.
5. Resin based sealer: as AH plus from Dentsply, from the best sealers you can use but from its drawbacks that it is very irritant if extended beyond apex, hydrophobic and cause voids, leakage and failure.
6. Bioceramic based sealer: fill all the spaces, hydrophilic so doesn’t cause voids, biocompatible, expand after setting so most accepted to use as single cone obturation technique, but has some drawbacks as being very expensive, has pH 12 so highly alkaline and affect collagen matrix of dentin walls making it more fragile.
7. Medicated sealer (history).

Obturation techniques

• Cold lateral compaction technique:

1. Choose largest spreader that reaches before working length by 2mm, preferably do this while putting master cone.
2. Put the sealer in the canal, put the master cone coated with sealer.
3. Auxiliaries used should be smaller than spreader size.
4. Compact cones in one direction towards canal walls.
5. Spreader should decrease 1mm with subsequent auxiliaries.
6. Obturate each canal separately.

• Warm lateral compaction:

1. Same steps except we introduce heat after putting gutta percha for more compaction.
2. Drawbacks: doesn’t fill canals in 3D.

• Thermafill:

Comes in 2 kits; large kit for anterior teeth and small one for posterior teeth, in a V-shape to create space for post.

Steps:

1. Use verifier to choose suitable size of gutta percha that will reach full working length.
2. Heat gutta purcha in the oven, fill the canal with gutta percha.
3. Cut the excess guttapercha with therma cut bur that will cut plastic but will not cut dentine.

Drawbacks:

1. Plastic core comes into the canal and extrude gutta percha.
2. Using therma bur generates a lot of heat ,So they made gutta percha without plastic core as VDW.
3. Main drawback of this technique that it is very expensive.

• Warm vertical compaction:

1. It was first used to fill the apical 5mms using heat carrier to soften gutta percha in canal then plugger to compact gutta percha, then Gutta flow in the middle and coronal third but heat cannot be controlled, so sometimes gutta percha sticks to the carrier and get out of the canal, also Gutta flow is a sealer and cannot be used to fill the middle and coronal third.
2. So they made continuous wave compaction (system B) in which degree of heating can be controlled.
3. Obtura was then introduced, then thermoplastic injection but gutta percha can extend beyond apex, so a combination of System B and Obtura was introduced in one device (pen and gun).

• Single cone technique:

     Accepted only with bioceramic sealer.