Lecture 3: Obturation Flashcards
The goal of obturation is to eliminates ______ from the oral cavity INTO the root canal system or OUT OF the root canal system into the periodontal or oral tissues
all avenues of leakage
The goal of obturation is to eliminates all avenues of leakage from the oral cavity _____ the root canal system or ____ the root canal system into the ______
INTO; OUT OF; periodontal & oral tissues
The goal of obturation is to seal _____ the RC system any irritants that cannot be fully remove during canal cleaning & shaping and ____ their _____ out to the peri-radicular tissues or leakage of saliva or other contaminates into the pulp system:
within; precent; leakage
RCT success depend upon thoroughness of _______ & _______ of the canal system including _____.
removable of irritants; quality of seal; coronal restoration
Primary functions of a root canal filling: (3)
- stop coronal leakage
- entomb surviving microorganisms
- prevent accumulation of stagnant fluid
The following qualities of gutta percha make it an ideal obturation material:
- can be softened by ____ & ___
- if heated sufficiently, will ______
- following softening ______
- GP by itself ______
- must consider ____
- heat & solvents
- will change phases
- shrinks
- does not seal
- sealers
GP can exist in different isometric forms including: (3)
- alpha phase
- beta phase
- amorphous melt
The “alpha phase” of gutta percha occurs at what degrees Celsius?
42-44
The “beta phase” of gutta percha occurs at what degrees Celsius?
below 42
CLC-GP!!!
The “amorphous melt” of gutta percha occurs at what degrees Celsius?
56-64
What isomeric form of GP is considered CLC-GP? What temp does this occur at?
Beta phase (below 42 degrees)
The requirements for an ideal root filling cement (obturation sealer)
- it should be _____ into the canal
- It should seal the canal ___ as well as ____
- It should not ____ after insertion
- It should be impervious to _____
- It should be _____ or at least not encourage ____
- It should be ____ (on x-ray)
- It should NOT ___ tooth structure
- It should NOT irritate ____
- It should be ____ or quickly and easily ____ before insertion
- It should be easily ____ from the root canal if necessary
- introduced
- laterally; apically
- shrink
- moisture
- bacteriostatic; bacterial growth
- radiopaque
- stain
- periapical tissue
- sterile; sterilized
Until _____ & ______ came into play no sealer was ideal due to shrink & dissolving
bio-ceramic; bio-active sealers
Until bio-ceramic & bio-active sealers came into play, no sealer was ideal and all sealers:
- shrank upon setting
- dissolved in body fluids over time
Bio-Ceramic & Bio-Active Sealers are considered ______ which allows a more efficient technique
dimensionally stable
Bio-Ceramic Sealers characteristics: (3)
- do NOT shrink
- do NOT dissolve
- are BIO active
Bio-ceramics provide viability to the ______.
Hydraulic (“single cone”) technique
With a bio-ceramic sealer, gutta percha is only necessary as a source of ____ and a route to retreatment or post should either become necessary
hydraulic sealer compression/flow
Standard of care: RC Obturation-
- GP is positioned ____ of the canal exit
- ____ with gutta percha and sealer with ____
- Radiographic appearance of a ____
- _____ into the peri-apical tissues (GP & Sealer)
- ____ beyond apical constriction
- No ____ in the presence of a _____
1) 1mm short
2) totally filled; NO voids
3) dense filling
4) Avoidance of gross overextension
5) Minimal sealer
6) under-filings; patent canal
When are we ready to obturate?
- asymptomatic
- free of all signs of infection/inflammation
- tooth is cleaned & shaped to facilitate obturation
- tooth is ISOLATIED
- comfortable & master cone fitter + XR
- RC is dry
- DST is healed
T/F: If the patient is still in pain or the original symptoms have not abated, obturation of the RC system will NOT resolve the patients symptoms
True
In what cases will obturation of the RC system NOT resolve the patients symptoms? (2)
- if patient is still in pain
- if original symptoms have not ceased
List 3 acceptable obturation techniques:
- cold lateral compaction of gutta percha
- hydraulic obturation technique
- warm vertical compaction
______ is the secret to CLC-GP obturation success (Fill must be dense and free of voids and have a ___ sealer layer to be effective)
Compaction; thin
CLC-GP:
Cold lateral compaction of Gutta percha
Acceptable obturation techniques at UMKC:
- Cold lateral compaction of gutta percha
- Hydraulic obturation technique
- Warm vertical compaction
What GP cone is used with cold lateral compaction?
0.25 GP cone (RED)
Quiz said 0.2???
Used to compact the MC gutta percha in the canal to create space for more gutta percha accessory cones to accomplish a dense fill and thin film of sealer on the canal:
finger spreaders
Finger spreaders are used to compact the MC gutta percha in the canal to create:
space for more gutta percha accessory cones
List the steps of lateral compaction:
- the master cone is fitted
- a finger spreader or plugger is inserted, ideally to 6-2mm of the prepared length
- the spreader is rotated and removed, and an accessory cone is placed in the space created
- the process is repeated
In lateral compaction, after the master cone is fitted, a finger spreader or plugger is inserted ideally:
6-2mm of the prepared length
What two components does hydraulic obturation use?
- BC sealer
- .04 GP cones
What size of cone is used with hydraulic obturation?
.04 GP cone
List the steps of hydraulic technique obturation:
- select a .04 GP cone & fit to WL
- Radiograph
- Dry canal following ETDA & NaOCl
T/F: The canal should be completely dry when the GP master cone is inserted
False- insert into wet canal
What is a VERY important step when inserting the gutta percha cone?
Mark exactly your point of reference
How should you evaluate the fit of the MC?
radiograph
On a radiograph, how can you determine if the master cone is too small?
Cone will distort (crinkle) near apex
Describe how a properly fitted cone will appear on a radiograph:
Properly fitted cone has an intimate fit at WL with NO SPACES and no crinkling
T/F: You should NEVER go beyond WL with ANY shaping instruments
True
For an open apex, you should use _____ instead of “single cone”
CLC-GP
T/F: Premolars and molar require crowns in ALL cases to prevent VRF
True
T/F: Anterior teeth with minimal loss of tooth structure require a crown
False- may only need a composite restoration to restore RCT access
Take home messages:
- Use GP with a bioceramic sealer
- Obturate when the canal is dry and the patient has remained asymptomatic
- Lateral compaction needs blue finger spreaders (COMPACTION)
- Hydraulic obturation technique uses a .04 GP cone and BC sealer
- Sear GP below the CEJ, clean the pulp chamber and seal the canal with GI
What is gutta percha?
Trans-polyisoprene (an isomer of latex)
What size of GP cone is used in cold lateral compaction?
.02 taper GP (sizes #20 & #50_
What phases of GP do we use?
Beta phase (below 42 degrees Celsius) CLC-GP
List the composition of GP: (4)
- Gutta percha
- zinc oxide (59-76%)
- waxes/resins/coloring agents
- metal sulfates
Silver points are considered:
BENEATH the standard of care
Paraformaldehyde-contain pastes are considered:
BENEATH the standard of care
GP requiires:
Sealer (dimensionally stable)
