Lecture 3: Obturation Flashcards
The goal of obturation is to eliminate ____ 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 eliminate all avenues of leakage from the oral cavity _____ the RC system or ___ of the RC system and into the ___ or ___
INTO; OUT OF; periodontal & oral tissues
For obturation, seal ___ the RC system any irritants that cannot be fully removed during canal cleaning & shaping and ___ their ___ out to the peri-radicular tissues of leakage of saliva or other contaminates into pulp system.
within; prevent; leakage
RCT success depends upon thoroughness of _____ and ____ of the canal system including ____.
removal of irritants; quality of seal; coronal restoration
The 3 primary functions of a root canal filling include:
- stop coronal leakage
- entomb surviving microorganisms
- prevent accumulation of stagnant fluid
The qualities of Gutta Perccha:
- can be softened by heat & solvents
- if heated sufficiently, will change phases
- SHRINKS following softening
- by ITSELF does not seal
Gutta percha can be softened by:
heat & solvents
If gutta percha is heated sufficiently, it will:
change phases
Following heating & softening of gutta percha, it will:
shrink
T/F: Gutta percha by itself is an ideal sealer
False- by itself it does NOT seal; must consider sealers
GP can exist in different isomeric 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
- easily introduced
- laterally & apically
- shrink
- moisture
- bacteriostatic; bacterial growth
- radiopaque
- stain
- periapical tissue
- sterile; sterilized
- removed
Until ____ & _____ sealers came into play, no sealer was ideal due to shrink and dissolving
Bio-ceramic & Bio-active
Until bio-ceramic & bio-active sealers came into play, no sealer was ideal and all sealers: (2)
- 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-ceramic sealers 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-fillings; 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 ISOLATED
- comfortable & master cone fitted + XR
- RC is dry
- DST is healed
T/F: IF the patient is still in pain of 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 patient’s 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??
____ are 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
- 0.4 GP cones
What size of cone is used with hydraulic obturation?
0.4 GP cone
List the steps for hydraulic technique:
- select an 0.4 GP Cone and fit to WL
- Radiograph (to make sure its at WL)
- Dry canal following EDT & NaOCl
T/F: The canal should be completely dry when the GP master cone is inserted
false- insert into wet canal
How should you evaluate the fit of the MC?
radiograph
What is a VERY important step when inserting the gutta percha cone?
mark exactly your point of reference
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?
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 molars require crowns in ALL cases to prevent VRF
True
T/F: Anterior teeth with minimal loss of tooth structure require crowns
False- may only need a composite restoration to restore RCT access
Take home messages:
- Use GP with a biocerampic sealer
- Obturate when the canal is dry and patient has remained asymptomatic
- Lateral compaction needs blue finger spreaders (COMPACTION)
- Hydraulic obturation technique uses a 0.4 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 for CLC?
0.2 taper (#20 2)
What phase 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-containing pastes are considered:
beneath the standard of care
GP requires:
sealer (dimensionally stable)
