obturation Flashcards
Goals of Obturation
eliminate?
seal?
success dependent on?
Eliminate ALL AVENUES OF LEAKAGE from the oral cavity INTO the ROOT CANAL SYSTEM or OUT OF the ROOT CANAL SYSTEM INTO the PERIODONTAL or ORAL TISSUES
Seal within the RC system any irritants that cannot be fully removed during canal cleaning & shaping and prevent their leakage out to the peri-radicular tissues or leakage of saliva or other contaminates into pulp system
RCT Success depends upon thoroughness of removal
of irritants and quality of seal of the canal system
including coronal restoration
obturation material
gutta percha
qualities of gutta percha
– Can be softened by?
– phases?
– deminsional change?
– sealing?
– Must consider?
– Can be softened by heat and solvents
– If heated sufficiently, will change phases
– Following softening SHRINKS
– GP by itself DOES NOT SEAL
– Must consider SEALERS
isometric forms of gutta percha
Standard of Care: RC Obturation
* Avoidance of?
* Minimal Sealer?
* under-fillings?
- Avoidance of gross overextension into the peri-apical tissues (GP and Sealer)
- Minimal Sealer beyond apical constriction
- No under-fillings in the presence of a patent canal
how is GP cone positioned (to what depth)
1mm short of exit (WL)
how should canal be filled
- Totally filled with gutta percha and
sealer (no VOIDS)
radiograph of filled canal
Radiographic appearance of a
dense filling
Acceptable Obturation Techniques:
- Cold Lateral Compaction of Gutta Percha
- Hydraulic Obt Technique
- Warm vertical compaction
bad obturation technique
carrier based techniques
chemoplasticized
custom cones/ solvents
secret to CLC-GP obturation success?
COMPACTION is the secret to CLC-GP obturation success (Fill Must be dense and free of voids and have a THIN sealer layer to be effective
WHEN ARE WE READY TO OBTURATE?
after cleaning and shaping and pt is asymptomatic
pt still in pain, obturation?
- If the patient is still in pain or the original symptoms have not abated, obturation of the RC system will NOT resolve the patient’s symptoms
what size GP cone do we use (taper)
0.4
insertion of GP cone
gently insert into wet canal (NaOCl) until R felt at apex
liquid req for master cone radiograph
marking the GP cone
Make sure the “mark” on the GP cone goes EXACTLY to your reference point (WL)
If it doesn’t, DON’T TAKE A RADIOGRAPH
evaluating master cone fit
Use MC X-Ray to evaluate MC fit
Master Cone too small radio app
– Cone is too small in diameter and distorts (crinkles) near apex.
Properly fitted cone has an intimate fit at WL with NO SPACES and no crinkling.
MC and WL
MC should not extend past working length
-When Master-Cone is inserted, it should STOP at WL.
-MC must NOT be able to be pushed beyond WL. (Tap on it to check)
If the MC is NOT TIGHT at WL or pushes longer;
GET A BIGGER MASTER CONE
Master Cone too large
– Cone is too large coronally or canal taper is insufficient and will not seat at WL Black Arrow indicates level of binding
*(MC should bind only at WL)
*Fit should be INTIMATE at WL
The Master Cone Radiograph is our last chance to:
The Master Cone Radiograph is our last chance to
correct a problem easily (without re-treatment)
Until Bio-Ceramic, Bio-Active Sealers came into play,
NO SEALER was ideal and ALL SEALERS:
SHRANK with setting
DISSOLVED In body fluids over time
DIMENTIONALLY STABLE SEALER
DIMENTIONALLY STABLE SEALER
which allows
a more efficient technique.
*BIO-CERAMIC SEALERS: important properties
*Do NOT shrink
*Do NOT dissolve
*Are BIO active
GP use with bio ceramic sealers
Gutta Percha is only necessary here primarily as a source of hydraulic sealer compression/flow and a route to retreatment or post should either become necessary
Cold Lateral Compaction CLC-GP
Finger Spreaders 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
how deep is spreader inserted
1-2mm from WL
sear stage
removal of excess cone in coronal portion
what is done after searing
Take Sear Check
Radiograph
HYDRAULIC OBTURATION dif from CLC
no finger spreader used
uses: BC sealer and 0.4 GP cones
Brief Overview of “Hydraulic technique”
*Same criteria to be ready to obturate
*Prepare as usual
*Select an .04 GP Cone and fit to WL & Radiograph
*Dry canal following EDTA & NaOCl
double coat technique of master cone
coat MC in BC sealer, take to WL, remove, recoat with sealer and back to WL
hydraulic technique process
Use a “double coat” technique on the Master Cone
* Place GP gently in the root canal
* May dart additional GP cones in irregular (wide) canals p.r.n.
* Sear off as per CLC-GP technique.
sealer and man canal
- BEWARE OF POSSIBLE SEALER GETTING INTO MANDIBULAR CANAL ON MANDIBULAR Premolars & Molars
how to pack GP
pack with cold tools, sear with hot
What do you do with a WIDE canal?
In a Type II canal, you pick the easiest canal to
fill to WL; the second canal will merely merge into the 1st at some point short of WL
“Single Cone” is easily customized if you have additional space that needs filling or if further compaction of the fill is necessary, simply by darting in additional 25/02 cones as necessary without the need of spreading.
HOW TO: Control the Apical
Constriction
*Do Not take any instrument larger than your patency file beyond WL, LOOK AT THE RUBBER STOP!!!
*Take care to NEVER go beyond WL with ANY shaping
instruments.
*What about an “open apex”? If it is open for any reason, you should use CLC-GP instead of “single cone”.
what is placed on top of the GP when seared
vitrebond
RESTORATIONS
posteriors vs anteriors
*Premolars and Molars REQUIRE CROWNS in all cases
to prevent VRF
*Anterior teeth with minimal loss of tooth structure may need only a composite restoration to restore RCT
access
where is GP seared
below CEJ
What is Gutta Percha?
Trans-Polyisoprene (an isomer of latex)
GP traditionally harvested from trees. Now made synthetically (naturally white color)
GP taper for CLC technique/sizes
.02 taper GP for use in ColdLateral Compaction of Gutta Percha Technique.
Sizes #20 to #50 available
composition GP
silver points
BENEATH STANDARD OF CARE
– Silver points
* Round peg in irregular hole
* Corrodes when sealer washes out (silver oxide)
* May stain both tooth & gingiva (Amalgam or silver Tattoo)
–Paraformaldehyde-containing pastes
*N-2 (Sargenti Technique)
*Potential for great damage
*Proven Carcinogen
*Legal Precedent (Liability)
paste only obturation
–Any “conventional” paste only obturation is doomed
*Paste alone will shrink dissolve & leak
excessive force of compaction (CLC-GP or WVC-GP)
Firm pressure is required for dense fill but excessive force of compaction (CLC-GP or WVC-GP) can cause iatrogenic fracture of root
ideal sealer qualities
- Compatibility
- Inertness
- Tissue Tolerance
- Inexpensive
- Malleable
- Relatively easy to work
- Useful in MANY techniques
- Dimensional Stability ???
- Resistant to Dissolving ???
