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Endodontics 2 > Obturation CLC-GP & Hydraulic > Flashcards

Obturation CLC-GP & Hydraulic Flashcards

1
Q

Goals of Obturation

A

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.

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2
Q

RCT Success depends upon thoroughness of

A

removal
of irritants and quality of seal of the canal system
including coronal restoration***

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3
Q

Gutta Percha:
–Can be softened by
–If heated sufficiently, will change
–Following softening
–GP by itself
–Must consider

A

heat and solvents
phases
SHRINKS
DOES NOT SEAL
SEALERS

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4
Q

GP can exist in different isomeric forms: (3)

A

alpha phase
beta phase
amorphous melt at 56-64

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5
Q

Standard of Care: RC Obturation
* Avoidance of
* Minimal Sealer beyond
* No under-fillings in the presence of
a

A

gross overextension
into the peri-apical tissues (GP and
Sealer)
apical constriction
patent canal

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6
Q
  • GP positioned — short of the
    canal exit
  • Totally filled with
  • Radiographic appearance of a
A

1 mm.
gutta percha and
sealer (no VOIDS)
dense filling

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7
Q

Acceptable Obturation Techniques:
(3)

A
  • Cold Lateral Compaction of Gutta Percha
  • Hydraulic Obt Technique
  • Warm vertical compaction
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8
Q
  • Carrier-based techniques (Thermafil ®) ??
    (5)
A
  • Carrier-based thermoplasticized
    – Carrier-based sectional thermoplasticized
    – RETX and posts a problem
  • Chemoplasticized (Chloropercha) NO
  • Custom Cones/Solvents NO
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9
Q

— is the secret to CLC-GP
obturation success (Fill Must be dense and
free of voids and have a — sealer layer to
be effective.

A

COMPACTION
THIN

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10
Q

skipped
WHEN ARE WE READY TO OBTURATE?

A

Comfortable
& Master
Cone Fitted
+ XR
Root canal is
dry DST is healed
Tooth is Cleaned &
Shaped to facilitate
obturation
Tooth isolated to prevent
contamination during
obturation
Free of all signs &
symptoms of
infection/inflammation

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11
Q

If the patient is still in pain or the original symptoms have
not abated, obturation of the RC system will

A

NOT resolve
the patient’s symptoms

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12
Q

GP: Master Cone Fitment
select proper size — GP cone (size MAF)
gently insert in — canal until resistance is felt near apex (NaOCL stimulates the lubricity of sealer)

A

0.04
wet

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13
Q

Make sure the “mark” on the GP
cone goes EXACTLY to your
reference point
If it doesn’t,

A

DON’T TAKE A
RADIOGRAPH

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14
Q

Master Cone too small
.

A

–Cone is too small in diameter and
distorts (crinkles) near apex

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15
Q

Properly fitted cone has

A

an intimate fit
at WL with NO SPACES and no crinkling.

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16
Q

MC should not extend past working length
-When Master-Cone is inserted, it should STOP at
-MC must NOT be able to be pushed beyond

A

WL
WL, tap on it to check

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17
Q

If the MC is NOT TIGHT at WL or pushes longer;

A

GET A BIGGER MASTER CONE

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18
Q

skipped
Master Cone too large (short)
(3)

A

–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)Red arrows indicates space along side of cone at apical end*Fit should be INTIMATE at WL

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19
Q

the Master Cone Radiograph is our last chance to

A

correct a problem easily (without re-treatment)

20
Q

Until Bio-Ceramic, Bio-Active Sealers came into play,
NO SEALER was ideal and ALL SEALERS:
(2)

A

DISSOLVED
In body fluids over
time
SHRANK
upon setting

21
Q

DIMENTIONALLY STABLE SEALER
which allows
a

A

more efficient technique.

22
Q

BIO-CERAMIC SEALERS:
(3)

A

*Do NOT shrink
*Do NOT dissolve
*Are BIO active

23
Q

BC SEALER
Provides viability to the Hydraulic (“single
cone”) techniquewhich will be taught in
addition to Cold Lateral Compaction.

Gutta Percha is only necessary here primarily as
a source of

A

hydraulic sealer compression/flow
and a route to retreatment or post should
either become necessary

24
Q

cementation of master cone

A

the master cone is then coated with sealer and placed slowly and carefully to WL in the canal, then the master cone is removed from the root canal, coated again with sealer and gently repositioned to WL without any pumping motion

25
Q

Finger Spreaders are used to

A

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.

26
Q

Brief Overview of “Hydraulic technique”
*Same criteria to be ready to obturate
*Prepare as usual
*Select an .– GP Cone and fit to WL & Radiograph
*Dry canal following EDTA & NaOCl

A

.04

27
Q

Use a “—” technique on the Master Cone

A

double coat

28
Q

Use a “double coat”technique on the Master Cone
*Place — gently in the root canal
*May dart additional GP cones in irregular (wide) canals p.r.n.
*Sear off as per — technique.
*BEWARE OF POSSIBLE SEALER GETTING INTO

A

GP
CLC-GP
MANDIBULAR CANAL ON
MANDIBULAR Premolars & Molars

29
Q

What do you do with a WIDE canal?
In a Type II canal, you

A

pick the easiest canal to
fill to WL; the second
canal will merely merge
into the 1st at some point
short of WL

30
Q

“Single Cone” is easily
customized if you have
additional space that
needs filling or if further
compaction of the fill is
necessary, simply by

A

darting in additional
25/02 cones as necessary
without the need of
spreading.

31
Q

HOW TO: Control the Apical
Constriction
*Do Not take any instrument larger than your
*Take care to NEVER go beyond WL with ANY shaping
instruments.

A

patency file
beyond WL, LOOK AT THE RUBBER STOP!!!

32
Q

*What about an “open apex”? If it is open for any reason, you

A

should use CLC-GP instead of “single cone”

33
Q

RESTORATION*Premolars and Molars REQUIRE

A

CROWNS in all cases
to prevent VRF

34
Q

Anterior teeth with minimal loss of tooth structure
may need

A

only a composite restoration to restore RCT
access.

35
Q

Take home messages:
1. Use GP with a
2. — when the canal is dry and patient has
remained asymptomatic
3. Lateral compaction uses — GP cones and needs

A

Bioceramic (BC) sealer
Obturate
.04, Blue finger spreaders (COMPACTION).

36
Q
  1. Hydraulic obturation technique uses
  2. Sear GP below the CEJ, clean the pulp chamber and seal
    the canal with GI
A

an .04 GP cone and BC
sealer, no spreader is used

37
Q

What is Gutta Percha?

A

Trans-Polyisoprene (an isomer of latex)GP traditionally harvested from trees. Now made synthetically (naturally white color)

38
Q

.02 taper GP for use in

A

Cold
Lateral Compaction of Gutta
Percha Technique.
Sizes #20 to #50

39
Q

GP can exist in different isomeric forms:

A
  • alpha phase (42ºC.-44ºC.)—WVC-GP
  • beta phase (below 42ºC.)—-CLC-GP *
  • amorphous melt at (56ºC – 64ºC)
40
Q

Composition:
(4)

A
  • Gutta Percha 18-22 % . .Matrix (plasticity)
    – Zinc oxide* 59-76 %. . Filler (mildly antimicrobial)
    – Waxes/resins/coloring agents 1-4 % . . . Plasticizer
    – Metal Sulfates 1.5-1.8% . Radiopacity (Barium)
41
Q

Beneath the standard of care:
– Silver points
(3)

A

*Round peg in irregular hole
*Corrodes when sealer washes out (silver oxide)
*May stain both tooth & gingiva (Amalgam or silver Tattoo)

These methods and materials are not acceptable

42
Q

Beneath the standard of care:
–Paraformaldehyde-containing pastes
(3)

A

*N-2 (Sargenti Technique)
*Potential for great damage
*Proven Carcinogen
*Legal Precedent (Liability)

43
Q

–Any “conventional”— is
doomed
*Paste alone will

A

paste only obturation
shrink dissolve & leak

44
Q

— is required for dense fill but — of
compaction (CLC-GP or WVC-GP) can cause iatrogenic fracture of root

A

Firm pressure
excessive force

45
Q

skipped
THE IDEAL SEALER

A
  • Compatibility
  • Inertness
  • Tissue Tolerance
  • Inexpensive
  • Malleable
  • Relatively easy to work
  • Useful in MANY techniques
  • Dimensional Stability ???
  • Resistant to Dissolving ???
46
Q

And some NOT so VALUABLE:
(5)

A

-Notoriously Poor Seal
-Expands & Contracts with:
-Solvent
-Temperature
-Will also change phases with sufficient
variation in temperature (Amorphous
Melt is NOT what you want to depend
upon in RCT)

Endodontics 2 (12 decks)

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