Obturation of the Root canal System By Ahmed labib

Why do we obturate?
Fidgor (2002) stated 3 functions of root canal obturation: 1- Prevent coronal leakage of bacteria. 2- Entombing remaining bacteria. 3- Prevent the influx of apical tissue-derived fluids and accumulation of stagnant fluids.

Functions of Obturation
Cohen et. al. stated that a 3D obturating material is essential to: 1- Prevents percolation and microleakage of periapical exudate. 2- Prevents reinfection. 3- Creates a favorable biologic environment for the process of tissue healing.

Where the obturating material should end?

Apically, at the apical constriction. Coronally, 1-mm beyond orifice of the root canal.

When to obturate?
After the completion of root canal cleaning and shaping, the root canal is ready to be filled when: 1- Tooth is asymptomatic. 2- The canal is dry. 3- There is no sinus tract. 4- There is no foul odor. 5- No swelling 6- Temporary filling is intact.

Root Canal Filling Materials:

Basically, root canal filling is composed of: 1- Core material. 2- Sealer.

Core Materials:
 Ideal Requirements of Core materials:
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. It should be easily manipulated. It should be dimensionally stable. It should seal the canal laterally and apically. It should not irritate the periapical tissues. It should be impervious to moisture. It should be unaffected by tissue fluids. It should not support bacterial growth. It should be radiopaque. I t should not discolor tooth structure. It should be sterile. It should be easily removed from the canal if necessary.

Core Materials:
1- Pastes:
Zinc oxide-eugenol cements with various additives Epoxy resins (AH-26) Acrylic, polyethylene, and polyvinyl resins polycarboxylate cements

2- Semisolid Materials:
Gutta Percha Resin based core filling Materials Combinations

3- Solid Materials:
Silver Points Titanium points

Core Materials:
 Materials of choice: 1- Silver Points. 2- Gutta Percha 3- Resin based core filling materials 4- Combinations.

Silver Points
Introduced by Jasper in 1940. Rigid so, easily introduced into canals, especially in narrow curved canals, but impossible to adapt to canal irregularities. When leakage occurs and the points contact tissue fluids, they corrodes, further increasing leakage. Corrosion products are toxic which impede healing.

Gutta Percha
Derived from dried juices from trees of the family Sapotaceae. Crystalline gutta-percha may occur in - or phase. Popularized by Bowman in 1867.

Gutta Percha
The gutta percha filling material was discovered by Bomann 1867 could be one of the most accepted obturation materials for Root Canals because it fulfill previous criteria of good condensed inside the root canal either by lateral or vertical condensation techniques & either if it is cold or warm.

Gutta Percha
Supplied as standardized or non-standardized forms. Standardized forms are used as a primary cones, Non-standardized forms are used as auxiliary cones , because they have greater taper, thus being more rigid and more controllable.

Gutta Percha
In their final form, gutta-percha points consist of some 20% gutta-percha and up to 65% zinc oxide. A dye and metal salts are added for color and radiographic contrast. Some manufacturers add antimicrobials. o e.g. calcium hydroxide Chlorhexidine iodoform

Gutta Percha
Advantages of gutta percha: 1.Adapts excellently to the irregularities. 2.Can be softened and made plastic by heat or organic solvents. 3.Inert. 4.Dimensional stability. 5.Tissue tolerant. 6.will not discolor the tooth structure. 7.Radiopaque. 8.Easily removed from the canal when necessary.

Gutta Percha
Disadvantages of gutta percha: 1.lacks rigidity. 2.lacks adhesive quality. 3.It can be easily displaced by pressure.

Resin Based Core Filling Materials:

Resilon material points, an apparently viable alternative to gutta-percha in clinical practice, has emerged. Physical and handling characteristics similar to gutta-percha. main advantage, bonding to sealers.

Resin Based Core Filling Materials:

Resilon is a polyester core material with bioactive glass, bismuth and barium salts as fillers. Presented as cones (like gutta percha), to be used for CLCT, pellets to be used in thermoplastic, vertical condensation techniques and apical plugs to be used with Simplifil system.

Resin Based Core Filling Materials:

Resilon is the central component of many endodontic obturation systems: I. RealSeal System. II. Resilon-Epiphany System. III. Resinate System.

Resin Based Core Filling Materials:

These systems include three primary components: 1. The Resilon core material. 2. The resin sealer. 3. The primer. (Self-etchant)

Resin Based Core Filling Materials:

Because Resilon is a synthetic polymer, the resin sealer attaches to it, as well as to the bonding agent/primer used to penetrate into the dentin tubules. As a result, a monobloc is formed, consisting of filling material, resin sealer-bonding agent/primer-dentin.

Resin Based Core Filling Materials:

Through the formation of the monoblock, coronal micro leakage has been decreased and root fracture resistance has been increased.

Resin-coated gutta percha points:

EndoREZ points. Points are standard ISO-sized gutta percha points overlayed with a thin layer of polybutadienediisocyanatemethacrylate resin coating. Bonds chemically with EndoREZ and other resinbased sealers. (creating a monobloc).

Glass-Ionomer-coated gutta percha points:

Activ GP. Uses a glass ionomer-impregnated and coated gutta-percha cone that can bond to a sealing agent made of barium aluminosilicate glass powder and polyacrylic acid. (creating a monobloc)

Glass-Ionomer-coated gutta percha points:

Supplied in two forms; Activ GP (employs a traditional gutta percha design) and Activ GP Plus (employs calibration rings for easy depth measurement and a unique barrel handle)

Root canal sealers

Functions of root canal sealers:

1. Sealing off of the root canal system, 2. Entombment of remaining bacteria 3. Filling of irregularities in the prepared canal.

A sealer is what should meet hard and soft tissues; the percha is merely a piston.

Root canal sealers

DESIRABLE PROPERTIES 1. Tissue Tolerance 2. No Shrinkage with Setting 3. Slow Setting Time 4. Adhesiveness 5. Radiopacity 6. Absence of Staining 7. Solubility in Solvent 8. Insolubility to Oral and Tissue Fluids 9. Bacteriostatic Properties 10. Creation of a Seal

Root canal sealers

1. 2. 3. 4. 5. 6. Types of root canal sealers: Solvent-based sealers Zinc-oxide-eugenol-based sealers Glass-ionomer-based sealers Resin-based sealers Materials with calcium hydroxide Silicone-based sealers

Solvent-based sealers
Rosin-chloroform (Johnston-Callahan technique) Chloropercha techniques

Kloroperka

Solvent-based sealers
Pros 1. Biocompatible 2. Clinical documentation? Cons 1. Leakage 2. Shrinkage

Zinc-oxide-eugenol-based sealers
Rickerts sealer Kerr PCS (Silver) Grossmans sealer Roths, ProcoSol (bismuth, barium salts)

Robinspaste N2, Endomethasone (Paraformaldehyde)

Zinc-oxide-eugenol-based sealers
Pros Used for a century Clinical documentation Good seal Cons Local toxicity Allergen Poor stability

Glass-Ionomer based sealer

Endion

Ketac-Endo

Activ GP Glass Ionomer Sealer

Glass-Ionomer based sealer

Pros Biocompatible Chemical Bonding to dentin Cons Leakage Shrinkage

Resin Based sealers

Epoxy-bis-phenol resin TopSeal. AH-26, AH-Plus,

BisGMA, UDMA and hydrophilic methacrylates Epiphany. UDMA EndoREZ. (hydrophilic, doesnt need primer) Epoxy-bis-phenol resin, metheneamine, enoxolone, calcium hydroxide Acroseal

Resin Based sealers

Pros 1. More than40 years 2. Clinical documentation 3. Stable Cons 1. Toxic when fresh 2. Allergen 3. Leakage?

Sealer based on Calcium hydroxide:

Toluene salicylate, calcium oxide, Sealapex Salicylates, calcium hydroxide, Apexit CRCS

Sealer based on Calcium hydroxide:

1. 2. 3. 1. 2. 3. Pros Clinical documentation Good seal Biocompatible Cons Inhomogeneous setting Poor x-ray contrast Lack of physical sturdiness

Silicone based RCS:

Polydimethylsiloxane, silicone oil, zirconium oxide, RoekoSeal.

Polydimethylsiloxane, silicone oil, zirconium oxide, gutta-percha, Guttaflow.

Silicone based RCS:

1. 2. 3. 1. 2. 3. Pros: Very good documentation Very good biocompatibility Clinically tested Cons No antibacterial effect Poor mechanical strength Short history