Obturation is the method used to fill and seal a cleaned and shaped canal using a root canal

sealer and a core filling material.

The primary objective of endodontic treatment is to create a fluid tight seal along the root
canal system and 3D obliteration of the root canal, in order to:
➔ Prevent percolation and microleakage of periapical exudates into the root canal space.
➔ Prevent infection.
➔ Create a favorable biologic environment to allow healing of periapical tissues.

When do we fill the canal?

➔ The canal is enlarged to the optimum size and shape.
➔ The canal is dry (no pus/blood).
➔ The tooth is asymptomatic.
➔ No foul odor.
➔ No swellings.
➔ The temporary filling is intact.
➔ No sinus tract.
➔ Negative culture.

Extension of the root canal filling:

➔ Coronally: 1 mm beyond the orifices of the root canal.
➔ Apically: at the apical constriction (CDJ)
**The CDJ is not only the anatomic limit of the root canal, but also the narrowest diameter of the
apical foramen, so it’s the major factor in limiting filling materials to the canal.
➢ The CDJ is about 0.5-0.7 from the external surface of the apical foramen.

Requirements for an ideal root canal filling material:

➔ Easily introduced into a root canal.
➔ Seals the canal laterally & apically.
➔ Shouldn’t shrink after insertion (dimensionally stable).
➔ Unaffected by fluids.
➔ Bacteriostatic.
➔ Radiopaque.
➔ Shouldn’t stain the tooth structure.
➔ Shouldn’t irritate the periapical tissues (inert).
➔ Sterile or easily and quickly sterilized before insertion.
➔ Removed easily if necessary.

Types of root canal filling materials:

➔ Plastic (Semi-solid materials): Gutta percha & Resilon (outdated).
➔ Solid (Semi-rigid material): Silver points (no longer used).
**Disadvantages of silver points:
- Corrosion, toxicity, staining.
- Lack plasticity so it’s not well adapted to the root canal & is difficult to remove.
 Gutta-Percha (gold standard obturating material)
● It’s a naturally occurring polymer of isoprene.
● GP exists in 2 different crystalline forms → alpha & beta.
● Both forms differ only in single bond configuration and molecular repeat distance.

● There are no differences in the physical properties between the two forms, merely
differences in the crystalline lattice related to the different rates of cooling from melting.

Beta form:
- Commercial GP.
- Solid

Alpha form:
- Comes directly from the tree.
- Tacky & sticky.

Amorphous phase:
- Properties similar to the alpha phase.

Alpha form → heated above 65 → amorphous.

Amorphous → cooled extremely slow → alpha form.

Amorphous → cooled routinely → beta form.

Beta form → reheated at 56 → amorphous.

What affects the melting point of gutta percha?

➔ Rate of cooling
➔ Purity of the material
➔ Average molecular weight
➔ Molecular weight distribution

● Applied using compaction not condensation.

● It’s thermoplastic (expands on heating and shrinks with solidification).
● Shrinkage is compensated by compaction.
● Ingredients:
○ 20% GP (Matrix)
○ 66% Zinc oxide
○ 1-18% Heavy metal sulphates/metal salts (to make the material radiopaque).
○ 1-4% Waxes and/or resins (to make the material pliable).
Advantages of GP:
1. Compactability: excellent adaptation to the walls.
2. Inertness: least reactive of all materials.
3. Dimensional stability.
4. Tissue tolerance
5. Easily introduced into the canal.
6. Radiopaque.
7. Easily removed from the canal.
8. Thermoplastic.
9. Soluble in common solvents.

Disadvantages of GP:
1. Lack of rigidity: it bends easily when subjected to lateral pressure, making it extremely
difficult to use in smaller canals.

2. Lack of length control: permits vertical distortion by stretching, unless it meets an

obstruction or is packed against a definite matrix or a stopping point.

3. It lacks adhesive quality: does not adhere to the canal walls, which is why a sealer is
required.

Availability of gutta percha cones:

A. Standardized Form:
- Easier to use for a master cone.
- Available in sizes 25 → 140.
- Conforming in apical width and taper to standardized instruments.

B. Non-standardized Form:
- Increased taper and is used in canals of unusual shape and as auxiliary cones in
lateral condensation technique.
- Available as extra-fine, fine fine, medium-fine, fine, medium, and coarse.

C. Pellet Form
D. Injectable Syringes (Cannules)
E. Pre-coated Core Carrier Gutta Percha (Thermal Fil System)
F. Gutta Flow (GP powder incorporated in Silicone-Based Sealer)

Resilon

- Core material: thermoplastic synthetic polymer (polyester based).

- Sealer: dual-cured resin based composite sealer.
- Primer: self-etch primer that enables bonding of the sealer to the canal walls.
 Root Canal Sealers (Holds the core materials together with/to the dentin walls)

Requirements & characteristics of an ideal root canal sealer:

➔ Tacky/Sticky when mixed to provide good adhesion when set between the solid core and
the canal wall.
➔ Hermetic seal: should provide a fluid tight seal.
➔ Radiopaque
➔ Very fine powder particles: for easy mixing with the liquid.
➔ Should not shrink upon setting.
➔ Should not stain the tooth structure.
➔ Bacteriostatic.
➔ Insoluble in tissue fluids.
➔ Tissue tolerant.
➔ Soluble in one or more of the common solvents.
➔ Slow setting.
➔ Should not provoke an immune response in periradicular tissues (not irritant).
➔ Should not be mutagenic/carcinogenic.

Function of root canal sealers:

➔ Antibacterial effect: all sealers contain an antibacterial agent.
➔ Sealers are needed to fill in the discrepancies between the hard core filling and the
dentin walls.
➔ Lubrication.
➔ Radiopacity.

Factors to be considered in sealers:

➔ Amount of lubrication needed.
➔ Working time anticipated (filling 4 canals vs. one canal).
➔ Temperature of core materials (a sealer should withstand the temperature of GP).
➔ Irritating potential (some sealers are irritant).

Forms: powder & liquid, tubes, dual syringes, and automixed syringes.
**Dual syringes and automixed syringes have accurate proportions, thus eliminating improper
proportioning or mixing.
➔
 Classification of Sealers

Advantages Disadvantages

Zinc Oxide Eugenol - Antimicrobial activity - Can stain the tooth structure
(e.g, Endofil) - Sedative effect - Slow setting time (cannot be used with
- Resorb if extruded into the periradicular patients in a hurry).
Powder & Liquid tissues. - Slight shrinkage on setting
(Indicated with warm - Long working time - High solubility
GP)

Resin-based - Adhesion - Stains the tooth structure

(e.g, AH26, AH Plus, - Long working time - Relatively insoluble in solvents (so not
Endorez) easily removed)

Combined Zinc - Increased strength - Irritant

Oxide & Resin - No staining
(e.g, Diakat, Kerr
Root Canal Sealer,
Tubli-Seal)

Calcium Hydroxide - Long working time - Soluble

Based Sealers - High pH (alkaline, so it stimulates the - Very slow setting
(e.g, Sealapex, induction of mineralized tissues at the
Apexit, Calcibiotic) apical foramen).
- High biocompatibility.
- Stimulates calcific barrier.
- Antimicrobial activity.

Silicon-based - Insoluble - Do not bond to dentin

Sealers - Dimensionally stable - Not antibacterial
(e.g, Roeko Seal,
Guttaflow).

Glass Ionomer - Adhere to dentin - Short working time

Based Sealers - Good seal - Difficult to remove in retreatment
(e.g, Ketac Endo, - Low shrinkage on setting
Endoseal).

Polycarboxylate - Adhere well to dentin - Short working time

Based Sealers (ZnO - Very hard - Impossible to remove for retreatment
& Polyacrylic acid) - Not soluble in water - Set rapidly

Medicated Sealers ---- - Severe irritation

(e.g, N2, Spad, - Destructive effect on periapical tissues
Endomethazone). (may cause osteomyelitis or paresthesia
if extruded periapically)
Bioceramic Sealers - Biocompatibility ----
- Stable in wet environment (hydrophilic)
- Calcium Silicate- - Good sealing ability
based sealer (e.g, - Expands upon setting
iRoot, MTA Filapex, - Bioactive
Endosequence). - Antibacterial

- Calcium
Phosphate-based
sealer (e.g, Apatite
Root Canal Sealer,
Bioaggregate).

**Guttaflow: combines the sealer with a very fine gutta-percha powder, making it the first sealer/gutta
percha combination that is flowable at room temperature → reinforcement.

Tests for proper consistency of sealers:

A. The drop test: mass of cement is gathered onto the spatula → spatula is then held edge wise →
the cement should not drop off the spatula’s edge in less than 10-12 seconds.
● If teardrops form, the mix is thin and more powder should be added.

B. The string out test: touch the mass of cement with the flat surface of a spatula, then raise the
spatula up slowly from the glass slab → the cement should string out for 1 inch without breaking.
● Otherwise, it’s of improper consistency.

Fitting the Master Point

The master point must be trimmed and fitted that:
1. Its adjusted length is sufficient to reach the apical end of the root canal.
2. Its adjusted apical cross section is of such diameter that it blocks or simply fits the apical
foramen.
3. The apical ⅓ of the canal is rather completely filled by that portion of the master point.

Tests:
A. Visual test:
- The master point is positioned equal to the working length.
- If the working length of the tooth was correct, then the visual test has been
passed.
- If it can be pushed beyond this position, then the point should be trimmed to the
proper length and tried again.
- If the point can be extended beyond the apex, choose a larger size.

B. Tactile sensation:
 - If the apical 3-4 mm of the canal has been prepared with parallel walls, some
degree of force should be required to seat the point, and once it’s in position, a
pulling force should be required to dislodge it (tug-back).
- If the point is loose in the canal, the next larger size is tried, or the method of
cutting segments from the tip of the master point is used.

C. Radiograph:
- The radiograph must show the point extending to within 1 mm from the
radiographic apex.
- If it’s beyond the apex, the over extended point should be shortened from the fine
end and then carefully retrieved.
- But it should never be just pulled back to the proper working length, otherwise it
would be loose in the canal.

Variations of the master points:

1. Fabrication of a customized G.P. cone:
- Three or more GP cones are warmed together over a flame → twisted into a bundle rolled
between two sterile glass slabs → after it cools, the apical end is softened in chloroform
(dip for 2-3 seconds) → insert into the canal.

2. Inverted point technique:

- Used in tubular shaped canal, more commonly found in maxillary anteriors.
- The serrated butt end of a GP is removed → the point is inserted with its inverted end.
- It should appear in the radiograph to be in optimum position to obliterate the
apical third of the canal.
- Then, additional GP points are carefully added by lateral condensation
technique.

3. Tailor made gutta percha points:

- If the tubular canal is so large that the largest inverted gutta percha is still loose
in the canal, a tailor made point must be used.
- Made by heating a number of GP points and combining them butt-to-tip on a
sterile glass slab.
- They are rolled into a rod shaped mass, approximately the size of the canal, then
chilled with ethyl chloride spray.
- Additional auxiliary points should be added as described in lateral condensation
technique.

Methods of Root Canal Obturation with GP

I. Cold Gutta Percha Points:
Lateral Condensation Technique (Compaction):
 - Effective in naturally large canals and in canals and which have been enlarged to the
extent that a master point, supplemented by smaller auxiliary point, and the cementing
substance is required for obturation.

➔ Prior to filling, irrigate and thoroughly dry the canal with dry, sterile, blunt-end, absorbent
points. The cavity should be completely dry.
➔ A spreader should be chosen, one which will reach to within 1-2 mm of the true working
length and should be the same size as the apical instrument.
➔ The apical one half of the master point is coated with a sealer and the master cone is
seated into the canal.
➔ The root canal spreader is passed into the canal as far as possible alongside the master
point and is used to condense the point against whichever side of the canal it will go
most readily.
● Subsequent rotation of the spreader and its careful removal from the canal
will prevent any displacement of the master point.
➔ Fill the space by inserting auxiliary GP points individually and thoroughly condense them
laterally. This is done until all of the canal space is obliterated.
➔ Using a warred, flat instrument, any excess GP extending into the pulp chamber is
removed to the entrances of the root canal(s).
● Any filling material left in the crown of the tooth increases the possibility
for later discoloration of the crown.
➔ Confirm proper obturation by evenly white-colored root canal filling seen in radiograph.

II. Chemically Plasticized Cold GP:

● Involves the use of a solvent to soften the primary GP point in an effort to ensure
that it will better conform to the apical canal anatomy.

A. The Callahan-Johnson Technique / Johnson Callahan Diffusion Technique:

- Flood the canal with a solution of Callahan’s rosin & chloroform for 2 minutes
before insertion of the master cone.
- The master cone is then compressed laterally and apically with the plugger until it
dissolves in the chloroform.

B. The Nygaard-Ostby Method:

- Reduces the shrinkage of the final filling.
- Reduces the apical extrusion of the toxic chloroform.
- The paste is composed of finely ground GP, Canada Balsam, and Zinc Oxide
powder dissolved in chloroform.

C. GP-Eucapercha Paste:
- Eucalyptol is used instead of chloroform, which is much less toxic.
- But it increases the voids.

III. Warm Gutta-Percha:

 1. Vertical Compaction Technique:
● Indications: ledges, perforations, unusual curvature, internal resorption, or lateral
canals.
● A. Pluggers for condensation, and heater tips.
- Pluggers:
➢ Wide plugger for coronal third.
➢ Narrower plugger for the middle third.
➢ Narrowest plugger for the apical third (Extending 4-5 mm of the
root end).
➢ NiTi pluggers are used for curved canals.

- Heater Tips:
➢ Must have a narrow enough tip to reach within 5mm of the root
end.

❖ Steps of down-packing of GP:

➔ Cut from the selected cone 1-2 mm to avoid overextension on vertical
compaction.
➔ The master cone is coated with sealer and inserted into the canal.
➔ Using a heated plugger, the coronal part of the master point is removed.
➔ The first wave of heat is then applied to the coronal part of the cone where it
remains for 2-3 seconds transferring heat to the GP. When retrieved, it carries
with it a small piece of softened GP.
➔ The widest plugger is used to compact the GP, forcing it apically and
compensating the shrinkage that occurred upon cooling.
➔ A second wave of heat is then applied further down to the middle part of the GP
cone for 2-3 seconds, retrieved, and then the GP is compacted with the middle
sized plugger.
➔ The process is repeated until the apical portion is reached.
➔ When the binding point is reached (where the GP binds to dentin walls, making
the instruments resistant to going further apically), the remainder of the canal will
be filled with back-filling technique.

**Binding point is 4-5 mm from the working length.

❖ Steps of back-filling technique:

● Method A:
➔ Insert the next cone and cut from it the number of mm filled by the 1st increment.
➔ The remaining part of the canal is filled by heating small segments of the GP,
welding them with heat carrier, carrying them into the canal, and compacting
them using pluggers.

● Method B:
 ➔ Empty canal space is filled with injection-plasticized GP, delivered from a gun in
increments of 3-4 mm and vertically compacted by pluggers to ensure its flow
into portals of exit and to counteract cooling shrinkage.

**In this technique, no auxiliaries are used.

❖ Continuous wave of compaction (System B):

- It’s an electronic heat carrier which allows rapid continuous heating and instant
cooling of tips, to facilitate their use as both heat carrier and plugger.
- It maintains apical pressure, activates the heat switch for 1 second, followed by 1
second pause, then remove the plugger.

2. Thermoplasticized Gutta Percha:

A. The Obtura II System:
- This method employs a device capable of heating regular beta-phase GP
to temperatures ranging from 160 to 200C.
- At this temperature, the GP flows through either a 20-gauge needle
(equals to a size 60 file) or 23-gauge needle (equal to size 40 file).
- Fitted to a gutta-percha gun.
- Both the injection needle and pluggers must reach within 3-5 mm of the
apical terminus and fit loosely at this point.
- The thermoplasticized GP extrudes through the needle tip with a
temperature of 55 to 66C.

- The injection should be less than 20 seconds, to prevent possible voids

and manual condensation with a plugger may be used.

B. The Ultrafil System:

- It’s a low heat system in which the cannules containing GP are heated
and placed in a syringe prior to delivery.
- Depending on the consistency desired, the clinician can choose one of
the three types of GP:
a. Regular set: requires no condensation because of its low
viscosity.
b. Firm set: condensation is optional.
c. Endoset: condensation is required.
- The temperature of the thermoplasticized GP as it’s extruded through the
needle tip ranges from 38 to 44C.

3. Thermo-Mechanical Compaction of GP:

- McSpadden Compactor.
- The compactor plasticizes the GP by frictional heat and then compacts the softened GP
apically.
 - The compactor instruments fit into a conventional contra angle handpiece and operate
on the principle of a reverse screw exactly opposite from the H-file.

● Disadvantages:
➔ Compact tip can separate within the canal during condensation due to its fragility.
➔ Inability to use in narrow canals.
➔ Frequent overfilling.

- A modification “NT Condenser” brought a slower and gentler model, but it still didn’t
overcome the problem of overfilling.

4. Gutta-Percha Carriers (Thermafil - Guttacore):

- Thermafil endodontic obturators are flexible metal (stainless steel or titanium) or plastic
carriers that have been coated with an alpha phase GP for obturating root canal
systems.
- Once heated, the alpha phase exhibits a marked wetting phenomenon and becomes
extremely tacky and adhesive.
- It’s inserted into the prepared canal that has been coated with a sealer → the shaft of the carries
protruding above the canal orifice is removed with a bur or heat, leaving the bulk of the carrier
with GP as the permanent obturation.

Errors during obturation:

● Over extension → no proper apical stop, or increased apical force during compaction.
● Under extension → improper WL, blockage, incorrect motion of spreader during lateral
compaction technique.
● Voids:
➔ Vertical voids: due to unfilled space during obturation in lateral compaction
technique.
➔ Horizontal voids: occur in vertical compaction technique between each
increment, and may be due to excessive pressure with plugger.
● Root fracture
● Thermal injury → prolonged use of heat tip will transfer the heat to PD space, leading to
postoperative pain.
● Adverse reaction to filling materials (rare).

Good luck :)
Loujine Elrafey