Lecturer: Levkiv

Mariana
Department of
Therapeutic Dentistry
TSMU

Root canal
filling
materials.
Root filling
techniques.

Purpose
of
root
canal
filling

To prevent bacteria and bacterial elements

from spreading from (or through) the canal
system to the periapical area,
the fully instrumented root canal has to be
provided with a tight and long-lasting
obturation.
A root canal filling material should, therefore,
prevent infection/reinfection of treated root
canals. Together with an acceptable level of
biocompatibility (inert material) this will
provide the basis for promoting healing of
the periodontal tissues and for maintaining
healthy periapical conditions.

Instruments for root canal filling

Lentulo

spiral filler/rotary paste filler

Function and features
Small exible instrument used to place
materials into the canal
Fits into the conventional handpiece
Use with caution as it can be easily
broken
Different sizes available

Finger spreader
Function, features and precaution
Used to condense gutta percha into the
canal during obturation
Finger instrument with a smooth, pointed,
tapered working end
Disposed of in the sharps container
Varieties
Can be of the hand instrument type (lateral
condenser)

Endodontic plugger
Function
Working end is at to facilitate plugging or
condensing the gutta percha after the excess
has been removed by melting off with a heated
instrument
Varieties
Different sizes of working ends are available
Available as hand or finger instruments

Gutta percha points

Function and features
Non-soluble, non-irritant points that are
condensed into the pulp chamber during
obturation
Standardised type: follows same ISO
classification as endodontic files
Non-standardised: have a greater taper than
the standard ISO type
Varieties

Can be packaged in single dose or bulk

packages
Different sizes with different tapers available

OBTURATING MATERIALS
Sealers
Regardless

of the obturation technique

employed, sealers are an essential
component of the process. Sealers fill
the space between the canal wall and
core obturation material and may fill
lateral and accessory canals, isthmuses,
and irregularities in the root canal
system.

The ideal properties of endodontic sealer

are
as follows:
1.
It should
be tacky when mixed to provide good adhesion
between it and the canal wall when set.
2. It should produce a watertight seal
3. It should be radiopaque so that it can be visualized o on X-ray.
4. The particles of powder should be very fine so they can mix
easily with the liquid.
5. It should not shrink on setting.
6. It should not stain tooth structure.
7. It should be bacteriostatic or at least not encourage bacterial
growth.
8. It should set slowly.
9. It should be insoluble in tissue uids.
10. It should be tissue-tolerant, that is nonirritating to
periradicular tissue.
11. It should be soluble in a common solvent in case removal of
the root canal filling becomes necessary.

The most popular sealers are grouped by

type:
Zinc oxide-eugenol formulations,
Calcium hydroxide sealers,
Glass- ionomers, and
Resins.
Regardless of the sealer selected, all are
toxic until they set. For this reason,
extrusion of sealers into the
periradicular tissues should be avoided.

 Zinc

oxide-eugenol and resin sealers have

a history of successful use over an extended
period. Zinc oxide-eugenol sealers have the
advantage of being resorbed if extruded into
the periradicular tissues .
Calcium hydroxide sealers were recently
introduced for their potential therapeutic
benefits. In theory these sealers exhibit an
antimicrobial effect and have osteogenic
potential. Unfortunately these actions have
not been demonstrated, and the solubility
required for release of calcium hydroxide and
sustained activity is a distinct disadvantage.
Glass ionomers have been advocated for
use in sealing the radicular space because of
their dentin bonding properties. A
disadvantage is their difficult removal if
retreatment is required.

 Sealers

containing
paraformaldehyde are
contraindicated in endodontic
treatment. Although the lead and
mercury components have been
removed from the formulations over
time, the paraformaldehyde content has
remained constant and toxic. These
sealers are not approved by the U. S.
Food and Drug Administration.

Controversy surrounds removal of the smear

layer before obturation. The smear layer is
created on the canal walls by manipulation
of the files during cleaning and shaping
procedures. It is composed of inorganic and
organic components that may contain
bacteria and their by-products. In theory
remnants left on the canal wall may serve
as irritants or substrates for bacterial growth
or interfere with the development of a seal
during obturation. Although uid movement
may occur in obturated canals, bacterial
movement does not appear to take place.
Recent evidence suggests that removal of
the smear layer can enhance penetration of
the sealer into the dentinal tubules.

 Removal

of the smear layer can be

accomplished after cleaning and
shaping by irrigation with 17%
ethylenediaminetetraacetic acid (EDTA)
for 1 minute. Irrigation should be
followed with a final rinse of sodium
hypochlorite.

Acceptable methods of placing the

sealer in the canal include the
Placing the sealer on the master cone
following:
and pumping the cone up and down in
the canal
Placing the sealer on a file and
spinning it counter clockwise
Placing the sealer with a lentulo spiral
Using a syringe
Activating an ultrasonic instrument
The clinician should use care when placing
sealer in a canal with an open apex to
avoid extrusion.

Core Obturation Materials

Historically,

a variety of materials have

been employed to obturate the root
canal, falling into three broad
categories:
solids,
semisolids, and
Pastes(sealers)

Sealers

A wide variety are available. The calcium

hydroxide materials (e.g. Sealapex) or the
eugenol-based sealers (e.g. Tubliseal) are perhaps
the safest choice. Some would advocate the
routine use of non-setting calcium hydroxide
paste (Hypocal) as an inter-appointment
medicament.
Calcium hydroxide This is considered
separately, because it has a wide range of
applications in endodontics due to its
antibacterial properties and an ability to promote
the formation of a calcific barrier. The former is
thought to be due to a high pH and also to the
absorption of carbon dioxide, upon which the
metabolic activities of many root-canal pathogens
depend. It is also proteolytic.

Indications for the use of calcium

hydroxide include:

To promote apical closure in immature

teeth.
In the management of perforations.
In the treatment of resorption.
As a temporary dressing for canals
where filling has to be delayed. In the
management of recurrent infections
during RCT.

Solid materials
Silver cones met many of the criteria
for filling materials but suffered from
several deficiencies. The rigidity that
made them easy to introduce into the
canal also made them impossible to
adapt to the inevitably irregular canal
preparation, encouraging leakage. When
leakage occurred and the points
contacted tissue uids, they corroded,
further increasing leakage.

Semisolid material
Gutta-percha,

a semisolid material, is the

most widely used and accepted obturating
material. Gutta-percha is a natural product
that consists of the purified coagulated
exudate of mazer wood trees (Isonandra
percha) from the Malay archipelago or from
South America.

Typical composition of gutta-percha cones.

 Gutta-percha

does not adhere to the canal

walls, regardless of the filling technique
applied, resulting in the potential for
marked leakage. Therefore, it is generally
recommended that gutta-percha (used
cold or heated) is used together with a
sealer. For an optimal seal the sealer layer
should generally be as thin as possible.

Root canal filling technique.

Solid core technique

Single cone

The single-cone technique consists of matching

a cone to the prepared canal. For this
technique a type of canal preparation is
advocated so that the size of the cone and the
shape of the preparation are closely matched.
When a gutta-percha cone fits the apical
portion of the canal snugly, it is cemented in
place with a root canal sealer. Although the
technique is simple, it has several
disadvantages and cannot be considered as
one that seals canals completely. After
preparation, root canals are seldom round
throughout their length, except possibly for the
apical 2 or 3 mm. Therefore, the single-cone
technique, at best, only seals this portion.

 Cold

lateral condensation This is a

commonly taught method of obturation and is
the gold standard by which others are judged.
The technique involves placement
of a master point chosen to fit
the apical section of the canal.
Obturation of the remainder is
achieved by condensation of
smaller accessory points. The
steps involved are:

1. Select a GP master point to correspond with the master

apical file instrument. This should fit the apical region snugly
at the working length so that on removal a degree of
resistance or 'tug-back' is felt. If there is no tug-back select a
larger point or cut 1 mm at a time off the tip of the point until
a good fit is obtained. The point should be notched at the
correct working length to guide its placement to the apical
constriction.
2 . Take a radiograph to confirm that the point is in correct
position if you are in any doubt.
3. Coat walls of canal with sealer using a small file.
4. Insert the master point, covered in cement.
5 . Condense the GP laterally with a finger spreader to
provide space into which accessory points can be inserted
until the canal is full.
6. Excess GP is cut off with a hot instrument and the
remainder packed vertically into the canal with a cold
plugger.

Sketch showing a cross-sectional cut

through a root canal filled with a master
cone and multiple accessory cones

 Warm

lateral condensation As above,

but uses a warm spreader after the
initial cold lateral condensation. Finger
spreaders can be heated in a ame or a
special electronically heated device
(Touch of heat) can be used.

Vertical condensation

In this technique the GP is warmed using

a heated instrument and then packed
vertically. A good apical stop is necessary
to prevent apical extrusion of the filling,
but with practice a very dense root filling
can result. Time consuming.

Diagram of the warm vertical condensation

technique.
A, After a heated spreader
is used to remove the coronal
segment of the master cone,
a cold plugger is used to apply
vertical pressure to the softened
master cone.
B, Obturation of the coronal
portion of the canal is
accomplished by adding a gutta
-percha segment.
C, A heated spreader is used to
soften the material.
D, A cold plugger is then used
to apply pressure to the
softened gutta-percha.

Thermomechanical compaction This involves a

reverse turning (e.g. McSpadden compactor or GP
condenser) instrument which, like a reverse
Hedstroem file, softens the GP, forcing it ahead of,
and lateral to the compactor shaft. This is a very
effective technique, particularly if used in
conjunction with lateral condensation in the apical
region, but requires much practice to perfect.
Thermoplasticized injectable GP (e.g.
Obtura, Ultrafil) These commercial machines
extrude heated GP (70-160C) into the canal. It is
difficult to control the apical extent of the root
filling, and some contraction of the GP occurs on
cooling. Useful for irregular canal defects, e.g.
following internal root resorption.

Coated carriers (e.g. Thermafil) These

are cores of metal or plastic coated with GP.
They are heated in an oven and then simply
pushed into the root canal to the correct
length. The core is then severed with a bur.
A dense filling results, but again apical
control is poor and extrusions common.
They are expensive and difficult to remove.
Once the filling is in place the tooth will
need to be permanently restored, provided
the follow-up radiograph is satisfactory.
Fillings that appear inadequate
radiographically may be reviewed regularly,
or replaced, depending upon the clinical
circumstances.

THE CORONAL SEAL

Regardless of the technique used to obturate the canals,
coronal microleakage can occur through seemingly wellobturated canals within a short time, potentially causing
infection of the periapical area. A method to protect
the canals in case of failure of the coronal restoration is to
cover the oor of the pulp chamber with a lining of glass
ionomer cement after the excess gutta-percha and sealer
have been cleaned from the canal. Glass ionomers have the
intrinsic ability to bond to the dentin, so they do not require
a pretreatment step. The resin-modified glass ionomer
cement is simply owed approximately 1 mm thick over the
oor of the pulp chamber and polymerized with a curing
light for 30 seconds. Investigators found that this procedure
resulted in none of the experimental canals showing
leakage