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GOOD MORNING ….

GOOD MORNING …. OBTURATION PART-I. DEF OF OBTURATION OBJECTIVES OF OBTURATION HISTORY – OBTURATION CLASSIFICATION OF OBTURATING MATERIALS APICAL LIMIT OF OBTURATION . ROOT CANAL SEALERS: CLASSIFICATION: Gutta percha based sealers. ZNOE based sealers Resin based sealers (Epoxy based).

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GOOD MORNING ….

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  1. GOOD MORNING ….

  2. OBTURATION PART-I

  3. DEF OF OBTURATION • OBJECTIVES OF OBTURATION • HISTORY – OBTURATION • CLASSIFICATION OF OBTURATING MATERIALS • APICAL LIMIT OF OBTURATION. • ROOT CANAL SEALERS: • CLASSIFICATION: • Gutta percha based sealers. • ZNOE based sealers • Resin based sealers (Epoxy based).

  4. Resin based sealers (Urethene methacrylate based sealer) • Calcium hydroxide based sealers. • Calcium phosphate based sealers. • Glass ionomer based sealers. • Formaldehyde based sealers. • Silicone based sealers. • Experimental sealers.

  5. Introduction “perhaps there is no technical operation in dentistry where so much depends on the adherence to high ideals as that of pulp canal filling” Dr. Hatton 1924 It has been 4 decades since the late Dr. Herbert Schilder published his classic article on filling the root canal space in 3 dimensions. DCNA: Nov: 1967:723-744.

  6. Filling - instrumented root canal is final step in the fulfilment of an endodontic treatment regardless of whether the treatment was undertaken to remove vital pulp, necrotic pulp or infected pulp or a previous root canal filling. • The obturation phase of root canal treatment has always received a great deal of attention.

  7. DEFINITION “The three-dimensional filling of the entire root canal system as close to the CDJ as possible with minimal amounts of root canal sealers, which have been demonstrated to be biologically compatible, are used with the core filling materials to establish an adequate seal” --American Association Of Endodontists (AAE) 1994

  8. OBJECTIVES OF OBTURATION • Substitution of an inert filling in the space previously occupied by the pulp tissue • To eliminate all avenues of leakage from the oral cavity or the periradicular tissues into the root canal system. (i.e. to attain a three dimensional fluid impervious seal apicaly, laterally and coronally within the confines of the root canal system)

  9. To adequately seal iatrogenic causes such perforations, ledges and zipped apices. • Radiographically: • To attain a radiographic appearance of a dense three dimensional filling which extends as close as possible to the cemento dentinal junction without gross over extension or under filling in the presence of a patent canal

  10. AAE: Obturated root canal should reflect a shape that is approximately the same shape as the root morphology and it should have a continious tapered funnel preparation without excess removal of tooth structure at any level of the canal system . • Lack of complete obturation – IS the most frequent cause of failure. • Dow and Ingle (JOE 1982) demonstrated that nearly 60% of endodontic failures were caused by an incomplete obturation of the root canal system

  11. HISTORY

  12. 200 B.C. – oldest known root canal filling with bronze wire - found in the root canal in the skull of a Nabatean warrior • 1825- Gold foil was used as root canal filing by Edward Hudson • Other materials • Lead, Paraffin, Amalgam, Wood points, • Ivory, Orangewood sticks In 1843, Gutta percha was 1st introduced by Sir Jose d Almeida to Royal Asiatic Society of England. Edwin Truman was the first man to introduce Gutta percha to Dentistry as a temporary restorative material.

  13. 1847- AsaHilldeveloped first gutta –percha material known as Hill’s stopping • Consisted of bleached gutta-percha & carbonate of lime and quartz. • 1867-Bowman, 1st use of gutta percha for obturating a root canal in an extracted first molar

  14. 1883-Perry claimed the use of : • Pointed gold wire wrapped with soft gutta-percha • Gutta percha rolled into points and packed into the canal • Chemical softening of shellac coated gutta percha using alcohol. • 1887- S.S. White Company began to manufacture Gutta percha points

  15. 1893-Rollinsintroduced new type of gutta percha to which he added vermilion (pure oxide of mercury) • 1899- 1st endodontic radiograph by Edmund Kells. • Canals were not cylindric • Need for additional filling material

  16. 1898-Gysi introduced a formaldehyde paste- Gysi’s Triopaste • 1933- Jasper introduced silver points • 1946- Sommer provided the technical essentials of application of the lateral condensation technique • 1953- Berg demonstrated - essentials of vertical condensation technique • 1967- Schilderpopularized vertical condensation technique. • 1977- Yee et al introduced the injectable thermoplasticized gutta-percha technique

  17. 1979- Mc Spadden introduced a special compactor for softening gutta percha by friction • 1984- Michanowicz introduced a low temperature (70C) injectable thermoplasticized gutta-percha technique- Ultrafil • 1994- James B. Roane -Inject R-Fill technique • 1996- Steven Buchanan developed a new method of vertical compaction of warm gutta percha - continuous wave of condensation technique (System B)

  18. CLASSIFICATION OF ROOT CANAL FILLING MATERIALS (by Grossman) • SOLID – CORE MATERIALS • Metals • Plastics • Cements/pastes • SEALERS • Plastics • Cements • Pastes

  19. 1984 ANSI/ADA Specification No.57 Endodontic filling materials --- Richard Burns: Chap: 8. • Type I • Core (standardized) and auxiliary (conventional) points to be used with sealer cements • Class 1 – Metallic • Class 2 – Polymeric • Type II • Sealer cements to be used with filling materials • Type III • Filling materials to be used with or without the use of sealer cements

  20. 1994 ANSI/ADA Specification No.78 Endodontic obturation points • Type I • Core standardized points to be used with sealer & cement • Type II • Auxiliary G.P (conventional or accessory points) of non standardized taper

  21. Hermetic seal : myth or misconception Grossman principle - 9 • Often cited as a major goal of root canal treatment in the achievement of a hermetic seal • According to dictionary definitions hermetic means “sealed against the escape or entry of air or made air tight by fusion or sealing” • Endodontically speaking the term hermetic is inappropriate and term such as fluid tight , fluid impervious, impermeable seal or bacterial tight seal - more accurate terms.. • Mid 1960’s --- Hermetic seal----Grossman • 1982 --- Fluid impervious seal ----Ramsey

  22. Apical position/limit of the Obturation Although filling entire root canal system is major goal - canal obturation. • A major controversy exists as to where to end the apical termination of the root canal filling material • W.L determination often cites the CDJ or apical constriction as the ideal position for terminating the C & S procedures and the point to which obturation should be placed

  23. The CDJ is a histological position and not a clinical position • The CDJ is not always the most constricted portion of the canal. • The distance from the apical foramen to the constriction depends on many factors like – increased cementum deposition, radicular resorption, age, Orthodontic movement, periradicular pathology etc

  24. BEYOND THE RADIOGRAPHIC APEX RHEIN (1922) MAISTO (1948) HESS (1954) ‘APICAL PUFF’ OR ‘BUTTON’ To compensate for shrinkage of the filling As an indicator that gutta percha has been densely packed in to apical preparation All abberations, lateral and accessory canals have been cleansed and filled. IEJ-1998:31:384-393.

  25. AT THE RADIOGRAPHIC APEX: SCHILDER (JOE:1967) Must fill lateral and apical ramifications.. CDJ/ apical constriction is variable CASTELLUCEI & BECCIANI (JOE:1992) Radiographic apex fixed point,

  26. SHORT OF RADIOGRAPHIC APEX: NYGAARD – ØSTBY (JOE: 1961) Apical space filled by connective tissue TORNECK (1966) SELTZER (JOE: 1964) SJOGREN (JOE: 1990): Obturation materials (especially sealers) may elicit sensitivity and immune response and should remain in the canal

  27. SHORT OF THE RADIOGRAPHIC APEX AT THE CEMENTO DENTINAL JUNCTION AT THE APICAL CONSTRICTION 2 – 3 mm SHORT

  28. AT THE CEMENTO DENTINAL JUNCTION • GROVE (1929) • CDJ • - maximal apical constriction • pulp tissue ends • KUTTLER ( 1951, 1955, 1958) – IEJ: 2006:39:595-609. • CDJ - is approximately 0.5-0.7mm from external surface of apical foramen. • CDJ --- 0.5 mm from A.P in young people • 0.75 mm from A.P in older individuals

  29. AT THE APICAL CONSTRICTION LANGELAND (1957, 1967, 1987, 1995) CDJ Histologic structure Not detected radiographically Can be detected only clinically, Highly irregular-Not a constant feature. SELTZER et al (1964) Minimizes irritation of periapical tissues IEJ-1998:31:384-393

  30. 2 – 3 mm SHORT (PARTIAL PULPECTOMY): DAVIS (1922) Apical periodontium not challenged Apical pulp stump acts as a barrier TRONSTAD (1979) SJOGREN et al (1990) Apical pulp tissue more resistant to disintegration; probably due to substantial blood supply AND Ultimately it gets replaced by fibrous tissue.

  31. DEFINITION OF TERMINOLOGIES Schilder: DCNA:1967 • Overfilling: • 3 dimensional obturation of the root canal space with excess material extruding beyond the apical foramen • Underfilling: • The apical seal is obtained but the canal space is incompletely filled leaving voids as potential areas for recontamination or infection • Overextension:lack of 3 dimensional – with excess beyond • Underextension:Canal space is incompletely filled without achieving apical seal

  32. According to • SCHILDER: JOE 2006:32:4:284-290. • 3 dimensional obturation with only the surplus is beyond the apex –good prognosis… • Over extension- without 3 dimensional obturation ---poor prognosis - more cases of endodontic failures.

  33. Timing of the root canal obturation The root canal is ready to be filled when the canal is cleaned and shaped to an optimum size and dried. Dry canals may be obtained with absorbent points except in cases of apical periodontitis or apical cyst, in which “weeping” into the canal persists. In case if pt presents- mild discomfort, pain, exudate, foul odour, perapical sensitivity, filling such a root canal which is known to be infected is risky. IEJ:1997:30:297-306.-------------IEJ:1994:27:47-51.

  34. MULTIPLE VISITS: • Presence of acute signs and symptoms • Presence of periapical pathology. • Infected canals, exudate • Presence of a non vital pulp open to the oral cavity,retreatment cases • JADA:DEC1981:103. SINGLE VISIT: • Isolation and sealing problems • Asympathomatic teeth. • Vital pulp exposures • No periapical pathology • JOE:MAY1999:25:5

  35. MULTIPLE VISIT: • Treatment in a two visit model proposed as a standard (by Sjogren in 1991). • 1st appointment • extirpation & complete debridement and irrigation of root canal • application of calcium hydroxide for one week or more. • 2nd appointment or later appointment • obturation of root canal

  36. REQUIREMENTS FOR AN IDEAL ROOT CANAL FILLING MATERIAL

  37. GROSSMAN in 1940 modified Brownlee’s (1900) criteria for ideal root canal filling materials: • Easily introduced • Seal laterally as well as apically • Not shrink after being inserted • Impervious to moisture • Bacteriostatic or at least should not encourage bacterial growth • Radiopaque, Non- stain tooth • Not irritate periradicular tissues • Sterile or sterilizable • It should be Easily removed if necessary.

  38. OTHER REQUIREMENTS ARE: • Free of impurities and inclusions • Uniform distribution of additives throughout • Also should comply with ADA Document No. 41 for biological evaluation

  39. ROOT CANAL SEALERS These are Cements / Resins / Semiliquid / which are used as binding agents to fill up the gap between walls of root canal and obturating material. • It also fills up the irregularities, discrepancies, lateral canals and accessory canals. • helps to achieve a proper seal.

  40. REQUIREMENTS FOR AN IDEAL ROOT CANAL SEALER GROSSMAN’S 11 REQUIREMENTS (1958): • Tacky when mixed – to provide good adhesion b/w it and the canal when set • Make a hermetic seal • Radiopaque – so that it can - visualized - radiograph • Particles of powder should be very fine so that they can mix easily with the liquid • Not shrink upon setting • Not stain tooth • Bacteriostatic or at least not encourage bacterial growth

  41. Set slowly • Insoluble in tissue fluids • Tissue tolerant i.e., nonirritating to periradicular tissue • Soluble in a common solvent if it is necessary to remove the root canal filling ADDITIONAL REQUIREMENTS • Not provoke an immune response in periradicular tissue • Neither mutagenic nor carcinogenic

  42. Functions of sealers • Serves as a filler for canal irregularities and minor discrepancies between the root canal wall and core filling material • To obturate the lateral canals • Acts as lubricant • Enhances the possible attainment of an impervious seal • Can assist in microbial control of root canal walls or in tubules

  43. Factors to be considered in selection of sealers • These are determined by the need for each case • Working time of the sealer • Irritating potential of sealer, if it escapes into periapical tissues • Choice of intra canal irrigants and medicaments • Antimicrobial action • Biocompatibility

  44. According to composition: (MESSING): • 1. Eugenol containing: • A. Silver containing: Rickett’s formula of Kerr’s Sealer Procosol silver containing sealer. -1936 • B. Silver free: Procosol Non-staining cement (Grossman-1958) Grossman’s sealer Tubliseal (Kerr-1961) Wach’s Paste (Wach 1925)

  45. 2. Non-Eugenol sealers: • DIAKET (1951) • AH 26 (1957), AH Plus. • Chloropercha, Eucapercha • Nogenol • Hydron • Endofil • Ketac-endo.

  46. 3. Medicated sealers: • N2 • Endomethasone • Spad • Iodoform paste • Riebler’s paste

  47. According to Grossman: • Zinc-oxide resin cements. • Ca(OH)2 cements. • Paraformaldehyde cement. According to Ingle: • Cements. • Pastes. • Plastic. According to Clark: • Absorbable. • Non-absorbable

  48. Absorbable • Kerr Sealer (Rickert) • Grossman's Sealer • Roth Root Canal Cement • Tubliseal , Tubliseal EWT • Sealapex Nonabsorbable • Diaket (polyvinyl resin) • AH-26 (epoxy type resin),AH Plus • Ketac Endo

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