CONTENTS

HISTORY
HISTORY
HISTORY
 DEFINITIONS
ROOT CANAL OBTURATION IS DEFINED AND
CHARACTERISED AS A THREE DIMENSIONAL
FILLING OF ENTIRE ROOT CANAL SYSTEM AS
CLOSE TO THE CEMENTO DENTINAL
JUNCTION AS POSSIBLE.
 TIMING OF OBTURATION

VITAL TOOTH
One step treatment procedures are acceptable
when the patient exhibits completely or partially
vital pulp.

NON VITAL TOOTH

Patients with acute symptoms – delayed
obturation.

During 1970s single visit endodontics was

controversial. It was suggested that patient would
have higher incidence of post operative pain. But
now many studies and systematic reviews have
suggested that there is no difference in periapical
healing of apical periodontitis between single and
multi visit endodontcs. Patient infact experience
less frequency of short term post obturation pain
after single visit endodontics compared to multi
visit.
Traditionally the apical point of termination of
root canal filling has been approximately
1mm from the radiographic apex as
determined by the radiographs.
Root resorption is an additional factor in
length determination. It is more common
with necrosis and apical bone resorption, and
can result in loss of the constriction.
Controversy also exists regarding the role
accessory canals play in success and failure
One of the controversies in endodontics that remains
unresolved is the apical limit of root canal treatment
and obturation. Early studies identified the
dentinocemental junction as the apical limit for
obturation.70,117,118,221,292 However, this
histologic landmark cannot be determined clinically,
and it has
been found to be irregular within the canal. The
dentinocemental junction may be several millimeters
higher on the mesial canal wall when compared with
the distal wall. In addition, the dentinocemental
junction does not coincide with the narrowest portion
of the canal or apical constriction.

Kuttler noted that the apical anatomy consists of the

major diameter of the foramen and the minor
diameter of the constriction (Fig. 10-3), with the apical
con-striction identified as the narrowest portion of the
canal. The average distance from the foramen to the
constriction was found to be 0.5 mm, with the foramen
varying in distance from the apex up to 2.5 mm. Kuttler
also noted that the foramen to constriction distance
increases with age because of cementum deposition.
Supporting this finding, other investigators found that
the location of the foramen was not at the apex.
Deviations occurred in 92% of the roots and averaged
0.6 mm.

the number of accessory canals ranged from 1 to 16.

Although lateral canals can be associated with
pathosis, one study indicates that accessory canals
are common but play little role in periradicular
pathosis. Accessory/ lateral canals are often obturated
by chance and only serendipitously identified on the
posttreatment radiograph. Investigators compared
obturation of lateral canals, using six obturation
techniques in resin blocks. All techniques were able to
obturate lateral canals with sealer. Warm vertical
compaction, carrier-based thermoplastic gutta-percha,
continuous wave compaction, and vertically
compacted high-temperature gutta-percha filled lateral
canals with gutta-percha significantly better than
lateral compaction or warm lateral compaction. The
use of sealer enhanced the ability of the gutta-percha
to obturate the lateral canals
A study by the Toronto group 99 on the prognosis of
retreatment identified perforation, pretreatment
periradicular disease, and adequate length of the root
canal filling as factors significantly influencing success
and failure. The authors speculated that canals filled
more than 2 mm short harbored necrotic tissue,
bacteria, and irritants that when retreated could be
cleaned and sealed. The success rate for negotiating
the apical unfilled canal was 74%.
The importance of length control in obturation relates
to extrusion of materials. Studies indicate that
extrusion decreases the prognosis for complete
regeneration.One study evaluated the quality of root
canal treatment in an American population. Periapical
disease was evident in 4.1% of all teeth and 31.3% of
root-filled teeth, and the study noted that a periapical
pathosis was found with 43% of the teeth with
overfills.
In another study of 1000 cases, investigators found
that overfilling resulted in a failure rate of 37%. This
was four times greater than for cases filled short.
Whereas the guideline of 1 mm from the radiographic
apex remains rational when using radiographs, the
point of apical termination of the preparation and
obturation remains empiric. The use of an apex locator
in conjunction with radiographs and sound clinical
judgment makes this decision more logical. Deciding
where the apical constriction of the canal lies is based
on the clinician’s basic knowledge of apical anatomy,
tactile sensation, radiographic interpretation, apex
locators, apical bleeding, and (if not anesthetized) the
patient’s response.
Nonsurgical root canal treatment of permanent teeth
“involves the use of biologically acceptable chemical
and mechanical treatment of the root canal system to
promote healing and repair of the periradicular
tissues.”
“Root canal sealers are used in conjunction with a
biologically acceptable semi-solid or solid obturating
material to establish an adequate seal of the root canal
system.”
The radiographic criteria for evaluating obturation
include the following categories: length, taper, density,
gutta-percha and sealer removal to the facial
cementoenamel junction in anterior teeth and to the
canal orifice in posterior teeth, and an adequate
provisional restoration or definitive.
Various endodontic materials have been advocated for
obturation of the radicular space. Most techniques
employ a core material and sealer. Regardless of the
core material a sealer is essential to every technique
and helps achieve a fluid-tight seal.
The obturated root canal should reflect the original
canal shape. Procedural errors in preparation, such as
loss of length, ledging, apical transportation, apical
perforation, stripping perforation, and separated
instruments, may not be correctable.Errors in
obturation, such as length, voids, inadequate removal
of obturation materials, and temporization, may be
correctable.An often overlooked aspect in the
assessment of root canal obturation is the density of
the apical portion of the fill.
Radiographically, the apical third of the canal appears
less radiodense. An ill-defined outline to the canal wall
is evident, along with obvious gaps or voids in the
filling material or its adaptation to the confines of the
canal. Because of the use of highly radiopaque root
canal sealers/cements, the apical portion may be filled
only with sealer, giving the clinician the false
impression of a dense, three-dimensional obturation
with gutta-percha. Root canal sealers vary in
radiopacity.243,305 Some contain silver particles or
significant amounts of barium sulfate to enhance their
radiopacity. They may also give the impression that a
canal is well obturated when voids are masked by the
density of the sealer. It is erroneous to claim that
obturations with highly radiopaque sealers are better
than those made with less radiopaque materials tclaim
that obturations with highly radiopaque sealers are
better than those made with less radiopaque
materials.
 PREPARATION FOR OBTURATION
During the cleaning and shaping process, organic
pulpal materials and inorganic dentinal debris
accumulate on the canal wall, producing an amorphous
irregular smear layer as shown in a study noting that
the smear layer is superficial, with a thickness of 1 to 5
μm. There does not appear to be a consensus on
removing the smear layer before obturation. The
advantages and disadvantages of the smear layer
remain controversial; however, growing evidence
supports removal of the smear layer before obturation.
During the cleaning and shaping process, organic
pulpal materials and inorganic dentinal debris
accumulate on the canal wall, producing an amorphous
irregular smear layer as shown in a study noting that
the smear layer is superficial, with a thickness of 1 to 5
μm,198 and this superficial debris can be packed into
the dentinal tubules to various distances. In cases of
necrosis this layer may also be contaminated with
bacteria and their by-products. For example, one study
found that bacteria can extend 10 to 150 μm into the
dentinal tubules of necrotic teeth.The smear layer is
not a complete barrier to bacteria but may act as a
physical barrier, decreasing bacterial penetration into
tubules. This was illustrated by a study demonstrating
that removal of the smear layer permitted colonization
of the dentinal tubules at a significantly higher rate
when compared with leaving the smear layer in place.
The smear layer may also interfere with adhesion and
penetration of sealers into dentinal tubules. Evidence
indicates that sealer penetration into dentinal tubules
does not occur when the smear layer is present.
Studies found that smear layer removal increased bond
strength and reduced microleakage in teeth obturated
with AH-26 (DENTSPLY Maillefer, Ballaigues,
Switzerland).Bacterial penetration in the presence of a
smear layer in canals obturated with thermoplasticized
gutta-percha and sealer has been shown to be
significantly higher than with smear layer removal
before obturation. The smear layer may interfere with
the adhesion and penetration of root canal sealers. It
also may prevent gutta-percha penetration during
thermoplastic techniques.
Interfere with the actions of irrigants used as
disinfectants.
Sodium Hypochlorite with sonic and ultrasonic
irrigation.
MTAD with sodium hypochlorite as final rinse.
17% EDTA and 5.25% sodium hypochlorite.

Passive sonic or ultrasonic irrigation for 30 seconds

resulted in significantly cleaner canals than hand filing
alone, and ultrasonic irrigation produced significantly
cleaner canals than irrigation. However, other studies
found ultrasonication and NaOCl to be ineffective in
removing the smear layer.A new method for removing
the smear layer employs the use of a mixture of a
tetracycline isomer, an acid, and a detergent (MTAD)
(BioPure; DENTSPLY Tulsa Dental Specialties, Tulsa, OK)
as a final rinse to remove the smear layer MTAD
removed most of the smear layer; however, some
organic components of the smear layer remained on
the surface of the root canal walls. The effectiveness of
MTAD in completely removing the smear layer was
enhanced when low concentrations of NaOCl were
used as an intracanal irrigant before the use of MTAD
as the final rinse.After the completion of cleaning and
shaping procedures, removal of the smear layer is
generally accomplished by irrigating the canal with 17%
disodium EDTA and 5.25% NaOCl (Fig. 10-10). Chelators
remove the inorganic components, leaving the organic
tissue elements intact. NaOCl is necessary for removal
of the remaining organic components. Fifty percent
citric acid has also been shown to be an effective
method for removing the smear layer, as has
tetracycline.
Root canal sealers are necessary to seal the space
between the dentinal wall and the obturating core
interface. Sealers also fill voids and irregularities in the
root canal, lateral and accessory canals, and spaces
between gutta-percha points used in lateral
condensation. Sealers also serve as lubricants during
the obturation process. Grossman outlined the
properties of an ideal sealer.
ZINC OXIDE EUGENOL SEALER
An early zinc oxide–eugenol sealer was introduced by
Rickert and Dixon. This powder/liquid sealer contained
silver particles for radiopacity. Marketed as Pulp Canal
Sealer (SybronEndo) and Pulp Canal Sealer EWT
(extended working time)

Although it was possible to demonstrate the presence

of lateral and accessory canals the sealer had the
distinct disadvantage of staining tooth structure if not
completely removed.
Grossman modified the formulation and introduced a
Non-staining formula in 1958. This is the formulation in
Roth’s Sealer.
Calcium hydroxide sealers were developed for
therapeutic activity. It was thought that these sealers
would exhibit antimicrobial activity and have
osteogenic–cementogenic potential.