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Lecture seven---------------------------------------------------------------------------- .

Obturation
Objectives
The objectives of filling, or obturating, the canal space are: 1. To prevent percolation of peri-radicular exudates into the pulp space via the apical foramina or lateral canals. 2. To prevent proliferation and spread of micro-organisms from the canal into the surrounding tissues. . To seal the canal from coronal lea!age. ". To encompass an# residual bacteria.

Material used
1. $ealers. 2. %utta percha &non-metallic or rubber' point or cone. . $ilver &metallic' point or cone.

Sealers
%utta-percha is the most commonl# used root canal filling material but does not adhere to dentine. (arm gutta-percha ma# contract a)a# from the root canal )alls, leaving a potential space into )hich fluids ma# percolate. There is therefore a need to use a sealant material that bridges the gap bet)een the filling and the )alls of the canal and fills an# potential spaces into )hich micro-organisms ma# proliferate. 1. 2. . ". ,. -. * sealer ma# fulfill an# one or more of the follo)ing functions: *cts as a luting agent &cementing the filling material into canal'. +ills an# discrepanc# bet)een the canal )alls and core material +ills an# discrepanc# bet)een gutta-percha points *cts as a lubricant during filling point insertion. *cts as a bactericidal agent. +ills an# lateral canals.

Requirements of Ideal Sealer: * sealer should have the follo)ing properties: 1. .e capable of achieving a thin film.
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2. /imensional stabilit#. . 0ave high tissue tolerance &non-irritating'. ". .e of uniform consistenc#. ,. 0ermetic sealing abilit#. -. 1asil# mixed. 2. 3adiopa4ue. 5. .acteriostatic. 6. 7on-staining for dentine. 18..e of lo) solubilit#. 11.0ave an ade4uate )or!ing time. 12.3eadil# removed if necessar#. Sealer Groups There is a variet# of sealers available, and these ma# be simpl# split according to their constituents: 1. 9inc oxide based 2. :alcium h#droxide based . 3esin sealers ". %lass-ionomer sealers ;n the initial setting phase, sealers ma# be c#totoxic< hence, overextension of the sealer be#ond the confines of the canal should be avoided.

Gutta-percha
%utta-percha has been used for more than 188 #ears. ;t is a form of rubber mixed )ith =inc oxide and other agents. *lthough not ideal, its advantages are that it is: 1. ;nert. 2. /imensionall# stable. . 7on-allergenic. ". *ntibacterial. ,. 7on-staining. -. 3adiopa4ue. 2. :ompactable. 5. >a# be softened b# heat. 6. $oftened b# organic solvents. 18.:an be removed from the canal.
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Disadvantages: 1. ?ac! rigidit#. 2. /ont adhere to dentin. . :an be stretched.

Silver points
dvantages: 1. 1asil# inserted into fine canals due to its rigidit#. 2. *pical pressure is easil# done . 3adiopa4ue ". /imensionall# stable. ,. 7on stretchable. Disadvantages 1. ?ess cleaning and shaping re4uired b# clinician, this ma# result in leaving a lot of debris and microorganism. 2. ;ts rigidit# and rounded cross section prevent perfect three dimensional fitting into canal )alls, this ma# result in future microlea!age. . :orrosion ma# readil# occurring b# tissue fluids, corrosion products can lea! into periradicular tissues. ". 3emoval from canal is almost impossible if its necessar# for the purpose of re-treatment or post insertion.

Gutta !ercha "illing techniques There are various techniques. These may e !ivi!e! into" # $o%i! or &o%! 'utta-(ercha techniques # $o)tene! 'utta-(ercha techniques *+utta-(ercha may e so)tene! usin' either heat or so%vents,.

Cold or Solid core techniques $o%i! core techniques may uti%i-e a sin'%e cone o) 'utta-(ercha or may em(%oy %atera% con!ensation o) mu%ti(%e cones o) 'utta-(ercha. .or these
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metho!s0 a 'utta-(ercha cone is se%ecte! to match the si-e o) the a(ica% (re(aration0 i.e. a master cone o) the same si-e as the master a(ica% )i%e is chosen. 1%thou'h a master cone is se%ecte! to match the si-e o) the master a(ica% )i%e0 the a(ica% (re(aration may e %ar'er than the nomina% si-e !ue to the )i%in' action o) the )i%e. There)ore0 the se%ecte! master cone may0 in )act0 e a %oose )it. 2n or!er to achieve a 'oo! )riction )it *terme! 3tu'- ac45,0 the ta(ere! master cone is shortene! s%i'ht%y so that it has a s%i'ht%y %ar'er !iameter at its en!. $evera% tria% )its may e necessary to o tain the require! tu'- ac4 at the correct %en'th. 2n the sin'%e cone metho!0 the 'utta-(ercha cone is se%ecte! to match the cana% (re(aration !imension. 1%thou'h this is a quic4 technique0 the main !isa!vanta'e is that on%y cana%s o) circu%ar !imension may e a!equate%y )i%%e! an! this rare%y re(resents the true c%inica% situation. $hou%! this metho! e use! in non-circu%ar cana%s0 there 6i%% not e a three!imensiona% )i%%. 2n the %atera% con!ensation technique *the )avore! metho! )or so%i! core techniques,0 a master 'utta-(ercha cone0 corres(on!in' to the a(ica% (re(aration !imension0 is (%ace! in (osition0 a%on'si!e 6hich are con!ense! a!!itiona% accessory 'utta-(ercha (oints. The a!vanta'e is that the cana% may e )i%%e! in a%% !imensions0 the )ina% materia% ein' a mass o) 'utta-(ercha (oints 7oine! y a thin %ayer o) sea%ant materia%. This is0 ho6ever0 a technique-sensitive metho!0 it can e time consumin' an! is not a((ro(riate in cases o) interna% resor(tion0 )or e8am(%e. 2t must a%so e remem ere! that )i%%in' o) %atera% cana%s y sea%ant cannot e 'uarantee!. 1 'utta-(ercha (oint o) the same si-e as the master a(ica% )i%e shou%! 6e!'e s%i'ht%y at 1.9 mm short o) the )u%% 6or4in' %en'th an! a try-in 3Tria%5 root )i%%in' ra!io'ra(h is use)u% to con)irm its (osition an! )itness a%on' a(ica% 2-/mm a%on' 6ith tu'- ac4 action0 these three criteria are ca%%e! TRIAL POINT MEASURMENT. :easurement o) a s(rea!er *a ta(ere!0 %an40 (ointe! instrument use! to (ush the 'utta-(ercha to one si!e, to 2 mm short o) the 6or4in' %en'th ensures that a(ica%%y !irecte! (ressure 6i%% not resu%t in overe8tension o) the 'utta-(ercha. The 6a%%s o) the cana% to 2 mm short o) the a(e8 shou%! e coate! 6ith an even0 thin )i%m o) sea%ant an! this a%so )aci%itates (%acement o) the master 'utta-(ercha (oint y actin' as a %u ricant. &ontro%%e! (%acement o) the coate! master cone a%%o6s e8trusion o) e8cess sea%er in a corona% !irection e)ore it is seate! 6ith )irm (ressure an! a t6istin' action. 2nsertion o) either a han! or )in'er s(rea!er to the !e(th in!icate! y the
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Lecture seven---------------------------------------------------------------------------- .

sto(0 a%on'si!e the master cone0 (ushin' it to one si!e an! osci%%atin' an! 6ith!ra6in' the s(rea!er resu%ts in creation o) s(ace )or the (%acement o) a!!itiona% 6e!'in' or %atera% cones. .in'er s(rea!ers are (re)era %e over han! s(rea!ers as they are stan!ar!i-e! as en!o!ontic instruments an! a((%ie! )orce is more contro%%a %e an! %ess (ossi i%ity )or vertica% tooth s(%ittin' or )racture. $(rea!er si-e se%ecte! accor!in' to cana% si-e. <hen e8cess )i%%in' materia% at the ase o) the (u%( cham er has een seare! o)) usin' a hot 3(%astic5 instrument to the %eve% o) the cana% ori)ice0 a chec4 root )i%%in' ra!io'ra(h shou%! e care)u%%y assesse! to con)irm that the root has een a!equate%y o turate!. Softened gutta- ercha !ethods $evera% metho!s have een !escri e! to (%astici-e 'utta-(ercha. These may e !ivi!e! into" 1- =eat a((%ie! insi!e the cana% <arm vertica% con!ensation <arm %atera% con!ensation Thermo-mechanica% com(action 2- =eat a((%ie! outsi!e the cana% in7ection technique /- &arrier- ase! metho!s heat a((%ie! outsi!e the cana% mechanica% sources o) heat ;- $o%vent metho!s *&h%oro)orm,. <arm %atera% con!ensation invo%ves the use o) a heate! s(rea!er a((%ie! to a master 'utta-(ercha cone insi!e the cana%. =eat may e !erive! either )rom an e8terna% source *such as a 6arm >unsen, or )rom a thermostatica%%y heate! s(rea!er. ?ressure is a((%ie! an! the heate! mass is a!a(te! to the cana% 6a%%s. The 6arm s(rea!er is remove! an! a co%! s(rea!er creates s(ace )or )urther cones to e a!!e!. This (rocess is re(eate!. <arm vertica% con!ensation invo%ves a (rocess simi%ar to the a ove0 e8ce(t vertica%%y !irecte! )orces are a((%ie!. The !isa!vanta'e is that

Lecture seven---------------------------------------------------------------------------- .

there is a !an'er o) overe8tension o) )i%%in' materia% an! sea%ant i) there is not 'oo! resistance to a(ica% e8trusion. +utta-(ercha may e 6arme! in a thermostatica%%y heate! !e%ivery 'un an! a((%ie!Ain7ecte! into the cana% via a nee!%e. 1 co%! vertica% con!enser is use! to com(act the materia%. This metho! is (articu%ar%y use)u% to )i%% root cana% systems o) non-conventiona% mor(ho%o'y *e.'. interna% resor(tion,. 1'ain0 there is a !an'er o) overe8tension o) materia% in the a sence o) a (ositive a(ica% sto(. ?rior (%acement o) a master cone (rec%u!es this (otentia% (ro %em. Bse o) a mechanica%%y o(erate! thermo-mechanica% com(acter *:c$(a!!en rotatin' com(actor, so)tens a 'utta-(ercha cone 6hich is a!a(te! to the cana% 6a%%s. ?%acement o) a 'utta-(ercha cone is essentia% to (rec%u!e overe8tension o) materia%. Cisa!vanta'es inc%u!e the ris4 o) instrument se(aration0 resu%ts may e inconsistent an! even i) a master cone is (%ace!0 a(ica% e8trusion o) materia% may resu%t.

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