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MATERIALS AND INSTRUMENTS  283
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Clovis Monteiro Bramante, Alexandre Silva Bramante, Ivaldo Gomes de Moraes, Norberti
Bernardineli, Roberto Brando Garcia

Apical isolation for root-end filling

Clovis Monteiro
Bramante
Department of Endodontics,
Faculdade de Odontologia
de Bauru USP,
Key words apical isolation, apical surgery, haemorrhage, retrograde obturation, Otvio Pinheiro Brisola 9-
root resection, surgical endodontics 75,
Bauru, CEP 17012-901,
Brazil
During apical surgery, it is fundamental to keep the root apex free of blood and humidity for Tel: +55(14) 3235 8671
Email: bramante@fob.usp.br
placement of retrograde filling materials. A new device, fabricated with silicone, was designed for
apical isolation for accomplishment of retrograde obturation. This device is economic, disposable, Alexandre Silva
Bramante
and easy to use and keep in place. Brasiliense Dental School,
DF, Brazil

Ivaldo Gomes de
Moraes
Faculdade de Odontologia
de Bauru USP,
SP, Brazil

 Introduction
In surgical endodontics for root-end obturation,
control of haemorrhage and humidity can be a
problem, and these may affect placement of the
retrograde filling material in the apical cavity.
Independent of the selected root-end filling material,
placement of the material requires adequate access,
visibility, illumination, and a dry and sterile field1. To
meet these goals, various devices and materials have
been used, such as bone wax, calcium sulphate,
haemostatic agents and adapted instruments.
Bone wax was recommended by Selden2 to con-
trol haemorrhage during endodontic surgery;
Rothschild3 advocated its utilisation to fill the surgical
cavity and enhance apical surgery. Guerra4 recom-
mended the utilisation of a perforated spatula to iso-
late the operative field with a rubber dam. Sauver et
al5 supported the utilisation of bone wax associated
with alginate fibres to fill the surgical site and contain
the haemorrhage at the apical region.
Materials to fill the surgical site, such as calcium Norberti Bernardineli
Faculdade de Odontologia
sulphate6-7 and haemostatic substances, including
de Bauru USP,
ferric sulphate and aluminium chloride8-9, have been SP, Brazil
recommended to control haemorrhage during apical
Roberto Brando
surgery. Garcia
Faculdade de Odontologia
The present paper presents a device for apical
de Bauru USP,
isolation, designed to aid apical surgery and root-end SP, Brazil
obturation.
 Device for apical isolation
The device described was developed by the
Endodontics Department, Bauru Dental School, in
partnership with Indusbello (Indusbello Indstria de
Instrumentos Odontolgicos Ltda. Londrina, Pr,
Brazil). It is made of silicone, comprising a 2.5-cm
diameter disc with a 2-mm diameter central
perforation and two parallel 1-cm-long straps (Fig 1).
For isolation, the perforated disc is initially placed
on the apex of the tooth and then gently pulled. The

ENDO 2007;1(4):283-285
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284  Bramante et al Apical isolation for root-end filling
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Fig 1 The silicone device for apical isolation.

straps are stretched up to the tooth crown and root apex (Fig 3). If necessary, the disc may be
secured on its proximal aspects (Fig 2). The disc is trimmed to fit the surgical cavity. These discs may be
then adjusted inside the surgical cavity, isolating the sterilised in an autoclave or discarded after use.

Fig 3 The disc

Fig 2 is adjusted, iso-
Placement of lating the root
the device. apex.

ENDO 2007;1(4):283-285

Bramante et al
 Discussion  References
The success rate of endodontic surgery has 1.
increased since the advent of new resources, such 2.
as operative microscope, ultrasound, and improved
3.
retrograde filling materials and membranes10.
However, when a retrograde filling material is 4.
placed in an apical cavity, humidity and bleeding 5.
complicate or even prevent this procedure. Ideally,
the root apex should be isolated before root-end 6.
filling is performed.
Bone wax has been used to control the 7.
haemorrhage2,3,5; however, after surgery, wax may
remain in the surgical wound and interfere with the
8.
repair process8. Haemostatic agents must also be
properly removed to avoid interference with the
9.
wound healing process11-14.
Use of a perforated spatula, as recommended by 10.
Guerra4, allows utilisation of a rubber dam; however, 11.
a dental assistant must be available to keep the
12.
device in place.
The present device is easy to place, has a low
13.
cost, and does not require an assistant to hold it in
place. However, for optimal utilisation of this
14.
device, the root should not be level with the bone
cavity.
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