Obturation%20techniques%20other%20than%20lateral%20condensation%20-17-

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Obturation techniques other than lateral condensation:

Obturation techniques other than lateral condensation Prof. Raef A. Sherif

Slide2:

Two schools: 1- Lateral condensation 2- Vertical condensation

Slide3:

Techniques that are derived from lateral: 1- warm lateral 2- ultrasonic activation 3- Inverted cone 4- Custom cone (rolled technique) & ( chloroform dipped cone ) For: better adaptation, and to avoid root fracture

Slide4:

Techniques that are derived from vertical: 1- sectional ( Chicago ) 2- continuous heat wave (system B )

Slide5:

Techniques that combine them both: Lateral/ vertcial ( Endotec )

Slide6:

Other techniques: Injection of hot GP ( Obtura ) ( injection moulded thermo-plasticized GP ) Carrier insertion ( ThermaFill ) - Thermo-mechanical compaction ( McSpadden )

Slide7:

Obturation in certain difficult situations: 1 - alternatives to gutta percha 2 - severely curved canals 3- canals with wide apices 4- confluent canals 5- C-shaped canals

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“to be married only to one obturation technique or material limits one’s ability to deal with complex cases”.

Slide9:

No single technique meets all endodontic needs.

Warm lateral :

Warm lateral What is the idea ? Spreader insertion can be easier and with less force since the gutta is softened by warming before spreader insertion.

Slide12:

A heat carrier is heated on the open flame and inserted in the canal, after the GP cone is inserted, to heat it. Then a cold spreader is inserted to compact the warm softened GP.

The use of ultrasonics for warm lateral condensation (Moreno):

The use of ultrasonics for warm lateral condensation (Moreno) Spreader tips designed for ultrasonic devices were introduced to heat the GP as warm lateral technique. Ultrasonic energy generates heat to the spreader in few seconds.

Slide17:

Warm lateral condensation enhances adaptation to the canal walls. It gives better hydraulic force to fill lateral canals. It is specially indicated for teeth with internal resorption and C-shaped canals

Advantages of warm lateral condensation:

Advantages of warm lateral condensation 1- Since it follows lateral condensatin , heat is not introduced to the apex of the tooth. 2- It allows precise length control. 3- It permits filling of voids, isthmuses, C-shaped canals, lateral and accessory canals, and internal resorption areas.

Slide21:

4- The potential for root fracture is reduced because less pressure is needed to adapt the thermoplasticised mass. 5- It is an easy technique to use and learn. 6- It requires only a relatively inexpensive addition to armamentarium 7- It does not require preheating or special GP. 8- Cleaning and sterilization are not complex.

Inverted cone technique:

Inverted cone technique When we don’t have a matching size for the apical preparation because it is larger than any GP cone, we might invert the cone to have larger diameter at the apex.

Rolled technique (custom cone) :

Rolled technique (custom cone) To create our own size in very large canals. Many cones are arranged butt to tip on a glass slab. The slab is heated over an open flame to warm them. Another slab or a spatula is used to roll the softened cones and make them one big cone.

Slide24:

The cone is tried in the canal for fitness. This will be the master cone follwed by lateral condensation.

Slide25:

Preparation of “tailor-made” gutta-percha roll. A: Number of heated, coarse, gutta-percha points are arranged butt to tip , butt to tip on sterile glass.

Slide26:

B: Points are rolled with spatula into rod-shaped mass

Slide27:

D: Before trial point testing of tailor-made roll, gutta-percha should be chilled with ethyl chloride spray.

Vertical compaction :

Vertical compaction Schilder , 1967

According to Franklin Weine:

According to Franklin Weine Vertical compaction is to be preferred in certain cases, namely “when the fitting of a conventional master cone to the apical portion of a canal is impossible , as when there is: - ledge formation, - perforation, - unusual canal curvatures, - internal resorptions , or - large lateral canals.

Slide35:

The vertical compaction succeeds when lateral does not & not vice-versa.

What do we need for vertical compaction ?:

What do we need for vertical compaction ?

pluggers:

pluggers The complete series of 9 pluggers Posterior.

Heat carriers:

Heat carriers

Slide39:

Touch’n Heat

Tray for vertical technique:

Tray for vertical technique

Phases of vertical compaction :

Phases of vertical compaction

Slide43:

The Stropko irrigator.

Fitting the master cone :

Fitting the master cone Conventional cones are indicated ( we need larger tapers for vertical compaction ). Extra fine 2% Medium fine 4% Fine 6% Fine medium 8% Medium 10 %

Slide45:

Standardized cone Conventional or accessory cone

Slide46:

We fit the master cone by trial and cutting till we get perfect fit and tug back

Slide48:

The relation between the gutta percha cone and the reference instrument (GP is 1 mm shorter)

Slide49:

The cone must not fold over. B . The cone must not twist

Selecting the pluggers:

Selecting the pluggers Large for cervical

Medium for middle:

Medium for middle

Small for apical:

Small for apical

Slide56:

Mix sealer

Slide59:

Selaer , Master cone inserted Cut to orifice Compacted with cervical plugger

Multiple heat waves ( heat, remove, compact ):

Multiple heat waves ( heat, remove, compact )

Slide61:

1 st selective removal of gutta

...... compaction :

...... compaction

2nd selective removal of gutta:

2 nd selective removal of gutta

Slide66:

........ compaction with midsized plugger

3rd selective removal:

3 rd selective removal

........ compaction with small plugger :

........ compaction with small plugger

...... repeat to make sure :

...... repeat to make sure

......... Classical backfill the canal:

......... Classical backfill the canal

Slide71:

Apply GP cold compaction heating warm compaction

Repeat till the canal is filled:

Repeat till the canal is filled

Is it an effective technique?:

Is it an effective technique?

“BACK-PACKING” WITH THERMOPLASTIC GUTTA-PERCHA :

“BACK-PACKING” WITH THERMOPLASTIC GUTTA-PERCHA

Obtura II & Element (system B + Obtura) :

Obtura II & Element (system B + Obtura )

.........inject & compact :

.........inject & compact

Voids due to rapid withdrawal of the Obtura syringe :

Voids due to rapid withdrawal of the Obtura syringe

Indications of vertical condensation:

Indications of vertical condensation Generally, it can be used in the same situations as lateral condensation. It is preferred in a few circumstances, such as with internal resorption and with root end induction.

Advantages :

Advantages The principal advantage over lateral condensation is the ability to adapt the warmed and softened Gutta-percha to the irregular root canal system.

Disadvantages:

Disadvantages 1- Difficulty of length control. 2- A more complicated procedure. 3- A larger assortment of required instruments. 4- A larger canal preparation is needed to allow manipulation of the instruments.

Techniques that are derived from vertical compaction:

Techniques that are derived from vertical compaction - continuous heat wave - Sectional technique

Continuous Heat Wave of Obturation (System B) :

Continuous Heat Wave of Obturation (System B)

Slide84:

Buchanan, in1996 , has developed a variation of vertical condensation that he described as faster and more accurate.

System B compared to vertical:

System B compared to vertical Instead of the complexity and time consumed in vertical obturation, Buchanan: retained the principles of vertical compaction but improved the methodology.

Slide86:

System B pluggers match the tapers of the non-standardized gutta-percha cones: fine, 6% taper fine-medium, 8% taper medium, 10% taper and medium-large 12% taper (F, FM, M, and ML).

Slide87:

Only one continuos heat wave to the apical few millimeters that will: Heat Remove, and Compact

Slide88:

After the continuous heat wave the canal will be filled and condensed in the apical few mm & empty in the middle and coronal thirds.

Slide89:

At this time we can either backfill the canal with: - Obtura or - with another cone to be softened and compacted with a larger system B plugger .

Warm/Sectional Gutta-percha Obturation. :

Warm/Sectional Gutta-percha Obturation. The use of small warmed pieces of gutta-percha , the so-called sectional obturation technique, is one of the earliest modifications of the vertical compaction .

Slide92:

Eventually this became known as the “Chicago” technique

Slide93:

The method begins like other methods: fitting the apical plugger to the prepared tapered canal.

Slide94:

It should fit loosely and extend to within 3 mm of the working length. A silicone stop is then set on the shaft marking this length

Slide95:

Next, the primary gutta-percha point (conventional) is blunted and carried to place. *It should be fitted 1 mm short of the working length and confirmed radiographically .

Slide97:

Upon removal, 3 mm of the tip of the point are cleanly excised with a scalpel and,

Slide98:

this small piece is then luted to the end of the warmed plugger .

Slide99:

Sealer is placed in the canal, the gutta-percha tip is warmed by passing it through an alcohol flame , and it is then carried to place.

Slide100:

Under apical pressure , the plugger is rotated to separate the gutta-percha and it is thoroughly packed in place.

Slide101:

At this point, it is best to expose a radiograph to be sure the initial piece is in position

Slide104:

Backfilling is done with small sections of GP like the classical vertical or with Obtura .

Slide107:

If a post is to be used, the compaction can stop after the second piece, leaving 5 to 6 mm of apical canal filled.

Indications and advantages::

Indications and advantages: 1- If a post should be placed in the same visit of obturation 2- Less time required to fill the apical third than vertical compaction

Lateral/Vertical Compaction of Warm Gutta-percha. :

Lateral/Vertical Compaction of Warm Gutta-percha. The Endotec ( Martin ) is an electric cordless device that carries tips that can work like pluggers & spreaders .

Slide110:

The tip is used to warm the GP to create a lateral space for more cones. Then the same tip is used for heating and vertical compaction of the softened cones.

Slide111:

Endotec

Slide112:

Considering the ease and speed of lateral compaction as well as the superior density gained by vertical compaction of warm gutta-percha, Martin developed a device that appears to achieve the best qualities of both techniques.

Slide113:

Martin claims that the “Endotec combines the best of the two most popular obturation techniques: warm/vertical and the relative simplicity of lateral compaction”

Endotec :

Endotec

Advantages::

Advantages: Simple as lateral, with good adaptation as vertcial .

Thermomechanical Compaction of Gutta-percha. :

Thermomechanical Compaction of Gutta-percha. McSpadden compactor (1979).

Slide118:

A totally new concept of heat softening and compacting gutta-percha was introduced by McSpadden in 1979.

Slide119:

Initially called the McSpadden Compactor, the device resembled a reverse Hedstroem file , or a reverse screw design. It fits into a latch-type high torque handpiece and is spun in the canal at speeds between 8,000 and 20,000 rpm.

Slide121:

At these speeds, the heat generated by friction softened the gutta-percha and the design of the blades forced the material apically. In experienced hands, canals could be filled in seconds.

McSpadden technique:

McSpadden technique Fit a master cone 1.5 mm short of the working length. Apply sealer to the cone. Select the compactor . It should be the same size as the largest file used within 1.5 of the apical stop. This is checked in the canal before the GP point is fitted and the length is marked on the shank of the compactor.

Slide123:

The compactor is inserted until a slight resistance is felt and then rotated to maximum speed. After one second the compactor is advanced apically in one fluid movement to the predetermined depth .

Slide124:

The compactor is then withdrawn slowly, still operating at full speed.

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A backing out force will be noticed, produced by the GP being forced ahead of the instrument. Do not withdraw the compactor quickly , or voids will occur.

Slide126:

A second larger compactor may be used to condense the flared portion of the canal. The whole condensation takes a few seconds.

Advantages::

Advantages: Quick and easy. ( the quickest technique)

Disadvantages of Mcspadden compactors:

Disadvantages of Mcspadden compactors 1- The high rotational speeds tend to result in many fractured instruments. 2- Considerable amount of heat is generated very quickly.

Precautions:

Precautions 1- The instrument must not be kept rotating in the canal for more than a few seconds to prevent build up of heat. 2- It has no particular advantage in fine, severly curved canals, and it is not recommended to be introduced around curves ,due to risk of fracture.

Slide131:

The technique is useful in cases where other techniques would be difficult, such as internal resorption cases.

Modifications of the technique:

Modifications of the technique 1- Fill with lateral condensation, master and accessory cones , till the apical 3-4 mm are filled. 2- Then use the compactor to complete obturation of the middle and coronal thirds of the canal quickly. *This method has been termed the hybrid technique.

Newer compactors:

Newer compactors Recently, two other compactors have been introduced: 1- Engine plugger: which is a K- file design with a reverse twist. 2- Gutta condenser: which is similar to the McSpadden except that: -it is blunt-tipped and -the flute depth has been reduced.

Slide135:

These instruments have enjoyed a good deal of use, particularly for “backfilling” after the initial vertical or lateral compaction is complete.

Slide137:

Nickle titanium compactors were developed recently to facilitate use beyond curves.

Thermoplasticized Injectable Gutta-percha Obturation. :

Thermoplasticized Injectable Gutta-percha Obturation.

Slide141:

Obtura was introduced in 1977 . Regular Beta phase GP is used.

Slide142:

Obtura II Small pieces of GP are placed into a heating chamber 160°C to 200°C GP is delivered inside the canal using needles: 20 gauge (equal to a size 60 file ) or 23 gauge (equal to a size 40 file )

Slide144:

Regular beta-phase gutta-percha is still used in this system. However the clinician can now choose a less viscous, higher flow form of gutta-percha known as Easy Flow.

Slide145:

Sealer serves its usual role of filling the microscopic interface between the dentin and gutta-percha as well as acting as a lubricant.

Slide146:

Compaction became necessary to: i) Close spaces and gaps while forcing the gutta-percha laterally and vertically. ii) compensates for shrinkage as the gutta-percha cools. Furthermore, the smallest injection needle, 23 gauge, was too large to reach the apex in most cases.

Slide148:

However, the Easy Flow gutta-percha does afford at least 10 to 15 more seconds of working time.

Obtura filling after apexification:

Obtura filling after apexification

Slide150:

The gutta-percha emerges from the needle at 71.2°C .

Slide151:

While still soft, hand pluggers are used for compaction. Sealer should be placed before injection.

advantages:

advantages Obtura II is effective in filling fins and cul-de-sacs , internal resorption cavities, “ C”-shaped canals , accessory canals , and multiple foramina.

Obtura filling in C shaped canal:

Obtura filling in C shaped canal

Disadvantages of Obtura II:

Disadvantages of Obtura II The same as those of other warm GP techniques and paste systems: Both over-extension & under-extension are common Lack of length control

SOLID-CORE CARRIER: MANUAL INSERTION :

SOLID-CORE CARRIER: MANUAL INSERTION This includes: - ThermaFil ( Dentsply /Tulsa)

Dreams can take you anywhere!:

Dreams can take you anywhere!

The idea!!:

The idea!! In 1978, Johnson suggested using thermoplasticized alpha-phase gutta-percha carried into the canal on an endodontic file .

A dream came true:

A dream came true What was a curiosity in 1978 has become today a popular and respected technique of canal obturation.

Thermafil:

Thermafil

What is Thermafil?:

What is Thermafil? “ ThermaFil is an endodontic obturator consisting of a flexible central carrier , sized and tapered to match variable tapered files (.04/.06) endodontic files. The central carrier is uniformly coated with a layer of refined and tested alpha-phase gutta-percha.”

Slide161:

Initially, the central carrier was a newly designed stainless steel device. Contemporary carriers are made of radiopaque plastic that is grooved along 60 degrees of their circumference

Slide163:

The core is grooved to allow for the release of trapped air during the placement of the carrier.

Slide165:

The plastic core carriers are heated in a controlled oven environment called the ThermaPrep Plus heating system.

Slide166:

Thermacut bur Post space bur

Slide168:

With this technique, gutta-percha will flow easily into canal irregularities such as fins, anastomoses, lateral canals, and resorptive cavities.

Slide170:

1 2 3

Slide171:

Condense with plugger Cut

Advantages:

Advantages ThermaFil allows simple , fast , predictable filling of root canals. It was found to be especially useful for small or very curved canals.

Gutta core:

Gutta core

Slide177:

Since its introduction to dentistry in 1847 , gutta-percha has been more universally trusted than any other obturation material.

The problem !!:

The problem !! Warm gutta-percha’s flowing characteristic made it unsuitable for use as an obturator core because it melts when heated.

The cross linking technology :

The cross linking technology DENTSPLY Tulsa Dental Specialties changed what’s possible by introducing cross linking technology to gutta-percha.

Slide180:

A well-established scientific process, crosslinking connects the polymer chains and transforms the gutta-percha: keeping it from melting , making it stronger , while keeping its best features.

Slide184:

Same gutta-percha transformed with subtle, flexible strength Retains shape when heated Removes easily Centrally compacts the surrounding warm flowable gutta-percha 3-dimensionally

Slide185:

Many obturation techniques use lateral or vertical compaction of gutta-percha. However, the hydraulic force from these techniques generally moves gutta-percha in one or two unequal directions ( laterally or apically ).

Slide186:

Gutta Core Cross linked Gutta-Percha Core Obturators centrally compact the gutta-percha with a hydraulic force that sends it flowing equally in three dimensions -- throughout the entire canal system.

Slide187:

The Cold Truth About Gaps and Voids.

Slide188:

You need your gutta-percha to go the distance in every case. Yet cold lateral techniques can leave voids in intricate areas. And warm vertical techniques can fail to warm the all-important last 3-5 mm of the master cone.

Slide191:

191 Pre-op Post-op Courtesy Dr. John West

Slide192:

Easy Removal. Easy Post Space Creation.

Any questions ?:

Any questions ? Thank you

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