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Root Filling 2_formatted_text

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Criteria for Selecting a Root Canal Filling Technique & Material1

Guiding Principles

Info

The success of a root canal treatment is more dependent on thorough disinfection than on the specific filling technique or material used. However, the chosen technique is still important and should adhere to the following principles:

  • Many choices are available.

  • Must suit the canal preparation technique

  • Must suit the instruments/materials available

  • Materials & techniques must suit each other

  • Must have alternatives for unusual cases

    • Probably not critical for success
    • Personal choice

Operator's Choice

Ultimately, the choice of technique and materials comes down to personal preference, provided it aligns with the principles of preparation, instrumentation, and material compatibility.

Available Techniques (Examples)234

  • Single Cone
  • Lateral compaction / condensation
    • Cold, Warm
  • Vertical compaction / condensation
  • Solvent techniques
    • Chloroform, eucalyptus
  • Thermomechanical compaction (McSpadden)
  • Thermoplastic Injection techniques
    • Obtura, Ultrafil, etc
  • Carrier-based techniques
    • Stainless steel, titanium, plastic
  • Hybrid techniques
    • Lateral compaction + thermomechanical techniques
    • Lateral + vertical compaction
    • Core + injection
    • Core + vertical compaction
  • … plus many more

Root Filling Materials5

Ideal Properties (Grossman 1985)6

The ideal root filling material should:

  • Be easily introduced into the root canal

  • Seal laterally and apically

  • Seal coronally as well

  • Not shrink

  • Shrinkage creates space for bacteria.

  • Be impervious to moisture

  • Be bacteriostatic

  • Be sterile or able to be disinfected

  • Be radiopaque

  • Not stain tooth structure

  • Not irritate periapical tissues

  • Be easily removed

A key principle in dentistry is that

Components7

  • Core Material
    • Gutta Percha - Used universally

Note

Gutta Percha is a natural rubber derived from the sap of a Malaysian tree.

  • Cement
    • Many types available

Core Material: Gutta Percha8

Composition of Gutta Percha Points

ComponentPercentage
Gutta percha:19 - 22 %
Zinc oxide:60 - 75 %
Waxes and resins:1 - 5 %
Metal sulphates:1 - 17 %

Component Functions

  • Gutta Percha: The rubber matrix
  • Zinc Oxide: The primary filler
  • Waxes and Resins: Provide plasticity
  • Metal Sulfates: Provide radiopacity

Types of Gutta Percha Points9

  • Standardised points

    • ISO sizes = file sizes

  • ==They have a standard taper of 0.02 mm/mm.==

    • ==Manufacturing standards allow for a tolerance of ±0.02 mm.==

  • Non-standardised points

    • Match size of spreader

  • ==These points have a greater taper than standardized points and are also known as Accessory Points.==

    • D11T = Fine-Fine
    • D11 = Fine

  • ==The Fine-Fine point has a smaller tip and less taper, while the Fine point has a larger tip and more taper.==

Instruments Required10

  • Spreaders

    • Lateral condensation
    • D11T and D11

  • ==Spreaders have a sharp, pointed tip.==

  • Pluggers

    • Vertical condensation

  • ==Pluggers have a flat tip, similar to an amalgam plugger. A common example is the double-ended 5/7 plugger.==

  • Hand instruments

  • Finger instruments

Warning

Finger spreaders/pluggers are not recommended. They are difficult to use effectively, make it hard to apply controlled pressure, and pose a significant risk of sharps injuries, especially in four-handed dentistry.

Cement11

Types of Cements

  • Resin based

  • The most common and recommended type.

  • Zinc oxide-eugenol based

  • Common, but less so than resin-based.

  • Calcium hydroxide based

  • Glass ionomer bases

  • Was available but is no longer common.

  • Medicated cements

  • ==Not recommended as they often contain toxic components like formaldehyde.==

Resin-Based Cements12

  • AH 26
  • AH Plus
  • Diaket

AH26 Properties

  • System: AH26 is a powder/liquid system, unlike AH Plus which is a paste/paste system. This allows the operator to vary the consistency.
  • Mixing and Consistency: A good working consistency is achieved when the mixed cement can be lifted 2.5-3 cm with a spatula before the strand breaks. A thicker mix may be used for large canals, while a thinner mix can aid flow in small, curved canals.
  • Setting Time: AH26 has a very long setting time of 2-3 days, providing ample working time. However, this means the root filling must be completed in a single session, as the cement will set between appointments.

AH 26 Composition13

  • POWDER:
    • Bismuth trioxide - 80%
    • Titanium dioxide
    • Hexamethylene tetramine
  • LIQUID:
    • Bisphenol resin

Suggested Simple Techniques1415

Lateral Condensation with Gutta Percha and AH 2616

  • Standard technique

  • Suits flared preparation techniques

  • Uses lateral vectors of the vertical force

Tip

This technique relies on creating an apical seat during canal preparation. When vertical force is applied to the GP point with a spreader, the hard stop of the apical seat translates this force into lateral vectors, pushing the material against the canal walls.

Point Selection17

  • Master point

    • Small canals: one size less than apical file

  • This applies to canals prepared to size 25 or 30 and compensates for manufacturing inaccuracies in GP points.

    • Medium canals: same size as apical file

  • For canals larger than size 30, start with a point of the same size, but be prepared to adjust.

    • Large canals: “heat-softened impression technique” for customised point

  • Accessory points

    • Fine-Fine - use with D11T hand spreader
    • Fine - use with D11 hand spreader

GP “Heat-Softened Impression Technique”1819

  • Customised GP master point
  1. ==A Glick #2 endospoon is heated until red hot.==
  2. The largest GP point that fits the canal is held over the hot instrument, allowing radiant heat to soften the tip.
  3. ==The softened point is then placed into the canal, taking an
  • Combine with lateral condensation or Obtura

Obtura - Thermoplasticised Injectable GP2021

  • Uses: Wide canals, apexification, internal resorption, surgery

Info

This technique, typically used by specialists, involves a device that heats GP pellets and injects the plasticized material into the canal via a fine needle. It is useful for complex anatomy like internal resorption or filling lateral canals.

  • Combine with vertical condensation (+ AH 26)

Detailed Procedure: Lateral Condensation Technique22232425

Step 1: Fit Master Point

  • Fit master point(s)
  • Check with radiograph
  1. ==Re-access and Irrigate: Remove the temporary restoration and cotton pellet. Irrigate the canal thoroughly with EDTAC to remove all intracanal medicament (e.g., calcium hydroxide). Use a small file to agitate the irrigant and ensure the canal is patent.==
  2. ==Measure Master Point: Measure the selected point to the working length and place a small notch with tweezers to mark the length.==
  3. ==Dry the Canal: After a successful trial fit, thoroughly dry the canal with paper points.==

Step 2: Cement Placement26

  • 1. On hand file or master GP point
  • 2. With a spiral root filler

Spiral Filler Technique

This is the most effective method.

  1. Apply a small amount of cement to the spiral.
  2. Insert the spiral into the canal before starting the handpiece. Keep it 3-4 mm short of the working length to prevent binding and fracture.
  3. Run the handpiece in a forward motion, using a gentle up-and-down

Step 3: Initial Condensation2728

  • Place cement & seat master GP point

  • Condense with D11T spreader

  • Lateral vectors of vertical force

  • ==Coat the master point with cement and slowly insert it with a slight vibrating or

Step 4: Filling the Apical Third29

graph TD
    A[Remove the<br>spreader] -->|**Red Arrow**| B[Add Fine-Fine<br>accessory GP point]
    B -->|**Red Arrow**| C[Condense again with<br>D11T spreader & remove]
    C -->|**Red Arrow**| D[Add another Fine-Fine<br>accessory GP point]
    C -->|**Orange Vertical Arrow**| E{**Repeat condensation and adding**<br>**Fine-Fine points until the apical**<br>**third of each canal is filled**}
    D -->|**Orange Vertical Arrow**| E

> [!info] Filling Order
> 
> - The apical third typically requires the master point plus **3-4 accessory points**.
> - To maintain visibility in multi-rooted teeth, work from back to front:
>   - **Upper Molar:** Distobuccal -> Mesiobuccal -> Mesiopalatal (if present) -> Palatal.
>   - **Lower Molar:** Distal canal(s) -> Mesial canals.

Step 5: Mid-Procedure Radiograph30

  • Periapical radiograph when the apical third of each canal is filled

Assessing the Fill

The purpose is to check the apical few millimeters.

  • Overfill/Extrusion: The material has gone past the apex. The canal must be emptied and the fill redone, possibly after adjusting the working length.
  • Underfill/Short: The material has slipped out. The canal must be emptied and the fill redone, being careful to hold the GP in place when removing the spreader.
  • Over-extension - 16 Pal
  • At W.L - 15; and 16 MB, DB
  • Not fully seated - Bu
  • At W.L - Pal

Step 6: Filling the Remaining Canal31

Safety Warning

Before continuing, use a heated instrument (e.g., Glick #2 endospoon) to cut the excess GP tags. The instrument must be red hot to cleanly sever the GP. NEVER heat a D11 or D11T spreader, as it will destroy the temper.

  • Repeat lateral condensation with the D11 spreader and adding Fine accessory GP points until each canal is completely filled

Info

After cutting the GP down to the pulp chamber floor, switch to the larger D11 spreader and Fine accessory points to more efficiently fill the wider mid-root and coronal portions. Continue until the spreader only penetrates 2-3 mm into the mass of GP.

Step 7: Finishing323133

  • Heat Glick No. 2 - Endo. Spoon in Bunsen burner – “red hot”

  • Cut off “tags” of GP

  • Use the red-hot Glick endospoon to cut all GP off at the level of the pulp chamber floor.

  • Finish with vertical compaction of GP.

  • ==Use a warm plugger (not red hot) to vertically compact and adapt the softened GP in the coronal part of the canal.==

  • Clean access cavity - isoprop. alcohol.

Critical Step

This is a critical step to prevent future tooth discoloration. Use a small cotton pellet with alcohol to thoroughly clean all traces of cement and GP from the pulp chamber walls and pulp horns. Alcohol is an effective solvent for unset AH26.

  • Place temporary restoration in access cavity; then remove RD
  • Take parallel periapical radiograph

Tip

Take a final, high-quality periapical radiograph using a beam-aligning holder (e.g., Rinn, Neoss). This serves as a baseline record for future reviews to assess periapical healing.

flowchart TD
    A[Finish with vertical compaction of GP.</br>Clean access cavity - isopгор. alcohol.] --> B{Image of root canal filled with GP, then cleaned access cavity}
    C[Place temporary restoration in</br>access cavity; then remove RD] --> D{X-ray image of filled root canals}
    B --> C
    C --> D
    D --> E[Take parallel periapical radiograph]

    style A fill:#00008B,color:#FFFFFF
    style C fill:#00008B,color:#FFFFFF
    style E fill:#00008B,color:#FFFFFF

Conclusion - Which RCF Technique & Materials?34

(This section reiterates the guiding principles outlined at the beginning.)

  • Many choices available
    • Must suit the canal preparation technique
    • Must suit the instruments/materials available
    • Materials & techniques must suit each other
  • Must have alternatives for unusual cases

es**

Obtura - thermoplasticised injectable GP Combine with vertical condensation (+ AH 26)

Conclusion - Which RCF Technique & Materials?34

Keep It Simple

For the general dentist, the key is to keep it simple. The lateral condensation technique using Gutta Percha and AH26 is a reliable, effective, and straightforward method suitable for the vast majority of cases. Remember the *

  • Many choices available

    • Must suit the canal preparation technique

  • ==This is often described as a *

    • Must suit the instruments/materials available
    • Materials & techniques must suit each other

  • Must have alternatives for unusual cases

  • For general dentists, a primary alternative is timely referral to an endodontist before complicating the case.

Footnotes

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