Under filled root canal

ENDO-surgery seminar

Nouri EsmaeilNouri Amin

Esmaeili MortezaRazon Arlhie

Presented by:

GOALS of obturation

• TO FILL THE ENTIRE CANAL SYSTEM AND ITS COMPLEX ANATOMIC PATHWAYS COMPLETELY WITH NONIRRITATING HERMATIC SEALINGAGENTS.

OBJECTIVES OF CANAL OBTURATION

• Prevents percolation and microleakage of periradicular exudate into the root canal space.

• ) ) Prevents reinfection through good sealing of the apical foramina.

• ) ) Creates a favorable biologic environment for the process of tissue healing to take place.

Ideal root canal filling material requirments :

. ) ) Easily introduced

•) ) Seals laterally and apically

•) ) No shrinkage

•) ) Impervious to moisture

•) ) Bacteriostatic

•) ) Does not stain tooth

• ) ) Non irritating to periapical tissues

• ) ) Easily removed

• ) ) Sterilizable

• ) ) Radiopaque

STEPS OF ROOT CANAL OBTURATION

• Rubber dam application

• Verify completion of the canal preparation.

• Check your working length, irrigate & DRY the canal.

• Fit the master cone (TUG- -BACK). BACK).

• Take radiograph. Take radiograph.

• Introduce the sealer cement.

• Condense the MC and accessory guttapercha.

• Take intermediate radiograph.

• Add more G.P points and remove access.

• Temporize the access and take final radiograph.

Master Cone

• (1) fit tightly laterally in the apical third of the canal (have good " canal),

• (2) fit to the full length of the canal (i.e., to the dentin- cementum junction or about 1 mm from the cementum junction or about 1 mm from the radiographic apex),

• (3) be impossible to force farther beyond the apical foramen.

LATERAL CONDENSATION

• Involves the compaction of the primary master cone and sealer against the apical foramen

• Condensing additional accessory gutta percha cones alongside the the master cone fills the remainder of the canal

Finishing

• GP to level with the CEJ

• Using cool end of plugger to vertically condense gutta percha at orifice

• Clean pulp chamber with cotton pellets soaked in alcohol

• Place temporary or final restoration

• Preferable to take radiograph before removing rubber dam

Radiographic evaluation of obturation

• Radiolucencies: Are there voids, indicating incomplete obturation?,

• Density: Is there uniform density from coronal to apical?

• Length: Does material extend to WL?

• Shape: Does fill reflect shape of the canal, tapered from coronal to apical?

Underfill

• An incomplete obturation of the root canal space with resultant voids

• Inadequate taper in preparation

• Improper spreader/cone placement

• Cannot be corrected by increased force

• An ideal root canal filling three-dimensionally fills the entire root canal system as close to the cemento-dentinal junction as possible

• •Teeth filled more than 2mm short of apex has poor prognosis underfillings with necrotic pulps

Causes

• o Dentin chips

•o Ledged canal

•o Curved canal

•o Master cone too large

•o Improper 3D shaping of canal in apical to middle third

Dentin chip

Ledged canal

Curved canal

Too large master cone

Improper shaping of canal

• Inadequate taper in preparation

Non-Surgical Retreatment

• Gain access to canal system and reach apical foramen via removal/bypass of obturation materials from canal

• - Patient usually has high outcome expectations - Requires greater clinical skill than original NSRCT treatment

• - Canal Obstructions – posts, separated instruments

Non-Surgical Retreatment

. GP removal

. Quality of condensation

Shape of root canal

Length of obturation material – short fill, overextension, etc

Gates Gliddens, ProFiles, GPX

Removes GP t

Provides reservoir for solvent

Heat and hedstrom removal technique

Non-Surgical Retreatment

• Solvents.

• Chloroform

• Methylchloroform, Eucalyptol, Halothane, Xylene, Rectified white turpentine

Thank you for your listening