Obturation

Obturation

1. When

   • One appointment
     • Figini 2006 cochrane
       • 1=2 Neither can prevent all short- and long-term complications.
         • more post op pain
   • Two appointments
     • Success
       • Paedes-Vieyra 2012
         • 1=2 no statistically significant difference
       • Trope 1999
         • 10% increase in succes with 2 appointments
           • due to intervisit CaOH2
       • coronal seal
     • Siqueira 2012
       • intervisit calcium hydroxide
         • more bacteria in ramifications, isthmuses, and dentinal tubules if 1 visit
           • reduces LPS
             • reduces microbial burden

2. Aim

   • provide an impermeable fluid tight seal within the entire root canal system, to prevent oral and apical microleakag

3. How

   • Lateral
     • warm
       • A master cone coated with sealer, inserted into the canal, heated with a warm spreader,
     • cold
       • A master cone coated with sealer, inserted into the canal, laterally compacted with spreaders and filled with additional accessory cones
   • thermal
     • continuous wave
       • Continuous wave is essentially a vertical compaction (down-packing) of core material and sealer in the apical portion of the root canal and then back filling the remaining portion of the root canal with thermoplasticized core material using injection devices
     • multiple wave
     • 1-2% shrinkage
   • carrier
     • Carrier-Based Thermoplasticized:
       • thermafill
         • Warm GP on plastic carrier delivered directly into the canal.
     • Carrier-Based Sectional:
   • resilon
     • lab studies
       • significantly better at preventing leakage than GP
   • MTA

4. ideal properties

   • gutta percha
     • alpha
     • beta
       • phase change at 46oC to alpha
         • amorphous alpha at 64oC
           • cool very slowly recrystallize to alpha- doesnt really happen clinically
     • composition
       • zinc oxide 50-79%)
       • heavy metal salts 1-17%
       • GP 19-22%
       • wax/resin 1-4$
     • soluble
       • chloroform
       • turps
       • eucalyptol
       • halothane
     • tapan tree
     • isomer rubber
   • Grossman's
     • easily introduced
       • seal the canal laterally as well as apically
         • should not shrink after insertion
           • impervious to moisture
             • radiopaque.
               • bacteriostatic
                 • should not stain tooth
                   • not irritate periapical tissue
             • should be sterile or easily and quickly sterilized immediately before insertion
               • easily removed

5. sealer

6. length