Chapter 9 HIGH YIELD

Symptomatic apical periodontitis or abscess obturation timing

Contraindication to obturate

Painful irreversible pulpitis treatment if time permits

Single-visit obturation OK

Necrotic pulp with persistent exudation management

Place Ca(OH)2 and delay obturation until dry

Case complexity and time threshold for multi-visit preference

Treatment exceeds ~2 hours or anatomy is challenging

Single-visit endodontics (SVE) definition

Complete cleaning, shaping, disinfection, and obturation in one appointment

SVE indication regarding symptoms

No acute symptoms (pain, swelling)

SVE indication regarding canal exudation

No continuous hemorrhage or exudation in canals

SVE indication regarding anatomy

No anatomical interferences (extremely curved, calcified, or fine canals)

SVE indication regarding appointment time

Enough time in appointment to finish

SVE indication regarding complications

No procedural complications (blockage, ledge, perforation)

SVE contraindication category for calcified or fine canals

Anatomical Challenges

SVE contraindication category for continuous hemorrhage or acute abscess

Active Infection/Exudation

SVE contraindication category for acute apical periodontitis

Symptomatic Non-vital Teeth

SVE contraindication category for asymptomatic necrotic teeth with periapical lesion (no sinus)

Periapical Pathology

SVE contraindication category for TMJ disorders or allergy history

Patient Factors

SVE contraindication category for prior interappointment pain/swelling

History of Flare-ups

Multi-visit RCT requirement if any SVE contraindication is present

Plan multi-visit RCT with interappointment medication (e.g., Ca(OH)2)

Grossman's ideal obturant criteria count

10

Gutta-percha percentage of zinc oxide

75%

Gutta-percha percentage of gutta-percha polymer

20%

Gutta-percha percentage of additives

5%

Resilon composition

Polycaprolactone + bioactive glass + Bis-GMA sealer

Silver points con

Corrode -> cytotoxic; poor seal of canal irregularities

Gutta-percha solvent

Chloroform (also xylol, halothane, etc.)

GP disinfection protocol

1 min in 5.25% NaOCl

Root canal sealer primary function 1

Seal core-dentin interface

Root canal sealer primary function 2

Fill accessory fins/canals

Root canal sealer primary function 3

Provide fluid-tight seal

Root canal sealer primary function 4

Act as lubricant during obturation

Zinc oxide-eugenol sealer example

Grossman's formula

Epoxy-resin sealer examples

AH26, AH Plus

Glass ionomer sealer example

Ketac Endo

Calcium hydroxide-based sealer examples

PulpDent, Sealapex

Bioceramic sealer examples

EndoSequence BC, TotalFill BC

Sealer type below Canadian standard of care due to paraformaldehyde content

Pastes (toxic, can cause paresthesia)

Sealer choice for single-visit vital cases

GP + resin or bioceramic sealer

Sealer choice for complex anatomy or retreatment

Consider resin sealer for adhesion

Sealer choice for pediatric or perforations

Glass ionomer sealers for biocompatibility

Sealer choice for persistent infection

Ca(OH)2 dressing before final obturation

Lateral condensation contraindications

Severely curved, irregular, or resorbed canals

Lateral condensation disadvantage

Non-homogeneous mass; relies heavily on sealer between cones

Master cone radiograph threshold requiring discard

≥ 2.5 mm short of the apex

Lateral condensation spreader depth requirement

Within 1–2 mm of WL

Vertical compaction indications

Irregular anatomies (e.g., internal resorption)

Vertical compaction advantage

Thermoplastic GP adapts to canal irregularities

Carrier-based systems examples

Thermafil, GuttaCore

Carrier-based systems disadvantages

Risk of periapical extrusion and difficult to remove in retreatment

Single-cone technique definition

One GP cone matching MAF size and taper, placed with sealer only

Single-cone technique indications

Straight, round canals prepared with matching-taper rotary files and bioceramic sealers

Single-cone technique advantages

Fast, simple, and minimizes instrumentation stress

Single-cone technique disadvantages

Heavily relies on sealer to fill irregularities and not ideal for wide or highly irregular canals

Obturation symptom note

Mild discomfort post-RCT is common; usually not obturation-related

Radiographic criteria: voids definition

Radiolucent spots between GP or at dentin interface -> incomplete fill

Radiographic criteria: density definition

Obturation mass of uniform density with distinct GP margins and no fuzziness

Radiographic criteria: length definition

Material extends to prepared length, coronally removed apical to orifice in posterior teeth and apical to gingival margin in anterior teeth

Radiographic criteria: taper definition

Taper need not be uniform but should be consistent

Ideal tissue response at the apex after successful RCT

Deposition of cementum

Definitive restoration timing note

Accomplished as soon as possible after obturation under rubber dam to preclude leakage and protect tooth structure