P3-ENDO-CHAPTER 1O BOOK

to obtain a hermetic seal

what is the major goal of obturation?

one visit

vital pulp = absence of bacterial contamination, therefore more successful treatmente

what is the timing for obturation of vital pulp cases

multiple visits

will require intracanal medication, waiting until patient becomes asymptomatic, and elimination of bacteria

what is the timing for obturation of necrotic pulp cases

1. canal is dry

2. patient is asymptomatic

what are the 2 requirements before obturation can be done

calcium hydroxide

gold standard for intracanal medication

water-based (powder form)

which form of CaOH is mixed with NSS and easier to remove

oil-based (paste form)

which form of CaOH is not mixed with NSS but harder to remove

CAR

- cauterizing effect

- antimicrobial effect

- root formation (apexification)

what are the effects of CaOH as an intracanal medicant?

0.5-1mm short of the radiographic apex

what is the length of obturation?

harbors bacteria

what is the effect of underfilled obturation?

incomplete obturation

what causes an underfilled obturation?

periapical irritation

what is the effect of overfilled obturation

apical extrusion of material

what causes an overfilled obturation?

apical puff

refers to the slight extrusion of a sealer beyond the apex

EDTA + NaOCl for 1-5 minutes

EDTA will chelate the inorganic materials which will expose the organic materials to NaOCl

what is used to remove the smear layer?

1-5 um

what is the thickness of a smear layer?

ultrasonics

what instrument is used for intracanal agitation of NaOCl and EDTA?

gutta percha

done in a fast filing motion!

what is instrument is used for manual agitation of NaOCl and EDTA?

paper points

used for eliminating residual moisture after irrigating the canals

slow!

what is the ideal setting time for a sealer?

ZOE sealer

this sealer chelates with dentin to create a mechanical seal

antimicrobial activity

what is the advantage of ZOE sealer?

Pulp Canal Sealer / Pulp Canal Sealer EWT

what is ZOE sealer marketed as?

Procosol

this is a modification of ZOE sealers where silver particles have been removed from its composition

1. shrinks over time

2. cytotoxic on periapical tissues

3. soluble

4. stains teeth!

what are the disadvantages of ZOE sealer?

Roth's Sealer

it is the non-staining formula/modification of ZOE sealers

Nogenol

a root canal sealer without eugenol and is composed of: zinc oxide, barium sulfate, and bismuth oxychloride

CaOH sealer

this root canal sealer releases hydroxyl ions that are antimicrobial and induces hard tissue formation

apexification

for which cases of open apex is CaOH sealer used?

soluble

what is the disadvantage of CaOH sealer?

12.5-12.8 pH

it can kill bacteria (acidic) because it is very basic

what is the pH level of CaOH sealer?

GI sealer

this sealer chemically bonds with dentin for adhesion

1. high radiopacity

2. enhances remineralization

what are the properties of GI sealers?

1. difficult to remove

2. dimensional changes

what are the disadvantages of GI sealers?

Ketac-Endo

what is GI sealer marketed as?

Activ GP

it is a glass ionomer-impregnated gutta percha with a glass ionomer sealer

resin-based sealer

these sealers create an adhesive bond with dentin

Resin-based sealer

property of this sealer includes minimal shrinkage and long setting time

1. requires complete dryness

2. cytotoxic

3. difficult to remove

what are disadvantages of resin-based sealer

AH plus

most commonly used resin-based sealer

EndoRez

it is a resin-based sealer that has hydrophilic properties

silicone-based sealer

this sealer expands during setting to create a tight seal

Silicone-based sealer

a property of this sealer is that it does not shrink and is biocompatible

1. weak dentin adhesion

2. expensive

disadvantages of silicone-based sealers

RoekoSeal

it is a polyvinylsiloxane sealer that expands on setting

GuttaFlow

this is a silicone-based sealer that consists of gutta-percha added to RoekoSeal

Bioceramic sealers

this sealer forms hydroxyapatite crystals and chemically bonds to dentin

1. excellent biocompatibility

2. strong antimicrobial properties

3. HYDROPHILIC

what are the properties of bioceramic sealers?

bioceramic sealer

this sealer is considered the gold standard

paraformaldehyde containing sealers

(endomethasone, SPAD, reibler's paste)

what sealers are contraindicated for use? what are examples?

1. master apical cone

2. ultrasonics

3. lentulo spiral

4. files/reamers

MULF

what instruments are used for delivering/placing sealers?

1. master apical cone

2. lentulo spiral

3. k-files

MLK martin lutha king

what instruments are used for delivering sealers in curved canals?

ultrasonics

these provide the best sealer distribution when used circumferentially

lateral compaction

this method of obturation provides the best sealer distribution than other techniques

silver cones

these core materials are more rigid than gutta-percha and cannot be used in irregularly shaped canals, it also corrodes when it comes into contact with fluid/saliva

gutta percha

most popular core material used for obturation

1. plasticity

2. ease of use

3. easily removed

4. minimal toxicity

5. radiopaque

what are the advantages of gutta percha?

1. lack of adhesion to dentin

2. shrinks on cooling

what are the disadvantages of gutta percha?

20% gutta percha, 65% zinc oxide, 10% radiopacifier, 5% plasticizer

what is the composition of gutta percha?

waxes, resin

what makes up the plasticity of gutta percha?

barium or strontium SULFATES

what makes up the radiopacity of gutta percha?

1,4-polyisoprene

what is the main chemical component of gutta percha?

beta phase

which phase of gutta percha is the solid, unheated form?

alpha phase

which phase of gutta percha is the pliable and tacky, heated form?

Alpha phase

which phase of gutta percha is used for obturation?

65 degrees celcius

at what temperature will gutta percha melt?

resilon

a synthetic polymer-based alternative for gutta percha

custom cones

what obturating materials are used if the apical foramen is open or a canal is large?

1. chloroform

2. eucalyptol

3. xylol

C(S)EX

what solvents can be used to plasticize gutta percha?

MTA

used as apical barrier material for vital teeth (apexogenesis)

cold lateral compaction

obturation technique:

- uses MAC and accessory cones compacted laterally using a spreader

cold lateral compaction

this obturation technique leaves voids and does not adapt to irregular canals

cold lateral compaction

this obturation technique provides good control

cold lateral compaction

this obturation technique is used if a single gutta percha cone cannot fill the canal

0.5mm

what is the distance from the orifice for cutting gutta percha?

warm vertical compaction

this obturation technique:

- softens gutta percha first and compacting it with a plugger vertically

warm vertical compaction

this obturation technique fills the canal in three dimensions

warm vertical compaction

this obturation technique is referred to as "Schilder's Technique"

warm vertical compaction

this obturation technique provides better wall adaptation in irregular canals and accessory canals

1. risk of vertical root fracture

2. potential for extrusion

3. less control

what are the disadvantages of warm vertical compaction?

3-4mm

how much of the gutta percha is left in the apical area for WVC?

continuous wave compaction

variation of WVC that uses a heated plugger to downpack gutta-percha in one motion

system B @ 200 degrees celcius

what specialized device is used for continuous wave compaction?

warm lateral compaction

(lateral compaction allows better length control than other techniques!!!!!!)

this obturation technique allows length control while incorporating a warm gutta-percha

Endotec II

what device is used for warm lateral compaction?

thermoplastic injection technique

this obturation technique heats gutta-percha outside the tooth and injecting the material into the canal via a delivery system

obtura III

this is a hand-held "gun" that heats pellets of gutta-percha for thermoplastic injection technique

ultrafil 3D

this is a thermoplastic gutta-percha injection technique involving gutta-percha cannulas, a heating unit, and an injection syringe

calamus

this is a thermoplastic device equipped with a cartridge system with 20- and 23-gauge needles, and allows temperature control and flow control

Elements

this thermoplastic device consists of a System B heat source and plugger as well as a handpiece extruder for delivering thermoplastic gutta-percha or RealSeal from a disposable cartridge

HotShot

this is a cordless thermoplastic device that has a heating range from 150° C to 230° C

thermoplastic technique

this obturation technique provides a homogenous fill and excellent adaption in irregular canals

thermoplastic technique

this obturation technique can overfill if not controlled

carrier-based gutta-percha technique

this obturation technique uses a central plastic or cross-linked gutta percha carrier coated with flowable gutta percha

Thermafil

a gutta-percha obturating material with a solid core

carrier-based gutta-percha technique

this obturation technique is difficult to retreat

thermomechanical compaction

this obturation technique uses a rotating compactor to generate frictional heat to soften and compact gutta percha

McSpadden compactor

what rotating compactor is used for thermomechanical compaction?

thermomechanical technique

this obturation technique is efficient and quick but has risk of apical extrusion