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Znaczenie polimorfizmu TGF-ß1 w patogenezie przerostu dziąseł indukowanego lekami immunosupresyjnymi u pacjentów po allogenicznym przeszczepieniu nerek

  • Autor: Dr n. med. Aleksandra Kulas-Bałaban

  • Kurs: Stomatologia Zachowawcza z Endodoncją, V rok, Wydział Lekarski i Stomatologii, Katedra Stomatologii Zachowawczej z Endodoncją

Root Canal Obturation - An Updated View

Seminar Plan

  1. Proper preparation of the root canal system before final obturation procedure.

  2. Overview of selected modern materials used for final filling of root canals.

  3. The problem of biocompatibility of materials used.

  4. Overview of the most popular modern methods of root canal filling.

Control Questions

  1. Under what conditions can you proceed to the final filling of the root canals?

  2. What material is used to maximize the volume of cone material in the root canals? Why?

  3. What materials are characterized by the highest biocompatibility with periradicular tissues?

  4. What are the advantages and disadvantages of thermoplastic condensation of warm gutta-percha?

  5. How to correctly choose the main gutta-percha point (Master Cone)?

  6. What is the recommended obturation technique for an open apex?

Before Obturation

  • Properly shaped and cleaned canal system is essential to provide ideal conditions for the final obturation!

  • Key points:

    • Lack of vital pulp means the root canal is not accessible to immune cells.

    • Aim to fill the entire endodontic space tightly to create a barrier against microorganisms and products.

    • A tightly sealed coronal restoration alongside root filling helps maintain healthy periapical conditions.

Necessary Conditions Before Final Obturation

  1. Thorough cleaning of the endodontic space.

  2. Cone-shaped canal (without apex transportation) and physiological constriction.

  3. Ability to dry the root canal.

  4. Asymptomatic tooth.

Cleaning of the Endodontic Space

  • Essential aspects of cleaning before obturation:

    • Removal of debris.

    • Elimination of smear layer.

    • Reduction of biofilm.

    • Proper techniques are vital to create optimal conditions for filling.

Proper Shaping Before Obturation

  • Key shaping principles include:

    • Maintaining the apical constriction.

    • The canal should be tapered from crown to apex, ending in an apical narrowing (CONE SHAPE).

Apical Barriers Definition

  • According to the American Association of Endodontists (AAE):

    • Apical stop: A dentin matrix or material at the root canal preparation’s apical end, preventing further advancement of instruments and obturation materials.

    • Apical seat: An incomplete barrier at the apical end of the root canal preparation.

Apical Patency

  • Definition: A technique maintaining the apical canal portion free of debris by recapitulation with a small file through the physiological constriction.

  • Ensures the canal is predictably negotiable, allowing a small No. 6-10 K-file passage.

  • A patency file (small flexible K-file) should be passively moved through the apical constriction 0.5–1 mm beyond the minor diameter, without widening it.

Note: Use of the patency technique should be withdrawn in specific cases including vital teeth, patients on bisphosphonates, and those with anticoagulation treatments or immunosuppression.

Ability to Dry the Root Canal

  • Critical step before final filling: ensuring that paper points matching the main file (MAF) are dry.

  • There should be no pathological exudate from the canal.

Asymptomatic Tooth Condition

  • Conditions like pain, swelling, active fistula, etc., constitute contraindications to final canal filling.

Obturation Process

  • Root canal filling should use a (semi-)solid material with a root canal sealer to fill voids.

    • The European Society of Endodontology recommends combining cones (usually gutta-percha) and sealers to maximize cone material volume and minimize sealer volume.

Basic Stages of Root Canal Obturation

  1. Selection of final filling method adjusted to clinical conditions.

  2. Matching of the main gutta-percha cone (Master Cone) (X-RAY).

  3. Drying of the root canal.

  4. Application of sealant.

  5. Tight filling of the apical canal part (lateral/vertical compaction).

  6. Tight filling of middle/coronal canal portion.

  7. Evaluation of filling (X-RAY).

Sealers

  • Most sealing materials are toxic right after mixing but reduce toxicity post setting.

  • Must have certifications for release for sale.

  • Extruding sealant over the apex can cause delayed healing of periapical inflammation.

Epoxy Resin Sealers

  • Popular sealer used with gutta-percha due to:

    • Long working time.

    • Flow into lateral canals and recesses.

    • Good sealing abilities and stable volume over time.

Disadvantages of Epoxy Resin Sealers

  • Immediate toxicity post mixing.

  • Risk of allergic reactions.

Bioceramic-Based Sealers

  • New concept from calcium silicates and bioceramics.

    • High Biocompatibility and enhancing tissue healing with bioactive properties.

    • Simplified filling procedure using higher volume sealant.

Concerns

  • Risk of excessive sealant pushing into periapical tissues if higher volumes are used.

  • Ongoing research required due to potential solubility and porosity issues.

Common Bioceramic Sealers

  • BioRoot RCS, Septodont, Wll-Root ST, Vericom, Nano-ceramic Sealer, B&L Biotech, EndoSequence BC Sealer, Brasseler, TotalFill BC Sealer, FGK, and MTA Fillapex.

Gutta-Percha

  • Most commonly used cone material in endodontics.

    • Rare allergic reactions; primary material filling the root canal volume.

Gutta-Percha Cones

  • Generally in β crystal form; don’t always fit optimally.

  • Compacted to fill irregularities and drive sealer into remaining voids.

Types of Gutta-Percha Cones

  1. Standardized cones (2% taper to root canal shapers).

  2. Accessory cones.

  3. Greater taper cones (4% or 6%, up to 12%).

α Gutta-Percha Form

  • Exists in crystalline α form, softer than β; used in injection systems at specified temperatures (e.g., Ultrafil at 70°C, systems at 160-200°C).

Methods of Obturation

Cold Gutta-Percha Methods

  • Single cone technique

  • Cold lateral compaction

  • GuttaFlow

Thermoplasticized Gutta-Percha Techniques

  • Warm lateral compaction

  • Warm vertical compaction

  • Plasticized GP injection

  • Continuous wave technique

  • Thermomechanical compaction

  • Carrier-based thermoplasticized technique

Cold Lateral Compaction Technique

  • The first spreader should be at least 1-2 mm shorter than the working length, determined by MAF Size.

Advantages of Thermoplasticized Techniques

  • Good 3-dimensional obturation.

  • Successful filling in irregular/morphologically complex canals.

  • Quick procedures for experienced clinicians.

Disadvantages of Thermoplasticized Techniques

  • Higher risk of apical extrusion.

  • Narrow canals may require enlargement.

  • Potential thermal damage to periodontium.

  • Expensive equipment costs.

Continuous Wave Technique

  • Parameters include a maximum temperature, duration, and application method.

  • Impacts pressures and filling efficacy based on conditions of use.

Apical Barrier Technique

  • Used for open apex situations due to incomplete root development or external resorption challenges.

  • Moist environment and thin walls complicate procedures.