Root Canal Obturation: Sealing and Timing

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Questions and Answers

What does the process of cleaning and shaping (C&S) determine in the context of root canal obturation?

  • The degree of disinfection and the ability to obturate the radicular space (correct)
  • Only the coronal seal
  • Only the level of GP obturation
  • Just the length and taper of the canal

What is NOT a reason why obturation of the radicular space is considered necessary?

  • To minimize coronal leakage from the oral environment
  • To entomb the remaining irritants in the canal
  • To completely eliminate bacteria from the oral environment (correct)
  • To seal the apex from periapical tissue fluids

Which factor does NOT influence the appropriate time to obturate a root canal system (RCS)?

  • The degree of difficulty
  • The status of the pulp and periradicular tissues
  • The color of the patient's teeth (correct)
  • The patient's symptoms

When is a one-step treatment procedure generally acceptable regarding vital pulp tissue?

<p>When the patient exhibits a completely or partially vital pulp (C)</p> Signup and view all the answers

What is a primary reason for obturating at the initial visit when dealing with vital pulp tissue?

<p>To preclude contamination from coronal leakage (B)</p> Signup and view all the answers

In cases of pulp necrosis with acute symptoms, when is obturation generally performed?

<p>After the patient is asymptomatic (C)</p> Signup and view all the answers

What is contraindicated regarding obturation of a root canal system (RCS)?

<p>An RCS that cannot be dried (A)</p> Signup and view all the answers

According to early studies, what was identified as the apical limit for obturation?

<p>The dentinocemental junction (C)</p> Signup and view all the answers

What is the traditional recommendation for the apical point of termination, as determined by radiographs?

<p>1 mm from the radiographic apex (D)</p> Signup and view all the answers

According to Kuttler, what constitutes the apical anatomy?

<p>Both the major diameter of the foramen and the minor diameter of the constriction (C)</p> Signup and view all the answers

After vital pulpectomy, what distance from the radiographic apex has been reported to have the best success rate when the procedures are terminated?

<p>2 to 3 mm short of the radiographic apex (D)</p> Signup and view all the answers

For pulpal necrosis, better success is achieved when procedures are terminated at what distance from the radiographic apex?

<p>At or within 2 mm (B)</p> Signup and view all the answers

What is the thickness range of the smear layer?

<p>1 to 5 μm (A)</p> Signup and view all the answers

What is a potential issue if the smear layer is NOT removed before obturation?

<p>It may interfere with adhesion of root canal sealers (B)</p> Signup and view all the answers

What irrigants are generally used to remove the smear layer after cleaning and shaping (C&S) procedures?

<p>17% EDTA and 5.25% NaOCl (D)</p> Signup and view all the answers

Which of the following is a property of an ideal obturation material?

<p>It is easily manipulated and provides ample working time (C)</p> Signup and view all the answers

What is a disadvantage of Gutta Percha?

<p>Lack of adhesion to dentin (D)</p> Signup and view all the answers

What is the approximate percentage of Gutta Percha in the composition of Gutta Percha points?

<p>20% (A)</p> Signup and view all the answers

What is used to sterilize Gutta Percha points?

<p>Placing in 5.25% NaOCl for 1 minute (C)</p> Signup and view all the answers

What component is added to Resilon core?

<p>Bioactive glass and radio-opaque fillers (B)</p> Signup and view all the answers

What is the main purpose of root canal sealers?

<p>To seal the space between the dentinal wall and the obturating core (C)</p> Signup and view all the answers

What is a desirable property of an ideal sealer?

<p>Exhibits tackiness to provide good adhesion (B)</p> Signup and view all the answers

Which characteristic is associated with Zinc oxide and eugenol sealers?

<p>Shrinkage on setting (A)</p> Signup and view all the answers

What is one advantage of using zinc oxide eugenol sealers?

<p>They have antimicrobial activity (A)</p> Signup and view all the answers

What is a characteristic of noneugenol sealers?

<p>They are developed from a periodontal dressing (B)</p> Signup and view all the answers

What is a potential issue with AH-26 epoxy resin sealer?

<p>It releases formaldehyde (C)</p> Signup and view all the answers

What does the term 'monoblock' refer to in the context of root canal obturation?

<p>Complete filling of the canal space as one solid mass (C)</p> Signup and view all the answers

What is a characteristic of EndoREZ sealer?

<p>It is hydrophilic (C)</p> Signup and view all the answers

What is the main advantage of self-adhesive sealers?

<p>They reduce the application time (D)</p> Signup and view all the answers

What is a characteristic of RoekoSeal silicone sealer?

<p>It is insoluble (C)</p> Signup and view all the answers

What was the original intended therapeutic activity of calcium hydroxide sealers?

<p>Antimicrobial and osteogenic potential (A)</p> Signup and view all the answers

What is a disadvantage of glass ionomer sealers?

<p>They are difficult to treat the dentinal walls (B)</p> Signup and view all the answers

Why are sealers containing paraformaldehyde contraindicated?

<p>They are strongly toxic (A)</p> Signup and view all the answers

What materials are tricalcium and dicalcium silicate-based sealers derived from?

<p>Mineral trioxide aggregate (MTA) (B)</p> Signup and view all the answers

A characteristic of tri/dicalcium silicate cements/sealers?

<p>Highly Alkaline (C)</p> Signup and view all the answers

What is a disadvantage of tricalcium silicate cements?

<p>Lengthy Setting time (B)</p> Signup and view all the answers

What can the staining of crown dentin be caused by in MTA?

<p>Bismuth Oxide (D)</p> Signup and view all the answers

What is used to dissolve Gutta Percha?

<p>Chloroform (C)</p> Signup and view all the answers

How is the master cone selected for lateral compaction?

<p>Has a tip and taper consistent with the prepared canal diameter (A)</p> Signup and view all the answers

What does the text mention about finger spreaders, compared to hand spreaders?

<p>Provide better tactile sensation and are less likely to induce fractures (A)</p> Signup and view all the answers

Light pressure is required during lateral compaction?

<p>Because Gutta Percha is not condensed, and minimal pressure can fracture root. (A)</p> Signup and view all the answers

What is the first step of inverted cone technique?

<p>Select a large Gutta Percha and remove the serrated butt and invert the cone into the canal. (D)</p> Signup and view all the answers

What is the preparation requirement for the teeth with the warm gutta-percha technique?

<p>Preparing the teeth with continuously tapering funnel. (C)</p> Signup and view all the answers

How far from prepared length should system B be fitted?

<p>5-7mm (D)</p> Signup and view all the answers

What is a property of the Ultrafil 3D cannula?

<p>90 degrees to pre set in the heater (C)</p> Signup and view all the answers

What is successfil associated with?

<p>Ultrafil 3D (C)</p> Signup and view all the answers

What does the evaluation of obturation NOT typically include?

<p>Material composition of the sealer (C)</p> Signup and view all the answers

Why might achieving a completely impervious seal during obturation be unrealistic?

<p>The porous nature of dentin and canal irregularities (C)</p> Signup and view all the answers

What is the primary purpose of obturating the radicular space?

<p>To minimize coronal leakage and entomb irritants (C)</p> Signup and view all the answers

What is the rationale behind performing obturation in a single visit when dealing with vital pulp tissue?

<p>To prevent coronal leakage and subsequent bacterial contamination (B)</p> Signup and view all the answers

When is obturation typically delayed in cases of pulp necrosis with acute symptoms?

<p>When the patient becomes asymptomatic (C)</p> Signup and view all the answers

Why is it contraindicated to obturate a root canal system that cannot be dried?

<p>It may promote bacterial growth and hinder proper sealing (A)</p> Signup and view all the answers

What is the traditional recommendation for the apical point of termination based on radiographs?

<p>1 mm short of the radiographic apex (C)</p> Signup and view all the answers

According to Kuttler, what does the apical anatomy consist of, relative to endodontic considerations?

<p>Both major diameter of the foramen and minor diameter of the constriction (A)</p> Signup and view all the answers

Why is clinical determination of apical canal anatomy considered difficult, especially in cases of pulpal necrosis?

<p>An apical constriction is often absent (D)</p> Signup and view all the answers

What is the clinical significance of the smear layer in the context of obturation?

<p>It may harbor bacteria and interfere with sealer adhesion (A)</p> Signup and view all the answers

What is the suggested method for smear layer removal after cleaning and shaping procedures?

<p>Irrigating with EDTA and NaOCl (C)</p> Signup and view all the answers

Which is NOT a property outlined by Grossman for an ideal obturation material?

<p>Dimensional instability after insertion (A)</p> Signup and view all the answers

Regarding Gutta Percha, which is considered a disadvantage?

<p>Lack of adhesion to dentin (C)</p> Signup and view all the answers

What is the primary ingredient by percentage in the composition of Gutta Percha points?

<p>Zinc oxide (A)</p> Signup and view all the answers

How can Gutta Percha points be sterilized before use?

<p>Placing in 5.25% NaOCl for 1 minute (A)</p> Signup and view all the answers

What is the role of the primer (self-etchant) in the Resilon obturation system?

<p>To enable bonding of the sealer to canal walls (A)</p> Signup and view all the answers

Which is NOT a property of an ideal sealer?

<p>High solubility in tissue fluids (C)</p> Signup and view all the answers

What is considered an advantage of Zinc Oxide and Eugenol (ZOE) sealers?

<p>They possess antimicrobial activity (C)</p> Signup and view all the answers

What component is present in Nogenol sealer, a noneugenol sealer, as its base?

<p>Zinc oxide (A)</p> Signup and view all the answers

What potential issue is associated with AH-26 epoxy resin sealer?

<p>It releases formaldehyde during setting (A)</p> Signup and view all the answers

What is the primary goal of materials that promote a 'monoblock' in root canal obturation?

<p>To create a gap-free, solid mass within the canal (C)</p> Signup and view all the answers

What is the implication of solubility in calcium hydroxide sealers?

<p>It is inconsistent with the purpose of a sealer (D)</p> Signup and view all the answers

Why are sealers containing paraformaldehyde strongly contraindicated in endodontic treatment?

<p>They are severely toxic (B)</p> Signup and view all the answers

What is a common component of tricalcium silicate-based sealers in addition to tricalcium and dicalcium silicate?

<p>Bismuth oxide (A)</p> Signup and view all the answers

How does the setting reaction of tri/dicalcium silicate cements/sealers affect their pH?

<p>It results in a highly alkaline pH (B)</p> Signup and view all the answers

What may cause staining of crown dentin when using MTA?

<p>The bismuth oxide component (C)</p> Signup and view all the answers

What solvent is commonly used to dissolve Gutta Percha during retreatment?

<p>Chloroform (B)</p> Signup and view all the answers

In lateral compaction, what is the desired fit of the spreader relative to the working length?

<p>Fitting within 1 to 2 mm of the working length (C)</p> Signup and view all the answers

When performing lateral compaction, when does the process end??

<p>Until the spreader no longer goes beyond the coronal one third of the canal (A)</p> Signup and view all the answers

In warm vertical compaction, what is a preparation requirement?

<p>Continuously tapering preparation (C)</p> Signup and view all the answers

In System B continuous wave condensation, how close to the prepared length should the plugger reach?

<p>Within 5-7mm (C)</p> Signup and view all the answers

What is a characteristic of the Ultrafil 3D system?

<p>The heater adjusts automatically (B)</p> Signup and view all the answers

What is the main difference between Guttaflow and Guttaflow bioseal?

<p>Guttaflow bioseal incorporates bioactive ingredients (A)</p> Signup and view all the answers

How does water function with tricalcium silicate sealers?

<p>It hydrates it for sealing (C)</p> Signup and view all the answers

What is a primary disadvantage of using calcium hydroxide as an apical plug?

<p>It provides an imperfect apical seal (C)</p> Signup and view all the answers

According to current evidence, which factor, alongside the quality of endodontic treatment, significantly affects healing outcomes?

<p>The coronal restoration (B)</p> Signup and view all the answers

Why it is impossible to definitively assess obturation quality using only radiographs?

<p>Dentinal tubules and canal irregularities might cause leakage, undetectable on a radiograph (C)</p> Signup and view all the answers

What is the primary reason why obturation reduces coronal leakage and bacterial contamination?

<p>It minimizes coronal leakage from oral environment (D)</p> Signup and view all the answers

What is the overarching goal of three-dimensional obturation of the root canal system (RCS)?

<p>Sealing the RCS apically, coronally, and laterally for long-term healing (C)</p> Signup and view all the answers

What is the decisive factor when determining the necessity to delay obturation in cases of pulp necrosis presenting with acute symptoms?

<p>The presence of an acute periradicular abscess requires waiting until patient is asymptomatic (B)</p> Signup and view all the answers

What is the critical factor that determines when obturation is appropriate after cleaning and shaping procedures?

<p>When the RCS can be dried and the patient is not experiencing significant pain or swelling (B)</p> Signup and view all the answers

Why is obturation contraindicated in a root canal system (RCS) that cannot be adequately dried?

<p>Excessive moisture prevents sealer adhesion and compromises the seal (A)</p> Signup and view all the answers

What is the risk of terminating procedures further than 3 mm short of the radiographic apex after vital pulpectomy?

<p>Compromised success rate (D)</p> Signup and view all the answers

Why is determining the apical constriction challenging when dealing with pulpal necrosis?

<p>Clinical determination of apical canal anatomy is difficult and apical constriction is often absent (A)</p> Signup and view all the answers

How might organic components within the smear layer impact long-term endodontic success if left in place?

<p>Serve as a nutrient source for residual bacteria, potentially leading to proliferation (D)</p> Signup and view all the answers

What is the most significant drawback of leaving the smear layer intact during obturation?

<p>The smear layer can prevent contact between the sealer and canal wall, leading to microleakage (C)</p> Signup and view all the answers

What is the combined purpose of using 17% disodium EDTA and 5.25% NaOCl for final irrigation?

<p>Removing the smear layer formed during instrumentation (C)</p> Signup and view all the answers

Which property is required for an ideal obturation material to ensure long-term success?

<p>No shrinkage once inserted ensures a stable, lasting seal (B)</p> Signup and view all the answers

Why is the lack of adhesion to dentin considered a disadvantage of gutta-percha?

<p>It necessitates the use of a sealer to bridge the gap between gutta-percha and the canal walls (A)</p> Signup and view all the answers

What phase change in gutta-percha contributes most to its disadvantage of shrinkage upon cooling?

<p>The transformation from alpha (α) to beta (β) phase, leading to contraction (B)</p> Signup and view all the answers

Why must caution be exercised when sterilizing gutta-percha points with heat?

<p>Gutta-percha points cannot be heat sterilized (A)</p> Signup and view all the answers

What is the specific role of the primer component in the original Resilon obturation system?

<p>To enable bonding of the sealer to the canal walls, forming a monoblock (A)</p> Signup and view all the answers

What is a crucial property that an ideal root canal sealer should possess to ensure long-term success?

<p>Exhibits tackiness when mixed to provide good adhesion between it and the canal wall when set (A)</p> Signup and view all the answers

How does the antimicrobial activity of zinc oxide eugenol (ZOE) sealers contribute to their clinical use?

<p>ZOE sealers help control the local bacterial population within the root canal (A)</p> Signup and view all the answers

What are the implications of formaldehyde release from AH-26 epoxy resin sealer?

<p>May lead to cytotoxic and potentially allergenic effects (D)</p> Signup and view all the answers

What is the primary clinical significance of achieving a 'monoblock' in root canal obturation?

<p>Creating a unified, gap-free mass within the canal to improve the seal and fracture resistance (D)</p> Signup and view all the answers

Why is solubility considered a notable characteristic of calcium hydroxide sealers, despite its apparent drawbacks?

<p>It facilitates the sustained release of calcium hydroxide for continued therapeutic effects (B)</p> Signup and view all the answers

What is the fundamental reason for the contraindication of sealers containing paraformaldehyde in endodontic treatment?

<p>Paraformaldehyde is severely toxic and poses a risk of systemic distribution (D)</p> Signup and view all the answers

How does the high alkalinity (pH) of set tri/dicalcium silicate cements/sealers contribute to their function?

<p>By promoting antibacterial activity and hard tissue formation (B)</p> Signup and view all the answers

What is the primary consideration when selecting alternative radiopacifiers to bismuth oxide in MTA-based sealers?

<p>To prevent staining of the crown dentin (C)</p> Signup and view all the answers

How do tricalcium silicate particles contribute to the sealing mechanism in root canal obturation?

<p>They exchange nonaqueous vehicles for water to hydrate within the tooth for sealing purposes (B)</p> Signup and view all the answers

What is the clinical implication of EndoSequence BC sealer being more cytotoxic than AH Plus?

<p>Lower biocompatibility (D)</p> Signup and view all the answers

What is the primary reason for using Grossman formulation sealers and resin sealers consistent with AH-26 and AH Plus?

<p>To achieve adequate sealing in conjunction with the chosen obturation technique (B)</p> Signup and view all the answers

What is the primary disadvantage of using heat to remove portions of the coronal GP?

<p>Causes changes in temperature of outer tooth surface (D)</p> Signup and view all the answers

Which factor is most influential in determining the appropriateness of single-visit obturation?

<p>Status of the pulp and periradicular tissues (B)</p> Signup and view all the answers

In cases of pulp necrosis with acute symptoms, what is the key factor in determining when obturation can be performed?

<p>Once the patient is asymptomatic (C)</p> Signup and view all the answers

Why is obturation contraindicated in a canals that display persistence of exudation?

<p>The presence of exudate prevents adequate sealer adaptation (D)</p> Signup and view all the answers

What is the primary limitation of silver cones?

<p>Prone to corrosion and may cause pathosis (C)</p> Signup and view all the answers

What is the rationale for using a self-etching sealer with an acidic primer?

<p>To demineralize surface smear layers (C)</p> Signup and view all the answers

What are the advantages of 4th generation methacrylate sealers?

<p>Do not require etching and bonding steps (D)</p> Signup and view all the answers

What is the rationale for adding bioactive ingredients to GuttaFlow bioseal?

<p>To stimulate tissue healing and regeneration (B)</p> Signup and view all the answers

What is a significant characteristic of tricalcium silicate cements/sealers concerning their long-term dimensional stability?

<p>They exhibit dimensional changes less than 0.1% expansion when set (D)</p> Signup and view all the answers

What is a primary disadvantage of tricalcium silicate cements' long setting time?

<p>Complicates clinical workflow, but not sealer applications (D)</p> Signup and view all the answers

What factor makes Inverted cone technique well-suited for tubular canals?

<p>Cone is easily introduced inside canal (A)</p> Signup and view all the answers

What is the rationale for adapting a cone that is slightly short of the prepared length using the Tailor made cone technique?

<p>To improve the potential for extrusion of the core material, and may improve the resultant seal (C)</p> Signup and view all the answers

What is the disadvantage of using chloroform to soften gutta percha?

<p>Chemical is carcinogenic and mutagenic (B)</p> Signup and view all the answers

What preparation requirement is necessary for warm vertical compaction?

<p>Canal is continuously tapered, requires a funnel shape (D)</p> Signup and view all the answers

Considering the technique in System B continuous wave condensation, what would be expected in the apical portion of the GP?

<p>Heat tranfers less effectively throughout the fill, remains single cone (D)</p> Signup and view all the answers

What is a disadvantage of using Ultrafil 3D?

<p>Commonly overextended or underextended (B)</p> Signup and view all the answers

What is the best material for use in immature apical development?

<p>Apical Plugs (B)</p> Signup and view all the answers

What is a major limitation in assessing the seal achieved during root canal obturation?

<p>No current material or technique can completely prevent leakage due to dentin's tubular structure and canal irregularities. (D)</p> Signup and view all the answers

What is the rationale for obturating the radicular space?

<p>To minimize coronal leakage, seal the apex from tissue fluids, and entomb remaining irritants. (B)</p> Signup and view all the answers

What would be considered when determining the optimal timing for obturation of a root canal system (RCS)?

<p>The patient's signs and symptoms along with the status of the pulp and periradicular tissues. (A)</p> Signup and view all the answers

In a scenario involving vital pulp tissue, when is a one-step treatment procedure considered acceptable?

<p>When the patient exhibits a partially or completely vital pulp. (C)</p> Signup and view all the answers

In managing pulp necrosis with acute symptoms, when is the timing of obturation typically delayed?

<p>When the acute periradicular symptoms are resolved. (D)</p> Signup and view all the answers

What is a primary reason for obturation to be contraindicated in a root canal system (RCS)?

<p>When bleeding within the canal cannot be controlled. (C)</p> Signup and view all the answers

What is the rationale behind the traditional recommendation for the apical point of termination during obturation?

<p>To terminate approximately 1mm from the radiographic apex to avoid overextension. (D)</p> Signup and view all the answers

In determining the apical limit of instrumentation and obturation in cases of vital pulpectomy, why is it necessary to terminate procedures 2 to 3 mm short of the radiographic apex?

<p>Better success rates have been reported when procedures are terminated short of the apex. (A)</p> Signup and view all the answers

In cases involving pulpal necrosis, what is the primary challenge in clinically determining the apical canal anatomy?

<p>An apical constriction might be absent. (B)</p> Signup and view all the answers

What is the potential consequence of the smear layer interfering with the adhesion and penetration of root canal sealers?

<p>Compromised adaptation of sealers, potentially leading to leakage. (C)</p> Signup and view all the answers

After completing cleaning and shaping (C&S) procedures, what irrigation protocol is typically used for smear layer removal?

<p>Irrigating the canal with alternating solutions of 17% disodium EDTA and 5.25% NaOCl. (B)</p> Signup and view all the answers

Why does the lack of adhesion to dentin pose a significant disadvantage for Gutta-Percha as an obturation material?

<p>It necessitates the use of a sealer to achieve a hermetic seal. (B)</p> Signup and view all the answers

What is the primary disadvantage related to the alpha (α) phase transition of Gutta-Percha (GP) when heated for obturation?

<p>Significant shrinkage upon cooling, which can compromise the seal. (B)</p> Signup and view all the answers

What is the significance of removing the smear layer before obturation despite inconclusive consensus?

<p>The growing evidence indicates that it supports an environment conducive to bacterial growth if left intact. (A)</p> Signup and view all the answers

What is the role of the primer (self-etchant) in the Resilon obturation system regarding the creation of a monoblock?

<p>The primer etches the dentin to create a hybrid layer for bonding of the sealer. (A)</p> Signup and view all the answers

Why is the potential of formaldehyde release from AH-26 epoxy resin sealer a clinical concern?

<p>Formaldehyde release may lead to cytotoxic and potentially allergenic effects. (A)</p> Signup and view all the answers

What is the significance of the 'monoblock' concept in root canal obturation, particularly with resin sealers?

<p>It describes the formation of a unified mass within the canal space, potentially improving the seal and fracture resistance. (B)</p> Signup and view all the answers

What is the primary clinical implication of the solubility of calcium hydroxide sealers?

<p>Potential for gradual degradation of the seal over time. (D)</p> Signup and view all the answers

What consideration is most important when selecting alternative radiopacifiers to bismuth oxide in MTA-based sealers?

<p>The potential for the alternative material to cause staining of the dentin. (D)</p> Signup and view all the answers

What is indicated by EndoSequence BC sealer being more cytotoxic than AH Plus?

<p>EndoSequence BC sealer could potentially be less biocompatible. (A)</p> Signup and view all the answers

How might using heat to remove portions of coronal GP be dangerous?

<p>The procedure may be more likely to cause an external root surface temperature change. (D)</p> Signup and view all the answers

What is the key factor in determining the appropriateness of single-visit obturation, especially in necrotic cases?

<p>Canal dryness. (C)</p> Signup and view all the answers

Why is it vital to consider evidence-based research in endodontic treatment planning?

<p>To integrate clinical expertise with systematic research and patient values. (B)</p> Signup and view all the answers

What is the best way to choose the obturation length for the best success in vital pulpectomy?

<p>Best results are observed with procedures ending 2 to 3 mm short of the radiographic apex. (A)</p> Signup and view all the answers

What is the primary aim achieved through a three-dimensional obturation of the root canal system?

<p>Achieving the seal apically, coronally, and laterally, ensuring a comprehensive barrier against microleakage. (B)</p> Signup and view all the answers

What is the primary purpose of using both gutta-percha and sealers in root canal obturation?

<p>Gutta-percha provides bulk volume, and sealers fill voids and irregularities to achieve a complete seal. (D)</p> Signup and view all the answers

What is the limitation for using silver points?

<p>Their inability to completely fill irregularly shaped canals, leading to potential leakage. (A)</p> Signup and view all the answers

Despite its advantages, what is the primary disadvantage of using chloroform to soften gutta-percha points during obturation?

<p>It poses carcinogenic and mutagenic risks. (A)</p> Signup and view all the answers

What is a significant disadvantage when using silver cones for obturation?

<p>Their propensity to corrode when in contact with tissue fluids, leading to cytotoxic effects. (D)</p> Signup and view all the answers

What is the significance of cleaning and shaping in relation to root canal obturation?

<p>It determines the degree of disinfection, affecting ability to obturate the radicular space. (C)</p> Signup and view all the answers

What is the correlation between radiographs and assessing quality of obturation?

<p>It is not possible to assess the quality of the seal established. (C)</p> Signup and view all the answers

What is Resilon Core based with?

<p>Thermoplastic synthetic polymer (polyester) (B)</p> Signup and view all the answers

What are four generations of methacrylate resin sealers?

<p>Marketable commercially. (D)</p> Signup and view all the answers

What is the purpose of the acidic primer in third-generation self-etching sealers?

<p>Increases the demineralization of the superficial dentin. (B)</p> Signup and view all the answers

Which of the following is an advantage of self-adhesive sealers?

<p>Reduces chance of error. (D)</p> Signup and view all the answers

What is the primary mechanism by which tricalcium silicate particles contribute to the sealing of the root canal:

<p>Forming calcium silicate hydrates upon contact with moisture, which creates a physical barrier. (D)</p> Signup and view all the answers

When lateral compaction using a spreader when introduced, at what depth during the preparation should the spreader be placed?

<p>It should be within 1 to 2 mm of the prepared length. (B)</p> Signup and view all the answers

What is the disadvantage of warm vertical compaction?

<p>Changes in temperature of outer surface and potential for vertical root fracture. (D)</p> Signup and view all the answers

Comparing continuous wave and warm backfill technique, what is a negative aspect?

<p>Causes significantly higher temperatures than other obturation. (C)</p> Signup and view all the answers

What is the apex terminus similar to in Obtura III?

<p>To prevent overextension of GP. (B)</p> Signup and view all the answers

When is successfil used?

<p>After Ultrafil 3D. (A)</p> Signup and view all the answers

Why an apical plug is placed?

<p>In cases with immature apical development, cases with external apical root resorption. (D)</p> Signup and view all the answers

What physical phenomenon, intrinsic to the nature of heat transfer during continuous wave condensation with System B, contributes most significantly to the potential for elevated temperatures beyond the intended apical area?

<p>The cumulative effect of repeated heat applications and GP removal before the apical binding point is reached. (B)</p> Signup and view all the answers

In the context of AH-26 epoxy resin sealer, what is the most critical consideration regarding its clinical utilization, given its historical context and known properties?

<p>The potential for formaldehyde release and its ramifications for periapical tissue response. (C)</p> Signup and view all the answers

A clinician is performing a root canal on a tooth with an open apex. Considering the limitations of traditional materials, what is the MOST critical factor for optimizing the long-term prognosis when selecting MTA as an apical barrier?

<p>The controlled hydration to initiate cementum deposition and bone formation, without compromising the seal. (C)</p> Signup and view all the answers

When employing lateral compaction in a root canal with an elliptical cross-section, what is the most critical consideration to prevent procedural errors and optimize obturation density?

<p>Alternating spreader placement along the long and short axes of the canal to achieve balanced gutta-percha distribution. (C)</p> Signup and view all the answers

Considering the complexities associated with root canal morphology, what is the most significant limitation in relying solely on radiographs for assessing the three-dimensional quality of root canal obturation?

<p>The projection of a three-dimensional structure onto a two-dimensional plane, potentially masking voids or irregularities. (B)</p> Signup and view all the answers

In the context of warm vertical compaction, what is the most significant long-term risk associated with over-instrumentation and excessive enlargement of the apical foramen?

<p>The creation of an irreparable 'apical stop', increasing the propensity for overextension and periapical inflammation. (B)</p> Signup and view all the answers

Given the limitations of current materials, what is the most compelling rationale for advocating three-dimensional obturation of the entire root canal system, despite the inherent challenges in achieving a truly impervious seal?

<p>To entomb residual irritants, denying nutrients and eliminating the pathway for microbes and their byproducts to reach the periapical tissues. (C)</p> Signup and view all the answers

A clinician is considering obturation immediately following cleaning and shaping in a case of irreversible pulpitis. What factor would most strongly contraindicate proceeding with single-visit obturation?

<p>The persistence of exudate within the canal despite thorough irrigation and aspiration. (B)</p> Signup and view all the answers

When selecting a solvent for gutta-percha removal during retreatment, what is the paramount concern regarding the clinical environment and patient safety?

<p>The volatility and potential for systemic toxicity upon inhalation or contact. (C)</p> Signup and view all the answers

In cases of pulpal necrosis, given the absence of vital tissue, what is the greatest challenge in accurately determining the apical extent of instrumentation and obturation?

<p>The frequent absence of a distinct apical constriction due to cementum resorption. (D)</p> Signup and view all the answers

What is the most significant long-term consequence of failing to remove the smear layer prior to obturation, considering its composition and location within the root canal system?

<p>The potential for bacterial proliferation within the smear layer, compromising sealer adaptation and long term success. (C)</p> Signup and view all the answers

What is the most critical consideration regarding the use of calcium hydroxide as a long-term interappointment medicament, especially in cases of necrotic teeth with persistent infection, and how does this influence subsequent obturation?

<p>Its limited efficacy against certain resistant bacterial species and its potential to weaken dentin, influencing the choice of obturation materials and techniques. (C)</p> Signup and view all the answers

What is the primary biomechanical principle underlying the risk of vertical root fracture associated with excessive forces during lateral compaction?

<p>The generation of hoop stresses exceeding the tensile strength of the root structure. (D)</p> Signup and view all the answers

In the context of tricalcium silicate sealers, what is the most critical factor influencing their long-term sealing ability and biocompatibility after complete setting?

<p>The alkaline pH facilitates continuous antibacterial activity and promotes biomineralization, alongside the formation of calcium silicate hydrates. (D)</p> Signup and view all the answers

When using thermoplasticized gutta-percha techniques for obturation, what is the primary mechanism by which rapid cooling of the gutta-percha mass can compromise the apical seal?

<p>Volumetric contraction leading to gap formation at the interface between the gutta-percha the dentinal walls. (D)</p> Signup and view all the answers

When considering the material properties of GuttaFlow bioseal, what distinguishes GuttaFlow bioseal from traditional GuttaFlow, and what is the most significant implication of this difference for long-term clinical outcomes?

<p>The addition of bioactive ingredients aiming to induce biomineralization and stimulate tissue healing, potentially improving long-term outcomes. (A)</p> Signup and view all the answers

In the context of developing new bioactive materials for endodontic obturation, what is the MOST critical factor to consider regarding their long-term dimensional stability within the root canal system?

<p>The materials' propensity for hygroscopic expansion and susceptibility of degradation. (A)</p> Signup and view all the answers

Which of the following aspects of sealer placement is MOST crucial to ensuring a homogenous distribution of sealer through the root canal system?

<p>The thorough coating of canal walls with a thin, uniform layer and instrumentation to place and distribute the sealer, avoiding voids. (D)</p> Signup and view all the answers

When using self-etching sealers, what is the fundamental chemical process by which the acidic primer component improves adhesion to dentin?

<p>It incorporates the smear layer. Once incorporated, the surface is then demineralized. (B)</p> Signup and view all the answers

Why is it difficult to achieve a completely impervious seal during root canal obturation?

<p>Because of the porous nature of dentin and canal irregularities. (C)</p> Signup and view all the answers

In endodontics, what is considered crucial for a long-term healing outcome?

<p>The three-dimensional obturation of the root canal system. (B)</p> Signup and view all the answers

What should be considered when determining the appropriate timing for obturation?

<p>The patient's signs and symptoms, pulp and periradicular tissue status, and degree of difficulty. (A)</p> Signup and view all the answers

When is a one-step treatment procedure most acceptable in endodontics?

<p>When the patient exhibits a completely or partially vital pulp. (D)</p> Signup and view all the answers

When managing pulp necrosis with acute symptoms, what is the general approach to obturation?

<p>Obturation is generally delayed until the patient is asymptomatic. (B)</p> Signup and view all the answers

What is the primary reason for contraindicating obturation in a root canal system (RCS)?

<p>If the RCS cannot be dried. (B)</p> Signup and view all the answers

What is the rationale behind Wu and co-workers' conclusion about the apical limit in vital pulpectomy procedures?

<p>Terminating procedures 2 to 3 mm short of the radiographic apex results in the best success rate. (D)</p> Signup and view all the answers

What is a key consideration for the apical limit of instrumentation and obturation in cases of pulpal necrosis?

<p>Clinical determination of apical canal anatomy is difficult, and an apical constriction is often absent. (B)</p> Signup and view all the answers

What potential problem can be caused by the presence of the smear layer?

<p>It may constitute a substrate for bacterial growth. (D)</p> Signup and view all the answers

What is the purpose of using 17% disodium EDTA and 5.25% NaOCl after C&S?

<p>To remove the smear layer. (D)</p> Signup and view all the answers

According to Grossman, which of the following is a property of an ideal obturation material?

<p>Should be easily manipulated, dimensionally stable, and nonirritating. (C)</p> Signup and view all the answers

What is a disadvantage of gutta-percha as an obturation material?

<p>Lack of adhesion to dentin. (D)</p> Signup and view all the answers

Which of the following is a property of an ideal sealer?

<p>Establishes a hermetic seal. (B)</p> Signup and view all the answers

What is an advantage of zinc oxide and eugenol (ZOE) sealers?

<p>Antimicrobial activity (B)</p> Signup and view all the answers

What is a characteristic of tri/dicalcium silicate cements/sealers setting reaction?

<p>They are set by reaction with water and form a highly alkaline (pH ; 12) mixture (A)</p> Signup and view all the answers

What is the setting time for tricalcium silicate cements?

<p>Setting time for tricalcium silicate cements is lengthy, about 165 minutes for the initial set and less than 6 hours for the final set (D)</p> Signup and view all the answers

What materials are known to dissolve Gutta Percha?

<p>Chloroform, Xylene, and Eucalyptol (C)</p> Signup and view all the answers

What potential impact does an overextended and underextended technique have?

<p>Lack of length control, both overextension and underextension are common results (D)</p> Signup and view all the answers

According to the current evidence, the quality of endodontic treatment is not as important as the coronal restoration for a successful healing outcome.

<p>False (B)</p> Signup and view all the answers

Obturation is evaluated based on factors like length, taper, density, level of GP obturation, and the quality of the coronal seal.

<p>True (A)</p> Signup and view all the answers

A radiograph is a reliable method to assess the quality of the seal established during obturation.

<p>False (B)</p> Signup and view all the answers

Obtaining a completely impervious seal is always feasible due to the homogenous structure of root canal dentin.

<p>False (B)</p> Signup and view all the answers

Sealing the apex is not a primary goal of obturation.

<p>False (B)</p> Signup and view all the answers

Factors influencing the timing of obturation include the patient's symptoms, pulp status, degree of difficulty, and patient management.

<p>True (A)</p> Signup and view all the answers

One-step treatment procedures are not acceptable when the patient exhibits a completely or partially vital pulp.

<p>False (B)</p> Signup and view all the answers

Obturation can be safely performed at the initial visit, even when irreversible pulpitis is present, as the removal of the vital pulp tissue usually resolves the patient's pain.

<p>True (A)</p> Signup and view all the answers

In cases of pulp necrosis and acute periradicular abscess, obturation should be performed immediately, regardless of the patient's symptoms.

<p>False (B)</p> Signup and view all the answers

Obturation of an RCS that is impossible to dry is still acceptable if proper techniques are employed.

<p>False (B)</p> Signup and view all the answers

The dentinocemental junction is a reliable clinical landmark for determining the apical limit of obturation.

<p>False (B)</p> Signup and view all the answers

Traditionally, the apical point of termination should be exactly at the radiographic apex.

<p>False (B)</p> Signup and view all the answers

The smear layer always promotes sealer contact with the canal wall.

<p>False (B)</p> Signup and view all the answers

The smear layer has no effect on the action of irrigants used as disinfectants.

<p>False (B)</p> Signup and view all the answers

Unlike gutta-percha, GP points can be heat sterilized without any impact on their physical properties.

<p>False (B)</p> Signup and view all the answers

Resilon, unlike gutta-percha, does not require a sealer for obturation.

<p>False (B)</p> Signup and view all the answers

An ideal sealer must not exhibit tackiness when mixed.

<p>False (B)</p> Signup and view all the answers

Sealers based on calcium hydroxide have consistently demonstrated osteogenic-cementogenic potential in clinical studies.

<p>False (B)</p> Signup and view all the answers

The Obtura II system, a thermoplastic injection technique, heats gutta-percha to approximately $90^\circ$C.

<p>False (B)</p> Signup and view all the answers

In the vertical compaction technique, the apical portion of the gutta-percha is meticulously heated to ensure complete softening for adaptation within the apical 2 to 5 mm of the canal.

<p>False (B)</p> Signup and view all the answers

Match the term with the description that best defines it:

<p>Obturation = Sealing of the root canal system Smear Layer = Superficial debris created during canal instrumentation Gutta Percha = A common core obturation material Sealer = Material used to fill the space between the dentinal wall and core material</p> Signup and view all the answers

Match the following obturation materials with their primary advantage:

<p>Gutta Percha = Ease of manipulation and removal Resin Sealers = Adhesion to dentin Calcium Hydroxide Sealers = Potential therapeutic activity (though not always demonstrated) Glass Ionomer Sealers = Dentin-bonding properties</p> Signup and view all the answers

Match the following canal conditions with the recommended timing of obturation:

<p>Vital Pulp Tissue = Obturation at the initial visit is acceptable Necrotic Pulp with Acute Symptoms = Obturation is generally delayed until patient is asymptomatic RCS that cannot be dried = Obturation is contraindicated Asymptomatic Apical Periodontitis = May be treated in one visit</p> Signup and view all the answers

Match the sealer with the description of each type:

<p>Zinc Oxide Eugenol Sealers = Have a history of successful use but can stain tooth structure Noneugenol Sealers = Developed to eliminate the irritating effects of eugenol Epoxy Resin Sealers = Provide adhesion and do not contain eugenol Silicone Sealers = Reported to expand slightly on setting</p> Signup and view all the answers

Match the obturation technique to its key characteristic:

<p>Lateral Compaction = Uses spreaders to create space for accessory gutta-percha cones Warm Vertical Compaction = Softens gutta-percha with heat for apical adaptation Thermoplastic Injection = Heats and injects gutta-percha into the canal Solid Core Insertion = Uses a carrier to deliver gutta-percha</p> Signup and view all the answers

Match the component with its percentage in Gutta Percha:

<p>Gutta Percha = 20% Zinc Oxide = 65% Radiopacifiers = 10% Plasticizers = 5%</p> Signup and view all the answers

Match the technique with materials or tools:

<p>Lateral Compaction = Spreaders Vertical Compaction = Pluggers Thermoplastic Injection = Obtura III Solid Core Insertion = Thermafil</p> Signup and view all the answers

Match the material to the component:

<p>Resilon = Thermoplastic synthetic polymer Guttaflow = RoekoSeal iRoot SP = Tricalcium Silicate AH Plus = Epoxy Resin System</p> Signup and view all the answers

Match each technique with the corresponding description:

<p>Tailor-made cone technique = Used when apical foramen is excessively large Inverted Cone Technique = Used for tubular canals Sectional Method = Placing 3 to 4 mm sections of GP approximating the size of the canal into the root Chloroform Dip Technique = Chemically plasticized cold gutta-percha technique</p> Signup and view all the answers

Match the generation number of each methacrylate resin sealer to its defining characteristic:

<p>First-generation = Designed for en masse obturations Second-generation = Nonetching and hydrophilic Third-generation = Self-etching primers Fourth-generation = Self-adhesive</p> Signup and view all the answers

Match the characteristic to its description:

<p>Apical Constriction = Narrowest portion of the canal Dentinocemental Junction = Early studies identified this as the apical limit for obturation Radiographic Apex = Traditionally, the apical point of termination has been approximately 1 mm from here Foramen = Varies in distance from the apex up to 2.5mm</p> Signup and view all the answers

Match the action to the indication:

<p>Use of Ca(OH)2 apical barrier = Apical root resorption Use of thermoplastic GP = Filling of canal irregularities Use of MTA apical barrier = inducing cementum deposition and bone formation Use of lateral condensation = Predictable length control during compaction</p> Signup and view all the answers

Match the term to its meaning:

<p>Monoblock = Gap-free, solid mass within canal space Working Length = Length established by the master apical file Cementum Deposition = Foramen to constriction distance increases with age oligodynamic property = destruction of microbes within the RCS</p> Signup and view all the answers

Match each description to the obturation technique:

<p>Less length control = Thermoplastic Injection Techniques Removal of material from apical = A-COLD GUTTA PERCHA TECHNIQUES Employs the System B = system B continuous wave condensation Has the potential for vertical root fracture = warm vertical compaction</p> Signup and view all the answers

Match each characteristic of an ideal sealer with its description:

<p>Exhibits tackiness = Provides good adhesion between it and the canal wall when set Establishes a hermetic seal = Prevents microleakage Radiopaque = Can be seen on a radiograph Tissue tolerant = Nonirritating to periradicular tissue</p> Signup and view all the answers

Match each statement to true or false:

<p>Silver cones contact tissue fluids and saliva = Corrode Silver cones posses oligodynamic property = False The average distance from the foramen to the constriction was found to be 0.5 mm = True It is possible to assess the quality of the seal established during obturation with a radiograph = False</p> Signup and view all the answers

Match each disease to its description and treatment:

<p>irreversible pulpitis = removal of the vital pulp tissue acute symptoms caused by pulp necrosis and acute periradicular abscess = obturation is generally delayed until the patient is asymptomatic apical periodontitis = healing rates are the same between single vs multiple visits pulp necrosis = 1 visit based on the best available information</p> Signup and view all the answers

Match the instruments to its description:

<p>HotShot delivery system = cordless thermoplastic device Pro-Post drills = recommended if post space is required for restoration of the tooth Elements obturation unit = hand piece extruder for delivering thermoplastic GP or RealSeal System B Connected = employs the System B connected to 0.04, 0.06, 0.08, 0.10, or 0.12 tapered stainless steel dead-soft pluggers</p> Signup and view all the answers

Match the material to its description:

<p>Guttacore = the latest generation of core carriers, uses cross-linked GP Simplifill = GP manufactured for use after canal preparation with LightSpeed instruments SuccessFil = carrier-based system associated with Ultrafil 3D (Fig. 9.49) iRoot SP = premixed sealers system</p> Signup and view all the answers

Match the action to its description:

<p>The removal of the smear layer is generally accomplished by irrigating the canal = 17% disodium EDTA and 5.25% NaOCl GP points can be sterilized by placing in = 5.25% NaOCl for 1 minute Remove biofilm = EDTA Remove vital pulp tissue = accomplished under aseptic conditions</p> Signup and view all the answers

According to the document, what two aspects are significant in achieving a successful healing outcome following endodontic treatment?

<p>The quality of the endodontic treatment and the coronal restoration.</p> Signup and view all the answers

Name three reasons why obturation of the radicular space is considered necessary.

<p>Minimize coronal leakage, seal the apex, and entomb remaining irritants.</p> Signup and view all the answers

List three factors that influence the timing of obturation in root canal treatment.

<p>Patient's symptoms, pulp status, and degree of difficulty.</p> Signup and view all the answers

What is the consensus regarding one-step treatment procedures when the patient exhibits a completely or partially vital pulp?

<p>They are acceptable.</p> Signup and view all the answers

Why is obturation of an RCS that cannot be dried contraindicated?

<p>Because moisture promotes bacterial growth and compromises the seal.</p> Signup and view all the answers

According to Wu et al. (2000), when is the best success rate achieved after vital pulpectomy in terms of termination length from the radiographic apex?

<p>2 to 3 mm short of the radiographic apex.</p> Signup and view all the answers

What is the range of thickness of the smear layer?

<p>1 to 5 µm</p> Signup and view all the answers

State two potential negative effects of the smear layer.

<p>Prohibits sealer contact and interferes with irrigant action.</p> Signup and view all the answers

Name two irrigants commonly used to remove the smear layer after C&S procedures.

<p>17% disodium EDTA and 5.25% NaOCl</p> Signup and view all the answers

List three advantages of Gutta Percha (GP) as an obturation material.

<p>Plasticity, minimal toxicity, and radiopacity.</p> Signup and view all the answers

Briefly explain why the alpha phase of gutta-percha is a disadvantage.

<p>It shrinks on setting.</p> Signup and view all the answers

What is the action of NaOCl when sterilizing GP points?

<p>It sterilizes them.</p> Signup and view all the answers

What is one major limitation of pastes when used as obturation materials?

<p>They should not used as a sole filling material.</p> Signup and view all the answers

What is the drawback to the AH-26 epoxy resin sealer?

<p>Releases formaldehyde when setting</p> Signup and view all the answers

Why is the use of self-etching primers advantageous in third-generation methacrylate resin-based sealers?

<p>It could reduce the technique sensitivity of bonding to RCS and when smear layers are inadvertently retained in the apical third.</p> Signup and view all the answers

According to Grossman formula, how much time is required for the initial and final set of tricalcium silicate cements and sealers?

<p>About 165 minutes for the initial set, and less than 6 hours for the final set.</p> Signup and view all the answers

Iodofirm is a medicated gutta percha. What is iodoform? (Insanely difficult)

<p>Iodoform is an organoiodine compound with the formula $CHI_3$.</p> Signup and view all the answers

Resilon has three components. What are they? (Insanely difficult)

<p>Resilon Core, Resilon Sealer, and Primer (Self-etchant)</p> Signup and view all the answers

According to Schilder warm vertical compaction, what are the requirements to prepare an RCS?

<p>Preparation requirements include preparing an RCS with a continuously tapering funnel and keeping the apical foramen as small as possible.</p> Signup and view all the answers

According to the current best available evidence, the quality of the endodontic treatment and the ______ restoration are significant in any healing outcome.

<p>coronal</p> Signup and view all the answers

The process of C&S determines both the degree of ______ and the ability to obturate the radicular space.

<p>disinfection</p> Signup and view all the answers

It is important to recognize that no ______ or technique prevents leakage during obturation.

<p>material</p> Signup and view all the answers

Obturation of the radicular space is necessary to minimize coronal leakage from the ______ environment.

<p>oral</p> Signup and view all the answers

Factors influencing the appropriate time to obturate an RCS include the patient's signs and symptoms, status of the pulp and periradicular tissues, the degree of ______, and patient management.

<p>difficulty</p> Signup and view all the answers

For a patient exhibiting a completely or partially vital pulp, ______ treatment procedures are acceptable.

<p>one-step</p> Signup and view all the answers

Obturation of an RCS that cannot be ______ is contraindicated.

<p>dried</p> Signup and view all the answers

Traditionally, the apical point of termination has been approximately ______ mm from the radiographic apices as determined by radiographs.

<p>1</p> Signup and view all the answers

Kuttler noted that the apical anatomy consists of the major diameter of the foramen and the minor diameter of the ______, with the apical constriction identified as the narrowest portion of the canal.

<p>constriction</p> Signup and view all the answers

There does not appear to be a consensus on removing the ______ layer before obturation, and the advantages/disadvantages of smear layer removal remain inconclusive.

<p>smear</p> Signup and view all the answers

The smear layer may interfere with the adhesion and penetration of ______ canal sealers.

<p>root</p> Signup and view all the answers

[Blank] is the most popular core material used for obturation.

<p>gutta percha</p> Signup and view all the answers

GP is the trans-isomer of ______, natural rubber, and exists in two crystalline forms, a and ẞ.

<p>polyisoprene</p> Signup and view all the answers

The Resilon system includes three components: The Resilon Core, the Resilon Sealer, and the ______.

<p>primer</p> Signup and view all the answers

Root canal sealers are necessary to seal the space between the ______ wall and the obturating core interface.

<p>dentinal</p> Signup and view all the answers

A key advantage of zinc oxide and eugenol-based sealers is their ______ activity.

<p>antimicrobial</p> Signup and view all the answers

A major concern with using N2 Sargenti paste is its content of 6.5% ______, a substance now strongly contraindicated in endodontics due to its toxic effects.

<p>paraformaldehyde</p> Signup and view all the answers

Tricalcium silicates and dicalcium silicates are the latest group of ______ root canal sealers introduced for obturation of an RCS.

<p>bioactive</p> Signup and view all the answers

The process of lateral compaction involves using accessory cones, placed in the space vacated by the spreader, until the spreader no longer goes beyond the ______ one third of the canal.

<p>coronal</p> Signup and view all the answers

What is the potential downside of having a metallic core in obturation materials, as it can render post placement and retreatment procedures more complex due to its inherent properties? ______

<p>the metallic core made placement of a post challenging and that retreatment procedures were difficult</p> Signup and view all the answers

Obturation is evaluated on the basis of length, taper, density, level of GP obturation, and the ______ seal.

<p>coronal</p> Signup and view all the answers

Obturation reduces coronal leakage and ______ contamination.

<p>bacterial</p> Signup and view all the answers

Three-dimensional obturation of the RCS is essential to a long-term healing outcome; the RCS should be sealed ______, coronally, and laterally.

<p>apically</p> Signup and view all the answers

Factors influencing the appropriate time to obturate an RCS include the patient's signs and symptoms, status of the pulp and periradicular tissues, the degree of difficulty, and ______ management.

<p>patient</p> Signup and view all the answers

Obturation at the initial visit also precludes contamination as a result of coronal leakage during the period between ______ visits.

<p>patient</p> Signup and view all the answers

When patients present with acute symptoms caused by pulp necrosis and acute periradicular abscess, obturation is generally ______ until the patient is asymptomatic.

<p>delayed</p> Signup and view all the answers

Traditionally, the apical point of termination has been approximately 1 mm from the ______ as determined by radiographs.

<p>apex</p> Signup and view all the answers

After vital pulpectomy, the best success rate has been reported when the procedures terminated 2 to 3 mm short of the ______ apex.

<p>radiographic</p> Signup and view all the answers

The smear layer is superficial, with a thickness of 1 to 5 ______.

<p>µm</p> Signup and view all the answers

The smear layer may interfere with the adhesion and penetration of root canal sealers, and it also may prevent GP penetration during ______ obturation techniques.

<p>thermoplastic</p> Signup and view all the answers

A disadvantage to the alpha phase of gutta percha, the material ______ on setting.

<p>shrinks</p> Signup and view all the answers

Sealers also serve as ______ during the obturation process.

<p>lubricants</p> Signup and view all the answers

[Blank] ______ sealers have a long history of use, provide adhesion, and do not contain eugenol.

<p>resin</p> Signup and view all the answers

The radiopaque agent, bismuth oxide, zirconia, or tantalum oxide, is important, without which ______ would not be distinguishable on a radiograph.

<p>MTA</p> Signup and view all the answers

Tri/dicalcium silicate cements/sealers are set by reaction with ______ and form a highly alkaline (pH ; 12) mixture consisting of a rigid matrix of calcium silicate hydrates and $Ca(OH)_2$.

<p>water</p> Signup and view all the answers

The solubility of the sealers is higher than AH Plus, which may be attributed to the formation of partially soluble $Ca(OH)_2$ within the set ______ silicate.

<p>tricalcium</p> Signup and view all the answers

Lateral ______ is a common method for obturation.

<p>compaction</p> Signup and view all the answers

The technique involves fitting a master cone ______ to 4 mm short of the prepared length with frictional resistance.

<p>2</p> Signup and view all the answers

Why is obturation of the radicular space necessary?

<p>To minimize coronal leakage, seal the apex from tissue fluids, and entomb remaining irritants.</p> Signup and view all the answers

What factors influence the timing of root canal obturation?

<p>Patient's symptoms, pulp status, periradicular tissues, difficulty of the case, and patient management.</p> Signup and view all the answers

Why is it typically recommended to delay obturation in cases of pulp necrosis with acute periradicular abscess?

<p>To allow the patient to become asymptomatic before proceeding.</p> Signup and view all the answers

According to Wu and co-workers' 2000 study, what is the recommended apical termination point for procedures after vital pulpectomy?

<p>2 to 3 mm short of the radiographic apex.</p> Signup and view all the answers

What irrigants are commonly used to remove the smear layer after C&S procedures?

<p>17% disodium EDTA and 5.25% NaOCl</p> Signup and view all the answers

List four advantages of using Gutta Percha?

<p>Plasticity, ease of manipulation, minimal toxicity and radiopacity</p> Signup and view all the answers

Why is the alpha phase of gutta percha disadvantageous?

<p>It shrinks on setting.</p> Signup and view all the answers

What is Resilon Core composed of?

<p>Thermoplastic synthetic polymer based (polyester) root canal filing material that contains bioactive glass and radio-opaque fillers.</p> Signup and view all the answers

Name 3 properties of an ideal sealer?

<p>Establishes a hermetic seal, radiopaque, very fine powder.</p> Signup and view all the answers

What is a disadvantage of using Zinc oxide and eugenol sealers?

<p>They exhibit a slow setting time, shrinkage on setting, solubility, can stain tooth structure.</p> Signup and view all the answers

What is the function of the self-etching primer in third-generation methacrylate resin sealers?

<p>Penetrates through the smear layer and demineralizes the superficial dentin.</p> Signup and view all the answers

What component of MTA may cause tooth discoloration and how has this been addressed?

<p>Bismuth oxide; replaced with zirconia dioxide or tantalum oxide.</p> Signup and view all the answers

Why is the presence of calcium hydroxide Ca(OH)2 in tricalcium silicate sealers significant?

<p>Its formation may contribute to the higher solubility of these sealers.</p> Signup and view all the answers

What is the main advantage of using GuttaCore?

<p>Makes retreatments simpler as the clinician can simply drill through the carrier to gain access into the canal space.</p> Signup and view all the answers

What is the main disadvantage of lateral compaction?

<p>The technique may not fill canal irregularities</p> Signup and view all the answers

What modification is made to the master cone in the inverted cone technique for cold lateral compaction?

<p>The serrated butt end of the cone is removed, and the cone is inverted.</p> Signup and view all the answers

What is the purpose of using chemicals in chemically plasticized cold gutta-percha technique?

<p>Soften gutta-percha to adapt better to canal aberrations.</p> Signup and view all the answers

What is a key preparation requirement for Schilder's warm vertical compaction technique?

<p>Preparing an RCS with a continuously tapering funnel and keeping the apical foramen as small as possible.</p> Signup and view all the answers

In the System B continuous wave condensation technique, how far from the apex should the heated plugger be placed?

<p>Within 5 to 7 mm from the tip of the gutta percha.</p> Signup and view all the answers

Outline a major drawback for lateral compaction, vertical compaction, and thermoplastic injection techniques.

<p>Lateral compaction may not fill canal irregularities, vertical compaction has the potential for vertical root fracture, and thermoplastic injection may have lack of length control</p> Signup and view all the answers

According to current evidence, the quality of the endodontic treatment and the coronal restoration both play significant roles in the healing outcome.

<p>True (A)</p> Signup and view all the answers

Obturation quality can be accurately assessed with a radiograph alone.

<p>False (B)</p> Signup and view all the answers

It's always feasible to achieve a completely impervious seal during obturation due to the nature of dentin.

<p>False (B)</p> Signup and view all the answers

Three-dimensional obturation includes sealing the RCS apically, coronally, and laterally.

<p>True (A)</p> Signup and view all the answers

In cases of irreversible pulpitis, obturation should always be delayed.

<p>False (B)</p> Signup and view all the answers

Obturation of an RCS is recommended even if the canal cannot be dried.

<p>False (B)</p> Signup and view all the answers

When treating pulp necrosis with acute symptoms, obturation is typically performed immediately.

<p>False (B)</p> Signup and view all the answers

The dentinocemental junction is a reliable clinical marker for determining the apical limit of obturation.

<p>False (B)</p> Signup and view all the answers

Kuttler determined that the foramen-to-constriction distance decreases with age due to cementum deposition.

<p>False (B)</p> Signup and view all the answers

The smear layer is primarily composed of inorganic debris and has no relevance in cases of pulpal necrosis.

<p>False (B)</p> Signup and view all the answers

Removing the smear layer before obturation has a universally agreed upon consensus among endodontists.

<p>False (B)</p> Signup and view all the answers

An ideal obturation material should shrink significantly after insertion to ensure a tight seal.

<p>False (B)</p> Signup and view all the answers

Gutta-percha is advantageous because it exhibits strong adhesion to dentin.

<p>False (B)</p> Signup and view all the answers

GP points can be effectively sterilized in an autoclave.

<p>False (B)</p> Signup and view all the answers

Resilon is a thermoplastic synthetic polymer that creates a monoblock within the RCS space.

<p>True (A)</p> Signup and view all the answers

According to Grossman, there are numerous sealers that fully satisfy the criteria of an absolutely ideal sealer.

<p>False (B)</p> Signup and view all the answers

AH-26 is considered a contemporary and formaldehyde-free epoxy resin sealer with excellent biocompatibility.

<p>False (B)</p> Signup and view all the answers

MetaSEAL uniquely achieved the fourth-generation classification because it requires a separate etching step, unlike its predecessors.

<p>False (B)</p> Signup and view all the answers

RoekoSeal, a silicone sealer, is known for significant micro-expansion upon setting.

<p>True (A)</p> Signup and view all the answers

Historically, N2 Sargenti paste's safety was greatly improved simply by removing the paraformaldehyde component.

<p>False (B)</p> Signup and view all the answers

Flashcards

Root Canal Sealing Importance

Sealing the root canal system is vital for endodontic treatment and coronal restoration, significantly impacting healing outcomes.

Obturation Necessity

Reduces coronal leakage and bacterial contamination, seals the apex from tissue fluids, and entombs remaining irritants.

Factors Influencing Obturation Timing

Factors include patient symptoms, pulp status, tissue condition, difficulty, & patient management.

Vital Pulp Treatment

One-step treatments are acceptable when the patient exhibits a completely or partially vital pulp

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Obturation Timing General Rule

Can be performed if the RCS can be dried and the patient isn't experiencing pain/swelling, unless substantial exudation persists.

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Traditional Apical Termination

The apical point Traditionally is approximately 1 mm from the radiographic apices.

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Foramen-Constriction Distance

The average distance from foramen to constriction is 0.5 mm and increases with age due to cementum deposition.

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Ideal Termination in Vital Pulpectomy

Aim to terminate procedures 2-3 mm short of radiographic apex in vital pulpectomy cases.

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Termination with Pulpal Necrosis

Terminate at or within 2 mm of radiographic apex for pulpal necrosis cases.

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Smear Layer Characteristics

Present with a thickness of 1 to 5 µm that can be packed into dentinal tubules to various distances.

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Smear Layer Removal

Irrigating with 17% disodium EDTA and 5.25% NaOCl.

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Ideal Obturation Material Properties

Easily manipulated, dimensionally stable, seals canal, biocompatible, impervious, radiopaque, sterile, and removable.

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Types of Obturation Materials

Include Gutta Percha and Resilon.

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Gutta Percha Advantages

Plasticity, minimal toxicity, radiopacity, and ease of removal.

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Gutta Percha Disadvantages

Lack of adhesion to dentin and shrinkage upon cooling.

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Gutta Percha Composition

The trans-isomer of polyisoprene existing in alpha and beta crystalline forms.

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Corrosion concerns of Silver Cones

Loss of adaptation to the root canal walls, leakage and bacterial contamination which lead to failure.

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Resilon Core Composition

Thermoplastic synthetic polymer-based material with bioactive glass and radio-opaque fillers.

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Resilon Sealer Composition

Dual-cure resin-based composite.

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Root Canal Sealers Importance

Necessary for the interface between the dentinal wall and obturating core.

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Ideal Sealer Properties

Tackiness, hermetic seal, radiopacity, fine powder, minimal shrinkage, bacteriostatic, slow set, insoluble, tissue tolerant, and soluble in a solvent.

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Ideal Sealer Properties

Tackiness, hermetic seal, radiopacity, fine powder, minimal shrinkage, bacteriostatic, slow set, insoluble, tissue tolerant, and soluble in a solvent.

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Zinc Oxide and Eugenol Sealers

Have a successful history, resorb if extruded, have slow setting, can stain.

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Noneugenol Sealers

Developed due to the irritating effects of eugenol that can be found in periodontal dressings.

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Resin Sealers

Provide adhesion & do not contain eugenol. Two Classes: Epoxy resin and Methacrylate resin.

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Epoxy Resin Sealers

AH-26 and AH Plus

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Methacrylate Resin Sealers

Include self-etching primers and dual-cured resin composites; aim for monoblock within RCS.

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Silicone Sealers

Polydimethylsiloxane reported to expand slightly when setting.

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Calcium Hydroxide Sealers

Developed for therapeutic activity, but effectiveness unproven. Their solubility is required for activity.

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Disadvantage of Calcium Hydroxide Sealers

Poor at generating a high pH and produce alkalinity at the root surface.

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Glass Ionomer Sealers

Have dentin-bonding properties, but difficult to treat dentinal walls and remove.

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Contraindicated Sealers

Sealers containing paraformaldehyde are strongly contraindicated!

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Guttaflow Composition

They consist of GP in particulate form less than 30 µm added to RoekoSeal and are cold flowable when triturated.

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Tri/dicalcium Silicate Sealers

Include tricalcium and dicalcium silicates, bioactive, hydraulic materials.

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Setting Reaction of Tri/dicalcium Silicate Sealers

Setting time for Tricalcium cements is Lengthy.

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Lateral Compaction Technique

Sealer is applied to canal walls, then a pre-fit spreader is inserted.

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Chemically Plasticized GP

Chemicals soften GP for canal adaptation (e.g., chloroform, eucalyptol, xylene).

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Warm Vertical Compaction Prep

Prepare RCS with continuous taper & small apical foramen.

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Thermoplastic Injection Technique

Heat outside tooth, then inject into canal (e.g., Obtura, Ultrafil).

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Heated Spreader

Used to remove portions of the coronal GP in successive increments and soften the remaining material in the canal.

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Obturation Definition

Reflection of canal cleaning & shaping, evaluated by length, taper, density, GP level & coronal seal.

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Assessing Obturation Seal with Radiograph

It is not possible to assess the quality of the seal established during obturation with a radiograph.

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General Obturation Timing

Obturate when canals are cleaned & shaped to optimum size, asymptomatic, and no sign of infection.

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Obturation Contraindication

Contraindicated if the root canal system cannot be dried.

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Kuttler's Apical Anatomy

Kuttler noted that the apical anatomy consists of the major diameter of the foramen and the minor diameter of the constriction

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Smear Layer

Superficial debris packed into dentinal tubules.

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Sealer Adhesion

The sealer should provide good adhesion between the canal wall and the obturation when set

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AH-26

Slow-setting epoxy resin; may release formaldehyde.

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Cone Selection in Lateral Compaction

After RCS preparation, a standard cone is selected that has a tip and taper consistent with the prepared canal diameter at the working length established by the master apical file.

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Purpose of Resistance to Displacement

It ensures the cone diameter is larger than the prepared diameter canal at the terminus.

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Technique of Thermoplastic injection

Heats GP, injects into canal at 160°C (Obtura II) or 90°C (Ultrafil 3D).

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HotShot Delivery System

A cordless thermoplastic device that has a heating range from 150°C to 230°C.

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GuttaCore

Uses cross-linked GP as the carrier of the outer thermoplasticized GP.

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Apical barrier Purpose

Necessary for immature apices, root resorption, or over-instrumentation.

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Apical Plugs

Immediate obturation involves placing barriers like Dentin chips, Ca(OH)2 which are designed to permit obturation without extrusion of materials

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Coronal Seal

Adequate provisional or definitive coronal restoration.

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Vital Pulp One-Step Treatment

The consensus is that one-step treatment procedures are acceptable when the patient exhibits a completely or partially vital pulp if performed under aseptic conditions

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Pain Relief via Obturation

Removal of vital pulp tissue will generally resolve the patient's pain.

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Necrotic Pulp Treatment Timing

Obturation is delayed until the patient is asymptomatic.

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Apical Limit of Obturation

The apical limit for obturation/NS RCT which remains unresolved in endodontics.

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Dentinocemental Junction

Cannot be determined clinically, irregular within the canal

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Ideal Obturation Material

Easily manipulated, provides ample working time.

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Sealer Requirements

Does not discolor tooth structure

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Hydron Material

The first generation of hydrophilic methacrylate resin-based material (Hydron; Hydron Technologies, Inc., Pompano Beach, FL, USA) was designed for en masse obturations and appeared in the mid-1970s

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Seal Setting Reaction

Tricalcium silicates/dicalcium silicates are set by reaction with water and form a highly alkaline (pH ; 12) mixture consisting of a rigid matrix of calcium silicate hydrates and Ca(OH)2.

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Sealer Application

Sealer placement with a master cone.

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Cone Selection After preparation

After RCS preparation, a standard cone is selected that has a tip and taper consistent with the prepared canal diameter at the working length established by the master apical file.

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Chemicals uses in GP

Use chemicals to soften gutta-percha to allow better adaptation of the gutta-percha to aberrations in canal anatomy

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GP introduction

Schilder introduced warm vertical compaction of GP as a method of obturating the radicular space in three dimensions.

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The Sectional Method GP

The sectional method consist of placing 3 to 4 mm sections of GP approximating the size of the canal into the root, applying heat, and compacting the mass with a plugger.

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Obturation Considerations

The continuous wave and warm backfill technique cause significantly higher temperatures than other obturation techniques by virtue of the technique.

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Titanium carriers

Titanium radiopaque plastic carriers are inserted into the syringe to the measured length of the canal.

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A technique to prepared

The technique involves fitting a carrier that is consistent with the master apical rotary file to within 1 to 3 mm of the prepared length.

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Fillers after compaction

When using lateral compaction, it is recommended that the first cone be the same size as the Simplifill carrier.

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Healing Outcome

Both the quality of endodontic treatment and the coronal restoration significantly affect the long term result.

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Achieving Impervious Seal

May not be feasible due to the porous, tubular nature of dentin and canal irregularities.

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Elective NS RCT Timing

Can be completed in one visit if the pulp is vital, to some degree, and time permits, when for restorative reasons.

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Smear Layer Risks

Organic material in the smear layer promote bacterial growth.

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Smear Layer Interference

Prohibits sealer contact & interferes with irrigant action.

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GP Popularity

GP is the most popular core obturation material

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Silver Cone Alternative

Jasper cones were introduced as an alternative, but didn't prevent leakage.

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Pastes in Obturation

Pastes should be used with solid cores, not alone.

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AH Plus

AH Plus is a modified version of AH-26 with no formaldehyde release.

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Self-Etching Sealers

Self-etching sealers incorporate smear layers.

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Tri/dicalcium Sealers Benefits

This type of root canal sealer is attractive because of the bioactivity that has been reported for MTA-type materials, which are all know as hydrophilic

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MTA Components

Is a hydraulically active powder that contains tricalcium silicate, dicalcium silicate, and a radiopaque powder

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Apical Plug Design

Prevents extrusion of the obturation materials

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Canal Cleaning and Shaping (C&S)

Determines the degree of disinfection and the ability to obturate the radicular space.

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Obturation reduces:

Reduces coronal leakage and bacterial contamination

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Difficult cases:

Can be managed more easily in multiple appointments.

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Pulp Necrosis NS RCT

Patients with pulp necrosis, with or without asymptomatic periradicular pathosis, may be treated in one visit

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Acute Symptoms & Pulp Necrosis

Obturation is generally delayed until the patient is asymptomatic.

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Post Obt duration Pain Frequency

Patients experienced less frequency of short-term postobturation pain after single-visit

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The problem of removal of the smear layer

It prohibits sealer contact with canal wall and permits leakage.

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After Vital Pulpectomy:

The best success has been reported when the procedures terminated 2 to 3 mm short of the radiographic apex.

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Tubli-Seal (Kerr)

a catalyst/base zinc oxide–eugenol sealer that is convenient to mix but has a faster setting time

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GuttaFlow bioseal

the most recent introduction to this family of silicone sealers, incorporates bioactive ingredients such as calcium and silicate into the original formulation

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Materials time

setting time of iRoot SP and MTA Plus materials are longer

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What does the Thermoplastic injection technique involves?

Heat outside tooth, then inject into canal

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Silver needles importance

Silver needles deliver themoplasticized the material into the RCS

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Warm vertical compaction of GP

a method of obturating the radicular space in three dimensions

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Obturation assessment

Assesses disinfection degree and radicular fill potential via length, taper, density, GP level, and coronal seal adequacy.

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GP Sterilization

Sterilize GP points in 5.25% NaOCl for 1 minute.

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Silver Cones

Introduced by Jasper, but have limited success rate to produce leakage

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Sealers Definition

Root canal sealers are necessary to seal the space between the dentinal wall and the obturating core interface.

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Noneugenol composition

Developed from a periodontal dressing due to the side effects of Eugenol, Nogenol (GC America, Alsip, IL) is a root canal sealer without the irritating effects of eugenol. The base contains zinc oxide, barium sulfate, and bismuth oxychloride.

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GuttaFlow ingredients

GuttaFlow consists of GP in a particulate form less than 30 µm added to RoekoSeal.

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Tri/dicalcium Sealers material

Tricalcium and dicalcium silicates are the latest group of that are biocompatible.

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Heated pluggers

Heat spreader sections of sections and soften the remaining material in the canal.

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Titanium visibility

Titanium allows radiographic visibility of canal.

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The elements systems

In the Elements systems there are B heat hand pieces

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Types of barricades for the Apical Plug

Immediate obturation involves placing barriers like Dentin chips, Ca(OH)2 are materials to permit obturation without extrusion of materials

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RCS Sealing Dimensions

RCS should be sealed apically, coronally, and laterally.

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When to Obturate?

In general, obturation can be performed after C&S procedures when the RCS can be dried and the patient is not experiencing significant pain and or swelling.

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Updates in Gutta Percha

Surface Modified, Medicated, and Nanoparticles Enriched

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AH-26 (DENTSPLY DeTrey,Key Facts

AH-26 (DENTSPLY DeTrey, Konstanz, Germany) is a slow-setting epoxy resin that was found to release formaldehyde when setting.

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RoekoSeal

RoekoSeal (Coltène/Whaledent AG, Altstätten, Switzerland) is a polydimethylsiloxane that has been reported to expand slightly on setting.

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Successfil

is a carrier-based system associated with Ultrafil 3D (Fig. 9.49);

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Lateral Compaction

Lateral compaction is a common method for obturation, provides predictable length control during compaction, however, it may not fill canal irregularities

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3D Obturation

Long-term healing requires sealing the root canal system apically, coronally, and laterally.

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Sealer Function

Root canal sealers fill voids and irregularities to ensure complete obturation.

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AH Plus Composition

AH Plus consists of epoxide paste with diepoxide and fillers, plus amine paste with monoamine, diamine, silicone oil and fillers, and has ~4hr working time.

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RoekoSeal Material

RoekoSeal is a polydimethylsiloxane based sealer that has a slight expansion on setting for great seal.

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Final Compaction

When using lateral compaction the final excess GP is removed with heat, coronal mass is compacted with an unheated plugger.

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Variations of cold lateral compaction

Inverted cone and tailor-made cone

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Cone-Cutting Devices

Devices available to accurately cut cones at a specified length.

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Spreader Type Advantage

Finger spreaders offer greater tactility and reduce root fractures vs. traditional hand spreaders

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Does not stain tooth structure:

This avoids issues if you place a filling later

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Sealers benefit

Sealers also serve as lubricants during the obturation process.

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Three-dimensional obturation of RCS

Should be sealed apically, coronally and laterally to ensure a long-term healing outcome.

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Zinc oxide and eugenol

Have a history of successful use, resorb if extruded, they exhibit a slow setting time, can stain tooth structure, and an advantage to this sealer group is antimicrobial activity.

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N2 Sargenti Paste

N2 sargenti paste contains 6.5% paraformaldehyde, lead and mercury. It has a risk of osteomyelitis and paresthesia.

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Thermoplastic injection

Silver needles (varying gauges of 20, 23, and 25) deliver the thermoplasticized material into the RCS.

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Apical Plasticization

A heated plugger is inserted into the RCS and the GP is compacted, forcing the plasticized material apically.

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Warm Vertical Compaction Technique

Includes preparing an RCS with a continuously tapering canal with minimal possible apical foramen using ISO standardized instruments.

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Nickel Titanium

The Sprader should fit to within 1 to 2 mm of the prepared length and they are flexible an stronger due to being made from nickel titanium.

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Filling the Spreader Space

After the spreader has been placed to its maximum depth, it is removed by rotating it back-and-forth as it is withdrawn. Then an accessory is then placed.

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Radiopacity Necessity

The radiopaque agent, bismuth oxide, zirconia, or tantalum oxide, is important for distinguishing on a radiograph. Minor phases of tricalcium.

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Difficult cases needs time

Procedural concerns also dictate the time of obturation. For instance, difficult cases may require more time for preparation and can be managed more uneventfully in multiple appointments.

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Optimum Canal Size

General timing for cleaning and shaping of the canal.

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What is the Smear Layer?

A superficial layer of debris found on canal walls after instrumentation.

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Why use radiopaque materials?

Radiopaque materials allow to check canals for filling and to see a clear outline on a radiograph

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AH Plus working time

AH Plus's system has a working time of approximately 4 hours.

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What is a spreader?

Cold lateral compaction uses this instruments in the obturation process.

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Nonstandard cones benefits

Nonstandard cones that replicate prepared canal tapers development of hydraulic pressure during compaction.

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The System's purpose

Remove excess coronal material and achieve initial apical compaction.

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Drying before sealing

The canal walls are dried with paper points.

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Why do we use silver needles?

These needles are used for placing the thermoplasticized GP into the RCS.

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Spreader after placement

After the spreader has been placed to its maximum depth, it is removed by rotating it back-and-forth as it is withdrawn

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3D Root Canal Sealing

Sealing apically, coronally, and laterally improves therapy longevity.

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Rigidity Provided by Silver Cones

The rigidity allowed better length control; however, irregularly shaped cannels permit leakage.

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Zinc Oxide and Eugenol Characteristics

They exhibit a slow setting time, shrinkage on setting, solubility and can stain tooth structure.

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AH-26 Sealers

AH-26 (DENTSPLY DeTrey, Konstanz, Germany) is a slow-setting epoxy resin that releases formaldehyde when setting.

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Spreader Size May be a Factor in Root Fracture

The apical foramen reduces the amount of dentin removed; the spreader size may be a factor in root fracture.

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After the spreader removed

After the spreader has been placed to its maximum depth, it is removed by rotating it back-and-forth as it is withdrawn.

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Requirements for the Technique

Preparing an RCS with a continuously tapering funnel. Also with the apical foramen kept as small as possible.

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carriers facts

Composed of two nontoxic materials and manufactured from a liquid crystal plastic

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Composed of polysulfone polymer features

Composed of polysulfone polymer and have similar physical characteristics.

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B continuous wave condensation

Employs the System B connected to 0.04, 0.06, 0.08, 0.10, or 0.12 tapered stainless steel dead-soft pluggers.

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RCS Sealing

The RCS should be sealed apically, coronally, and laterally.

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Apical Constriction

The narrowest portion of the canal.

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Smear Layer Substrate

The organic debris might boost bacteria.

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AH-26 Sealing abilities

AH-26 and AH Plus appear comparable.

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MTA Sealers Composition

MTA contains tri/dicalcium silicate.

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Cone adapted

If the cone is loose, it can be adapted by removing small increments from the tip.

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Self-adhesive sealer benefits

Reduces time and errors as it combines etchant, primer, sealer.

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Warm Vertical Compaction disadvantage

Changes in temperature of outer root surface/less length control.

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The canal is in the spreader

Is located in the upper third of the canal.

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Barrier Purpose

Are designed to permit obturation without extrusion of materials

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3D Obturation of RCS

Essential for long-term healing, sealing apically, coronally, and laterally.

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Post-C&S Irrigation

After C&S, irrigation removes debris using 17% EDTA and 5.25% NaOCl.

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Pastes as Sealers

Pastes should be used with solid core materials, not alone during obturation.

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Second-Generation Sealers

Non-etching, hydrophilic sealer that uses no dentin adhesive.

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Antimicrobial Activity

Is an advantage of the sealer group due to a slow setting time.

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System B Technique

Uses a System B heat source to warm and compact GP

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Tailor-Made Cone Technique

Used when the apical foramen is excessively large.

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Gutta Percha (GP)

The main solid filling material used in obturation.

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Study Notes

Importance of Effectively Sealing the Root Canal System

  • Both the quality of the endodontic treatment and coronal restoration are significant for healing.
  • C&S determines the degree of disinfection and the ability to obturate the radicular space
  • Obturation reflects the C&S and is evaluated on length, taper, density, GP obturation level, and coronal seal
  • Seal quality from obturation cannot be assessed with a radiograph
  • No material or technique prevents leakage
  • An impervious seal may not be feasible due to dentin's porous structure and canal irregularities

Necessity of Radicular Space Obturation

  • Minimizes coronal leakage from the oral environment, reducing coronal leakage and bacterial contamination
  • Seals the apex from periapical tissue fluids
  • Entombs remaining irritants in the canal
  • Three-dimensional obturation of the RCS is essential for long-term healing and should be sealed apically, coronally, and laterally

Timing of Obturation

  • Influenced by the patient's signs and symptoms
  • Status of pulp and periradicular tissues
  • Degree of difficulty and patient management

General Timing of Obturation

  • Canal should be cleaned and shaped to optimum size
  • When the tooth is asymptomatic and there isn't pain (Noooo. Pain)
  • Absence of infection signs
  • Absence of exudate
  • Absence of foul odor
  • Lack of a draining sinus tract

Vital Pulp Tissue

  • One-step treatment procedures are acceptable if the patient has a completely or partially vital pulp
  • Removing normal or inflamed pulp tissue under aseptic conditions results in healing due to the relative absence of bacterial contamination
  • Initial visit obturation prevents contamination from coronal leakage between visits
  • Elective NS RCT can be completed in one visit if the pulp is vital, and time permits
  • Obturation depends on the pretreatment diagnosis in patients with urgent conditions
  • Obturation can occur at the initial visit for irreversible pulpitis because removing vital pulp tissue generally resolves the patient’s pain

Necrotic Pulp Tissue

  • Patients with pulp necrosis, asymptomatic periradicular pathosis, such as asymptomatic apical periodontitis, chronic apical abscess, or condensing osteitis, may be treated in one visit
  • Obturation is delayed until the patient is asymptomatic when acute periradicular abscess symptoms are present with pulp necrosis.
  • Apical periodontitis healing rates show no significant difference between single and multiple-visit NS RCTs.
  • Single-visit patients experience less short-term postobturation pain compared to multiple-visit patients.
  • In general, obturation can be performed after C&S procedures when the RCS can be dried and the patient is not experiencing significant pain and or swelling but is not advised with exudation from the canal.
  • Obturation is contraindicated in RCS that cannot be dried.
  • Procedural concerns and difficult cases may require more preparation time and be managed in multiple appointments.
  • Medical conditions, psychological state, and/or fatigue may warrant multiple short appointments.

Length of Obturation

  • Remaining controversy is the apical limit of NS RCT and obturation
  • Early studies identified the dentinocemental junction as the apical limit
  • Histologic landmark cannot be determined clinically and is irregular within the canal.
  • Traditionally, the apical point of termination is approximately 1 mm from the radiographic apices.
  • Kuttler noted foramen consisting of major diameter and minor constriction, with the apical constriction the narrowest part of the canal.
  • The foramen to constriction average distance is 0.5 mm, varying from apex up to 2.5 mm according to Kuttler
  • Kuttler indicated foramen to constriction distance increases with age because of cementum deposition.
  • The 1 mm guideline from the radiographic apex remains rational when using radiographs
  • The point of apical termination of preparation and obturation remains empirical
  • The use of an apex locator in conjunction with radiographs and clinical judgement makes the decision more logical.

Studies on Length of Obturation

  • In 2000, Wu and co-workers concluded procedures terminated 2 to 3 mm short of the radiographic apex yield the best success rate after vital pulpectomy
  • With pulpal necrosis, apical canal anatomy is difficult to determine clinically
  • An apical constriction is often absent
  • Better success occurs when procedures terminate at or within 2 mm of the radiographic apex (0 to 2 mm).

Preparation for Obturation

  • Smear layer is superficial, 1 to 5 μm thick, and can be packed into dentinal tubules.
  • The layer may be contaminated with bacteria and their by-products in cases of pulpal necrosis.
  • There is no consensus on smear layer removal before obturation, and advantages/disadvantages are inconclusive.
  • Evidence is growing supporting smear layer removal. Organic debris in the smear layer might constitute a substrate for bacterial growth.
  • The smear layer may prohibit sealer contact with the canal wall and permit leakage
  • The layer may interfere with irrigants and root canal sealer adhesion and penetration.
  • Prevents GP penetration during thermoplastic obturation techniques
  • Smear layer is removed post C&S procedures by irrigating the canal with 17% disodium EDTA and 5.25% NaOCl.

Obturation Materials

  • Properties of the ideal material have been outlined by Grossman
  • Historically, usage include solids, semisolid materials, and pastes; silver cones were a past solid material

Properties of an Ideal Obturation Material

  • Easily manipulated and provides ample working time
  • Dimensionally stable with no shrinkage once inserted
  • Seals the canal laterally and apically, conforming to its complex internal anatomy
  • Nonirritating to periapical tissues
  • Impervious to moisture and nonporous
  • Unaffected by tissue fluids—no corrosion or oxidization and inhibits bacterial growth
  • Radiopaque and easily discernible on radiographs
  • Does not discolor tooth structure
  • Sterile and easily removed

Types of Obturation Materials

  • Semisolids (Plastics): Guttapercha, Resilon
  • Solid (Solidcore): Semirigid - Silver point
  • Rigid: Titanium, stainless steel, gold
  • Pastes, Sealers, Gutta flow, MTA, and Calcium Silicate Cements

Semi Solids Core Materials

  • Gutta Percha (GP) is the most popular core material for obturation.
  • Advantages include plasticity, ease of manipulation, minimal toxicity, radiopacity, and ease of removal with heat or solvents.
  • Disadvantages include lack of adhesion to dentin and shrinkage upon cooling.
  • GP exists in two crystalline forms: α and β
    • β-phase: A solid mass that is compactable when unheated
    • α-phase: pliable and tacky when heated, flows when pressure is applied, and shrinks upon setting
  • Available forms are cones (standardized and nonstandardized), injectable syringes, pellets, cannulas, solid core, capsules, and coated or medicated forms.
  • Composition: 20% GP, 65% zinc oxide, 10% radiopacifiers, and 5% plasticizers.

Sterilization of GP Points

  • GP points can be sterilized by placing in 5.25% NaOCl for 1 minute despite not being heat sterilizable.

Updates in Gutta Percha

  • Surface Modified Gutta Percha: Resin, glass ionomer, bioceramic coated, and non-thermal plasma
  • Medicated Gutta Percha: lodoform, calcium hydroxide, chlorhexidine, tetracycline, and cetylpyridinium chloride (CPC)
  • Nanoparticles Enriched Gutta Percha: Nanodiamond, silver nanoparticles

Silver Cones

  • Jasper introduced these, claiming they were easier to use and had the same success rate as GP.
  • Silver's rigidity allowed for easier placement and length control
  • Silver's rigidity prevented the material from filling the irregularly shaped RCS, permitting leakage.
  • The belief that silver possesses an oligodynamic property resulting in microbe destruction within the RCS was found to be untrue and corrosion occurs when silver contacts tissue fluids or saliva.
  • Cytotoxic and produces pathosis or impedes periapical healing

Resilon System

  • Includes:
    • A thermoplastic synthetic polymer based root canal filling material with bioactive glass and radio-opaque fillers (Resilon Core)
    • A dual cure resin based composite sealer (Resilon Sealer)
    • A Primer (Self-etchant) enables bonding of the sealer to the canal walls, creating Monoblock

Pastes

  • Not used as a sole filling material; act as sealers when used with a solid core.

Sealers

  • Necessary to seal the space between the dentinal wall and obturating core interface
  • Fill voids and irregularities in the RCS, lateral/accessory canals, and spaces between GP points used in lateral compaction
  • Serve as lubricants during obturation
  • Grossman outlined properties for an ideal sealer; presently, no sealer satisfies all criteria

Properties of an Ideal Sealer

  • Exhibits tackiness when mixed to provide good adhesion between it and the canal wall when set
  • Establishes a hermetic seal
  • Radiopaque, so that it can be seen on a radiograph
  • Very fine powder, so that it can mix easily with liquid
  • No shrinkage on setting
  • No staining of tooth structure
  • Bacteriostatic and doesn't encourage bacterial growth
  • Exhibits a slow set
  • Insoluble in tissue fluids
  • Tissue tolerant (nonirritating to periradicular tissue)
  • Soluble in a common solvent for removal if necessary

Types of Sealers

  • Zinc oxide and eugenol
    • History of successful use over an extended period
    • Will resorb if extruded into the periradicular tissues
    • Exhibit a slow setting time, shrinkage on setting, solubility
    • Have antimicrobial activity
    • Can stain tooth structure
    • Marketed as Pulp Canal Sealer (Kerr Endo) and Pulp Canal Sealer EWT (extended working time)
    • Grossman modified the formulation and introduced a nonstaining formula in 1958 but it has been discontinued
    • Tubli-Seal (Kerr) is a catalyst/base zinc oxide–eugenol sealer is easy to mix but has a faster setting time compared to liquid/powder sealers with an extended working time (EWT)
  • Noneugenol sealers
    • Developed from a periodontal dressing
    • Example is Nogenol (GC America, Alsip, IL), made without irritating effects of eugenol, containing zinc oxide, barium sulfate, and bismuth oxychloride.
  • Resin sealers
    • resin sealers have a long history of use, provide adhesion, and do not contain eugenol and categorized into epoxy resin and methacrylate resin

Epoxy Resin Sealers

  • AH-26 (DENTSPLY DeTrey, Konstanz, Germany) is a slow-setting epoxy resin that was found to release formaldehyde when setting.
  • AH Plus (DENTSPLY DeTrey) is a modified formulation of AH-26 in which formaldehyde is not released
  • The sealing abilities of AH-26 and AH Plus appear comparable
  • AH Plus is an epoxy resin-amine based system in two tubes
    • The epoxide paste tube contains diepoxide (bisphenol A diglycidyl ether) and fillers as major ingredients
    • The amine paste tube contains a primary monoamine, a secondary diamine, a disecondary diamine, silicone oil and fillers as major ingredients
  • Exhibit a working time of approximately 4 hours

Methacrylate Resin Sealers

  • Commercially marketed for 4 generations are methacrylate resin based root canal sealers
  • First generation: Hydron: Hydrophilic methacrylate resin-based material (Hydron) was designed for en masse obturations
    • Appeared in the mid-1970s when scientific foundations behind dentin bonding were still in their infancy
    • Hydron was injected into an RCS and polymerized in situ without a core obturation material
    • Hydron became obsolete in the 1980s as subsequent clinical outcomes were unacceptable
  • Second-generation: nonetching and hydrophilic in nature and does not require the adjunctive use of dentin adhesive. It facilitates resin and seal after smear layer removal with NaOCl and EDTA.
  • Endorez (Ultradent Products Inc., South Jordan, UT, USA) is a dual-cured radiopaque hydrophilic methacrylate sealer with nonacidic dimethacrylate that flows to accessory canals, facilitates resin tag formation for retention and seal after smear layer removal
    • Seals best when applied to slightly moist intraradicular dentin and recommended for use cones or specific resin-coated GP
  • New, third and fourth-generation materials involve the use of self-etching and self-adhesive properties similar to what has been used for restorative bonding procedures
    • These systems simplify bonding procedures and contain a dual-cured resin composite root canal sealer and acidic primer combination

New Generation Sealers

  • acidic primer is air-dried to remove the volatile carrier, applied and polymerized
  • Materials must be sufficiently aggressive to etch through thick smear layers, reducing technique for RCS bonding when smear layers is retained
  • Third-generation sealers became popular after Resilon's introduction, a polycaprolactone-based thermoplastic root filling material which is no longer on the market
  • Fourth-generation sealers is functionally self-adhesive eliminating the separate etching/bonding step due to monomers presenting dentin substrates.
  • MetaSEAL is the first commercially available fourth-generation self-adhesive dual-curable sealer that creates hybrid layers purported to binds to thermoplastic root filling and radicular dentin
  • Marketed as Hybrid Bond SEAL and reported to have similar sealing properties as conventional nonbonding epoxy resin-based sealers

Silicone Sealers

  • Polydimethylsiloxane RoekoSeal expands slightly, requiring no hand mixing
  • No bubbles due to 1:1 mixing
  • Absolutely insoluble and biocompatible, has dimensional stability and sets in any environment with easy flowing

Calcium Hydroxide Sealers (Ca(OH)2)

  • Developed for therapeutic activity, such as antimicrobial and osteogenic–cementogenic potential, which was never demonstrated
  • Solubility is required for release of Ca(OH)2 and sustained activity, inconsistent with the purpose of sealer
  • CRCS is a zinc oxide–eugenol sealer with Ca(OH)2
  • Sealapex is a catalyst/base system with zinc oxide, Ca(OH)2, butyl benzene, sulfonamide, and zinc stearate, a catalyst with barium sulfate and titanium dioxide as radiopacifiers
  • Apexit and Apexit Plus consist of disalicylate, bismuth hydroxide/bismuth carbonate activators and Ca(OH)2, hydrated colophonium bases
  • Although an osteogenic response has been observed, the ability of these sealers to sustain a high pH and produce an alkaline pH at the root surface has been questioned

Glass Ionomer Sealers

  • Have dentin-bonding properties
  • Ketac-Endo enables adhesion between the material and canal walls
  • Conditioning agents cannot properly treat the dentinal walls in the apical and middle thirds
  • Are more difficult to remove if retreatment is required and have minimal antimicrobial activity

Medicated Sealers

  • Medicated Sealers containing paraformaldehyde are a strong contraindication in endodontic treatment
  • N2 sargenti paste
    • Contains 6.5% paraformaldehyde as well as lead and mercury
    • Lead has been reported in distant organ systems when N2 is used
    • Removal of the heavy metals resulted in a new formulation: RC2B
  • Osteomyelitis and paresthesia manifested as dysesthesia has been linked to formaldehyde.
  • Other paraformaldehyde sealers Endomethasone, SPAD, and Reibler’s paste

Guttaflow

  • GuttaFlow and GuttaFlow2, cold flowable matrices that are triturated.
  • Consist of GP in a particulate form less than 30 μm added to RoekoSeal
  • Material is provided in capsules for trituration.
  • The technique involves injection of the material into the RCS, followed by placement of a single master cone.
  • Provides a working time of 15 minutes and it cures in 25 to 30 minutes
  • Fills canal irregularities with consistency and is biocompatible
  • GuttaFlow bioseal incorporates bioactive ingredients (calcium and silicate). The manufacturer claims it stimulates tissue healing and regeneration

Tri/dicalcium Silicate Sealers

  • Tricalcium Silicates and dicalcium silicates are the latest group of bioactive root canal sealers.
  • These materials are based on tricalcium silicate and dicalcium silicate (a water setting hydraulic powder).
  • Bioactivity is due to the hydrophilic properties.

Types of Tricalcium Silicate Sealers

  • MTA Fillapex, iRoot SP, Endosequence BC sealer, Endo CPM Sealer, MTA Plus, Endoseal MTA, Total Fill BC Sealer, BioRoot RCS, Seal Plus B.
  • iRoot SP (EndoSequence BC Sealer), TotalFill Sealer, and Bio-C Sealer are premixed sealers.
  • MTA Fillapex and Seal Plus BC are available as two paste syringes
  • BioRoot RCS, Endo CPM Sealer, and MTA Plus sealers are powder/gel systems
  • MTA Fillapex has “natural or diluent resins,” with “filler and thickening agents.”
  • Both MTA Fillapex and iRoot SP sealers have nonaqueous vehicles and the powders are dispersed
  • EndoCPM Sealer and MTA Plus sealer uses water-based gels, excluding nonaqueous resin

Physical Properties of the Sealers

  • Vary, but dimensional stability is excellent.
  • Solubility is higher than AH Plus, possibly due to Ca(OH)2 formation within the tricalcium silicate
  • Radiopacities are less than AH Plus
  • Longer Working and setting times compared to MTI Fillapex sealer.
  • Biocompatibility tests, EndoSequence BC was more cytotoxic than AH Plus.

Gutta Percha Removal

  • Materials, Chloroform, Xylene, Eucalyptol
  • Products, endosolve and endosolve R

Sealer placement

  • Methods include master cone, lentulo spiral, file and reamer, and ultrasonics

Methods of Obturation

COLD GUTTA PERCHA TECHNIQUES

  • Lateral compaction is a common method for obturation which provides length control during compaction, but it has the disadvantage of the inability to fill canal irregularities

Steps for Obturation

  • Measure standard, taper consistent file.
  • Small is norm
  • Resistance to dislodgement
  • loose cone means change
  • Small prepared length and cone selection
  • Device is prepared
  • Larger is better and cone size and length count
  • Radiographs, with point is canal
  • Important Spreader sizes
  • Titanium allows spread, depth and with less pressure.
  • One to two is the rule is most cases

Variation With Lateral Step

  • A coarse gutta-percha cone is selected and the serrated butt end of the cone is removed, the cone is inverted and introduced inside the canal.
  • Inverte with the cone and length, then compaction
  • Adaptation important
  • Measure or size a master cone
  • Heat cones
  • Place in canals

Cold Gutta

  • Chemicals must use for better prepare
  • Needs, chloroform, halothane, eucalyptol
  • Callahan technique
  • Warmed better with vertical for structure.

Important Steps and Techniques

  • Warm is a great way to better help with the structure
  • The method helps prepare the canal to lessen chances for a split
  • Instruments are key and this leads to terminal expansion
  • Adapt cones a half to two mm and length measured
  • Replicate to a non-standard cone

Core Technique

  • cone outer wall needs help
  • Heat and compress.

Various Techniques to Ensure Proper Procedure Follow Through

  • Apply compression should have a wave of technique
  • Connections and increases overall
  • Unit the canal and with it use a point.

Heat Transfer is Important

  • Heat to help seal the cones.
  • Injections
  • Units should heated
  • There should be a control

Obtura

  • Needles
  • The needle controls pressure and length
  • Steps with coasts the canals
  • Guns compress, compression.

Disadvantage

  • Lack of control
  • Under over extension

The GP for Seal

  • Viscosity

Ultrafil for visco

  • Compaction important after setting.
  • Cannulas can be pre-curved
  • Units help

Sealers for GP

  • Is Important and
  • Measurements with carriers

The Plug and step

  • to work
  • is key
  • to seal

SuccessFil

  • Is a carrier-based system associated with Ultrafil 3D and the GP in this technique comes in a syringe
  • Titanium or radiopaque plastic carriers are placed into the syringe for the canal
  • Expressed and sealed around the sides of the canal where the plug seal
  • Measure and the seal above with various

Technique

  • Apical Barrier, needed for cases ,Dentin
  • A way to stop without extrusion of materials.
  • Chips from seal
  • Has also a step better seal
  • For seal a use a better seal.

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