Seal of approval
Obturation techniques play a crucial role in the success of root canal treatment
Obturation, the process of sealing the cleaned root canal system, is vital for long-term treatment success. Studies show that one of the key factors to significantly improve the outcome of primary root canal treatment is the presence of a root filling with no voids.[i]
Indeed, inadequate root filling is a primary cause of treatment failure[ii] and the lack of a hermetic seal in the root canal system creates a favourable environment for bacterial growth.[iii]
The perfect obturation should be well condensed, seal all the canals connecting the pulp space with the periodontum, be adapted to the previous instrumented canal walls and end in the apical constriction.[iv] Various obturation techniques have been developed over the years, each with its own advantages and limitations.
Cold lateral condensation
The cold lateral condensation technique is considered the gold standard in obturation. It involves the use of gutta-percha cones combined with a sealer to fill the root canal space (gutta-percha does not bind by itself to the root canal walls).[v] Although a time-consuming procedure, this technique offers several advantages, including cost-effectiveness, ease of use, and biocompatibility. Furthermore, gutta-percha’s thermal properties allow for efficient obturation.[vi]
Warm vertical compaction
Which brings us to the warm vertical compaction technique. This utilises a thermoplasticized gutta-percha technique to effectively fill the root canal system. It offers advantages such as excellent adaptation to root canal irregularities and superior apical seal due to the hydraulic pressure exerted during obturation. Using heated gutta-percha in combination with a sealer, this technique allows for a more homogenous and three-dimensional obturation. Thermoplasticized gutta-percha has superior flow characteristics, enabling it to adapt well to irregular canal spaces and inaccessible regions. This technique also provides enhanced apical control, enabling an optimal seal and a denser fill thereby minimising voids and the potential for bacterial leakage.[vii]
Single-cone technique
The single-cone technique employs a single gutta-percha cone combined with a sealer to fill the root canal space. It is a time-efficient technique that offers simplicity and ease of use, making it particularly advantageous in cases with round, narrow and regular root canals. However, the main disadvantage of this technique is limited adaptation to root canal walls, potentially compromising the quality of obturation.[viii] This technique requires a higher amount of sealer, thus its outcome depends more on the properties of the sealer.[ix]
Resin-based obturation
Resin-based obturation techniques, such as the epoxy resin and resin-coated gutta-percha techniques, have gained popularity due to their superior sealing ability and enhanced adhesion to dentine. Resin-based obturation materials have minimal shrinkage during setting, ensuring a tight seal and minimising potential leakage. Additionally, resin-based obturation techniques allow for effective retreatment if required, as the material can be easily removed.[x]
MTA obturation
Mineral trioxide aggregate (MTA) has emerged as a reliable bioactive material with extended applications in endodontics such as root end filling, repair of root perforations and resorptions, vital pulp therapy and the obturation of the root canal space. MTA boasts favourable physicochemical and biological properties like superior sealing, good marginal adaptation, minimal microleakage, high biocompatibility and bioinductive and antimicrobial properties.[xi]
An obturation needs to achieve a high level of adaptability to the prepared canal walls and the filling material must penetrate the dentinal tubules, if possible. Preparation is key. CanalPro™ Jeni, from COLTENE, is the autonomous assistance system that helps clinicians achieve safer, more efficient root canal treatment. It features an integrated apex locator, continuously and precisely measuring root canal length without interruption. This enables dental professionals to monitor progress in real time, and switch to the next file size until the desired preparation has been achieved. CanalPro™ Jeni will also alert the clinician when it’s a good time to irrigate, as well as monitor factors like intensity, torque, and file stress, helping to reduce the risk of file fracture.
Obturation techniques play a crucial role in the success of root canal treatment. Each technique has its distinct advantages and limitations, and the choice of technique should be based on the complexity of the root canal system, clinician experience and patient factors. Cold lateral condensation remains the gold standard, but newer techniques, such as warm vertical compaction, thermoplasticized gutta-percha, and resin-based obturation, offer improved adaptation, enhanced sealing ability, and better clinical outcomes. Dental professionals need to be familiar with the various techniques to tailor the obturation process to each patient’s unique needs, ensuring optimal root canal treatment outcomes.
Mark Allen is General Manager at COLTENE
For more on COLTENE, visit www.coltene.com,
email info.uk@coltene.com or call 0800 254 5115.
[i] Ng, Y, Mann L, Rahbaran , Lewsey S and Gulabivala K. (2008), Outcome of primary root canal treatment: systematic review of the literature – Part 2. Influence of clinical factors. International Endodontic Journal, 41: 6-31. https://doi.org/10.1111/j.1365-2591.2007.01323.x [Accessed January 2024]
[ii] Tabassum S, Khan FR. Failure of endodontic treatment: The usual suspects. Eur J Dent. 2016 Jan-Mar;10(1):144-147. doi: 10.4103/1305-7456.175682. PMID: 27011754; PMCID: PMC4784145. [Accessed January 2024]
[iii] Dioguardi M, Di Gioia G, Illuzzi G, Arena C, Caponio VCA, Caloro GA, Zhurakivska K, Adipietro I, Troiano G, Lo Muzio L. Inspection of the Microbiota in Endodontic Lesions. Dent J (Basel). 2019 May 1;7(2):47. doi: 10.3390/dj7020047. PMID: 31052361; PMCID: PMC6630690. [Accessed January 2024]
[iv] Cueva-Goig R, Forner-Navarro L, Llena-Puy MC. Microscopic assessment of the sealing ability of three endodontic filling techniques. J Clin Exp Dent. 2016 Feb 1;8(1):e27-31. doi: 10.4317/jced.52847. PMID: 26855702; PMCID: PMC4739364. [Accessed January 2024]
[v] Pereira TM, Piva E, Cuevas-Suárez CE, Ricci Volpato LE, Neto MDSDS, Pivatto K, Pécora JD, Borges ÁH. Experimental Resin-Based Monoblock Endodontic Obturation System. Biomed Res Int. 2019 Nov 7;2019:3512606. doi: 10.1155/2019/3512606. PMID: 31815132; PMCID: PMC6877987. [Accessed January 2024]
[vi] Bhandi S, Mashyakhy M, Abumelha AS, Alkahtany MF, Jamal M, Chohan H, Raj AT, Testarelli L, Reda R, Patil S. Complete Obturation-Cold Lateral Condensation vs. Thermoplastic Techniques: A Systematic Review of Micro-CT Studies. Materials (Basel). 2021 Jul 18;14(14):4013. doi: 10.3390/ma14144013. PMID: 34300930; PMCID: PMC8304925. [Accessed January 2024]
[vii] Eid D, Medioni E, De-Deus G, Khalil I, Naaman A, Zogheib C. Impact of Warm Vertical Compaction on the Sealing Ability of Calcium Silicate-Based Sealers: A Confocal Microscopic Evaluation. Materials. 2021; 14(2):372. https://doi.org/10.3390/ma14020372 [Accessed January 2024]
[viii] Nouroloyouni A, Samadi V, Salem Milani A, Noorolouny S, Valizadeh-Haghi H. Single Cone Obturation versus Cold Lateral Compaction Techniques with Bioceramic and Resin Sealers: Quality of Obturation and Push-Out Bond Strength. Int J Dent. 2023 Jan 17;2023:3427151. doi: 10.1155/2023/3427151. PMID: 36704662; PMCID: PMC9873427. [Accessed January 2024]
[ix] Loushine BA, Bryan TE, Looney SW, Gillen BM, Loushine RJ, Norman Weller R, Pashley DH, Tay FR, Setting Properties and Cytotoxicity Evaluation of a Premixed Bioceramic Root Canal Sealer, Journal of Endodontics, Volume 37, Issue 5,2011, Pages 673-677, ISSN 0099-2399, https://doi.org/10.1016/j.joen.2011.01.003. https://www.sciencedirect.com/science/article/pii/S0099239911000471
[x] Asheibi FK, 2014 Investigate of selected properties of a resin-based root canal filling material – an in vitro study, University of Manchester. https://research.manchester.ac.uk/files/54552296/FULL_TEXT.PDF
[xi] Wahengbam B, Wahengbam P, Tikku AP. A simplified technique of orthograde MTA obturation on the elected canals of posterior teeth: Two case reports. J Conserv Dent. 2014 Jan;17(1):80-4. doi: 10.4103/0972-0707.124159. PMID: 24554868; PMCID: PMC3915394. [Accessed January 2024]
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