Aae Ob Turati on 2006

7/27/2019 Aae Ob Turati on 2006

1/120

David E. Witherspoon


2/120

Understand the general principles of root canal obturation

Discuss the various option available for root canal obturation

Understand the application of various root canal filling techniques

Compare and contrast various root canal filling techniques


3/120

Cleaning & Shaping

Bacteria

Remove Debris Obturation 3D Creating a barrier from the oral environment Length of the root canal system

Coronal seal (Restoration)


4/120

Cleaning & Shaping

Bacteria

Remove Debris Obturation 3D Creating a barrier from the oral environment Length of the root canal system

Coronal seal (Restoration)


5/120

DEFINITION: The complete filling and closing of acleaned and shaped root canal using a root canalsealer and core filling material

Objectives:1. Eliminate of all avenues of leakage from the oral cavity and

periradicular tissues into the root canal system

2. Seal within the system any irritants that are not fully

removed during cleaning and shaping


6/120

Biocompatible

Bactericidal Seal

Bacteria

Bacteria by products

Biologic Stability Workability

Easily placed and distributed

Reasonable setting time Enhance tooth structure Homogeneous

Radiopaque


7/120

89.6% teach lateral compaction is the primaryobturation technique Most common material is gutta percha

One school teaches core carrier system One school use Resilon in the undergraduate


8/120

What is the role of obturation in outcomes?

What is an appropriate means of testing ?

Obturation techniques

Obturation materials


9/120


10/120

Going RE. Myers HM. Prussin SG. Quantitative method forstudying microleakage in vivo and in vitro.Journal of Dental

Research. 47(6):1128-32, 1968 Nov-Dec.

Wayman WH. Mullaney TP. A comparative study of apicalleakage with endodontic implant stabilizers. J Endod. 1(8):270-3, 1975 Aug.

The apical seals of 75 extracted teeth that were treated withthree methods of endodontic implant stabilizers werecompared with the seals of 25 teeth filled with silver conesand 25 teeth filled with laterally condensed gutta-percha.Apical leakage was measured with the use of methylene bluedye solution. Statistical analysis showed that there were

significant differences between the apical leakage obtainedfrom the teeth treated with endodontic implant stabilizersand those teeth filled with silver cones and with laterallycondensed gutta-percha.


11/120

Klevant FJ. Eggink CO. Int Endod J 16:68-75, 1983

Exp grp 86 Teeth C&S - Obturation Control grp 336 teeth C&S + Obturation

Over 2 years the outcome was similar


12/120

Vernieks AA. Messer LB. Calcium hydroxideinduced healing of periapical lesions: a study of 78non-vital teeth. J Brit Endod Soc 11:61-9, 1978

C&SCa(OH)2 3-48 mths 55/78 complete healing (70.5%)

20/78 some healing (25.6%)

3/78 no healing (3.9%)


13/120

Peters OA. Barbakow F. Peters CI. Int Endod J37:849-59, 2004 179 pts NSRCT

Lightspeed + LC GP AH Plus

ProFile .04 + LC GP AH Plus ProFile .04 & .06 or GT System B, Obtura II & Roth's 801

86% healing Outcome was not significantly affected byinstrumentation or obturation system.


14/120


15/120


16/120

LC+ Sealapex


17/120

LC+ Sealapex


18/120

Augsburger RA. Peters DD Radiographic evaluation ofextruded obturation materials. J Endod. 16:492-7, 1990

AbstractThe radiographic appearance of filling material extruded intoperiradicular tissues during obturation of root canals wasstudied over time. Recall radiographs for up to 6 1/2 yr. werecompared with immediate postoperative films. Consistently, lessmaterial was evident at successive postoperative periods. Thisstudy indicated that given time, the two zinc oxide and eugenol-

based sealers studied will be removed from periradiculartissues. It also indicated that sealer is removed fromperiradicular tissues more rapidly than gutta-percha.


19/120


20/120

Gutta percha Core carrier Niti/SS/Plastic Additives or modified GP

EndoRez system GuttaFlow ActiV GP

Silver cones

MTA Resilon Paste

Sealer

Cement/Bonding Agent

Specialized sealer


21/120

ZOE Rickerts Pulp Canal Sealer /EWT

Wachs Sealex-Extra Endo-Fill MCS Canal Sealer Iodoform

Endomet Thymol Iodide

Pulpdent

Canals Canals-N Grossman - Type Roth 801, 811, 601, 511, 515 Procosol Endoseal Tubliseal /EWT

Not recommended with heat Formaldehyde N2 Endomethasone SPAD

Ca(OH)2 Not recommended with heat

CRCS Acroseal Sealapex

Apexit Sealer 26 Resin

AH26 Sealer 26 AH Plus EndoREZ

Topseal Silicone

Lee Endo-Fill Roeko Seal Automix RoekoSeal Not recommended with heat

GIC Ketac-endo ActiV GP Not recommended with heat

Other Nogenol root canal sealer Salicylic Acid

Not recommended with heat


22/120

All GP obturation techniques routinelypreform better in leakage studies when a

sealer is used

Evans JT. Simon JH. J Endod 12:100-7, 1986

Tagger M. Katz A. Tamse A. Oral Surg Oral Med Oral Pathol 78:225-31, 1994

Wu, MK; van Der Sluis, LWM Wesselink, PR Oral Surg Oral Med Oral Pathol OralRadiol Endod 97:257-262,2004.

Wu, M K; Fan, B; Wesselink, P R. Int Endod J. 33:121-5, 2000


23/120

Amount / Thickness Stability

Solubility

Dimensional change Adhesion

Tissue Tolerance / cytotoxicity Bacteria

Application


24/120

Kontakiotis EG. et al Int Endod J 30:307-12, 1997 2 yrs. 0.05 mm (thin layer) and 0.3 mm (thick layer)

Roth andPulp Canal Sealer EWT Thick layers of allowed more leakage AH26, Ketac-Endo, Sealapex

No sig diff was found between the thin and thick layers

Wu MK. et al Int Endod J 28:185-9, 1995 AH26, Ketac-Endo, Tubli-Seal & Sealapex 1 yr. thinner was better Wu MK. et al Int Endod J27:304-8, 1994

AH26, Ketac-Endo, Sealapex & Tubli-Seal thickness of 0.05, 0.25 or 3 mm

AH26, Ketac-Endo, & Sealapex sealed better than Tubli-Seal @ 0.25 mm Ketac-Endo sealed better the other three sealers @ 0.05 mm

Hall MC. Clement DJ. et al. J Endod 22:638-42, 1996 No methods exceeded an AV of 62.5% wall coverage of sealer after obturation

Complete wall coverage after obturation may not be possible.
http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKELLHJJCP00D&Search+Link=%22Hall+MC%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKELLHJJCP00D&Search+Link=%22Hall+MC%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKELLHJJCP00D&Search+Link=%22Hall+MC%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKELLHJJCP00D&Search+Link=%22Clement+DJ%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJKJFEGBK00D&Search+Link=%22Wu+MK%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJKJFEGBK00D&Search+Link=%22Wu+MK%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJKJFEGBK00D&Search+Link=%22Kontakiotis+EG%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJKJFEGBK00D&Search+Link=%22Kontakiotis+EG%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKELLHJJCP00D&Search+Link=%22Clement+DJ%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKELLHJJCP00D&Search+Link=%22Clement+DJ%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKELLHJJCP00D&Search+Link=%22Hall+MC%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKELLHJJCP00D&Search+Link=%22Hall+MC%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJKJFEGBK00D&Search+Link=%22Wu+MK%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJKJFEGBK00D&Search+Link=%22Wu+MK%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJKJFEGBK00D&Search+Link=%22Wu+MK%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJKJFEGBK00D&Search+Link=%22Wu+MK%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJKJFEGBK00D&Search+Link=%22Kontakiotis+EG%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJKJFEGBK00D&Search+Link=%22Kontakiotis+EG%22.au.


25/120

Hand File (type of file) Rotary file

Forward vs. reverse Master cone Paper point

Lentulo spirals Ultrasonic Specialized instruments


26/120

Facer SR. Walton RE. J Endod. 29:832-4, 2003Distribution patterns of sealers after lateral compaction

Roth's, Sealapex, AH 26 Sealer placed with a fileNo sealer group demonstrated complete coverage

Wiemann AH. Wilcox LR. J Endod. 17:444-7, 1991File, lentulo spiral, ultrasonic files, and master gutta-percha cone AH26No statistically significant differences among the four groups.

The greatest variation in sealer coverage was found in the apical levelKahn FH. Rosenberg PA. et al. Int Endod J 30:181-6, 1997

lentulo spiral =Max-i-Probe >ultrasonic = sonic files >paper point = K file.Aguirre AM. el-Deeb ME. Aguirre R. J Endod. 23:759-64, 1997

Ultrasonic and hand methods of sealer placement

Sultan "Grossman's formula," AH-26, and CRCS.Ultrasonics was superior to manual placement only for CRCS.Method of sealer placement had no effect on apical leakage

Stamos DE. Gutmann JL. Gettleman BH. J Endod 21:177-9, 1995In vivo evaluation Master gutta-percha cone or an ultrasonic file.

Sig. more radiographically visible accessory canals ultrasonic


27/120

Hall MC. etal J Endod 22:638-42, 1996 Curved canals AH26 sealer K-file, lentulo spiral, or master gutta-percha cone.

No statistical difference in canal wall coverage Average of 62.5% wall coverage of sealer after obturation Complete wall coverage after obturation may not be possible.

Hugh CL. Walton RE. Facer SR. Quint Int 36:721-9, 2005 WVC, Obtura II, System B, SimpliFill, Thermafil, LC SimpliFill had the most samples with complete coverage in both

the coronal and the apical portions.

No technique had sealer forming a continuous layer

between the gutta-percha and canal wall.


28/120


29/120

All sealers are initially cytotoxic in the unset form Double edge sword Chemical agent that have a bacteria effect have a

tendency to be cytotoxic Huang FM. Etal J Biomed Mat Res 59:460-5, 2002 Cytotoxicity order of N2 > Endomethasome > AH Plus > Sealapex.

Lai CC. Etal Clin Oral Invest 5:236-9, 2001 N2 was the most effective against the microorganisms

The concept of Ca(OH)2 sealers Stimulate hard tissue formation Tagger M. Tagger E. Endod & Dent Trauma 5:139-46, 1989 Sonat B. et al Int Endod J 23:46-52, 1990 Holland R. etal Revista de Odontologia Da Unesp. 19:97-104, 1990

Sealapex stimulated hard tissue


30/120

Cohen BI. Pagnillo MK. et al Oral Health. 88:37-9, 1998

Formaldehyde release

AH-Plus 3.9 ppm EZ-Fill 540 ppm

AH-26 1347 ppm

Spangberg LS. etal J Endod 19:596-8, 1993 Spangberg L. etal OOO 36:856-71, 1973


31/120

Saleh IM. Etal Int Endod 37:193-8, 2004

CFU recovered from infect RCT

AH Plus = Grossman killed bacteria (mean CFU = 0) < Ca(OH)2 (0.53)< RoekoSeal Automix (1.36)< Apexit (1.40) Sealapex (0.8 mm) > Kerr EWT

(0.5 mm), > AH-Plus (0.0 mm)

Kayaoglu G. etal Int Endod J. 38:483-8, 2005 Direct contact test, MCS = AH Plus (greatest kill) >

Grossman's sealer, > Sealapex > Apexit.

Membrane-restricted contact test, MCS > AH Plus>Grossman's sealer > Apexit > Sealapex


32/120

Sipert CR. etal Int Endod J. 38:539-43, 2005 Sealapex and Fill Canal antimicrobial activity E. faecalis EndoRez no antimicrobial activity

Fuss Z. etal Int Endod J 30:397-402, 1997 1-hour CRCS = Roth > Sealapex 24-hour, Roth best 7-day Sealapex best

Shalhav M. etal J Endod 23:616-9, 1997 Ketac Endo very potent short-acting effect Roth effect over 7 days after setting.


33/120

Sipert CR. etal Int Endod J. 38:539-43, 2005 Sealapex and Fill Canal antimicrobial activity E. faecalis EndoRez no antimicrobial activity

Fuss Z. etal Int Endod J 30:397-402, 1997 1-hour CRCS = Roth > Sealapex 24-hour, Roth best 7-day Sealapex best

Shalhav M. etal J Endod 23:616-9, 1997 Ketac Endo very potent short-acting effect Roth effect over 7 days after setting.


34/120

Sealer:Solubility

Peters DD. Endod. 12:139-45, 1986.

Procosol + GP LC, WVC ,Thermomechanical, Chloroform Dip

Sealer loss Stored in H2O for 2 yrs.

LC >WVC >Thermomechanical >Chloroform Dip McComb D. Smith DC. J Endod. 2:228-35, 1976

Only AH26 adhered to dentin

Solubility Pulp Canal Sealer>Roth 801 > Procosol >Pulpdent > AH26 = Roth 511 = Tubliseal >Diaket


35/120

Tronstad L. et al Endod Dent Trauma 4:152-9, 1988


36/120

Kazemi RB. etal OOO 76:766-71, 1993 ZnOE , AH26, Endo-Fill 0-180 days

AH26 Little water sorption /no disintegration Endo-Fill

No water sorption/ Little disintegration

ZnOE

Dissolved during setting Greatest dimensional change overtime (shrinkage)

Sleder FS. etal J Endod. 17:541-3, 1991 Sealapex, Tubli-Seal Immersed in a saline solution for 2 and 32-wk Linear ink penetration leakage study No Sig Dif

S h f E Z dbi l i T I t E d d J 36 660 9 2003


37/120

Schafer E. Zandbiglari T. Int Endod J. 36:660-9, 2003 AH 26, AH Plus, RSA RoekoSeal, Apexit, Sealapex, ZnOE, Ketac Endo,

Diaket

Solubility in water or artificial saliva 30 s 28 days.

Most sealers had low solubility Sealapex, ZnOE and Ketac higher solubility Sealapex greatest

AH 26, AH Plus, RSA RoekoSeal, and Diaket had low solubility AH Plus lowest

McMichen FR. etal. Int Endod J. 36:629-35, 2003 Roth 801, Tubli-Seal EWT, AH Plus, Apexit and Endion AH Plus was the least soluble Apexit was the most soluble AH Plus < Tubli-Seal EWT< Endion < Apexit

Roth 801 did not set sufficiently to test soluble Kaplan AE. etal J Endod. 23:439-41,1997 Ketac-Endo, Tubli-Seal, AH26

Immersed in water for 48 h, 7d 45d Statistically no diff Ketac endo looked the worst


38/120


39/120


40/120


41/120


42/120


43/120

Gutta percha Core carrier Niti/SS/Plastic

Additives or modified GP EndoRez system GuttaFlow ActiV GP

Silver cones MTA Resilon

Specialized sealer


44/120

Corrosion

Silver sulfides, silver sulfates, silver carbonates,silver amine sulfate amide hydrates.

Seltzer S. Green DB. Weiner N. DeRenzis F. J Endod 30:463-74; discussion 462,

2004

Koren LZ. Yesilsoy C. Sinai IH. Chivian N. Oral Surg Oral Med Oral Path66:86-92, 1988

Zmener O. Dominguez FV. Oral Surg Oral Med Oral Path 65:94-100, 1988

Zielke DR. Brady JM. del Rio CE. J Endod 1:356-60, 1975

Brady JM. del Rio CE. J Endod 1:205-10, 1975 Seltzer S. Green DB. Weiner N. DeRenzis F. Oral Surg Oral Med Oral Path

33:589-605, 1972

Zmener O. J Endod 15:319-22, 1989.
http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22Zmener+O%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22Brady+JM%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22del+Rio+CE%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22Zmener+O%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22Zmener+O%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22del+Rio+CE%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22del+Rio+CE%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22Brady+JM%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22Brady+JM%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22del+Rio+CE%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22del+Rio+CE%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22Brady+JM%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22Brady+JM%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22Zielke+DR%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22Zielke+DR%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22DeRenzis+F%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22DeRenzis+F%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22Weiner+N%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22Weiner+N%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22Green+DB%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22Green+DB%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22Seltzer+S%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOHCBAHO00D&Search+Link=%22Seltzer+S%22.au.


45/120

Gutta percha most common root canal filling material It is not inert Sjogren U. Sundqvist G. Nair PN. Euro J Oral Sci 103:313-21, 1995

Fine particles evoked an intense, localized tissue response macrophages

Sjogren U. Ohlin A. et al. Eur J Oral Sci 106:872-81, 1998 Stimulated macrophage release PG E2 & I2 Pascon EA. Spangberg LS. J Endod 16:429-33, 1990 Leonardo MR. Utrilla LS. et al Int Endod J 23:211-7, 1990

Moderate to severe inflammatory response No contemporary root canal filling material ortechnique is impervious to leakage

Coronal restoration Coronal leakage


46/120

Seal/Leakage/ Marginal Adaptation Prevents leakage

Super EBA, IRM & Amalgam Sets in the presence of blood Marginal adaptation Super EBA, IRM & Amalgam

Prevents leakage = resin based materials


47/120

Cellular Response

Histologically better than Super EBA, IRM & AmalgamTorabinejad et al.J Endod 1995

Torabinejad et al.J Endod 1998

Moretton et al.J Endod 1997 (abs)

Appears to form cementum tissue over the root-endfilling material in the periradicular region

Torabinejad et al. 1997


48/120

Instrument dimensions Ca(OH)2

Canal drying Pulpal floor Root fracture

Spreader / Plugger penetration

Heat generation Open apex teeth


49/120


50/120

Rococo D. Langeland K. Int Endod J 30:418-21, 1997

Case report Incomplete Ca(OH)2 removal resulted in Tx Failure

Holland R. et al Endod Dent Trauma 11:261-3, 1995

H2O +files #40 up to #70 ZnOE+GP

Significantly less leakage Ca(OH)2 Porker P. etal. J Endod 16:369-74, 1990 Ca(OH)2, Calasep, Vitapex, control group

Removed NaOCL+File ZnOE+GP

Ca(OH)2 leakage not sig dif sig less than the control group


51/120

Lambrianidis T. etal J Endod 25:85-8, 1999

Saline + file+ saline

NaOCL + file + NaOCL NaOCl + file + EDTA None of the methods efficiently removed all Ca(OH)2 25-45% of canal walls had Ca(OH)2

Caliskan MK. etal. Int Endod J 31:173-7, 1998 NaOCl + K file CRCS, Diaket sealer +GP Diaket + Ca(OH)2 leaked the least

Margelos J. etal J Endod 23:43-8, 1997

NaOCl

NaOCl+file NaOCl +EDTA +file Removed the most Ca(OH)2 ZnOE +Ca(OH)2 Rapid set reaction at the interfacebrittle granular


52/120

Lambrianidis, T. Kosti, E. etal Int Endod J 39:55-61,2006.

NaOCL+EDTA -/+ size 10 H-file

Ca(OH)2+CHX) (gel), Ca(OH)2+CHX (sol) and Ca(OH)2+saline None of the techniques removed all Ca(OH)2 File helped

Hosoya N. etal Int Endod J 37:178-84, 2004

Calcipex,Vitapex,Calkyl,Ca(OH)2

Canals, Canals-N, Ketac Endo, Sealapex Removed NaOCL H2O2 Working time decreased in all except Canals+Calcipex Sealapex extremely variable Sealing ability of all four sealers was affected Sealapex improved with all combinations Sevimay S. Oztan MD. Dalat D. J Oral Rehab 31:240-4, 2004

NaOCl NaOCl + File EDTA + NaOCl + File removed the most Ca(OH)2

AH 26+GP Ca(OH)2 had no effect on coronal leakage


53/120

Kim SK. Kim YO. Int Endod J 35:623-8, 2002

NaOCl + EDTA + files NaOCl + files ZnOE+ GP Ca(OH)2 leaked more than no Ca(OH)2

No sig dif between removal method Goldberg, F. etal J Endod. 28:99-101,2002 NaOCl + File Difficult to remove Ca(OH)2 from lateral canals

Calt S. Serper A. J Endod 25:431-3, 1999

NaOCl alone Did not completely remove Ca(OH)2

EDTA + NaOCl

Completely removed Ca(OH)2

Engel GT. Goodell GG. McClanahan SB. J Endod. 31:620-3, 2005
http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKELNCHAHO00D&Search+Link=%22McClanahan+SB%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKELNCHAHO00D&Search+Link=%22McClanahan+SB%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKELNCHAHO00D&Search+Link=%22Goodell+GG%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKELNCHAHO00D&Search+Link=%22Goodell+GG%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKELNCHAHO00D&Search+Link=%22Engel+GT%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKELNCHAHO00D&Search+Link=%22Engel+GT%22.au.


54/120

Engel GT. Goodell GG. McClanahan SB. J Endod. 31:620 3, 2005Leakage or sealer penetrationFinal rinse 70% isopropyl alcohol, Peridex, 6% NaOClRoth's 801 lateral compactionNo significant differences between groups for microleakage or sealer penetration

Hosoya N. Nomura M. etal J Endod. 26:292-4, 2000

Grp 1,one paper point, Grp 2, four paper points, Grp 3 four paper points+ gentleburst of warm air, Grp 4 four paper points, + internal 200 degrees C heat probe.

Zinc oxide-eugenol sealer vs glass ionomer sealerGlass ionomer sealer appeared more susceptible to moistureGroup 4 Best

Horning TG. Kessler JR. J Endod 21:354-7, 1995Procosol, Sealapex, Ketac-EndoSaline as a moisture contaminant

Procosol


55/120

Accessory canals in the furcation region Gutmann JL. J Period 49:21-6, 1978 29.4% mandibular molars

27.4% maxillary molars

Haznedaroglu F. Ersev H. et al Int Endod J 36:515-9, 2003 24% maxillary first molars 16% maxillary second molars

24% mandibular first molars 20% mandibular second molars

Blaskovic-Subat V. Acta Stomat Croatica. 24:85-95, 1990

32.0% of all furcations


56/120

In all studies a second seal was beneficial

Intraorifice vs pulpal floor 2-4 mm Little difference

Sealing the entire pulpal floor is easier Flowable adhesive materials may be better Bond to pulpal floor weakercoronal dentine

Teeth should be restored as quickly as possible
http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOPHKCHO00D&Search+Link=%22Wells+JD%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOPHKCHO00D&Search+Link=%22Wells+JD%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOPHKCHO00D&Search+Link=%22Hammad+HM%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOPHKCHO00D&Search+Link=%22Hammad+HM%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOPHKCHO00D&Search+Link=%22Barrieshi-Nusair+KM%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOPHKCHO00D&Search+Link=%22Barrieshi-Nusair+KM%22.au.


57/120

Super Bonder

Single Bond

Protect Liner F Panavia F DC core-Light cured

DC core-Chemically cured Principle C&B Metabond

Clearfil SE Bond

One-Step Cermet cement Cavit

Amalgam

IRM

Super-EBA Coltosol Vidrion R

Scotch Bond

MTA Glass ionomer

Ketac

Vitrebond GC America Ketac-Bond

C ti f G tt h


58/120

Cold compaction

Compaction of heat-softened gutta-percha

Non-injected

Injected

Core carrier Mechanical compaction

Compaction of Gutta-percha


59/120

Master cone selection

Fits to or within 0.5 mm of the working length Snugness of fit in the apical 1 to 3 mm

Radiograph space lateral to the master cone in mid and coronal third

Spreader selection Sealer placement

Compaction

Spreader place lateral to the master cone to within 0.5-1 mm of WL Accessory cone is lightly coated with sealer

Add accessory cones until the spreader can penetrate only 2 to 3 mm


60/120

Spreader needs to be 1-2 mm of WL Walton RE Johnson WT 1996

Johnson WT Gutmann JL 2006

Spreader needs to reach WL Gutmann JL Witherspoon DE 2002

Spreader needs to be 2 mm of WL with GP in place Allison DA. Michelich RJ. Walton RE. J Endod 7:61-5, 1981


61/120

RCS3 0.35 RCSD11 0.50 RCSD11S 0.28 RCSD11T 0.34 RCSD11TS 0.25 RCSGP1 0.24

S20 0.23 S25 0.30 S30 0.33 S40 0.44 S50 0.42 S60 0.55

RCSGP2 0.24 RCSGP3 0.30 RCSMA57 0.22 RCSW1S 0.36 RCSW2S 0.39 RCS30 0.30

Need To Shape to Accommodate the Spreader

RCSD11T 0.34

RCSD11TS 0.25


62/120

Spreader penetrate more tapered canal systems Dulaimi, S. F. 1; et al Int Endod J 38:510-515, 2005.

Finger spreaders appear to be better than hand spreaders Simons J. Ibanez B. etal J Endod 17:101-4, 1991

Niti Vs stainless steel

Sobhi MB. Khan I. J College Phys & Surg Pak 13:70-2, 2003

In vivo curved root canals. Nickel-titanium finger spreader was significantly deeper

Stainless steel penetration decreased with increasing angleof curvature of the canal.

Berry KA. Loushine RJ. et al. J Endod 24:752-4, 1998

NiTi spreaders penetrated to a significantly greater depththan SS spreaders in curved canals


63/120

Gharai SR. Thorpe JR. et al J Endod 31:198-200, 2005

Curved canals NiTi finger spreaders produce sig less force than SS finger spreaders

No significant difference in microleakage between spreaders Blum JY. Esber S. Micallef JP. J Endod 23:340-5, 1997

Warm vertical compaction lateral condensation thermomechanical compaction Vertical forces WVC, 2.5 +/- 0.4 kg, LC 1.1 +/- 0.3 kg, and TMC 1.65 +/- 0.2 kg Lateral forces WVC, 0.85 +/- 0.2 kg, LC 0.35 +/- 0.1 kg, and TMC 0.5 +/- 0.2 kg

Lertchirakarn V. Palamara JE. Messer HH. J Endod 25:99-104, 1999 Max loads and strains generated by finger spreaders were sig lower than D11T

Joyce AP. Loushine RJ. West LA. Runyan DA. Cameron SM. J Endod 24:714-5, 1998 Stress in canal walls Stainless-steel spreaders created three areas of concentrated stress

Nickel-titanium spreaders stress spread out along the surface of the canals Dang DA. Walton RE. J Endod 15:294-301, 1989 D11 spreaders or B-finger pluggers D11, produced vertical root fractures and caused greater root distortion

Schmidt KJ. Walker TL. et al. J Endod 26:42-4, 2000

Nickel-titanium spreader sig less force than a stainless-steel spreader
http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKKOCBLBHO00D&Search+Link=%22Schmidt+KJ%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKKOCBLBHO00D&Search+Link=%22Schmidt+KJ%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKKOCBLBHO00D&Search+Link=%22Walker+TL%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKKOCBLBHO00D&Search+Link=%22Walker+TL%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKKOCBLBHO00D&Search+Link=%22Walker+TL%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKKOCBLBHO00D&Search+Link=%22Schmidt+KJ%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKKOCBLBHO00D&Search+Link=%22Schmidt+KJ%22.au.


64/120

Force required to cause vertical fracture during LC

DIIT spreader Smallest fracture load was 1.5 kg (3.31 lb.) Mainly buccolingual direction

Incomplete fracture was seen in 26%. Positive linear correlations were found between fracture load and root

width, canal width, canal taper, ratio of canal width to total root width,and number of accessory cones placed.

Obturated using forces 1 to 3 kg or 4.5 to 7.5 kg. 3 teeth obturated using 7.0 to 7.3 kg of force demonstrated

vertical root fractures.

Up to 4.9 kg are safe


65/120

Chloroform, methychloroform, halothane,rectified white turpentine and eucalyptol

Dip softened paste of gutta-percha(chloropercha Kloropercha)

Removal of the excess solvent with alcohol Dimensional change

Compact GP within 15 - 30 sec Dissipation of the chemical solvent Irritation / toxicity of solvent


66/120

Barbosa SV. Burkard DH. et al. J Endod. 20:6-8, 1994 Cytotoxicity of chloroform, halothane, or turpentine All solvents were toxic

Turpentine > halothane >chloroform Allard U. Andersson L. Endod Dent Trauma 8:155-9, 1992

Chloroform - Kloroperka open medical cups Exposure levels close to the accepted limit values in Sweden, more then one

NSRCT per day may lead to unacceptably expose

Evacuation significantly reduced expose McDonald MN. Vire DE. J Endod. 18:301-3, 1992

FDA banned drugs & cosmetics containing chloroform No negative health effects to the dentist or assistant and air vapor levels well

below OSHA mandated maximum levels.

Chutich MJ. Kaminski EJ. Et al J Endod. 24:213-6, 1998 Chloroform, xylene, or halothane. Residual volume of solvent expressed through the apex during Re:Tx was well

below the permissible toxic dose.

Pose negligible risk to the patient.


67/120

Recommend for Lightspeed prep Trial fit an GP Plug, 2 mm short of WL Bind

Place Sealer in the apical 1/3

AH Plus Advance the GP Plug to WL

Disengage GP plug at WL

Rotate Counter Clockwise Backfill

Available in GP and Resilon


68/120

Pluggers Pre-fitted non-binding Smallest plugger within ~ 4 mm of WL Incrementally fit larger plugger

Non-standardized gutta-percha cones

F, FM, M, ML Fitted 0.5-2 mm short of WL

Heat source


69/120

Pluggers Pre-fitted non-binding Smallest plugger within ~ 4 mm of WL Incrementally fit larger plugger

Non-standardized gutta-percha cones

F, FM, M, ML Fitted 0.5-2 mm short of WL

Heat source


70/120

GP Simultaneously

Thermoplasticized

Compacted


71/120

4 to 6 mm from WL 5 to 7 mm from WL

Buchanan LS. Endod Prac 1998; 1: 710, 136, 18.

Buchanan LS. Dent Today 1994; 13: 805.


72/120


73/120


74/120

2 to 4.5 mm from WL

Guess GM. et al J Endod 29:509-12, 2003

Villegas JC. Yoshioka T. et al Int Endod J 38:218-22, 2005

Jung IY. Et al Oral Surg Oral Med Oral Path Oral Radiol &Endod 96:453-7, 2003


75/120

92

.04 Taper/30

.06 Taper/40

.08 Taper/50

.10 Taper/60

.12 Taper/70

30 prep to .06 taper25 prep to ~.08 taper


76/120

GP cannulas 22 Gauge needle 21 mm long

Low viscosity material Regular set 30 min

Firm set

4 min High viscosity material Endo set 2 min

Heating unit preset to 90 C

Injection syringe GP flows for ~ 45-60 sec


77/120

GP backfill in a system

Single use device made with a stainless-steel carrier that is packed with GP

Heating unit

Heat-R remains at a constant 150C Prepare up to six Inject-R Fills


78/120

ThermafilSoft-Core

Successfil


79/120

Select obturator to match the C&S technique

GT Protaper Profile

Size verifiers Confirm canal size before placement of core carrier Fine adjustments to apical prep

Sealer canal walls carrier insertion AH Plus

File or paper point Heated obturator inserted into canal system Pre-determined length ~ WL Cool for 2-4 min

Remove excess with prepi bur


80/120

SuccessFil Syringe must be warmed 3-10 min SuccessFil Titanium Cores

Implant-grade titanium alloy Non-cutting tips highly flexible 25 mm lengths ISO sizes 20-80

Notch the core with a fissure bur where severingalong the shaft is desired


81/120

McSpadden CompactorMicroseal Condenser

Quick-fill


82/120

Spreader within 2-3 mm of WL Avoid sealer effected by heat

Place a cone to WL

Microseal Spreaders NiTi engine spreaders 350 rpm

Microseal Condensers

NiTi engine condensers reverse-helix design 5000-6000 rpm Load with Microseal Low-fusing GP Place in space made by engine spreader

Activate


83/120

Thermo mechanical

Alpha phase GP on an inverted K type file Two sizes smaller than the last file used to WL

1 mm short of the apex Lightly coat or dip Quick-Fill in sealer of choice Position the Quick-Fill at the orifice of the canal Clockwise rotate @ 3000-6000 rpm, and Apply light pressure


84/120

Warm vertical System B Touch n Heat

Injection systems Thermo-mechanical compaction

Ultrasonic

Rotary Core carrier systems


85/120

Heating bone to 117 to 122 F (47 to 50 C) for 1 min Reduces bone formation

Irreversible cellular damage

Fatty cell infiltration Increased blood flow Stagnation

Deactivation alkaline phosphatase Temperature increase and length of increase 117 F (47 C) for 1 min = 118 F (48 C) for 30 sec

Temps > 127 F (53 C) for < 1 sec adversely affect osteogenesis


86/120

Lipski M. J Endod. 30:441-3, 2004 Thermafil 3.87 C Soft-Core 3.67 C

Ultrafil 2.14 C Trifecta low-temperature 2.03 C Behnia A. McDonald NJ. J Endod. 27:203-5, 2001

Thermafil Plus Mean temp rise of the external root surface 4.26 - 4.87 C
http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJKGFKGGO00D&Search+Link=%22Behnia+A%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJKGFKGGO00D&Search+Link=%22McDonald+NJ%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJKCALHGO00D&Search+Link=%22Lipski+M%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJKGFKGGO00D&Search+Link=%22McDonald+NJ%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJKGFKGGO00D&Search+Link=%22McDonald+NJ%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJKGFKGGO00D&Search+Link=%22Behnia+A%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJKGFKGGO00D&Search+Link=%22Behnia+A%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJKCALHGO00D&Search+Link=%22Lipski+M%22.au.http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJKCALHGO00D&Search+Link=%22Lipski+M%22.au.


87/120

System B (SB) Touch 'n Heat (TH) Flame-heated carrier (FH)

Mx incisor, premolar, and Md incisor

2 mm below the cementoenamel junction

SB temperature rise < 10 C for all teeth

TH temperature rise

< 10 C Mx incisors and premolars > 10 C Md incisors

FH temperature rise < 10 C for all teeth


88/120

Floren JW. Weller RN. et al J Endod. 25:593-5, 1999 250, 300 , 350, 400, 450, 500, 550 , and 600 C.

5 mm from the apex temperatures 8.85-12.06 C Romero AD. Green DB. et al J Endod. 26:85-7, 2000

Temperature at the apex and 5 mm from the apex Av temperature ~1 C at the apex and ~2 C at 5 mm

Lipski M. OOOOE. 99:505-10, 2005 Mx central incisors and canines temperature < 10 C Md central incisors temperature by more than 10 C

Sweatman TL. Baumgartner JC. et al J Endod. 27:512-5, 2001

Highest mean internal temperature 74.19 C at the 6 mm from WL FM set at 300 C Lowest mean internal temperature change was 2.09 C at WL

F set at 200 C

Did not

external root surface 10 C


89/120

Donley DL. Weller RN. et al. J Endod. 17:307-9, 1991

Obtura Mean temperature of the extruded GP was 137.81 C Ultrafil Mean temperature of the extruded GP was 62.88 C Weller RN. Koch KA. Int Endod J. 28:86-90, 1995

Obtura II set at 160, 185, and 200 C

mean intracanal temperatures 40.21 to 57.24 C

mean root surface temperatures 37.22 to 41.90 C Weller RN. Koch KA. Int Endod J. 27:299-303, 1994

Obtura II @ 160, 185, and 200 C intracanal temp 38.52 C- 61.58 C GP decreased heating chamber ~ 20 C

Extruded GP was ~ 100 C < GP in the heating chamber Sweatman TL. Baumgartner JC et al. J Endod. 27:512-5, 2001 Obtura II did not external root surface 10 C lowest mean internal temperature change was 5.22 C at WL,

highest mean internal temperature change was 26.63 C at 6 mm from WL


90/120

Slight inflammatory reaction Does not appear to be at clinically deleterious levels No long-term effect

Temperature mid-point on the root Castelli WA. Caffesse RG. et al. Oral Surg Oral Med Oral Pathol 71:333-7, 1991

Molyvdas I. Zervas P. et al. Endod Dent Trauma. 5:32-7, 1989 Gutmann JL. Rakusin H. et al. J Endod. 13:441-8, 1987 Gutmann JL. Creel DC. Bowles WH. J Endod 13:378-83, 1987

Hand RE. Huget EF et al Oral Surg, Oral Med Oral Pathol 42:395-401, 1976

Saunders EM. Int Endod J. 23:263-7, 1990 No sig diff between temperature recorded in vitro and in vivo. Temperature elevations dissipated more rapidly in vivo than in vitro


91/120

Lipski M. J Endod. 31:297-300, 2005 Mean temp LC + Engine Plugger 23.8 9 C

Mean temp Microseal 5.5 3 C

Bailey GC. Cunnington SA. et al. Int Endod J. 37:447-54, 2004 Ultrasonic power setting 5 for 15 s

Temperature > 10 C mid-root level

Sweatman TL. Baumgartner JC. et al J Endod. 27:512-5, 2001 Ultrasonic lateral compaction external root surface not > 10 C lowest mean internal temp change5.01 C WL highest mean internal temp change 28.95 C 6 mm from WL

McCullagh JJ. Biagioni PA. et al Int Endod J. 30:191-5, 1997 Thermomechanical obturation Gutta Condensor Surface root temperature rises of > 97 C were recorded during all three speed

Saunders EM. Int Endod J. 23:268-74, 1990 Thermomechanical compaction of gutta-percha Ferret canine @ 24 hrs, 20d & 40d.

PDL damage in a minority of the experimental specimens 20 and 40 days


92/120

Bi-Directional Spiral Filler EZ-Fill Epoxy Root Canal Cement AH plus Single cone of GP


93/120

Fit a single GP cone to WL binds apically Fit EZ-Fill bi-directional spiral 1 mm short of WL Coat the bi -directional spiral with the cement

Place into the canal Run at ~ 1000 RPM Use a slow up & down circular motion

For approximately 5 seconds Seat the pre-fitted GP cone

Sear off the end of the Gp with a heated plugger

How too articles


94/120

How too articles

Weathers AK. Denti Today. 23:100, 102-3, 2004

Musikant BL. Cohen BI. Deutsch AS. The evolution of instrumentation and obturationleading to a simplified approach. Comp Cont Edu Dent 21:980-6, 988, 990, 2000

Musikant BL. Cohen BI. Deutsch AS. Rethinking endodontics: attaining total obturationof the root canal system with a simplified system. Gen Dent 47:73-82, 1999

Musikant BL. Cohen BI. Deutsch AS. Report of a simplified endodontic technique.Comp Cont Edu Dent. 20:1088-90, 1092-4, 1999

Seidman D. A general dentist's viewpoint of two new endodontic techniques. CompCont Edu Dent. 20:921-4, 926, 928 passim; quiz 934, 1999

Musikant BL. Cohen BI. Deutsch AS. Simplified obturation of tapered canal

preparations. Comp Cont Edu Dent. 19:1152-5, 1998

Musikant BL. Cohen BI. Deutsch AS. A two-and-a-half year perspective on simplifiedendodontic techniques Comp Cont Edu Dent. 24:46-8, 50, 52 passim, 2000

Musikant BL, Cohen BI, Deutsch AS. Traditional, modern and post modernendodontics: part two. Endod Prac March:6-17.


95/120

Cohen BI. Pagnillo MK. et al Gen Den 46:618-23,1998 Lateral compaction EZ Fill sealer Thermafil with Thermaseal

EZ-Fill Bi-directional spiral EZ Fill sealer

No sig diff Hata G, Imura N, et al; J Endod 28[absPR31]:261, 2002

EZ-Fill

System B Lateral compaction EZ-Fill technique showed the least dye penetration.


96/120

GuttaFlowEndoREZ System

Activ GP System


97/120

RoekoSeal Automix silicon-based sealer

Contains gutta-percha particles < 30 m as a filler Approximately 50 % gutta-percha and 50 % sealer

Nano-silver

Flowable and sets within 10 min Material expands slightly on setting

Cannot be dissolved with chloroform

Thoroughly rinse with sterile water or alcohol Dry with paper points

Remove all residues of NaOCl, H2O2


98/120

Elayouti etal. J Endod 31:687-90, 2005

GuttaFlow completely filled the preparedroot canal, but small voids were frequentlypresent within the core of the fillingmaterial.


99/120

Resin Coated Gutta Percha Points Polybutadiene-diisocyanate-methacrylate

Resin coating bonds chemically to EndoREZ Standard ISO-sized points Resin sealer EndoRez Create a monoblock in the canal Works with all resin-based sealers


100/120

Dual cure; self-priming; hydrophilic sealer

Methacrylate-based resin ~30% Urethane dimethacrylate

Radiopacity similar to as gutta percha ~ 50 wt% filled;contains bismuth oxychloride, calciumlactate pentahydrate, silicon dioxide as fillers

Peroxide-based lubricants and NaOCl effect bond

EDTA final rinse

Sets harder than ZOE but not as hard as restorativesresin There is no chemical solvent


101/120

Endorez sealer Injected into the root canal via a 30-gauge Tip

2 to 3 mm short WL Place pre-fitted master cone

Passive place multiple 0.02 taper resin-coated GPaccessory cones


102/120

Bouillaguet S. etal Eur J Oral Sci. 112:182-7, 2004

Cytotoxicity & leakage Kerr PCS, RoekoSeal, TopSeal and EndoREZ All cytotoxic particularly when freshly mixed

Roeko Seal Least cytotoxic More effective in sealing root canals against LPS

Kardon BP. etal J Endod. 29:658-61, 2003

Leakage EndoRez + single cone of GP > AH Plus + single cone

of GP = WVC + AH Plus


103/120

Bouillaguet S. etal Eur J Oral Sci. 112:182-7, 2004

Cytotoxicity & leakage Kerr PCS, RoekoSeal, TopSeal and EndoREZ All cytotoxic particularly when freshly mixed

Roeko Seal Least cytotoxic More effective in sealing root canals against LPS

Kardon BP. etal J Endod. 29:658-61, 2003

Leakage EndoRez + single cone of GP > AH Plus + single cone

of GP = WVC + AH Plus

Sipert CR. etal Int Endod J. 38:539-43, 2005


104/120

EndoRez does not have antimicrobial activity

Eldeniz AU. etal J Endod. 31:293-6, 2005

Bond strength Diaket, AH Plus and Endo-REZ AH Plus highest bond to dentin +/- smear layer

Sevimay S. Kalayci A. J Oral Reh 32:105-10, 2005

LC and either AH plus vs EndoRez AH Plus leaked less AH plusbetter adapted to dentine

Zmener O. Pameijer CH. Amer J Dent. 17:19-22, 2004 145/180 patients LC+ EndoRez 91%. overall success rate NSRCT adequately filled WL 6.9% Extruded sealer


105/120

Glass ionomer particles incorporated into the GP 8% Adhesive coating of particles to the surface of GP

2 microns Activ GP glass ionomer sealer Working time 15 min if use a chilled glass slab

Highly radiopaque

Cones match to the Endosequence Single Cone Technique

Sever with heat


106/120

Fit needle snugly 1-2 mm from the apex Turn the screw plunger 1/4 turn clockwise.

Wait 5 seconds This fills the 1-2 mm at the apex. disposable needles 18, 22, 25, 27 & 30 gauge

Pulpdent Root Canal Sealer


107/120


108/120


109/120


110/120

Ca(OH)2 : Non Setting Form

Calyx

Calasept

Pulpdent Tempcanal

Hypo-Cal

Reogan

Ultracal Self Mixed

Methyl Cellulose+ or - Water


111/120


112/120


113/120


114/120


115/120


116/120


117/120


118/120

165


119/120

H15060340I


120/120

Aae Ob Turati on 2006

Documents

Transcript of Aae Ob Turati on 2006