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David E. Witherspoon
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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
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Cleaning & Shaping
Bacteria
Remove Debris Obturation 3D Creating a barrier from the oral environment Length of the root canal system
Coronal seal (Restoration)
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Cleaning & Shaping
Bacteria
Remove Debris Obturation 3D Creating a barrier from the oral environment Length of the root canal system
Coronal seal (Restoration)
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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
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Biocompatible
Bactericidal Seal
Bacteria
Bacteria by products
Biologic Stability Workability
Easily placed and distributed
Reasonable setting time Enhance tooth structure Homogeneous
Radiopaque
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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
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What is the role of obturation in outcomes?
What is an appropriate means of testing ?
Obturation techniques
Obturation materials
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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.
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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
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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%)
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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.
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LC+ Sealapex
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LC+ Sealapex
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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.
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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
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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
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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
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Amount / Thickness Stability
Solubility
Dimensional change Adhesion
Tissue Tolerance / cytotoxicity Bacteria
Application
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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.7/27/2019 Aae Ob Turati on 2006
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Hand File (type of file) Rotary file
Forward vs. reverse Master cone Paper point
Lentulo spirals Ultrasonic Specialized instruments
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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
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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.
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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
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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
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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
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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.
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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.
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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
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Tronstad L. et al Endod Dent Trauma 4:152-9, 1988
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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
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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
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Gutta percha Core carrier Niti/SS/Plastic
Additives or modified GP EndoRez system GuttaFlow ActiV GP
Silver cones MTA Resilon
Specialized sealer
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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.7/27/2019 Aae Ob Turati on 2006
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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
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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
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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
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Instrument dimensions Ca(OH)2
Canal drying Pulpal floor Root fracture
Spreader / Plugger penetration
Heat generation Open apex teeth
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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
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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
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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
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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.7/27/2019 Aae Ob Turati on 2006
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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
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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
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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.7/27/2019 Aae Ob Turati on 2006
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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
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Cold compaction
Compaction of heat-softened gutta-percha
Non-injected
Injected
Core carrier Mechanical compaction
Compaction of Gutta-percha
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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
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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
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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
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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
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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.7/27/2019 Aae Ob Turati on 2006
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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
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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
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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.
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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
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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
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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
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GP Simultaneously
Thermoplasticized
Compacted
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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.
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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
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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
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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
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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
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ThermafilSoft-Core
Successfil
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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
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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
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McSpadden CompactorMicroseal Condenser
Quick-fill
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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
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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
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Warm vertical System B Touch n Heat
Injection systems Thermo-mechanical compaction
Ultrasonic
Rotary Core carrier systems
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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
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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.7/27/2019 Aae Ob Turati on 2006
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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
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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
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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
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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
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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
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Bi-Directional Spiral Filler EZ-Fill Epoxy Root Canal Cement AH plus Single cone of GP
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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
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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.
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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.
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GuttaFlowEndoREZ System
Activ GP System
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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
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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.
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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
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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
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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
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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
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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
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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
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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
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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
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Ca(OH)2 : Non Setting Form
Calyx
Calasept
Pulpdent Tempcanal
Hypo-Cal
Reogan
Ultracal Self Mixed
Methyl Cellulose+ or - Water
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165
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