Lecture 3: Obturation

Question 1

The goal of obturation is to eliminate ____ from the oral cavity INTO the root canal system or OUT OF the root canal system into the periodontal or oral tissues.

Answer 1

all avenues of leakage

Question 2

The goal of obturation is to eliminate all avenues of leakage from the oral cavity _____ the RC system or ___ of the RC system and into the ___ or ___

Answer 2

INTO; OUT OF; periodontal & oral tissues

Question 3

For obturation, seal ___ the RC system any irritants that cannot be fully removed during canal cleaning & shaping and ___ their ___ out to the peri-radicular tissues of leakage of saliva or other contaminates into pulp system.

Answer 3

within; prevent; leakage

Question 4

RCT success depends upon thoroughness of _____ and ____ of the canal system including ____.

Answer 4

removal of irritants; quality of seal; coronal restoration

Question 5

The 3 primary functions of a root canal filling include:

Answer 5

1. stop coronal leakage
2. entomb surviving microorganisms
3. prevent accumulation of stagnant fluid

Question 6

The qualities of Gutta Perccha:

Answer 6

1. can be softened by heat & solvents
2. if heated sufficiently, will change phases
3. SHRINKS following softening
4. by ITSELF does not seal

Question 7

Gutta percha can be softened by:

Answer 7

heat & solvents

Question 8

If gutta percha is heated sufficiently, it will:

Answer 8

change phases

Question 9

Following heating & softening of gutta percha, it will:

Answer 9

shrink

Question 10

T/F: Gutta percha by itself is an ideal sealer

Answer 10

False- by itself it does NOT seal; must consider sealers

Question 11

GP can exist in different isomeric forms including: (3)

Answer 11

1. alpha phase
2. beta phase
3. amorphous melt

Question 12

The “alpha phase” of gutta percha occurs at what degrees Celsius?

Answer 12

42-44

Question 13

The “beta phase” of gutta percha occurs at what degrees Celsius?

Answer 13

below 42

CLC-GP!!!

Question 14

The “amorphous melt” of gutta percha occurs at what degrees Celsius?

Answer 14

56-64

Question 15

What isomeric form of GP is considered CLC-GP? What temp does this occur at?

Answer 15

Beta phase (below 42 degrees)

Question 16

The requirements for an ideal root filling cement (obturation sealer)

1. It should be _____ into the canal
2. It should seal the canal ___ as well as ___
3. It should NOT ____ after insertion
4. It should be impervious to ____
5. It should be ____ or at least not encourage ____
6. It should be _____ (on x-ray)
7. It should NOT ____ tooth structure
8. It should NOT irritate _____
9. It should be ___ or quickly and easily ___ before insertion
10. It should be easily _____ from the root canal if necessary

Answer 16

1. easily introduced
2. laterally & apically
3. shrink
4. moisture
5. bacteriostatic; bacterial growth
6. radiopaque
7. stain
8. periapical tissue
9. sterile; sterilized
10. removed

Question 17

Until ____ & _____ sealers came into play, no sealer was ideal due to shrink and dissolving

Answer 17

Bio-ceramic & Bio-active

Question 18

Until bio-ceramic & bio-active sealers came into play, no sealer was ideal and all sealers: (2)

Answer 18

1. shrank upon setting
2. dissolved in body fluids over time

Question 19

Bio-Ceramic & Bio-Active Sealers are considered ____ which allows a more efficient technique

Answer 19

dimensionally stable

Question 20

Bio-ceramic sealers characteristics: (3)

Answer 20

1. Do NOT shrink
2. Do NOT dissolve
3. Are Bio active

Question 21

Bio-ceramic sealers provide viability to the ____.

Answer 21

Hydraulic (“single cone”) technique

Question 22

With a bio-ceramic sealer, gutta percha is only necessary as a source of ___ and a route to retreatment or post should either become necessary.

Answer 22

hydraulic sealer compression/flow

Question 23

Standard of care: RC obturation-

1. GP is positioned _____ of the canal exit
2. ___ with gutta percha and sealer with ____.
3. Radiographic appearance of a ____.
4. ____ into the peri-apical tissues (GP & Sealer)
5. ____ beyond apical constriction
6. No ____ in the presence of a ____

Answer 23

1) 1mm short
2) Totally filled; NO voids
3) Dense filling
4) Avoidance of gross overextension
5) Minimal sealer
6) Under-fillings; patent canal

Question 24

When are we ready to obturate?

Answer 24

1. asymptomatic
2. free of all signs of infection/inflammation
3. tooth is cleaned & shaped to facilitate obturation
4. tooth is ISOLATED
5. comfortable & master cone fitted + XR
6. RC is dry
7. DST is healed

Question 25

T/F: IF the patient is still in pain of the original symptoms have not abated, obturation of the RC system will NOT resolve the patients symptoms

Answer 25

true

Question 26

In what cases will obturation of the RC system NOT resolve the patient's symptoms? (2)

Answer 26

1. if patient is still in pain 2. if original symptoms have not ceased

Question 27

List 3 acceptable obturation techniques:

Answer 27

1. cold lateral compaction of gutta percha 2. hydraulic obturation technique 3. warm vertical compaction

Question 28

______ is the secret to CLC-GP obturation success (Fill must be dense and free of voids and have a ____ sealer layer to be effective)

Answer 28

Compaction; thin

Question 29

CLC-GP:

Answer 29

Cold Lateral Compaction of Gutta Percha

Question 30

Acceptable obturation techniques at UMKC:

Answer 30

1. cold lateral compaction of gutta percha 2. hydraulic obturation technique 3. warm vertical compaction

Question 31

What GP cone is used with cold lateral compaction?

Answer 31

0.25 GP cone (Red) Quiz said 0.2??

Question 32

____ are used to compact the MC gutta percha in the canal to create space for more gutta percha accessory cones to accomplish a dense fill and thin film of sealer on the canal

Answer 32

Finger spreaders

Question 33

Finger spreaders are used to compact the MC gutta percha in the canal to create:

Answer 33

space for more gutta percha accessory cones

Question 34

List the steps of lateral compaction:

Answer 34

1. the master cone is fitted 2. a finger spreader or plugger is inserted, ideally to 6-2mm of the prepared length 3. the spreader is rotated and removed, and an accessory cone is placed in the space created 4. the process is repeated

Question 35

In lateral compaction, after the master cone is fitted, a finger spreader or plugger is inserted ideally:

Answer 35

6-2mm of the prepared length

Question 36

What two components does hydraulic obturation use?

Answer 36

1. BC sealer 2. 0.4 GP cones

Question 37

What size of cone is used with hydraulic obturation?

Answer 37

0.4 GP cone

Question 38

List the steps for hydraulic technique:

Answer 38

1. select an 0.4 GP Cone and fit to WL 2. Radiograph (to make sure its at WL) 3. Dry canal following EDT & NaOCl

Question 39

T/F: The canal should be completely dry when the GP master cone is inserted

Answer 39

false- insert into wet canal

Question 39

How should you evaluate the fit of the MC?

Answer 39

radiograph

Question 40

What is a VERY important step when inserting the gutta percha cone?

Answer 40

mark exactly your point of reference

Question 41

on a radiograph, how can you determine if the master cone is too small?

Answer 41

cone will distort (crinkle) near apex

Question 42

Describe how a properly fitted cone will appear on a radiograph?

Answer 42

Intimate fit at WL with no spaces and no crinkling

Question 43

T/F: You should NEVER go beyond WL with ANY shaping instruments

Answer 43

true

Question 44

For an open apex, you should use ___ instead of "single cone"

Answer 44

CLC-GP

Question 45

T/F: Premolars and molars require crowns in ALL cases to prevent VRF

Answer 45

True

Question 46

T/F: Anterior teeth with minimal loss of tooth structure require crowns

Answer 46

False- may only need a composite restoration to restore RCT access

Question 47

Take home messages:

Answer 47

1. Use GP with a biocerampic sealer 2. Obturate when the canal is dry and patient has remained asymptomatic 3. Lateral compaction needs blue finger spreaders (COMPACTION) 4. Hydraulic obturation technique uses a 0.4 GP cone and BC sealer 5. Sear GP below the CEJ, clean the pulp chamber and seal the canal with GI

Question 48

What is gutta percha?

Answer 48

Trans-polyisoprene (an isomer of latex)

Question 49

What size of GP cone for CLC?

Answer 49

0.2 taper (#20 2)

Question 50

What phase of GP do we use?

Answer 50

Beta phase (below 42 degrees Celsius) CLC-GP

Question 51

List the composition of GP: (4)

Answer 51

1. Gutta percha 2. Zinc oxide (59-76%) 3. waxes/ resins/ coloring agents 4. metal sulfates

Question 52

Silver points are considered:

Answer 52

beneath the standard of care

Question 53

Paraformaldehyde-containing pastes are considered:

Answer 53

beneath the standard of care

Question 54

GP requires:

Answer 54

sealer (dimensionally stable)