Thermal GP Obturation

Question 1

Aim obturation?

Answer 1

A fluid tight barrier that protect the periradicular tissues from microorganisms

Question 2

Where should obturation provide the seal?

Answer 2

Coronal orifice of canal as ACJ

Question 3

Functions of obturation?

Answer 3

Prevent coronal leakage - micro-organisms
Prevent periapical/periodontal fluid entering canal
Entomb residual micro-organisms - prevent proliferation/ pathogenicity

Question 4

Ideal properties root filling?

Answer 4

Easy handle
Seal canal apical and laterally 
Conform internal anatomy
Non-irritant 
Anti-microbial 
Non-porous
Unaffected tissue fluid
Radiopaque

Question 5

Why do root fillings need to be non-irritant?

Answer 5

Close contact w/ PA tissue

Question 6

What is GP?

Answer 6

Gutta percha - naturally occurring rubber

Produced in variety of cone size

Question 7

What are two phases of GP?

Answer 7

Has two crystalline forms - alpha and beta phase

Question 8

Difference between alpha and beta phase?

Answer 8

Alpha - 42-49 degree C

Beta - below 42 degree C

Question 9

What happens to GP above 49 degree?

Answer 9

Becomes amorphous

Question 10

Role of Endodontics sealers?

Answer 10

1. Seal space between obdurating core and internal root surface
2. Seal space between core and accessory filling material
3. Seal irregularities of complex canal anatomy
4. Lubricate and facilitate seating filling

Question 11

6 types of Endodontics sealers?

Answer 11

Zinc oxide/ eugenol 
Calcium hydroxide based
Glass ionomer based
Resin-based
Calcium silicate based 
Sillicone based

Question 12

Most commonly used sealer?

Answer 12

Zinc oxide/eugenol - Tubliseal

Question 13

Adv of calcium hydroxide based sealer?

Answer 13

Less toxic

But less antimicrobial

Question 14

Disadv glass ionomer based sealers?

Answer 14

Difficult to remove

Question 15

What are different ways to obtrude?

Answer 15

Lateral compaction
Single cone
Thermo-mechanical compaction 
Warm vertical compaction
Carrier based

Question 16

How carry out cold lateral compaction?

Answer 16

Master GP file - fits snug w/ tug back
Coat sealer and place WL
Place finger spreader 1mm from WL
Place accessory 1mm from WL
Continue w/ accessory 
Continue until accessory just below canal orifice
Sear cones 
Compact vertically

Question 17

What is warm lateral compaction?

Answer 17

Uses energised spreading
K file inserted into piezoelectrical ultrasonic unit
File activated and introduced into GP to soften it
Finger spreader placed followed by accessory

Question 18

Adv of warm lateral compaction > cold?

Answer 18

Thermoplastic GP may flow into accessory anatomy

Question 19

Why is single cone obturation not recommended?

Answer 19

Doesn’t provide good 3D seal

Question 20

What is thermo-mechanical compaction?

Answer 20

Heat generated from reverse H file which is driven w/ slow handpick
Master point placed w/ sealer and instrument 3-4mm from WL
GP driven apical and lateraly

Question 21

Disadv thermo-mechanical compaction?

Answer 21

Extrusion from apex

Instrument fracture

Question 22

What is warm vertical compaction otherwise known as?

Answer 22

Continuous wave compaction

Question 23

Aim of warm vertical compaction?

Answer 23

Create apical plug of GP which seal and fills apical 3-4mm canal

Question 24

How to do warm vertical compaction

Answer 24

1. Create apical plug GP - seal apical 3-4mm

2. Backfill - using molten GP

Question 25

Step by step warm vertical compaction?

Answer 25

1. Select GP fits apical prep and has tug back 2. Choose plugger extend 4mm from apex 3. Turn heat source on and plunge plugger through GP 4. Apply pressure to pre-determined binding point 5. Stop heat source and maintain apical pressure to prevent shrinkage 6. Place tip injectable GP gun against apical plug and extrude 3-4mm burst 7. Use condenser to compact GP

Question 26

Adv of warm vertical compaction?

Answer 26

Improved 3D obturation Homogenous mass GP Good internal resorption defect

Question 27

Disadv of warm vertical compaction?

Answer 27

Technique sensitive | Expensive

Question 28

What is carrier based obturation?

Answer 28

Carrier coated in GP | Plastic carrier surrounded heated GP - inserted into canal - carrier cut at orificce

Question 29

Adv of carrier based obturation?

Answer 29

Improved 3D obturation | Quick and easy learn

Question 30

Disadv of carrier based obturation?

Answer 30

Length control Increased post-op pain Carrier issue remove if re-tx/ need endo post

Question 31

What obturation technique should be used if immature apex?

Answer 31

Apical barrier

Question 32

When should apical plug be considered?

Answer 32

If apical size >0.7mm (ISO 70)

Question 33

Material of choice for apical plug?

Answer 33

MTA

Question 34

What is placed next MTA help it set?

Answer 34

Damp cotton wool pledget - then next appt MTA will have set

Question 35

How to assess obturation?

Answer 35

Judge taper, condensation and length

Question 36

Ideal assessment of obturation?

Answer 36

Want well condense filling, coronal to apical foramen, no extrusion of GP into apical tissue