Root canal filling Warm techniques ALWAYS A SEALER IS USED – IN ALL TECHNIQUES!!! Cone Fit & Plugger Selection Vertical compaction various possibilities Irrigation and desinfection of root canal system Manual Pluggers for compaction Schilder Pluggers Heat-Carrier Plugger Machtou Pluggers Selection large size manual plugger Selection medium size manual plugger Selection small size manual plugger 4-5 mm Selection of the Heat Plugger 4-5 mm Down-Pack handpiece Plugger 3 sizes 1 warm pulp-tester Mesured paper point to Working Length Trim the master cone Insert lubricate (sealer) master cone Downpack : Vertical Condensation Activate heating and sear off the master cone Select the larger prefit, manual plugger and move Gutta Percha apically Activate heating and plunge 3-4 mm into the gutta-percha Desactivate heating 1-2 seconds, then remove “bite” of Gutta Percha Select the medium size, manuel plugger and move Gutta Percha apically Press apically for 5 seconds Activate heating, plunge deeper 3-4mm and wait 1-2 seconds after desactivate it Select small size manuel Plugger, move gutta-percha apically Press small Plugger 5 seconds into the apical third Downpack : Continuous Wave Technique Activate heating and sear off the master cone Select the larger prefit, manual plugger and move Gutta Percha apically Activate heating In one continuous motion press until the “stop” is at 2 mm of the reference point Desactivate heating maintain firm apical pressure till the reference point is reached Maintain firm pressure for 10 seconds Activate heating for 1-2 seconds and desactivate , then remove the plugger This will separate and remove Gutta-Percha Select the small size, prefit manual plugger and condense the Gutta-Percha Downpack : Hybrid Technique Activate heating and sear off the master cone Select the larger prefit, manual plugger and move Gutta Percha apically, press 5 seconds to compact gutta-percha Activate heating and plunge 3-4 mm into the gutta-percha Desactivate heating maintain 5 seconds pressure to compact gutta.percha Activate heating Desactivate and maintain 5 seconds . Maintain apical pressure till the working depth is reached Activate heating 1-2 seconds Desactivate and remove the plugger. Select the small size, prefit manual plugger and condense the Gutta-Percha BACKPACK Technique Guttapercha flow handpiece Internal view of activated flow handpiece Cartridge of Gutta-Percha Cartridge-tip bender Position the tip against the packed filling material #20(0,8) and #23(0,6) Placing warm tip against packed-material re-thermosoftens gutta-percha Activate gutta flow, dispense 2-3 mm warm gutta-percha Select smaller prefit manuel plugger and condense material With the same plugger, press 5 seconds to avoid shrinkage during cooling phase Position tip 5 seconds aginst packed material Activate gutta flow flow and dispense 3-4 mm warm gutta-percha With a prefit, medium size manual plugger condense the material And press the material for 5 seconds (avoiding shrinkage) Continue the backfilling in the same manner until the canal is full OR stop to accommodate a post for restorative Injection of heated guttaprecha • Can be used also only without vertical compaciton – usually in teeth after apexification or teeth with internal resprpiton. Core-Carrier (PP) - Gutta-Percha Filling Technique – an example Thermafill or Protaper Obturator and others… Core-Carrier Gutta-Percha Filling Technique Obturators PROTAPER Calibrated Gutta-Percha Cones F1 F2 F3 F4 F5 Sterile Paper Points Finishing Files (Apical shape) F1 F2 F3 F4 F5 Paper points - Protaper sizes Obturators - Protaper sizes F2 ProTaper Obturator calibrated to each Finishing File F1 F2 F3 F4 F5 3D Filling of the Root-Canal System with THERMAFIL Or PROTAPER OBTURATOR Thermacut bur Post space burSize verifier to measure the apical size Thermaprep Oven 1st step : Opening cleaning Shaping … Core-Carrier Obturator Technique Gauge the Canal with Verifiers, which should snug within 0,5mm form Working Length 1 2 3 Place the Obturators Heat The Obturator Select the right size and start Dry the Canals with Sterile Paper Points Mix the Sealer and coat thewalls of the canal with a thin layer using a Probe or a paper point Topseal MIX 1 2 3 Take it out and insert it in the canal Use of a selected Plugger to ensure homogeneity of the filling. Heat Carrier Plugger 0.5 0,6 0,8 1.0 Mc Spadden technique After each point of Gutta-Percha with sealer, use the Gutta-Condensor to melt and fill the canal. Warm vertical compaction • Gutta cones are heated with special spreader – e.g.: Endo Twinn, Endotec and others. • No widely used. Plug of MTA MTA GUN ProRoot MTA For Apexification (Apical Plugs) Shahabang et al. 1999 Simon et al. 2007 Felippe et al. 2006 Hachmeister et al. 2001 Tittle et al. 1996 Shahabang et al. J Endodon 1999 0 10 20 30 40 50 60 70 80 90 100 OP1 Ca(OH)2 MTA Collagen A comparative study of root-end induction using osteogenic Protein-1, calcium hydroxide and Mineral Trioxide Aggregate in dogs. Shahabang et al. J Endodon 1999 ; 25 : 1-5. % of roots with apical closure Reendo – an example of FRC post - Translucent glass fiber posts in 6 sizes 3 largo reamers + 6 calibrated drills X-Post™ X-Post ™ Blister Refill Features & Benefits  Translucent & light conducting  High aesthetics  Facilitates light curing  Excellent fatigue resistance  Durable post for long-lasting restorations  High shear strength  Optimal bond between post and cement  Radio opaque  X-ray detection for easy diagnostics and monitoring  Compatible with all Dual Cure composite systems  Corresponds to different user habits Clinical Case with Radix Fiber Post X-POST (Dr.Frédéric Raux) Clinical View Pre-op. X-Ray Removal of root canal filling + preparation of post space Cleaning of root canal Choice of post and length Wetting of post with bonding agent Validation of adapted pre-form for core build-up Etching and rinsing of dentin Application of the bonding Elimination of surplus Application of the cement Placement of post Placement of pre-form Elimination of surplus Light-curing Core build-up