obturation is a procedure in which the root canal space is filled with
canal-filling materials at the final stage of root canal treatment, after
cleaning and shaping. The objective of root canal obturation is to prevent or
treat periapical disease by preventing recontamination by bacteria that may
have remained in the dentinal tubules or that exist in the oral cavity (Kim, et
dimensional seal of the root canal system is achieved by proper root canal
obturation to prevent the recurrence of bacterial infection. The microleakage
between the root canal and the periapical tissues is hindered leading to death
of any surviving microorganisms. This prevents the entry of nutrients and toxic
bacterial products into the periapical tissues. Various techniques have been
developed to achieve the proper obturation of root canal system including the
vertical compaction, lateral compaction and carrier based obturation (Gupta, et
nickel-titanium (NiTi) instruments are widely used for root canal
instrumentation. This widespread use of these instruments has caused
manufacturers to offer corresponding gutta-percha cones that match the taper
and diameter of the instruments. It is claimed that these cones will match the
taper and diameter of the canals prepared with the rotary NiTi instruments.
Obturation with these cones used as a single-cone technique is alleged to
provide a 3D obturation in less time than traditional obturation techniques and
to ensure a high volume of gutta-percha in the canal (Schafer, et al, 2013).
The root canal
preparations with NiTi rotary systems are more conical than manual
preparations. Tapered single cones were introduced in the market in order to
improve the gutta-percha/root canal sealer balance. If the diameter and
conicity correspond exactly with the final shaping instrument, the quality of
obturation would be superior to that of the classic single-cone technique
(Robberecht, et al, 2012).
The advent of
computed tomography (CT) has started a revolution of information in health
studies and has contributed to planning, diagnosis, treatment, and prognosis
analysis of several diseases. Cone-beam computed tomography (CBCT) is a
recently developed technology with potential for applications in different
areas of research and clinical dentistry. It designed for imaging hard tissues
of the maxillofacial region, and capable of providing a 3-dimensional
representation of the maxillofacial skeleton with minimal distortion (Decurcio,
et al, 2012. Scarfe, et al, 2006).
The goal of successful endodontic
treatment is to complete the obturation of the root canal with an inert filling
material and hermetic apical seal also one of the criteria believed to be
important the integrity
of the root canal filling in the apical few millimetres. A solid core cemented
in the root canal with a sealer is the most use obturation methods (Gencoglu,
et al, 2002).?
studies the percentage of gutta-percha filled area (PGP) has been measured. The
better quality of obturation have smaller area of sealer and voids and the PGP
is higher. When the PGP score is lower reveal a problem in filling or anal
occupied by debris. The PGP score lower in oval canal due to difficult to place
secondary cones in the wing and irregular shape of the wing reveal a problem
when using the cold lateral compaction technique (Sluis, et al, 2005).
condensation technique resulted in virtually of gaps and high amounts of sealer
on the root surface, unlike the thermafil obturation technique. With the
lateral condensation technique tubule sealer penetration occurred, it’s deeper
especially in the mid and apical zones (Guigand, et al, 2005).
studies the comparison between the thermoplasticized gutta-percha and cold
lateral condensation in the quality of root fillings has been evaluated, with
differing conclusions. On radiographs, results in the apical third for both
methods were similar, but generally better adaptation than lateral condensation
showed with the thermafil obturation technique. Scanning electron microscopic
observations for Ultrafil, Thermafil and lateral condensation showed better
dentinal wall adaptation in roots obturated with thermoplasticized gutta-percha
than in laterally condensed root canal fillings, regardless of the presence or
absence of a smear layer (Kqiku, et al, 2006).
The total obturation of the root canal
space is the final objective of endodontic procedures. To achieve total root
canal obturation many root canal filling techniques have been developed. Most
of the currently employed techniques use either a solid core and a cementing
substance, or a plastic material which can be adapted more or less to the shape
of the root canal system (Schilder,2006).
showed the lowest gaps and voids at the apical third where Gutta-percha
exhibited the lowest percentage of voids and gaps in the root sections. This
also can be attributed to the filling technique, because the manufacturers of
GuttaFlow recommend that it is dispensed first in the apical part of the root
canal, and then a master gutta-percha cone is placed. This ensures the least
amount of voids and gaps in the apical third (Hammad, et al, 2009).
materials and techniques have been developed for filling root canals. It has
been reported that the quality of adaptation between the surface of the root
canal and the gutta-percha is uncertain in fillings created by the lateral
condensation technique, even though this method has the advantage of creating a
tight apical seal through compression of several gutta-percha cones with
spreaders. However, canal curvature and other anatomic features may prevent
achievement of this tight seal.6 In addition, metal spreaders must be placed in
the canal several times during the filling process for lateral compaction of the
gutta-percha, but practitioners may have difficulty achieving the required
balance between optimal compression of the gutta-percha and avoidance of root
fracture through application of too much pressure (Tasdemir, et al,2009).
On a study of
using micro-CT-based quantitative three-dimensional method for analysis of root
canal filling adaptation to the canal walls was presented. It may serve as a
useful tool to study and compare the quality of root canal fillings. Within the
limitations of the present study, the self-adjusting files allowed better
cleaning and shaping and better adaptation of the root canal filling than those
allowed by rotary files (Metzger, et al, 2010).
facilitates three-dimensional cleaning by removing restrictive dentin, allowing
a more effective volume of irrigant to penetrate, circulate, and potentially
clean into all aspects of the root canal system. Well-shaped canals result in a
tapered preparation that serves to control and limit the movement of warm gutta
percha during obturation procedures. Importantly, shaping also facilitates 3D
obturation by allowing pre-fit pluggers to work deep and unrestricted by
dentinal walls and move thermosoftened obturation materials into all aspects of
the root canal system. Improvement in obturation potential is largely
attributable to the extraordinary technological advancements in shaping canals
and cleaning and filling root canal systems (Ruddle, 2010).
was found between root canal morphology and the master cone adjustment variables
in the “Single-cone” group. When the morphology was oval, we observed better
gutta-percha adjustment. This could be explained by the smaller amount of
friction between the master-cone and the root canal walls in an oval canal
compared with a circular canal. This correlation was not found in the “Combined
system” group. This was to be expected, because if the gutta-percha is heated
and condensed, the root canal morphology no longer matters (Robberecht, et al,
To cope with
such different obturation difficulties many root obturating techniques have
been evaluated over the years and the filling materials from simple paste
mixtures to silver points with sealing cements. To obturate root canal system the
ideal obturating material chosen should be non-irritating, non-toxic,
radiopaque, easily manipulated, insoluble in tissue fluids and able to adapt to
canal walls. Gutta-percha
is currently the material of choice due to its inertness, biocompatibility,
dimensional stability and plasticity (Qureshi, et al, 2012).
obturation of the prepared root canals is essential to long- term clinical
success of root canal therapy. The root canal system should be sealed apically,
coronally, and laterally and the obturation material should be of uniform
density. Epley et al and Schilder suggested that the ideal root canal obturating
material should be well-adapted to the canal walls and its irregularities and
the entire length of the canal be densely compacted with homogenous mass of
gutta-percha. Several materials and techniques have been developed for
achieving a successful obturation, gutta-percha is the most commonly used root
canal obturation material and its physical properties have made it possible to
use it in several different techniques (Mustafa, 2013).
consideration of gutta-percha has been proven to be a very popular and
clinically effective filling technique. However, Schilder reported that final
filling by lateral consideration resulted in a non-homogeneous mass of many
separate gutta-percha cones pressed together and joined only by friction and
the cementing substance. Warm gutta-percha best fulfills the requirements of a
root canal filling because homogeneity is provided throughout the entire length
of filling (Samson, et al, 2013).
long-term stability, the filling should be well adapted to the canal walls, and
its irregularities and the entire length of the canal should be densely
compacted with a homogeneous mass of gutta-percha (Wolf, et al, 2014).
amount of obturating material was observed in Calamus group followed by
Thermafil and lateral compaction. Minimum voids were seen in obturation by
Calamus technique (Gupta, et al, 2015).
In a study
that concluded the carrier-based gutta-percha obturation systems revealed
significantly higher percentage of gutta-percha-filled area in comparison to
single-cone and lateral condensation techniques (Yilmaz, et al, 2016).
In all the
pervious study showing that different obturation method can get different
result which will affect in the quality of the root canal filling. Using
guttaflow and carrier-based gutta-percha obturation systems show the least
amount of voids and also the highest in filled area in comparing to the others