Dentaltown November 2017 - 79

Objectives of root filling
Currently, it is not possible to effect
optimal sterilization of the root canal space,
nor can biofilms be completely eradicated
from the interfacial dentin. Thus, the aim
involves three basic requirements from a
root filling:
1. Stop coronal leakage after the root
canal is filled and the final restoration
placed.
2. Entomb surviving microflora in the
interfacial dentin so that they cannot
reassert their presence and communicate with the periradicular tissues.
3. Prevent influx of periapical fluids
to provide nutrients for residual
microflora in the root canal space.2

Lateral- and carrierbased obturation
Many in vitro, in vivo and clinical
outcome studies have been performed primarily on single cone or lateral condensation
techniques. It is apparent that they fail in
their primary function of sealing the root
canal space long term.3-4
Sabeti et al found no diffence in the
outcome when a canal was root-filled compared to left empty. This study and others
emphasize the poor quality of our current
root filling techniques and the importance
of the coronal restoration for successful root
canal treatment outcomes.5-6
A study by Gihooly et al showed that
multiphase gutta-percha obturation had
significantly less apical dye leakage than
lateral condensation in curved canals (P <
0.05).7 Success based on degree of density is
not the issue as gutta-percha does not bond
to dentin. Sealer remains the dominant
concern re: leakage over the long term.
Fig. 2 shows that when tested in an in
vitro model, microbes will permeate the
length of the canal space in two hours if only
gutta-percha is present in the canal without

DE
GP

SE

Fig 1a. SEM of cut root filled with gutta-percha
and AH Plus sealer. Note the gap between the
gutta-percha (GP) and sealer (SE). (Courtesy of Dr.
Eldeniz, AU.)

Figs 1b (top) and 1c (above). Image shows molar
roots filled with bioceramic sealer cut at different
distances from the apex. A single gutta-percha
point is used as a cold plugger to create hydraulic
pressure that moves the sealer to the apical pulp
stump and fills any irregularities in the root canal
space.

Human Saliva Penetration of Coronally
Unsealed Obturated Root Canals
30

22,5

15
7,5
Negative
Vertical Cond

GP Only
Positive

Lateral Cond

Fig 2. In vitro evaluation of saliva penetration of root canals. Note that the seal achieved with guttapercha alone is indistinguishable from the negative control. (from Khayat et al).

dentaltown.com \\ NOVEMBER 2017

79


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Table of Contents for the Digital Edition of Dentaltown November 2017

Dentaltown November 2017 - Intro
Dentaltown November 2017 - Cover1
Dentaltown November 2017 - Cover2
Dentaltown November 2017 - 1
Dentaltown November 2017 - 2
Dentaltown November 2017 - 3
Dentaltown November 2017 - 4
Dentaltown November 2017 - 5
Dentaltown November 2017 - 6
Dentaltown November 2017 - 7
Dentaltown November 2017 - 8
Dentaltown November 2017 - 9
Dentaltown November 2017 - 10
Dentaltown November 2017 - 11
Dentaltown November 2017 - 12
Dentaltown November 2017 - 13
Dentaltown November 2017 - 14
Dentaltown November 2017 - 15
Dentaltown November 2017 - 16
Dentaltown November 2017 - 17
Dentaltown November 2017 - 18
Dentaltown November 2017 - 19
Dentaltown November 2017 - 20
Dentaltown November 2017 - 21
Dentaltown November 2017 - 22
Dentaltown November 2017 - 23
Dentaltown November 2017 - 24
Dentaltown November 2017 - 25
Dentaltown November 2017 - 26
Dentaltown November 2017 - 27
Dentaltown November 2017 - 28
Dentaltown November 2017 - 29
Dentaltown November 2017 - 30
Dentaltown November 2017 - 31
Dentaltown November 2017 - 32
Dentaltown November 2017 - 33
Dentaltown November 2017 - 34
Dentaltown November 2017 - 35
Dentaltown November 2017 - 36
Dentaltown November 2017 - 37
Dentaltown November 2017 - 38
Dentaltown November 2017 - 39
Dentaltown November 2017 - 40
Dentaltown November 2017 - 41
Dentaltown November 2017 - 42
Dentaltown November 2017 - 43
Dentaltown November 2017 - 44
Dentaltown November 2017 - 45
Dentaltown November 2017 - 46
Dentaltown November 2017 - 47
Dentaltown November 2017 - 48
Dentaltown November 2017 - 49
Dentaltown November 2017 - 50
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Dentaltown November 2017 - 53
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Dentaltown November 2017 - 55
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Dentaltown November 2017 - 63
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Dentaltown November 2017 - 65
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Dentaltown November 2017 - 71
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Dentaltown November 2017 - Cover3
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