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Obturation
The process of filling canals has moved toward the use of thermoplasticized gutta percha. The days of cold gutta percha techniques are numbered simply because research has shown that vertical compaction of warmed gutta percha produces the best seal. Here are some of the products that help me achieve reliable, predictable fill of endodontic cases.



Touch and Heat M5002

The Analytic Technology Company was the first to introduce an electronic heat carrier for use with the Schilder Technique back in the 1980s. I prefer the M5002 unit that unfortunately is no longer available. I found the battery-based units were too heavy and large. Since I was purchasing one for each operatory, I did not need a "portable unit". This version is extremely compact and relies upon a transformer based power supply that plugs in to the back of the device. Even without a battery, this allows for easy "swap' of units when one is down or if I need one from another operatory.

I use the 5002 in the "Constant" heat setting rather than the intermittent "heat/cool - touch on/off" method. Tip life is slightly shorter with this method but heat is more consistent.

Clinical Tips:
  1. Clean the tips frequently. They can easily get coated with charred Gutta percha residue. This makes it harder to insert the tips into the deeper portions of the canal.
  2. Resist the urge to use sandpaper or an emery board too often on the tips. The tip is essentially a hollow heating element with a wire inside, connected at the end of the tip. Filing off the extreme end of the tip will sever the connection between the wire and element and ruin it. You will notice this immediately, as the tip will be cold even at the highest setting. Replace it.
  3. Tips can be bent to conform to the canal shapes but be careful when bending them.
  4. When placing the tip wand back in the holder, always insert it "tip up" to prevent bending it the next time you retrieve it from the holder.
  5. Always align the tip opposite to the direction of the light indicator at the end of the wand. This ensures that the power cord is pointing "down" in the same direction as the tip. Otherwise the power cord can tangle or snag when the wand is being passed.
  6. Tips will need to be replaced occasionally. You can tell that the tip is getting old because you will need to use a higher setting to get it to heat properly.
 
 

Feathered Gutta Percha

As canal tapers increase with the use of Ni-Ti instrumentation, canal shapes will take on a smaller diameter at the apex and become less large cervically. I am currently using Analytic Technology brand feathered gutta percha. Many different brands of gutta percha are available. The use of a warm vertical technique demands close adaptation of the gutta percha cone to the canal space. This means that feathered edge gutta percha cones of the "non standardized" type must be used to ensure adequate position and tugback during placement. The feathered tips also allow for better sizing by virtue of their ability to be accurately cut to approximate the apical foramen size or MAF ( Master apical file ) diameter.
   
Kerr Sealer - Std.

Proponents of the warm gutta percha technique ( especially those from Boston University) are familiar with the research associated with this well known sealer. They have used it with great success for over 30 years. It is available in "Extended Working Time" (EWT) version but I prefer the original. When mixed properly it should have a creamy consistency and will set in about 15-20 minutes depending on how it is mixed and the heat/humidity level of the operatory. I like it because unlike some of the resin based cements, it is easy to remove during retreatment. It also has shown to cause minimal clinically perceptive periapical irritation to my patients, even in the cases where larger than desirable amounts of sealer have been extruded during packing procedures.
   
   

Obtura II

The Obtura Thermoplasticized Gutta Percha system remains the standard for Gutta Percha backfilling of canals. It is quick, easy, reliable and relatively inexpensive. While the initial cost of purchase may be higher than some of the syringe-type injectable systems, it is far superior. Although some have advocated its use for the entire canal fill, I have some concerns regarding its results when used with patent canals. I prefer to have good patency in my shaped canals. The "gutta percha gun" technique suggests the use of this product with a non patent apex or "apical constriction" ( both are concepts that I believe do not work with modern endodontics) Still, its great for backfilling. Buy it. It's worth it.

Here are some tips on using it:

  1. For multi-op situations where only one Obtura has been purchased, always purchase a second power cord and leave it plugged into the second operatory socket. In that way, all you have to do is move the unit and plug the power cord into the back of the control unit.
  2. Place only one GP cartridge into the heating chamber at a time.
  3. Clean the Unit regularly.
  4. Use the bending tool to bend the needles. They are made of silver and kink easily. Replacing them often is expensive.
  5. When backfilling the canal, leave the needle in the canal for a few seconds before injecting. This heats the gutta percha in the canal and results in better union with less chance of voids.

NEW Obtura Spartan has just released the new version of its Obtura product:


A .pdf file of the specifications of this new device can be downloaded with this link Obtura web site link: NewObtura