Determining the optimal obturation length

Dr.\ Ranya Elemam

BDS. Msc Endodontics

Email : [email protected]

9/11/2013

Root Canal Obturation: Determining The Optimal Obturation Length

Aim

Provide an understanding in determining termination

of obturation.

Ranya Elemam Root Canal Obturation 9/12/2013

Objectives

ↄ Understand The Anatomical Land Marks Of Apical

Zone Of The Root .

ↄ Know What Literatures State About The Termination

Length Of The Obturation .

ↄ Recognize The Relation Between The Obturation

Length And Endodontics Outcome.


Where to End the Gutta Percha?


Termination should be to the apical constriction

(Kulter et al 1955)

Kuttler Y. Microscopic investigation of root apexes. Journal of the American Dental Association (1939).

1955;50(5):544-52.


Recommendation by Literatures: 1

Obturating short of the radiographic apex 0.5–2.0 mm

(Weine 1996 )

FS W. Endodontic therapy. 6th ed. ed: MO: Mosby; 1996.



In presence of root and/or bone resorption

should be to even shorter length.

( Walton And Torabinejad 2002 )

Richard E. Walton MT. Principles and practice of endodontics. 3rd ed ed: Philadelphia, Pa. ; London :

Saunders, c2002; 2002



Apex is a more reliable reference point.

(Ricucci 2003)

5. Ricucci D, Bergenholtz G: Bacterial status in root-filled teeth exposed to the oral environment by loss of

restoration and fracture or caries—a histobacteriological study of treated cases. Int Endod J 36:787, 2003.



Debridement and obturation to the radiographic apex, results

in material being extruded into periradicular tissues. (Schilder

1974)

Schilder H. Filling root canals in three dimensions. Dental clinics of North America. 1967:723-44.



Apical Anatomy


Anatomical Rational

Radiographical apex

Anatomical Apex


Apical Anatomy

1. Apical Construction AC (Minor Apical Diameter)

2. Cement dentinal Junction CDJ

3. Radiographic apex


Anatomical Landmarks

AC: Apical Construction

ↄ May be more conceptual than real

ↄ Considered the part of the root canal with the smallest diameter.

ↄ The reference point clinicians use most often to terminate shaping, cleaning, and obturation

ↄ present less than half the time, particularly when apical root resorption was a factors .

ↄ 0-2.5 mm from the apex and increases with age because of cementum deposition

ↄ believed to coincide with the cemento-dentinal junction (CDJ)

1. Buckley M, Spangberg LS: The prevalence and technical quality of endodontic treatment in an American subpopulation. Oral Surg Oral Med

Oral Pathol Oral Radiol Endod 79:92, 1995.

2. Castelli WA, Caffesse RG, Pameijer CH, Diaz-Perez R, Farquhar J: Periodontium response to a root canal condensing device (Endotec). Oral

Surg Oral Med Oral Pathol 71:333, 1991.

3. Levitan ME, Himel VT, Luckey JB: The effect of insertion rates on fill length and adaptation of a thermoplasticized gutta-percha technique. J

Endod 29:505, 2003.

1. Kuttler Y: Microscopic investigation of root apexes. J Am Dent Assoc 50:544, 1955.


ↄ The point in the canal where cementum meets dentin and where pulp tissue

ends and periodontal tissues begin.

ↄ The location of the CDJ in the root canal varies considerably.

ↄ Estimate placed approximately 1 mm from the AF.

ↄ Based on histological section and ground specimen and cant located

precisely on radiograph

Lawley GR, Schindler WG, Walker WA, III, Kolodrubetz D: Evaluation of ultrasonically placed MTA and fracture

resistance with intracanal composite resin in a model of apexification. J Endod 30:167, 2004.

Machnick TK, Torabinejad M, Munoz CA, Shabahang S: Effect of MTAD on flexural strength and modulus of

elasticity of dentin. J Endod 29:747, 2003.

Cement dentinal Junction (CDJ)


Radiographic Apex:

ↄ It is the tip of the root where as determined radioghraphicaly

ↄ


ↄ location of the foramen not at the apex as deviations occurred in 92% of the roots.

ↄ Shaping to the radiographic apex is likely to produce over instrumentation with

potential clinical squeals of post treatment pain and inoculation of

microorganisms into periapical spaces.

Buchanan L: Continuous wave of condensation technique. Endod Prac 1:7, 1998.

El Ayouti A, Weiger R, Löst C: Frequency of overinstrumentation with an acceptable radiographic

working length. J Endod 27:49, 2001.

Thought “ is out only .5-1

mm” 0.5-1 mm

http://www.endomail.com


Thoughts: Imperfection !

http://www.endomail.com/

.

Cohen KMHaS. Cohen's Pathways of

the Pulp 10th Edition ed: Mosby; 2011.


Reality

Cohen KMHaS. Cohen's Pathways of

the Pulp 10th Edition ed: Mosby; 2011.


Reality

This variable structure in the apical region presents

challenges for root canal therapy !


Pulpal And Periapical Condition ??

1. Vital Pulpectomy: (Irreversible Pulpitis ) :

procedures terminate 2 to 3 mm short of the radiographic

apex.

2. Pulpal Necrosis:

procedures terminate at or within 2 mm of the radiographic

apex (0 to 2 mm).

Wu MK, Wesselink PR, Walton RE. Apical terminus location of root canal treatment procedures. Oral surgery, oral

Pulpal Condition


1 mm 1.5 mm 2 mm


Periapical Condition

Other Considerations

Re-treatment

It is preferable to clean the canal to the AF in retreatment !


medicine, oral pathology, oral radiology, and endodontics. 2000;89(1):99-103.

Systemic considerations

There is no definitive evidence that introducing bacteria or antigens

from infected canals into the bloodstream causes systemic diseases, it

would seem prudent to avoid this situation when possible.

Debelian G, Olsen I, Tronstad L. Anaerobic bacteremia and fungemia in patients undergoing endodontic therapy: an

overview. Ann Periodontol 1998;3:281-7


medicine, oral pathology, oral radiology, and endodontics. 2000;89(1):99-103.

Obturation Length

And

Treatment Outcome


“ Length of root canal filling was found to influence the outcome

of the endodontic treatment.

The most successful outcomes were associated with teeth without

apical extrusion of the filling material .The overextension of filling

materials was combined with delayed healing “

Elemam RF, Pretty I. Comparison of the success rate of endodontic treatment and implant

treatment. ISRN dentistry. 2011;2011:640509.


Obturation Length And Treatment Outcome

The importance of length control in obturation relates to extrusion of

materials. Studies indicate that extrusion decreases the prognosis for

complete regeneration.

Swartz DB, Skidmore AE, Griffin JA, Jr: Twenty years of endodontic success and failure. J Endod 9:198, 1983.

When the therapeutic procedures shorter 2 mm from or past the

radiographic apex, the success rate for INFECTED CANALS

was approximately 20% lower than that when the procedures

terminated at 0 to 2 mm.



ↄ Periapical pathosis was found with 43% of the teeth with overfills.

ↄ An overfilling resulted in a failure rate of 37%. this was four times greater

than cases that filled short.

Buckley M, Spangberg LS. The prevalence and technical quality of endodontic treatment in an

American subpopulation. Oral surgery, oral medicine, oral pathology, oral radiology, and

endodontics. 1995;79(1):92-100.

Swartz DB, Skidmore AE, Griffin JA, Jr. Twenty years of endodontic success and failure. Journal

of endodontics. 1983;9(5):198-202.



ↄ Teeth with root canal fillings 0–2 mm from the root apex showed significantly

better periradicular conditions than teeth with either overfillings or underfillings

ↄ The success rate in group of teeth obturated from 0 to 1 mm short of the apex

was 28.9% better than group of teeth those obturated beyond the apex and 5.9%

better than group of teeth where they were obturated 1 to 3 mm short of the apex

Moreno JO, Alves FRF, Gonçalves LS, Martinez AM, Rôças IN, Siqueira Jr JF. Periradicular Status and Quality of Root

Canal Fillings and Coronal Restorations in an Urban Colombian Population. Journal of endodontics. 2013;39(5):600-4

Schaeffer MA, White RR, Walton RE. Determining the optimal obturation length: a meta-analysis of literature. Journal

of endodontics. 2005;31(4):271-4.



On the basis of biological and clinical principles, instrumentation and

obturation should not extend beyond the apical foramen.

Ricucci D, Langeland K. Apical limit of root canal instrumentation and obturation, part 2. A histological

study. Int Endod J. 1998;31(6):394-409.



Clinical determination of apical canal morphology

is difficult at best. !!!


The apical limit of instrumentation and obturation continues

to be the subject of major controversy in root canal therapy.

However ,the use of an apex locator in conjunction with

radiographs and sound clinical judgment makes this decision

more logical.

Cohen KMHaS. Cohen's Pathways of the Pulp 10th Edition ed: Mosby; 2011.


Conclusions

Remember:

A little short is better and more conducive to a

successful root canal procedure !!


Recommended Articles/books:

1. Schaeffer MA, White RR, Walton RE. Determining the optimal

obturation length: a meta-analysis of literature. Journal of

endodontics. 2005;31(4):271-4.

2. Wu MK, Wesselink PR, Walton RE. Apical terminus location of

root canal treatment procedures. Oral surgery, oral medicine,

oral pathology, oral radiology, and endodontics. 2000;89(1):99-

103.

3. Cohen KMHaS. Cohen's Pathways of the Pulp 10th Edition ed:

Mosby; 2011.


Question ?

Determining the optimal obturation length

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