Squirt obturation technique
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Michael, John & Joey have never minded that I share some of their info. As much as I’ve learned online, this is one area that I feel I really benefited in having a hands on course. I recommend you consider their courses. Here I am describing what I learned from John & Joey as per the obturation process. The shaping process I describe isn’t exactly how they teach it but is pretty similar.. Mark ======================================================================================================================= Squirt obturation techique First of all prior to doing this technique, the canal should be shaped with gg's 1-4, or 2gg and 2 peezo. Then the apical should be shaped so as to provide continuity of taper. I use Protapers S1, S2, F1, F2, F3, and if the foramen is larger than 30 then I do some extra refinement with either .02 or .04 taper k3 files. I choose the appropriate k3 file based on the size of the foramen and the degree of curvature of the canal. Needed supplies: Obtura Gun Sterile Fine paper points 20 gauge obtura needles Kerr's EWT sealer Blue/Black Dovgan niti condensor Steps in squirt technique: 1. Canal must be as dry as possible-alcohol, evacuate, dry-paper points, stropko to air dry 2. Apply Kerr's Sealer to the canal walls with a paper point then dry off excess using dry paper point. 3. Introduce obtura tip into canal as far as it wants to go. Obtura should be turned to maximum temperature. Needle should touch canal walls, but not be firmly wedged into the canal. Begin injecting. Allow backpressure to back the obtura needle out of the canal. 4. Vertically condense with blue (size 60) Dovgan niti condenser. Condense the gutta percha (called wadding-this is something that is hard to describe), switching to the black condenser after using the blue one initially. Once the gutta percha is well "wadded" place, maintain firm condensing pressure on the gutta percha for 30 seconds/canal to help counteract the cooling shrinkage of the gutta percha. 5. Go to www.excelinendo.com if you are interested in John & Joey's hands on course which will help you master this technique. =======================================================================================================================
Mark, do you use this technique religiously or have you hybridized it a bit. I've got an Obtura II sitting on a shelf because I can't get past the point of hot gutta percha/Resilon shrinking. With Bill Watson and Fred's apical control lesson I've learned that cold material does not shrink. In my untrained reasoning, the more cold gutta percha/Resilon I can put in that well gauged apex and the less ZOE/Epiphany I put there then the less the shrinkage will be and the less leakage I'm going to allow. If I plug the apex with a cold point and back fill will I heat that plug/fitted clipped cone to the point it will shrink? I am now using System A on some cases but still feel that I'm heating the Resilon at the apex. This is the problem I have with Barry Musikant's technique. He's not really concerned with filling the shaped apical area with gutta percha. He's using the same size point on every case and slamming it home. He's depending on cold sealer to fill the apex and we know that shrinks...even AH 26. We know hot gutta percha shrinks even when held under pressure. I can't get past the reasoning that fitting a well shaped apex with an apically sized cone and very little sealer is going to give a better seal. Could I use the clipped plug pushed into place with a plugger and then back fill without heating up the plugged apex? Any answers will be welcomed. Guy Guy, I don’t have all the answers for you. I don’t know that any of these obturation techniques represent utopia. As much experience I have in doing resin bonding from my restorative years (only adhesive restorations for the last 5 years of practice), I still don’t trust that I can effect a leak-proof seal in the apical third with resin bonding. I know you feel differently. Have you ever treated some extracted teeth and cut them back to evaluate your obturation technique? I’ve done it with my technique and it looks pretty good - Mark Guy, You simpify things a bit too much and lose some accuracy in the process. I always state that the MINIMUM preparation I create is a 35 at the apex and an .08 mm/mm taper. The medium point that I fit (I prefer the ones from Dentsply Maillefer) binds about 1 mm coronally to the most apical position of the preparation. You get excellent tugback consistently when you do this. The epoxy-resin cement that we place with the bidirectional spiral followed by the generous coating of the prefitted medium gutta percha point has been shown thru dye studies to seal the apex at least as well as any other technique used. The gutta percha point's major function is to act as a carrier and a driver of the cement. it has no inherent sealing abilities of its own. One of the nice things about not doing thermoplastic techniques is you have the luxury of completely flooding the canal and the point with cement without any concern for driving signficant amounts of cement over the apex. This is simply because the coronal escape route for excess cement remains patent, unlike the almost immediate coronal blockage that occurs when using any thermoplastic technique. Another advantage is that as the cement and gutta percha warm to body temperature (from 24 degrees c to 37 degrees C) they expand approximately 1.75%. This is not a lot. but it is headed in the right direction. Between the bidirectional spiral and .08 mm/mm taper of the gutta percha, the cement is driven laterally with great efficiency. Since the viscosity of the cement at room temperature is thinner than plasticized gutta percha it takes less apical pressure to drive the cement laterally into all the nooks and crannies of the canal in the goal of achieving a 3-dimensional fill. When canals require further widening I do notg hesitate to create wider apical preparations and at times greater tapered preparations. In these cases i will either cut back on a medium point or place a .10 mm/mm tapered gutta percha point (a medium large) or a .12 mm/mm tapered gutta percha point (a large). So there is no philosophy of one size fits all, although I would say that most teeth are adequately shaped to a 35 at the apex and an .08 mm/mm taper. Certainly with the correlation of thicker rotary Niti instruments negotiating curved canals separating more frequently, the impetus to create these tapers with a rotary system encounters more risk than when done with a reciprocating system that shapes 95% of the canal space with tough inexpensive stainless steel before it uses any Niti at all. Under any circumstances we are not "slamming" that medium gutta percha home. We are placing it with care after creating a shape that accepts it with predictable tugback. In the next few days, I'll post 6 or so cases and you can judge for yourself, if it looks like the fills are just slammed home. I have a huge number of cases with lateral canals filled in the most apical 2 mm of the canal too. Regards, Barry Haven't had to extract any yet, thank God. Guy What I was talking about is doing some endo on teeth you’ve had to extract due to perio or ortho, or non-restorability, and then cut them back and look at your fills - Mark Mark, my point was not that you were not getting good fills. I have no question about that. Part of the hoopla about the new resin sealers is just how much they shrink and disintegrate. I have no doubt at all that they do not disintegrate because that would be a very easy thing to research. The question is just how much they shrink on setting. We know we have to go to great lengths to remove all bleach before obturation and that is not a difficult thing to do with modern canal preps but the material still shrinks on setting as does hot gutta percha. We also know that all resins shrink on curing whether they are self cure or light cure. I've considering going to the Simplifills as Bruce suggests and backfilling with the Obtura but how much shrinkage does that add to the resin mix? Now I only have the sealer shrinking because I'm using a single well fitted cone to plug the apex and attempting to get as little sealer as possible in that seal. Bruce, do you think that you get a better seal with Simplifill and back filling with hot Resilon or with a well fitted single cold cone alone with sealer/well fitted cone and lateral condensation? You have to heat the Simplifill with the back fill. Guy Guy, I Don’t have a definitive answer on what would seal better – Simplifill/Obtura or the lateral technique. There is research that suggests that the Simplifill technique with an Obtura backfill may be better. Heated Resilon only shrinks about 0.5%, where the sealer shrinks about 2%. Whichever technique allows the minimization of sealer should seal better. Maybe Dan Shalkey can comment on his experience with Simplifill with Resilon. Dan? - Bruce Bruce, Testing with ISO standards by Gianluca Gambarini showed that Resilon sealer expanded 0.2% - Fred Now that I like. I'm staying with cold Resilon fitted to a gauged apex with Epiphany. Hey, Fred, think Alvin Artz could put paraformaldehyde in Epiphany and do Sargenti with that since it expands rather than shrinks like ZOE? :-) Guy I like the Simplifill with PacMac backfill, or a well fitted cone pacmaced - DanS
