Root Canal Therapy: Efficient ObturationAug 16, 2022
Sometimes instrumentation of a root canal system isn't the hard part, it's the obturation.
So you've accomplished a near miracle instrumenting a premolar with a deep bifurcation (it always seems to be a premolar). But, now you have to figure out how to obturate the canal system. How do you get the gutta percha sealed in each canal to seal the canal system?
What's the best way to accomplish this?
First, let me say that I'm a single cone obturation guy. It's simple, effective and has as high a success rate as any other method of obturation.
Don't let the dental supply companies tell you differently. Look at the research. Look at the position statements of the national endodontic societies. Look at the results, not how pretty it is on the radiograph.
OK, end of rant. Moving on…
If the common trunk is wide enough to fit both GP points in simultaneously then it's relatively simple. Fit gutta percha (GP) in both canals. Now place sealer in both canals and obturate both canals simultaneously. Simple enough.
How about if the trunk is not quite wide enough? Try placing a paper point in one canal and sealer with a fitted GP in the other. Sear off the first cone, pull the paper point. Now place sealer and the second fitted GP point in the second canal.
If you've ever had to re-clear the second canal when doing these previously, give this method a try. It'll save you some time and frustration.
How about if the trunk is only wide enough for a single GP point at a time? First, fit all the cones. Now, place the first GP point with sealer and sear it off down to the bifurcation. Now reclear the second canal and obturate with GP and sealer.
I've once used this method to obturate a trifurcated lower premolar.
What about a garden variety two canals that merge short of the apex? Is there a quick and accurate way to obturate that system?
In this case, fit a cone into each canal separately and mark the measured point on the cones with a crimp on each cone. Now replace the cone that fits best first. Then place the second cone which should now not go quite all the way to place. Measure between the previous crimp and the measuring point on the tooth and trim this length from the apical end of the second cone. Now when reseated, the second cone will go to place with the crimp coming into line with the measuring point on the tooth. Place sealer and GP to finish the obturation.
I once asked a dental school instructor which was the most important phase of root canal therapy. He, in all his wisdom, said "Why doctor, it's the step you're on.” All phases of root canal therapy need to be performed well but it's important not to stumble before we cross the finish line.
P.S. Wanting to stop sending those lucrative RCT/Crowns out of the office? Join Dr. Aaron Nicholas September 16th, 2022 in Burtonsville, MD for his Hands-On One-Hour Molar Root Canal Buildup and Crown Course.
Dr. Nicholas developed this technique over decades of practicing dentistry and makes keeping molar endo in-house simple, predictable and profitable.