Root Canal Obturation general concepts principles

RootcanalOBTURATION
DEEPTHI P.R.
II YEAR MDS
“Perhaps there is no technical operation in dentistry or
surgery where so much depends on the conscientious
adherence to high ideals as that of pulp canal filling.”
-Hatton (1924)

Contents
• Introduction
• Definition
• Challenges & Importance of sealing the root canal system
• History
• Timing
• Preparation
• Apical extent/ length
• Longitudinal studies
• Overfilling/ overextension
• Ideal root canal filling
• Evaluation of obturation
• Errors
• Summary

Introduction
• The final objective of endodontic procedures should be the
total obturation of the root canal space
• It is the sealing off of the complex root canal system from the
PDL & bone which insures the health of the attachment
apparatus against breakdown of endodontic origin
• Key to success: The elimination of microorganisms & their by-
products
Schilder.H. JOE — Volume 32, Number 4, April 2006

After disinfection, the obturation stage:
• Fill the root canal- hermetic seal from the coronal orifice of
the canal to the apical foramen at the CDJ
• The responsibility does not end here
• Coronal seal- an integral part of endodontic treatment & vital
role in the treatment’s success
BRITISH DENTAL JOURNAL Volume 216 No. 6 MAR 21 2014

DEFINITIONS
Obturate—To fill the shaped and debrided canal space with a
temporary or permanent filling material.
Obturation technique—The method used to fill and seal a
cleaned and shaped root canal using a root canal sealer and core
filling material; sealers are frequently used as the sole
obturating material in deciduous teeth; there are a variety of
techniques used to obturate the canal space
Glossary of Endodontic Terms

Rationale, Objectives,
Importance
• Prevent the reinfection of root canals that have been
biomechanically cleaned, shaped and disinfected
Successful obturation :
• use of materials & techniques capable of densely filling the
entire root canal system
• providing a fluid tight seal from the apical segment of the
canal to the cavo-surface margin in order to prevent
reinfection.
Colleagues for Excellence. Fall 2009

Three main functions
1. Prevent coronal leakage of microorganisms or potential
nutrients to support their growth into the dead space of the
root canal system
2. Prevent periapical or periodontal fluids percolating into the
root canals and feeding microorganisms
3. Entomb any residual microorganisms that have survived the
debridement & disinfection stages of treatment, in order to
prevent their proliferation & pathogenicity
BRITISH DENTAL JOURNAL VOLUME 216 NO. 6 MAR 21 2014

• Value of total obturation of the root canal system: important
elements or judgement
1. The inability to know with certainty whether the apex has
been sealed in a nonsurgical procedure
2. The existence of numerous accessory canals, many of which
contain significant potential for the production of lateral root
abscesses

Challenges in obturation
• A space whose parameters vary infinitely from root to root or
from tooth to tooth must be obliterated completely
Coronal cavity Root canal system
• Space can be visualized
easily
• Margins of the cavity must
be extended in certain
ways to insure the removal
of all carious dentin, to
provide for the placement
of a suitable filling, & to
protect against redecay
• Filling must be most
complete in regions
beyond the visibility of the
dentist
• Cavity form developed in
cleaning & shaping root
canals must provide for the
removal of all organic
debris, give good access to
the foramina, & offer a
shape conducive to the
placement of a dense
permanent root canal
filling.

Importance of Effectively
Sealing the RC System
• Ingle & colleagues: 58% of treatment failures - incomplete
obturation
• Often poorly prepared
• Procedural errors
• Correlation between the quality of obturation & nonhealing:
presence of bacteria – Fabricus et al.
• Obturation may not influence the short-term success rates:
but in long-term studies if coronal leakage were to occur

• Cleaning & shaping determines: the degree of disinfection &
the ability to obturate the radicular space.
• Reflection of the cleaning and shaping

• Not possible to assess the quality of the seal with a radiograph
• No material or technique prevents
• Porous tubular structure of dentin and canal irregularities
Obturation of the radicular space:
• Eliminates leakage
• Reduces coronal leakage & bacterial contamination
• Seals the apex from the periapical tissue fluids
• Entombs the remaining irritants in the canal

• Coronal leakage: treatment failure
• Effective coronal seal and placing an appropriate restoration
• Use a final restorative material versus a temporary material to
prevent leakage
• Ray & Trope. (1995):
Good postendodontic restorations (80% ) vs good endodontics
& poor restorations (75.7%)
Prognosis for endodontically treated posterior teeth restored
with crowns was enhanced sixfold

• An adequate radiographic appearance : may not- adequate
seal
• Variation in radiographic interpretation by the clinician
• Overlying osseous structures
• Lack of uniformity in the obturation materials

Historical Perspectives
• Over 100 years
• Edward Hudson in 1825: Filling with gold foil
• Edmund Kells- first endodontic radiograph in 1899
• “Hermetic seal” of the canal terminating at the
dentinocemental junction- Grossman’s Principle 9 in 1967
• “Sealed against the escape or entry of air” or made ‘Airtight
by fusion or sealing’ – inaccurate
• Hermes Trismegistus - seal of wax
• Obturating the canal space: fluid leakage at the apex or the
coronal level.
• ‘‘Impermeable seal’’
• fluid-tight, fluid-impervious, or bacteria-tight seals

• Various metals, ZnOCl, paraffin & amalgam
• 1847- Hill developed the first GP root canal filling material:
“Hill’s stopping.”
• Bleached GP, carbonate of lime and quartz: patented in 1848
• 1867- Bowman made claim : the first use of gutta-percha for
canal filling in an extracted first molar.

• Perry
1883- Pointed gold wire wrapped with some soft gutta-percha
GP rolled into points & packed into the canal
Saturated the tooth cavity with alcohol
• 1887- S.S. White Company :manufacture GP points
• 1893 Rollins introduced a new type of gutta-percha to which
he added vermilion

• Additional filling material : fill the voids
• Hard-setting dental cements: unsatisfactory
• Strong antiseptic action: phenolic or formalin-type paste
cements
• Callahan (1914): softening & dissolution of the gutta-percha -
cementing agent
• Various pastes, sealers & cements

Factors influencing complete
obturation
• Quality of the cleaning and shaping of the canal system
• Skill and experience of the clinician
• Materials and their usage
• Restoration of the tooth
• Health of the supporting periodontium
www.ineedce.com Root Canal Obturation: An update

Timing of Obturation
• RC system is dry and time permits, obturating at the same visit
is recommended.
• If a dry root canal system not achieved: inter-appointment
dressing.
• Asymptomatic
• Mild/ significant symptoms: asymptomatic upon obturation
BRITISH DENTAL JOURNAL VOLUME 216 NO. 6 MAR 21 2014

• Negative bacterial cultures.
• Sjogren et al. 5-year recall
• 94% of cases - negative cultures: successful
• 68% of those filled with positive cultures were successful
• Procedural concerns
• Difficult cases- multiple appointments
• Medical conditions, psychologic state of mind, and fatigue.

Preparation for Obturation
• Obturation materials designed to bond with dentin, irrigation
solutions must be used with consideration of the condition of
the dentin surface that is most suitable for bonding
• Smear layer: slowly disintegrate & dissolve around leaking
obturation materials
• Sealer penetration into dentinal tubules does not occur when
the smear layer is present

• Increased bond strength and reduced microleakage in teeth
obturated with AH-26
• Removal of the smear layer: adhesion of sealers to dentin &
tubular penetration
• Clarke- Holke et al. 60% of the samples in which the smear
layer was not removed demonstrated bacterial leakage. There
was no leakage in specimens from which the smear layer was
removed.

Preparation for Obturation
• 17% disodium EDTA for one minute, followed by a final rinse
of sodium hypochlorite
• Sonic and ultrasonic instrumentation
• Mixture of a tetracycline isomer, an acid, and a detergent
(MTAD)
• 50% HNO3
• Tetracycline
• Concern: increased dentin permeability due to
demineralisation

LENGTH/ APICAL EXTENT OF
OBTURATION
• The totality of the 3D filling of the RC is more important than
its vertical extent alone
• Disagreement where to terminate instrumentation and
obturation
• Kuttler : Termination should be to the apical constriction,
when the apical constriction exists.
• Seltzer et al. The reaction to tissues were milder when
instrumenting short of the apex as compared to instrumenting
beyond the apex.
Schaeffer et al. JOE — Volume 31, Number 4, April 2005

OBTURATION
• Most North American and European Schools: instrumentation
& obturation should be contained within the root canal
(Cailleteau & Mullaney 1997)
• Weine: A point located 1mm coronal to the apex is close to
the area of the CDJ; 1mm short of the radiographic apex-
probably acceptable.
• Agreed with Kuttler's study (1955) which identified a smaller
diameter or `apical constriction‘ as the point where the canal
preparation should end and where the deposition of calcified
tissue is most desirable.
Ricucci.D. International Endodontic Journal (1998) 31, 384 -393

• Weine: Periapical radiolucency with radiographic signs of
apical resorption, the preparation should be shortened by an
additional 0.5mm from the radiographic apex.
• Suggested instrumentation & obturation to the CDJ, (1982)
which he believed was located at the same level as the apical
constriction
• Nguyen (1985) indicated the CDJ as the limit of the
preparation
• Ingle (1973): Obturation at 0.5mm from the radiographic
apex; obturating up to the radiographic terminus of the root
actually results in an overfilling.

• Frank et al. (1988) suggested an apical stop located between
0.5mm and 1mm from the apex
• Too much importance has been given to lateral & accessory
canals; their importance is relatively little if the main canal is
properly prepared and filled. Their obturation happens by
chance & does not have clinical significance.
• Guldener (1985): A working length which corresponds to the
tooth length less 0.5mm for cases with a necrotic pulp. In
cases of vital pulp extirpation: an additional reduction of
0.5 mm, 1mm short of the tooth length.

• Taylor (1988): a narrower spot at the apical level called `Minor
Diameter' which he believed to correspond histologically to
the CDJ
• Langeland (1957, 1967, 1987, 1995): termination of
instrumentation & obturation at the apical constriction
• “The most frustrating clinical aspect is that no exact distance
from the radiographic apex could be given, because the
distance from the radiographic apex to the apical constriction
varies widely from root to root”
• All endodontic sealers are irritant and resorbable (1974, 1995)

Langeland- 1996
• CDJ: histopathological structure which cannot be found
clinically and thus cannot be instrumented/ obturated.
• Carefully study a high quality radiograph in a viewing device
blocking out all extraneous light
• Have the knowledge of the variations of RC anatomy foremost
in your mind
• Use your tactile sense to locate the apical constriction,
observe if blood or other tissue fluids appear on the
instrument tip, or anywhere on a paper cone, indicating that
you are in the periapical tissue.
• This is an inaccurate art, based on precise science.

Langeland
• Finally, put it all together using common sense
• Instrumentation beyond the foraminal constriction causes an
unnecessary enlargement of the pulpal wound
• Contaminants :wound healing
• Medicaments and/or materials - tissue destruction,
inflammation, and a foreign body reaction in the periapical
tissue'

OBTURATION
• Pecchioni (1983) : “during instrumentation it is better not to
go nearer than 0.5±1mm from the radiographic apex”.
• Obturation should end at 0.5mm from the radiographic apex
• `. . . while it is very serious and damaging to go beyond this
limit with instrumentation, it is less serious to slightly overfill
the apex, since the common sealers are generally tolerated
and easily resorbable‘
• Weine (1982) suggested shortening the working length,
Guldener (1985) suggested increasing it.
• An apical overfilling in necrotic cases has also been suggested
Pecchioni (1983).

Schilder -1967, 1976
• Debridement and obturation to the radiographic apex, which
often results in material being extruded into periradicular
tissues
• 3 - 5% NaOCl solution completely removes necrotic organic
debris
• Opposed limitation of preparation at the CDJ or at the apical
constriction: too approximate to apply a mathematical or
statistical formula (0.5, 1 or 2 mm).
• Schilder (1987) later requested that canal instrumentation and
obturation should stop at the canal terminus
• Scianamblo (1989): RCs & ramifications can be effectively
cleaned during cleaning and shaping if these systems are
properly irrigated with NaOCl

OBTURATION
• Green, Frank, & Stein advocated obturating short of the
radiographic apex (0.5–2.0 mm)
• Walton, Torabinejad & Weine : obturating short of the
radiographic apex, and in the presence of root and/or bone
resorption, preparation and obturation should be to even
shorter lengths

• Obturations 0 to 1mm short of the apex were better than
obturations 1 to 3mm short of the apex
• Both were superior to obturations beyond the apex.
• Obturating materials extruding beyond the radiographic apex
correlated with a decreased prognosis

Cementodentinal Junction:
• The point which divides the pulp tissue from the tissue of the
periodontal ligament.
• Small distance within the apical end of the root canal and at a
somewhat constricted portion of the apical opening.
• Fills the root canal without impingement on the periapical
tissues & encourages the eventual physiologic closure of the
root canal with cementum.

Cementodentinal Junction:
In order to fill to the CDJ:
• sense of feel
• fills all canals 0.5 to 1mm short in the hope of ending the root
canal filling properly.
• Position of CDJ is highly variable
from one tooth to another &
even from one wall to the
opposite wall of the same root.

• The cementum may join the dentin 0.5mm inside the root on
one surface, and 3 or 4 mm inside on the opposite surface
• CDJ may occur outside the RC completely.
• Feeling for the apical constriction, very difficult for less
experienced operators.

Radiographic apex
• The point where the
root canal appears to
join the PDL as viewed
in a roentgenogram
• 100% total filling
• Probably overextended
beyond the root
• Markedly curved
canals exit their roots
at a point which is
invisible
radiographically: such
filling avoided
Schilder.H.JOE—Volume
32,Number4,April2006

• Success: filling RCs to their radiographic apices or beyond
• Stimulation by RC filling material: healing
• Continued success: Filling to the CDJ
• Thoroughness of 3D filling along the major extent of the RC.

Longitudinal studies
• Strindberg (1956): 775 endodontically treated roots, reviewed
up to 10 years after treatment: the highest success rate -
obturation terminated 1mm short of the radiographic apex
• Swartz et al. (1983): 1007 endodontically treated teeth, 1770
canals: ‘ overfilled canals were four times more likely to fail
than canals filled short of the radiographical apex'.

• Marin (1989): Retrospective analysis: 1200 roots treated over
a period of 5 years: `cases with fillings at 0.5 and 1mm from
the radiological apex appear to have a significantly superior
clinical prognosis’
• Reaches or goes beyond radiological apex: decrease in the
number of complete repairs and a consequent increase in
incomplete repairs and failures

• Sjogren et al. (1990): roots with necrotic pulps & periapical
lesions the best prognosis was obtained when the filling
reached within 2mm of the apex (94%).
• Excess root filling: success rate decreased to 76%
• Excess root filling during retreatment of previously filled
roots : 50%.
• Smith et al. (1993): 86.95% success rate when the position of
the root filling was within 2mm of the radiographic apex
• `Long' obturation : 75%
• Friedman et al. (1995): Presence of extruded sealer the
success rate was 56.7% against 81.9% in the absence of
extrusion.

Anatomical evidence
• Preiswerk (1903): First to describe the presence of an
anastomosing canal system
• Hess (1917) : study of the anatomical complexity of the root
canal system.
• Kuttler (1955) : impressive number of measurements on the
apical part of the canal

• Gutierrez & Aguayo (1995): 140 extracted permanent teeth
with a SEM.
All the root canals- deviate from the long axis of their roots
The number of foramina : 1 to 6
The openings always ended short of the apices by 0.20±3.80
mm.
Very seldom does a root canal end at the radiographic apex.

• Phenomenon: recognizable on the radiograph only when the
foramen ends on the mesial or distal aspect of the root
• Cases of endodontic failure where the canal appeared to be
filled short of the apex radiographically: obturated beyond
the foramen.
• Langeland (1996): refused to settle for any particular length
from the apex.
• The radiographic apex with all its radiographic inaccuracies is
the `constant' against which the everchanging distance from
the anatomical apical constriction must be measured:
inaccurate
Ricucci.D International Endodontic Journal (1998) 31, 384 -393

Histological evidence
• The first scientific basis for modern clinical endodontology was
established by Davis (1922)
• On the basis of Hess's study (1917): first to suggest that
careful treatment of the apical tissue was a requirement for
success in endodontics
• First histological studies on pulp wound healing were made by
Hatton et al. (1928) & by Blayney (1929)
• Studies: Vital pulp treatment- partial pulpectomy was
preferred to total pulp removal
Ricucci.D International Endodontic Journal (1998) 31, 384 -393

• The recommendation for the termination at the apical
constriction is based on sound wound healing principles:
• Severance of the tissue creates the smallest possible wound;
the less tissue to heal the better the cure.
• The patency technique by Buchanan (1989) violates this cure.
• `Patency' means the use of `a small flexible K-file which will
passively move through the apical constricture without
widening it'.
Ricucci & Langeland—International Endodontic Journal, 31, 394-409

• Nygaard-Ostby (1939 & 1944): Better prognosis was obtained
when that tissue was left undisturbed in vital cases
• Langeland (1987): demonstrated that undisturbed &
uninflamed tissue also occurs in cases where there is necrosis
in the canals

• Apical foramen: more often than not, >1 mm short of the
radiographic apex
• Obturations 1 mm short of the radiographic apex are in fact in
the periapical tissue creating a larger wound (Ricucci et al.
1990)
Ricucci&Langeland—InternationalEndodonticJournal,31,394-409

• Sealers & GP tissue destruction, inflammation & a foreign
body reaction
• Oblique apex and the filling radiographically ends short on one
side & is over-extended on the opposite side of the apex

• The filling beyond the apex : lowest prognosis.
• Materials used are not biocompatible
• Clinical failures could be observed even in the absence of
bacteria

Wise old suggestion :
• Slightly underextend root canal fillings in cases of vital
extirpation
• Fill to the radiographic apex or slightly beyond in cases of
pulpal necrosis and gangrene

• Best prognosis for RCT : adequate instrumentation &
homogeneous obturation to the apical constriction.
• Worst prognosis: instrumentation & filling beyond the apical
constriction.
• Second worst prognosis: Obturation >2 mm short of the apical
constriction, combined with poor instrumentation and
obturation.

• The distance between the foramen & the apical constriction is
often > 1 mm, e.g. 3 mm.
• Lateral canals and/or apical ramifications:
(i) cannot be debrided mechanically or chemically
(ii) when `filled', the injected material causes tissue destruction
and inflammation
• Radiographic demonstration of them does not mean
excellence in endodontics

Overfilling vs Overextension
• Over and under extension refer solely to the vertical
dimension of the root canal filling, beyond or short of the root
apex.
• Underfilled tooth : A tooth whose RC system has been
inadequately obturated in any dimension, leaving large
reservoirs for recontamination and infection.
• Underfilling—An incomplete obturation of the root canal
space with resultant voids

• Overfilled tooth: One whose RC system has been filled in
three dimensions,& where a surplus of material extrudes
beyond the foramina
• Overfilling—A solid or semi-solid core root canal filling
extending beyond the apical foramen; commonly used to imply
that the root canal space is completely obturated.
• Overextension—A solid or semi-solid core root canal filling
extending beyond the apical foramen, often the result of
failure to create an apical stop during instrumentation;
commonly used to imply that the root canal space is not
completely obturated.

Overfilling vs Overextension
• No case of endodontic failure due to overfilling, ie. when the
root canal has been obturated in its entirety & surplus
material has been intruded into the apical periodontium (prev.
fig)
• Numerous cases of failure of vertical overextensions of
underfilled root canals.
• GP or silver cones- carelessly forced into the apical
periodontium
• Additional insult to the primary problem, namely the
underfilled root canal.

• Obturation: surrogate marker of how well the canal has been
prepared and cleaned
• Judged by its taper, condensation & length
• Aiming to provide a well condensed root filling ending just
coronal to the apical foramen is desirable and important

Ideal Root Canal Filling
• Three-dimensionally fills the entire RC system as close to the
CDJ as possible
• Shape reflecting a continuously tapered funnel: approx. the
same as the external root morphology
• Radiographically: dense, 3D filling that extends as close as
possible to the CDJ
Root Canal Obturation: An update

Ideal Root Canal Filling
• “ RC sealers are used in conjunction with a biologically
acceptable semisolid or solid obturating material to establish
an adequate seal of the RC system”-AAE’s Guide to Clinical
Endodontics
• “Paraformaldehyde-containing paste or obturating materials
have been shown to be unsafe. Root canal obturation with
paraformaldehyde-containing materials is below the standard
of care for endodontic treatment”

Evaluation of obturation
The radiographic appearance of a completed case should show
the obturation material:
(1) At the apical terminus without excessive material
overextending into periapical tissues
(2) Completely filling the root canal system in three dimensions
(3) Appearing as a dense radiopaque filling of the root canal
system

Clinical evaluation
• Normal findings to routine tests
• Concerned about prognosis, the reevaluation visit should be
scheduled in a few weeks
• Routine reevaluation periods: 6 months and 1 year.
• If symptoms occur they should call the office for an
appointment

Radiographic evaluation
• Length, Shape & Density
• The length of an ideal fill should be from the canal’s apical
minor constriction to the canal orifice unless a post is planned.
The core restoration- the cavo-surface margin.
• The shape of the completed case: obturation technique being
used
• Voids should not be visible on the radiographic image
• GP & sealer removal to the facial CEJ or the canal orifice in
posterior teeth
• Adequate provisional restoration or definitive

Variability in radiographic
interpretation
• Differences in radiopacity in sealer/cements
• Constituents in specific brands of GP
• Interpretation of voids in vivo versus in vitro
• Overlying bony anatomy
• Radiographic angulation
• Limited 2D view

Density of the apical portion of the fill:
Highly radiopaque sealers/cements
Apical portion filled only with sealer: the false impression of a
dense,3D obturation with GP
• Voids masked by the density of the sealer.
• Radiopacity of selaer: claim to superiority- unfounded &
unwarranted.
• Aesthetic appearance of the obturated canal system-
secondary to meticulous cleaning and shaping

In vitro methods
• ‘Sealability’ of root canals following obturation: traditionally
tested by leakage studies.
• Validity of these studies ???
• The clinical implications for laboratory-based ‘sealability’
experimental models: unclear
• Many leakage models are non-reproducible
Int Endod J. 2012 Dec;45(12):1063-4

In vitro studies
Methods of microleakage evaluation
• Dye penetration
• Radioisotopes
• Electrochemical
• Fluorometrics
• SEM
• Root clarification
• Fluid filtration
• Fluid transport
• Proteins
• Endotoxins
• Glucose penetration

Leakage
Coronal leakage
Microorganisms from the oral cavity that penetrates the whole
root canal system to eventually trigger a host reaction in the
apical periodontium.
Apical leakage
Infiltration of the apical root segment by peptides and other
molecules, which have the potential to support microbial
metabolism in the filled root canal system
International Endodontic Journal, 44, 183–194, 2011

Issues in research
• Anatomy of the RC system: main confounding factor
Use paired teeth
• Routes of microbial leakage -traced histologically to validate
the two-chamber model
• RC sealer penetrating into dentinal tubules: not indication of
superior root filling technique or material
Int Endod J. 2012 Dec;45(12):1063-4

Two-chamber system
• Tooth sealed in between the upper & the lower chamber.
• Turbidity or a colour reaction in the originally sterile broth in
the lower chamber
Leakage of viable microorgansims
• Bacterial leakage around fillings (Mortensen et al. 1965)
• Endodontics: Goldman et al. 1980

Possible reasons
• More sensitive than histology
• Inherent problem with the set-up: the assumption that
leakage should occur through the RC space rather than
through other routes could be wrong

• Route of leakage between the two chambers: inadequately
controlled for
• Check the interface between outer root surface and the
sealing material used to separate the chambers

Voids
• Concern when using GP
• Eguchi et al.
• ‘using different condensation techniques and different sealers
would likely produce more sealer (and less GP) in some areas
of the canal
• Obturating techniques: the most mass of core filling material
would require much less sealer for an adequate canal seal

Tissue toxicity
(1) cytotoxicity evaluation
(2) subcutaneous implantation
(3) intraosseous implantation
(4) in vivo periapical
Chisholm: ZnO & oil of cloves 130 years ago, to dentistry
• Eugenol: quite cytotoxic
• Proven track record

Obturation Errors
• Result of inadequate cleaning and shaping
• If not an instrumentation error: reversible procedural error on
the obturation check film
• Gross overextension of material into the periapical tissues:
conventional means /periapical surgery
• Difficulty with the obturation phase: Cleaning and shaping
technique should be reevaluated prior to consideration of
changing obturation techniques

Summary
• The most desirable way to render RCs innocuous is to clean
and shape them, to eliminate bacteria and tissue debris from
within them, & then to obliterate them by means of a dense
3D filling
• Root canal filling procedures should be directed toward the
filling of significant lateral canals as well as the filling of main
root canals
• The final test of a root canal filling is its capacity to seal off the
RC system from the periapical tissues

References
• Cohen’s Pathways of the Pulp
• Endodontics. 6th ed.
• R. M. E. Tomson, N. Polycarpou & P. L. Tomson. Contemporary
obturation of the root canal system .BRITISH DENTAL
JOURNAL VOLUME 216 NO. 6 MAR 21 2014
• Schilder H, D.D.S. Filling Root Canals in Three Dimensions. JOE
— Volume 32, Number 4, April 2006, 281-290
• Obturation of Root Canal Systems . Colleagues for Excellence.
Fall 2009
• D . Ricucci. Apical limit of root canal instrumentation and
obturation, part 1. Literature review. International Endodontic
Journal (1998) 31, 384-393

• D. Ricucci & K. Langeland. Apical limit of root canal
instrumentation and obturation, part 2. A histological study.
International Endodontic Journal (1998) 31, 394-409
• Schaeffer MA, White RR, Walton RE. Determining the Optimal
Obturation Length: A Meta-Analysis of Literature. JOE —
Volume 31, Number 4, April 2005
• De-Deus G. Research that matters - root canal filling and
leakage studies. Int Endod J. 2012 Dec;45(12):1063-4.
• James L. Gutmann. Root Canal Obturation: An update.
www.ineedce. com.
• D.-K. Rechenberg, G. De-Deus & M. Zehnder. Potential
systematic error in laboratory experiments on microbial
leakage through filled root canals: review of published articles.

Root Canal Obturation general concepts principles

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