Optimize Your Obturation Technique: How To Save Time and Be More Efficient

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Endodontic procedures are very technical and time-consuming. Are there ways to be more efficient and save time?

Obturation: the crucial step of a successful endo treatment

 

Obturation is of critical importance and can be quite difficult to achieve. It’s considered a heavy procedure, usually occurring after 45min as the last step during a typical endodontic treatment like a root canal (RCT).


Pr. Stéphane Simon confirms this difficulty in an interview: “Obturation is the final step of a root canal treatment, and it’s an important one, why? Because we know now that … we can’t sterilize the root canal. So we still have bacteria inside the root canal and we have to close them -entomb them- inside the root canal filling.”[1]


Without a long-lasting, tight seal, there’s a risk of bacteria proliferation and infection, which lead to larger negative health effects for the body. Add to this, the potential risk of failure can mean further work and procedures for the dentist, which means extra chair time and costs! 

The warm vs. cold techniques battle: is it still relevant?

 

When it comes to obturation during an endodontic procedure, there’s no shortage of options and techniques. According to Pr. Simon, “in the past, a lot of techniques ... cold lateral condensation, single cone technique, warm compaction of gutta-percha - [these three] are the most used techniques across the world.”[2] So which one is best for optimal efficiency? Which is going to save you time and money, without compromising quality? 

Up until recently, scientific literature and traditional practices strongly favored warm techniques for obturations during root canals, for long-lasting results and a higher quality seal. But these are usually more expensive and take significantly more time.[3] So if you were looking for more productivity, you could use a cold technique, but you were also looking at potential retreatment due to a less effective procedure prone to shrinkage and leaks. [4] 

Pr. Simon expounds on the fact that all techniques share a common difficulty, whether cold or warm, which is sealer instability and shrinkage: “In all these techniques, we’re using a core material - [usually] gutta-percha (GP) is considered the best one - and a sealer to seal the GP to the root canal dentin. One of the problems with this root canal sealer is that it is not stable over time. It can [dissolve over time], creating a void between the GP and the root canal dentine … Every technique is acceptable as soon as you have a maximum of GP and a minimum of sealer. That’s why the warm vertical compaction is [considered] the best technique by specialists all over the world.”[5]

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Traditional “cold technique”[6]

 

Benefits:

  • Easy to implement

  • Time-efficient

  • Cost-effective

  • Offers options for single cone technique or lateral condensation 

  • Good length control

Drawbacks: 

  • Risks of weaker seal (leakage, voids)

 

Traditional “warm technique”[7]

 

Benefits:

  • Options for vertical condensation or thermo-plastic 

  • High seal quality as GP is melted

Drawbacks:

  • Heat up the GP = longer preparation time

  • Thermo-plastic is fast but more expensive 

  • Time-consuming

  • Risk of damaging periodontium and causing periapical inflammation from heat

Dentists speak: why new bioactive sealers are the best of both worlds

 

These techniques aren’t your only choice anymore. There is a real paradigm shift according to many practicing dentists’ testimonials and a growing body of research: bioactive sealers. While sealer shrinkage was the principal obstacle to optimal obturation, the GP was used to obturate and guarantee a high seal. However, these new innovative sealers don’t shrink and are stable over time, eliminating the need for more complicated techniques with multiple GPs. Pr. Simon elaborates on this point: “The true paradigm shift is to revisit the ‘single cone technique.’ The GP is not used as a core anymore, it’s used as a carrier and in the possible case of re-treatment. … BioRoot™ is not just a sealer, it’s also a core material.”[8] 

Bioceramics used in cold techniques could replace warm techniques

 

Scientific advances in bioceramics sealers or calcium silicate sealers mean that the “cold technique” now yields high results, and can be just as effective as warm techniques.[9] These results are possible thanks to unique low shrinkage and high sealability and are recognized by prominent endo practitioners. 

In a webinar talk about calcium silicate sealers, Pr. Francesco Mannocci, Head of Endodontology at King’s College London comments on results from a CBCT clinical trial[10] and explains that while “the technique used most often [by endodontists] remains warm thermoplastic techniques, ... single cone technique obturation with BioRoot™ has a success rate comparable to that of an epoxy-resin sealer used with thermoplasticized GP condensation,” with no discernable statistical difference. [11] 

In another webinar on bioactive-hydraulic sealers, Prof. Elisabetta Cotti and Dr. Giulia Bardini presented a new clinical study that shows that the single cone technique with BioRoot™ RCS is as efficient as warm obturation with ZOE sealers (95% of success). [12] [13]

Bioceramic materials make re-treatments easier to achieve for all dentists

 

In a recent webinar on the retreatment of root canal filled with BioRoot™ RCS, Pr. Stéphane Simon seeks to dispel a common misconception. Many dentists “don’t want to use this filling material because … they think it’s not possible to re-treat the teeth.”[14] Pr. Simon conducted his own research with a recently graduated practitioner to test re-treatment of teeth using a single cone technique, with BioRoot™ RCS versus another popular root canal sealer. Both specialist and the junior practitioner were able to disobturate to reach the apical third and retreat close to 100% of their teeth. According to this expert, there were no differences in final results and no difference between materials: “BioRoot™ is easy and fast ... Using a simple and easy technique with a good biomaterial is one of the key points to facilitate the treatments for juniors, GPs, and even seniors.” 


Another advantage according to Pr. Simon is that “BioRoot™ material cannot be infected.” BioRoot™ RCS has a high pH value, which means that even if some bacteria remain, it is not detrimental to the patient as the conditions are not in favor of bacterial growth. 


Pr. Mannocci shares this opinion, as he’s also shown successful retreatments by his colleagues done using these types of sealers, as “single-cone BioRoot™ obturations are easily removed, unlike other silicate sealers techniques.”[15]

As a versatile material, bioceramic materials help save time

 

Furthermore, Pr. Simon says you can also use BioRoot™ RCS for perforation repairs, especially apical perforations, where previously dentists were using multiple materials. “BioRoot is the most appropriate material so far on the market in the case of stripping ... because of its optimal fluidity, BioRoot™ will seal the perforation but also the root canal. ... So you do two steps in one.”[16] 

So we’ve seen that bioceramic materials like BioRoot™ RCS are easier to use and faster to use in the single-cone cold technique of root canal obturation. And here’s the real paradigm shift: because it does not shrink and provides a high seal, it is clinically proven that the BioRoot™ RCS in combination with the single-cone technique provides a successful clinical result comparable to warm obturation technique in combination with other generations of sealers. 

About BioRoot™ RCS

 

BioRoot™ RCS RCS changes the game in root canal obturation, by providing a new easy option for general practitioners and endo specialists alike. BioRoot™ RCS creates a high, long-lasting seal, without resorting to warm techniques. Its patented tricalcium silicate composition also demonstrates high clinical success rates. 

Why BioRoot RCS is the optimal choice:

 

Fast and cost-efficient

  • Faster treatment, potentially finishing in a single appointment (fast to mix and place) 

  • BioRoot™ RCS with single cone technique is as efficient as warm obturation technique with other types of sealers[17] [18]

  • You can do a multiple root tooth or even several obturations during the same appointment - reducing the number of appointments per patient

 

Easy

  • BioRoot™ RCS provides high-quality sealing even with single-cone technique (the least challenging), every dentist can achieve it

 

High clinical performance, low risk of failure

  • High seal and no shrinkage: reduce the risk of potential retreatment 

  • High biocompatibility 

  • Bioactivity ensures periapical healing

  • Alkaline pH limits bacterial growth

  • Easy to place and follow-up

In conclusion, BioRoot™ RCS is easy, fast, reliable, and a cost-efficient choice in root canal treatment for all dentists who practice endodontics. 

References

 

[1] Simon, S. “Interview Septodont.” Youtube, uploaded by Dental Sky Ltd, April 4, 2016. https://youtu.be/-oxF4rKKZHo 

[2] Simon, S. “Interview Septodont.” Ibid. 

[3] Shäfer, E. et al. A comparative evaluation of gutta-percha filled areas in curved root canals obturated with different techniques. Clin Oral Invest (2012) 16:225–230 doi 10.1007/s00784-011-0509-z

[4] Collins, J. et al. A Comparison of Three Gutta-Percha Obturation Techniques to Replicate Canal Irregularities. JOE (Vol 32, N. 8), August 2006. 

[5] Simon, S. “Interview Septodont.” YouTubeopus cit. 

[6] Septodont Endodontic Market Research (2011)

[7] Septodont Endodontic Market Research (2011)

[8] Simon, S. “Interview Septodont.” YouTubeopus cit. 

[9] Zavattini A, et al. Outcome of Root Canal Treatments Using a New Calcium Silicate Root Canal Sealer: A Non-Randomized Clinical Trial. J Clin Med. 2020;9(3):782. Published 2020 Mar 13. doi:10.3390/jcm9030782

[10] Zavattini A, et al. Outcome of Root Canal Treatments. Ibid.

[11] Mannocci. “Calcium silicate sealers and the future of root canal obturation - Pr Mannocci.” YouTube, uploaded by Septodont, June 2020. https://youtu.be/3KCezXTjwQg  

[12] Bardini G, et al. A 12-month follow-up of primary and secondary root canal treatment in teeth obturated with a hydraulic sealer [published correction appears in Clin Oral Investig. 2021 Jun 18;:]. Clin Oral Investig. 2021;25(5):2757-2764. doi:10.1007/s00784-020-03590-0

[13] Cotti, E., Bardini, G. “Webinar Bioactive-Hydraulic Sealers in a Contemporary Simple Endodontic Obturation.” YouTube, uploaded by Septodont, May 4, 2021. https://youtu.be/68JS_J17ju0 

[14] Simon, S. “Retreatment of root canal filled with BioRoot™ RCS: is it possible?” YouTube, uploaded by Septodont. Feb 28, 2018. https://youtu.be/9SURhOrWJN0 (subsequent quotes from the same source) 

[15] “Calcium silicate sealers and the future of root canal obturation - Pr Mannocci”, YouTubeopus cit.

[16] Simon, S. “Retreatment of root canal filled with BioRoot™ RCS: is it possible?” opus. cit.

[17] Bardini G, et al. A 12-month follow-up of primary and secondary root canal treatment. opus. cit.

[18] Zavattini A, et al. Outcome of Root Canal Treatments. opus. cit.