Obturation Techniques - Castelucci

Obturation Techniques: Castelucci
Hollow tube theory:
In 1931, Rickert and Dixon 125 formulated the “hollow tube theory,”
according to which an empty space within a living organism tends to fill
with tissue fluids in a short period of time. This theory was based on the
observation of an inflammatory reaction around the ends of hollow steel and
platinum anesthetic needle fragments implanted in experimental animals.
This reaction did not occur if the implant was made of a solid, non-porous
material.
Anachoresis:
Coolidge arrived at the conclusion that, just as within unfilled or underfilled

root canals, fluids that accumulate within empty spaces are rapidly colonized
by bacteria which reach these spaces by means of a phenomenon of
“anachoresis”. In other words, bacteria transported by the blood circulation
(bacteremia) colonized these areas, where they remained sheltered from
phagocytosis by the organism’s defenses.
The irritating substances derived from the breakdown of the organic material
contained in the tissue fluid and from the products of the bacterial
metabolism were supposedly the cause of the surrounding inflammatory
reaction.
There are more recent studies, therefore, strongly invalidate the previous
“hollow tube theory” and make it possible for us to conclude that empty
spaces within a living tissue are not necessarily accompanied by
inflammation or tissue destruction; on the contrary, they can be associated
with physiological repair.
Three dimensional obturation:
If, however, the root canal system is completely obturated in its three
dimensions, any remaining microorganism will be entrapped within the
dentinal tubules between the cementum on one side and the canal filling
material on the other, with no possibility of survival. Confirming Morse’s
findings, Moawad has demonstrated that such bacteria entrapped within a
completely filled root canal are nonviable within five days after root canal
filling.
The physical obturation of the canal system, withholding from bacteria their
sources of nutrients and limitating the space for multiplication. In
conclusion, obturation with gutta-percha and sealer during the first
appointment, after chemo-mechanical cleaning and disinfection with sodium
hypochlorite, also deprives the remaining microorganisms their nutrition and
leaves them no space to multiply to sufficient numbers to cause or maintain
disease.
Requirements for the ideal root canal filling material:
John West states that the ideal material must:
 be capable of being fully adapted to the prepared root canal walls

 be dimensionally stable
 be non-resorbable for an indefinite period of time
 be non-irritating
 be bacteriostatic, or at least should not encourage bacterial growth
 prevent discoloration of teeth
 preferably be semi-solid upon insertion and solid afterward
 be capable of sealing canals laterally as well as apically
 be impervious to moisture
 be radiopaque
 be sterile or sterilizable
 be easily removable from the root canal, if necessary
 be easily manipulable
 stick to the canal walls
 be a non-conductor of thermal changes
 be slightly expandable after placement
 set in a reasonable period of time.
Types of obturating material:
Apart from solid or semisolid materials (silver cones and gutta-percha

cones), root canal filling materials can be divided into cement-sealers,
cements, and non-setting pastes, on the basis of their method of application
and their setting characteristics in the root canal.
The cement or “sealer” must be used in absolutely minimal amounts, since it

must only improve the adaptation to the canal walls of the other, more
important, filling material, the gutta-percha.
The use of cements containing paraformaldehyde (just as, until a short time
ago, were N-2, Rocanal, and Endomethasone) is therefore unacceptable,
especially if used as the sole canal filling material as they are cytotoxic.
Sargenti’s technique:
In the past 15 years, Angelo Sargenti has repeatedly changed the

composition and name of his N-2 preparation. One of the last formulations
(1972) consisted of hydrocortisone (1.5%), titanium dioxide (2%),
trioxymethylene (7%),* lead oxide (16.5%), and zinc oxide (73%). In 1974,
the Council on Dental Therapeutics of the American Dental Association2
classified N-2 as an “unacceptable” preparation in the light of scientific
studies indicating the potential danger of the various formulations of N-2 for
the patient.
Requirements of the ideal cement-sealer:
 Easily manipulatable with ample working time

 Easily mixable in very fine powder particles and liquid form
 Tacky when mixed and adhesive to the canal walls
 Biocompatible
 Expansible while setting
 Absolutely inert
 Physically stable (unshrinkable after setting)
 Non-resorbable
 Insoluble in tissue fluids
 Radiopaque
 Not staining the tooth structure
 Bacteriostatic
 Easily removable with common solvents, if necessary
 Non-immunogenic in the periapical tissues 8,10,152
 Neither mutagenic nor carcinogenic
Jasper introduced the use of silver cones in Dentistry about 60 years ago.
Gutta percha:
The semi-solid material most widely used in Endodontics is gutta-percha,

which is derived from a rubber base obtained from several tropical plants
belonging to the genera Sapotaceae.
It is also readily sterilizable, since immersion in 5.25% sodium hypochlorite

for as little as 60 seconds suffices to eliminate even the most resistant
Bacillus subtilis spores.
If necessary, gutta-percha can easily be removed once dissolved in its

solvent (chloroform, chlorothene, eucalyptus, rectified white turpentine, or
others).
Once introduced in the root canal and heated, gutta- percha expands. This
helps to ensure a tighter seal. As already suggested, gutta-percha shrinks
during the cooling phase; thus, to compensate for thermal shrinkage, any
technique that requires heating must also require compaction.
Standardized cones:
 They are available in numbers 25 to 140, and their apical diameter and
conicity correspond to those of the instrument of the same number. These
cones are indicated in the lateral condensation technique, in which the
master cone is chosen on the basis of the last instrument used.
Non-standardized cones:
 Non-standardized cones, on the other hand, are much more conical and
pointed. Rather than being distinguished by number, they are
distinguished by size: extra-fine, fine-fine, fine, medium fine, fine-
medium, medium, medium-large, large, and extra-large.
 These cones are indicated for Schilder’s technique, since their greater
conicity allows better adaptation to the tapered preparation form of this
technique.
Recently, Stephen Buchanan introduced new gutta-percha cones called “GT

gutta-percha” and “Autofit”, distinguished by their taper: .04, .06, .08, .10, .
12. They automatically fit into the preparation made with Nikel Titanium GT
Files.
Techniques for root canal obturation with gutta-percha:
In regards to the cold lateral condensation technique and the warm vertical
condensation technique, by all means, one can discuss which technique is
superior, but one should not do so in terms of “lateral” or “vertical”, but
rather “cold compaction” or “warm compaction”. This is the true difference
between the two techniques.
Lateral condensation technique:
This technique requires the introduction of a gutta- percha cone that fits well
to the apical preparation (master cone), together with a small amount of
sealer. The appropriate metallic, rigid, conical and smooth instrument
(spreader) is used cold to compress the cone against the canal wall,
introducing this instrument between the dentin and gutta-percha. In this way,
one creates the space into which the first auxiliary cone is to be introduced.
The spreader is then re-introduced vertically. It pushes aside the gutta-percha
placed previously, so as to make space for a second auxiliary cone, and so
on, until one obtains a dense, well-adapted filling.
In vitro studies demonstrated that lateral condensation shows significantly

greater volumetric leakage as compared to other techniques, which means
that this technique cannot guarantee a good apical seal.
Lateral condensation requires a smaller amount of force than vertical

condensation to produce the same amount of stress near the apex.
In other words, vertical condensation produces a high lateral stress (namely,
lateral forces) that is uniformly distributed over the entire root surface, while
lateral condensation creates a lesser mean lateral stress with higher stresses
only in a small area, that is, near the tip of the spreader.
Thermoplastic gutta percha:
The thermoplastic gutta-percha technique was introduced by Yee et al.,

Torabinejad et al., and Marlin et al. It consists of injecting gutta-percha
heated by an electrical device into the prepared root canal.
The instrument looks like a gun whose cartridges are small gutta-percha
cylinders that are heated to a temperature that can be regulated by the user.
Exerting pressure on the “trigger” activates a piston that presses the gutta-
percha toward the tip of the instrument. Here, the gutta-percha is conveyed
through a thin silver needle that, when appropriately bent, allows one to
operate in the root canals of the various sectors of the mouth. The technique
does not exclude the use of sealer, which in this case also has the function of
lubricating the plastic material in its path toward the apex, in addition to
ensuring a better seal.
A similar study by Weller et al. has demonstrated with the operating

microscope that the Obtura II thermoplasticized injectable technique showed
the best adaptation to the prepared root canal, when compared to Thermafil
and cold lateral condensation.
They emphasize the importance of combining gutta-percha with a sealer for

the purpose of lubrication, which has also been confirmed by subsequent
studies and warn against the danger of extrusion of material beyond the
apex.
This is one of the great drawbacks of this technique: it completely lacks

apical control of the obturation. If one wishes to use this method for
complete filling of the root canal, it is necessary to construct, during the
shaping procedure, a good “apical barrier” to prevent the extrusion of
material into the periodontium.
The needle of the Obtura syringe must be positioned no less than 4-6 mm
from the end of the preparation, since if it were positioned further (8 mm or
more), a high percentage of underextended, that is, short obturations would
result.

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Obturation Techniques: Castelucci

Hollow tube theory:

Coolidge arrived at the conclusion that, just as within unfilled or underfilled

Three dimensional obturation:

Requirements for the ideal root canal filling material:

John West states that the ideal material must:

 be capable of being fully adapted to the prepared root canal walls

Types of obturating material:

Apart from solid or semisolid materials (silver cones and gutta-percha

The cement or “sealer” must be used in absolutely minimal amounts, since it

In the past 15 years, Angelo Sargenti has repeatedly changed the

Requirements of the ideal cement-sealer:

 Easily manipulatable with ample working time

The semi-solid material most widely used in Endodontics is gutta-percha,

It is also readily sterilizable, since immersion in 5.25% sodium hypochlorite

If necessary, gutta-percha can easily be removed once dissolved in its

Recently, Stephen Buchanan introduced new gutta-percha cones called “GT

Techniques for root canal obturation with gutta-percha:

Lateral condensation technique:

In vitro studies demonstrated that lateral condensation shows significantly

Lateral condensation requires a smaller amount of force than vertical

Thermoplastic gutta percha:

The thermoplastic gutta-percha technique was introduced by Yee et al.,

A similar study by Weller et al. has demonstrated with the operating

They emphasize the importance of combining gutta-percha with a sealer for

This is one of the great drawbacks of this technique: it completely lacks

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