I recently had a “girls’ night out” with a bunch of my friends (all happened to be dentists – go figure). Of course, the majority of the night we talked about teeth and our struggles as dentists. The topic of obturation came up and it inspired this blog post.
I know that we all have trouble with obturation. Even after 10 years, I do too!! I mean, I will have cases that are going SO smoothly in the beginning, I access and find the canals fast, and instrumentation is a breeze. But then I try to fit in a cone, and it’s all down hill.
I can tell you from experience that your obturation is so dependent on your instrumentation, and the real problems originate in your instrumentation.
So, when you get stuck on this last step it most likely means that you didn’t instrument well enough. I will tell you to go back to your instrumentation and do a little more.
Run your master apical file, check patency and irrigate all over again. Since the success of a root canal is more dependent on what you take out as opposed to what you put in, make sure that you have sufficiently cleaned out all the canals and created a shape that will accept your obturation. So, what I am telling you is that if you have trouble obturating your canals, there is a possibility that your canals just aren’t clean enough. Now I know that there are several reasons why your obturation may be going wonky, but the majority of the time is because of improper instrumentation.
Knowing what your file is doing for you is also really important. You should understand the shape that your file is creating for you — this will tell you how to fill it. Often times, I see dentists using a matching gutta percha cone to the size of their master apical rotary file, and it just doesn’t fit perfect as the company promised. When it comes to gutta percha there can be so much variation from cone to cone that obturating this way can be frustrating, to say the least. Ideally we want to finish our cases in one visit when possible, and it royally stinks when we obturate, take a radiograph and then realize that we want to start all over.
So, my friend (I will keep her anonymous) graciously shared her case with me so that we could turn it into a teaching point since I know that she is not alone with her struggle. I gave her feedback on the overall case, but I want to focus on the obturation in this post.
Here is the cone fit radiograph and all was going well…
She then did her downpack and backfill….
And took her final radiograph…
There are a few things that she could have done in this case to create a better outcome. The slight overfill on the distal could have been prevented by apical gauging, and the mesial working length could be improved by focusing on patency a bit more. Now there is some info that I don’t have, like what equipment is she using, and how it was used. I know I can help her with that, too.
But, the real question is: What do you do now? Do you leave it or do you take it all out and start over?
She wasn’t happy with how it turned out and I can understand her frustration. Since we are all judging each other’s root canals by the radiograph, this final radiograph needs to be spot on. She has decided that she is going to redo this root canal, but that means another visit for her patient, and lost chair time for her. But what if you could prevent this from happening? It won’t just be better for the patient, it would be better for you, too.
You know I always like to throw in a little tip that will help you out, so here it is. My question is how do you get your gutta percha out? Tell me your way, and then I will tell you mine.
I love to use a 25/.06 Profile rotary at 1000 rpms!!!
This will buzz my gutta percha out of my canals in a pinch, and can get me back to another conefit radiograph in no time. If it’s a fresh obturation you probably won’t even need chloroform to get your gutta percha out. But, if you redo the root canal on another day (like my friend will be doing) then the sealer may set and you will most likely need a solvent to get the gutta percha out of the canal. If you are nervous about running the file at that speed, then don’t take the file all the way down the canal, go about ⅔ the way down to working length, and then switch to your hand file to get the remaining gutta percha out. And don’t be too aggressive with your file since it can still separate, and then you’d have another issue. Take out only a little bit of gutta percha at a time, and if you feel that there is too much resistance, use some chloroform (aka C solution) to help soften the gutta percha at each increment.
Once you remove the gutta percha, don’t forget to reestablish patency, run your master apical file again and irrigate. And Voila! You are back at your conefit step.
Now, my friend is lucky because we work together all the time and she has me at her disposal as her specialist. But what about all the other dentists out there who don’t have someone to go to? Get on the waitlist for E-school (there’s a sign-up right below this blog) and let me help you walk through these issues so they can stop happening to you!