Obturation isn’t easy. From learning what obturation is to nailing it—most of us struggle. At least a little bit. And if someone tells you otherwise, they’ve either ascended to endo enlightenment or they’re lying.
Even after more than a decade, I still have my days. 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 downhill and I end up frustrated.
In fact, I recently had a “girls’ night out” with a bunch of my friends (naturally, we all happened to be dentists!), and at the end of the night we got to talking through our struggles at work—and we ALL confessed to hating the obturation step of a root canal. All that to say—if you struggle with it, you’re not alone.
What is obturation, anyway?
Let’s get some definitions out of the way.
Obturation is a step of the root canal procedure during which the pulp chamber is filled and sealed with gutta percha.
During obturation, you’ll heat up the gutta percha, put it in the tooth, compact it, and seal it right up.
Let me just say right now that, from experience, the quality of your obturation step is so dependent on your instrumentation. If you’re encountering issues in obturation, this probably originates in your instrumentation, so start there. Go back to your instrumentation and do a little more.
Making your obturation step seamless
When you go back to do a little more instrumentation, 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.
Basically, 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. There are several reasons why your obturation may be going wonky, but improper instrumentation is such a likely culprit.
Knowing what your file is doing for you is also really important. You should understand the shape that your file is creating—this will tell you how to fill it.
I see so many dentists matching the gutta percha cone to the size of their master apical rotary file, and it just doesn’t fit perfectly 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 can really leave you feeling upset when you obturate, take a radiograph, and then realize that you should start all over.
A friend of mine (let’s keep her anonymous for the blog!) graciously shared one of her cases with me so that I could turn it into a teaching point, since I know we could all use a little extra support around obturation, so we can nail both our instrumentation and obturation steps as often as possible.
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.
For one, 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. But I’m pretty darn sure I could 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 that final obturation 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 decided that she was going to redo this root canal, but that meant another visit for her patient, and lost chair time for her.
Naturally, that had both of us thinking: What if you could prevent this from happening? It would be better for the patient AND you!
How to remove gutta percha from the canal
You know I always like to throw in a little tip that will help you out as you do endo cases. So get ready, because here it comes.
My question for you is, “How do you get your gutta percha out?” Tell me your way in the comments below (I’m always looking for new tips and tricks), and 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 quickly 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), 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 remove the remaining gutta percha.
And don’t be too aggressive with your file since it can still separate, and then you’ll have a whole new issue to straighten out. 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. Ready to run your obturator and nail that final radiograph.
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?
When you need quick tips on stuff like what obturation is all about, how to troubleshoot your obturation step of a root canal, and tricks for mastering your instrumentation, I encourage you to enroll in E-School LIVE, my 4-day, in-person, hands-on, live patient CE training for dentists..
In the meantime, if you want to get a little more support on your instrumentation processes, why not download my free instrumentation workflow? I promise, you’re gonna love it.
I’m General Dentist. N love joy doing root canals . I want to explore or master my skills on how to not miss MB2 almost 99% . I need your guidance on that .
Hi Anuradha!! This is a great question. If you love endo so much, have you ever thought about investing in a microscope? I hate to say it, but even after 10 years of being an Endodontist, I still have trouble finding this canal sometimes on 1st AND 2nd maxillary molars. In fact, it’s the last tooth I encourage people to try because without high magnification it’s easily missed. I tend to find this canal more apical to the main MB canal, so I have to trough down and be very careful not to perforate. The microscope helps me be very selective with my dentin removal and therefore more conservative. I know that this isn’t the most helpful answer, but it’s the truth. There is no magical way to find them, but you should be finding them almost every single time. So really consider if you are helping your patient by doing this particular tooth yourself. And consider your amount of chair time too — could you be more productive doing another procedure. I know that sometimes I need two visits for a maxillary molar and I prefer one visit if I can. But, some people love endo and the best thing you can do is invest in a microscope. It will change your life😊!! Hope this helps.
hello, how do you get out the gutta percha that passed the apex ?
Hi Varvara! This can be done one of two ways: first, and probably the best for this case is to use chloroform at the apex and then use a paper point slightly long and “wick” up the dissolved gutta percha. Another option is to use a hedstrom file to engage the gutta percha and to pull the gutta percha out of the canal. You will have to sort of “yank” the file once it’s engaged so be careful😊. This second technique I use when the gutta percha is longer than what you see in this case.
Hello friends, fastidious article and nice arguments commented
at this place, I am really enjoying by these.
Thank you for following along!
Hello maam,i am a general dentist and love endo.would love to master it.
Then I am so glad you are following my blogs! Be sure to check out E-School, my endo course that’s launching soon. You can get more info here: https://soniachopradds.mykajabi.com/
Practising dentistry since 18 yes and live doing endo the most….but still I follow the traditional obturation technique of master cone ,lateral condensation and accessory cones..happy with the outcome….do I need to shift to warm vertical condensation …which machine is best?
Switching is totally up to you, just remember that there is a learning curve. I love the System B for doing my downpack and the Hot Shot for my backfill. Hope this helps!!
Thank you for all your valuable tips
I can already see myself improving with reading the material from your blog
I have a question while doing Re RCT can I use my wave one rotary file to remove the Old GP
I know u use protaper at 1000rpms
If I can use wave one what specific speed should I use it at ? And what file should I use ?
Hello Dr Sonia!
This is definitely what everyone has gone through at least once in their practice. I am sure many still go through, including me. Thank you for the tips!
I would like to discuss about sealers. They do play an important role in obturation, as well. Would you agree to that? What’s your favorite Sealer?
I totally agree that sealer is important too. There are a ton of good options out there, but my go to these days is AHPlus. I haven’t played much with the BC sealer, but I plan on it. Roth’s 801 and Kerr EWT work well too.
I’m a general dentist. Love doing endo. So happy to have found your blog. Got so much to learn here.
Thank you Dr. – I am happy you found it, too! More content to come.
Hi Dr. Chopra,
Just love reading your blogs.
What are the consequences of overobturation & how would be the prognosis of that tooth ?
Thanks for reading. As long as the bacteria is completely removed from the canals, a little overfilling should not really hurt anything. I am not advocating it, but I wouldn’t try to surgerize every overextension that occurs. The key is disinfection. -Sonia
Thanks a lot for all your lovely tips n tricks
If I am doing are RCT can I use my wave one rotary file to remove GP
If yes , which file and what speed
Thanks for your notes and questions. This is a reply to both of your questions. I would not use a gold file to remove gutta percha. You would need a file that has a stiffer metal in order to be more efficient at removing the gutta percha. -Sonia
Hi again Ummesalma,
Thank you for your question. I would try using something like a Profile 25/.06 at 1000 rpm. -Sonia
hello thanks for sharing tricks.
Sometimes after bmp when i proceed for obturation in next appointment patient feels pain when gp is inserted in canal .
why is that so? and also how to decide when obturation can be done
If your patient feels your gutta percha while obturating it tells me that their anesthesia is wearing off or the gutta percha is too long and is sticking out of the tooth! Hope that helps!
Hi, how to get obturation for a canal with separated file at 1/3 at apex that canal can’t treat by bypass or remove the separated file ? To this type of case for get excellent apical seal and puff .!!
Thanks for your answer ….
It sounds like this tooth will need an apicoectomy in order to complete treatment.
If endo was done just couple days ago…….and on post restoration radiograph you notice under filling laterally where you could have fitted some accessory cones but you did not then Would you recommend using profile 25.06 with chloroform to retrieve that GP or would you be able to remove the restoration and warm the existing GP followed by lateral compaction to fit accessory cones?
I feel that there are many ways to remove the GP in this situation. You could use a small gates glidden, a heated plugger or the 25/.06 you just mentioned.
As always, grateful for sharing all the marvelous tips.
Do you have any experience using gutta condenser?
I think you are referring to GuttaCore and no I don’t have experience with that.