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.