Most root canals have apical diameter of 350-400uM

- hence, instrumentation needs to be min. ISO #35

35-53% of the root canal is uninstrumented - rely on irrigants to penetrate

uninstrumented areas

Moderate taper, larger apical size - able to clean more surface area of the root
canal and removes less dentine
*Greater enlargement of apical size leads to increased healing outcomes wrt
radiographic and clinical evaluations (Aminoshariae 2015)

Advantages of NiTi:
- Conservative coronal flaring
- No apical transportation
- Smooth and tapered canal
- No difference between specialists and novices
- Faster (reduced file use)
- Better (improved healing outcomes)
- Easy shaping of canal into consistent, round shape corresponding to GP

Glide path - hand file 8 times, H-file watch-winding motion (push, turn 1/4-1/8,
pull)

NiTi rotary - at working length, 2-3 passes

NaOCl: 0.5-6%
Endosure hypochlorite: 1% (pH 11-12), 4% (pH 11-13)
*Remains in tubules after drying with paper points!
*Removes organic matter and bactericidal

EDTA: 15% w/v, pH 7.2 - lubricant and removes smear layer, exposes dentine tubules
to subsequent irrigation by NaOCl

Interappointment medicaments:

Ca(OH)2 paste (pulpdent) - antibacterial high pH (12.0-12.8): destroys bacterial

cell walls and protein, hydrolyses lipid moiety of bacterial LPS
Slow acting, at least 7 days to eliminate bacteria
Do not use if patient is symptomatic (may make pain worse)

Odontopaste - 1% triamcinolone, 5% clindamycin

Good for reducing pain, does not discolour, improved zone of inhibition against E.
faecalis

Interappointment access seal:

- seal with Cavit (orifice barrier)- need at least 3.5mm min. thickness of Cavit to
prevent leakage!

Cavit: zinc oxide, calcium sulphate, zinc sulphate, resin

IRM: ZOE cement reinforced with polymethyl methacrylate

*eugenol has anti-microbial effect
improved compressive strength but less sealing ability than Cavit
*Double seal: inner layer Cavit, outer layer IRM recommended

GIC: good physical properties, good sealing ability (chemical bonding), F- release
but... cost, technique sensitive, time consuming, slow setting, seal deteriorates
over time
Role of obturation:
- Physical barrier between root canal and oral env., prevents ingress of bacteria
and nutrients
- Prevent ingress of periapically derived fluids which may supply nutrients to
residual bacteria
- Antimicrobial effect of GP and sealer(cement)
- Entombment of remaining bacteria within root canal space (biofilm formation,
antimicrobial resistance, survival in starvation state)

Root canal sealers

1. Resin based - epoxy (unimelb- gold standard), methacrylate, polymer
2. Ca(OH)2 based - sealant tends to break down apically
3. ZOE based - used in Sydney, more aggressive effect and post-op discomfort
4. Silicone based
5. Bioceramic based

Epoxy based resin sealer: AH26 has antibacterial effect due to formaldehyde release
in first 24 hours (AH plus removed formaldehyde)
- biocompatible once set, good sealing ability, good record of favourable healing
outcome

Lateral compaction advantages:

- can control/modify length of GP cone readily
- deficiencies can be monitored and corrected readily
Disadvantages (traditional lateral compaction):
- technique sensitive
- time consuming
- lots of accessory cones used
- poor compaction is common (voids)
- excessive sealer
- risk of root fracture, as spreader goes down quite deep apically
Modified lateral compaction: excellent adaptation, uniform thin sealer, minimum
accessory cones

Thermoplastic obturation:- obturates irregular canal spaces v. well BUT problem

with shrinkage and placement!
- Vertical compaction
- System B
- Carrier based (carriers carry layer of GP - thermafill, GuttaCore, etc.); GP goes
into irregularities and fills accessory canals; BUT risk of
extrusion of GP and sealer, and carrier remains in canal which is a problem for re-
treatment
- Heated GP systems

MTA (Mineral Trioxide Aggregate):

- Mixture of Portland's cement and bismuth oxide
- Sets by hydration reaction of tricalcium silicate and dicalcium silicate and
forms colloidal gel setting time 3-4 hours
- Properties: Does not bond to dentine
Formation of apatite-like interfacial deposits due to interaction of released
calcium with hydroxyl ions in phosphate containing body fluids
Apatite-like deposits fills gaps during shrinkage phase --> seal
- Clinical applications:
Apexification (induce apical closure)
Wide and irregular canal obturation
Perforations
Vital pulp therapy
Periapical surgery