Apical plug with Bioceramic putty

Fig. 1

Pre-operative X-ray.

Fig. 2

Image of the canal after final irrigation protocol ready for obturation.

Fig. 3

X-ray with a plugger 2mm shorter of the working length.

It’s important do this type of X-ray to have the control after the compaction of the material.

When the dimension of the apex it’s very high we have the possibility to put a collagen sponge into the apical area like as stop to control the extrusion of the material.

Fig. 4

First placement with dedicated tool.

Fig. 5

Compaction with plugger. The rubber stop was positioned 2mm shorter than the working length.

We have more control over the extrusion beyond the apex.

Fig. 6

Check with microscope of the first placement.

Fig. 7

Second placement of bioceramic putty.

Fig. 8

Compaction with paper cone. 

At the end of the 2 placement with the dedicated tool and with the plugger I finished my compaction with a paper point for more control and final adaptation of the material.

Fig. 9

Final check of the material.

Fig. 10

X-ray to check the apical plug. This X-ray it’s very important to do because if we need to correct  something we still have time ( the material doesn’t arrived to the apex, empty spaces between the placement..).

A suggestion: do this type of x-ray after 1 or 2 placement of the material because if we put too material and we need to correct something will become too difficult or impossible.

Fig. 11

In the same session after the positioning of 4-5 mm of bioceramic putty into the apical area the canal was fill with guttaperca.

Fig. 12

Final result.

Fig. 13

X-ray with the Back-filling with guttaperca.

Fig. 14

Final X-ray with the composite obturation and control.