Long canal obturation: tips and tricks
Root canals whose length is more than 23 mm are considered as long.
When the clinician faces this kind of teeth there are some aspects to take into consideration, from xrays to endodontic obturation, in order to avoid problems.
Xrays normally are taken with films in horizontal verse. In case of long root the endodontist need to visualize in the film the entire root without cropping the apex.
Tips and tricks: rotate the film and take the X-ray with the film in vertical position.
Tips and tricks: Cusp reduction.
This simple action can help the clinician to have some more millimeter to shape and fill the root canals smoothly.
The main problem is during the phases of drying and obturating the root canals, because guttapercha points, thermafil carriers and paper points are available in standard version.
To avoid this problem it is important to know few tricks.
Guttapercha point elongation.
It's necessary in case of long canal in which we decide to use the continuous wave of condensation or warm vertical compaction techniques.
In case one choses to use a carrier based technique, it is possible to thin the handle of the carrier. This makes the carrier thinner and allows to gain some millimeter in the filling phase.
Coneless is a warm guttapercha injection technique. The advantage of this technique is that we don't need to inject the guttapercha close to the apex, in this manner we can obturate canals longer than 25 mm
Long canals filled with Coneless technique.
All described techniques are warm guttapercha based and need the application of the sealer. The Sealer is really important because it acts as a lubricant for the warm gutta-percha and it allows the adhesion between gutta-percha and dentine. EssenSeal (Produits Dentaires SA, Vevey, Switzerland) is a zinc oxide sealer that has some peculiar characteristic.
The powder of EssenSeal (picture on the left) is thinner than that of the traditional ZOE sealers (picture on the right): this is an advantage because the powder can penetrate in a smaller area
The liquid of EssenSeal (picture on the left) has not the classical oil-like consistency (picture on the right), but it's more "water like": this means that it's easy to mix, requires less time and the product has a better consistency.
The ideal consistency is nutella like.
Essenseal is a Zinc Oxide Eugenol sealer, it works very well with different obturation technique in very long canals.
J Endod. 1967 . 2006 Apr;32(4):281-90.
Katia Greco,Enrico Carmignani,Giuseppe Cantatore. Il sistema di otturazione canalare Thermafil Volume 25, Issue 3, November 2011, Pages 97-109
J Endod. 1977 May;3(5):168-74Three-dimensional obturation of the root canal using injection-molded, thermoplasticized dental gutta-percha.