Filling Root Canal Systems with Centered Condensation

Concepts, Instruments and Techniques

L. Stephen Buchanan, DDS, FACD, FICD
Filling root canals seems to be the primary obsession
of dentists providing endodontic therapy to their
patients. This is because we (especially endodontists)
are judged as clinicians by how ideal the fill looks
after the case is finished. But the more fundamental
cause of this focus is the common frustration dentists
experience during the obturation procedure itself.

the cases worked when the canals were filled to or

beyond the terminus!
For me this study proved two things; first, the old
adage that we really dont even need to fill the
canals in teeth, if we can just create a totally sterile
environment inside root canal systems and place
perfect seals coronal to them.4 Second, because no
one can insure sterility in any given root canal space,
the surest chance of clinical success is gained when
root canal systems, in all of their complexities, are
filled to their full apical and lateral extents, even
though that means that there may be surplus material
beyond the confines of the root canal space.

Ironically, problems encountered during filling

procedures are most often not about obturation but
are related to missteps during negotiation and shaping
procedures.1 If you never get to the end of a root
canal during the negotiation phase of treatment, you
will never shape or fill to that point afterward. When
curved canals are blocked, ledged, or prematurely
obturated by separated instruments, it is impossible
to enjoy the fill unless you state that you meant to do
that that you like filling short apically.

Surplus Filling Material

What about all the studies reported in the literature that
show a correlation of overfills to higher failure rates?
How do we reconcile these findings with Sjogren and
coworkers results? There is a very straightforward
but generally unrecognized difference between most
of the studies done in the 60s, 70s, and 80s versus
studies done in the last 14 years. Virtually all of those
earlier studies looked at fills in preparations done
with the apical stop technique.

Fortunately, our concepts, instruments, and techniques

for the preparation of primary canals prior to obturation
have never been so accessible to dentists having a
wide range of talent and experience. With the use of
patency clearing and lubricants during negotiation,
apex locators for length determination, and variablytapered nickel titanium files for shaping, ideal root
canal preparations can be accomplished by novice
dentists in nearly every case, thereby eliminating
most of the frustrations inherent to obturating primary
canals to any desired endpoint.2

By definition, an apical stop preparation cannot be

overfilled (a stop is an intentional ledge form just short
of the canal terminus) unless length determination
was mistaken and the stop is non-existent. Sjogren
et al3 stated in their discussion that success in their
overfilled cases was likely due to the specialist
clinicians ideal preparation form which ensured an
adequate seal. Schilder would describe this result as
overextended but not underfilled.5

Apical Extent of Filling

So now that root canal preparation is more a science
than an art, how do we decide the ideal endpoint for
filling? The best research Ive read in answer to this
question was done by, Sjogren, Figdor, Persson, and
Sundqvist, 3 who looked at root canals filled short
and long, with positive and negative culturing results
in each group. They showed that high success rates
were achieved regardless of long or short filling
when the culture came back negative, but when
the culture came back positive only the fully filled
cases worked predictably. The authors theorized that
success was achieved because the remaining bacteria
were entombed in the canal. Infected or not, all of
Dentistry Today

OK, that sounds logical, but what about surplus

sealer? Why do clinicians who use lateral
condensation fear sealer puffs while clinicians who
use warm gutta percha techniques not only feel like
they are nothing to fear but actually enjoy seeing
them at the root surface in post-operative films?
This great difference in opinion also has a basis in
many clinicians experience. AH26 and Grossmans
sealers (for decades the most commonly used sealers
l

November 2004

by clinicians doing cold lateral condensation) are not

only extremely inflammatory but they take days to
set, extending the time that their toxic effects are felt
when they are pushed into periradicular tissues during
obturation. Its no surprise that clinicians become
gun-shy of sealer puffs when they so often have
patients complain about pain in these circumstances.

In fact, if filling lateral canals is so important, what

about all of those millions of endodontic cases filled
with single cone or lateral condensation techniques?
30-50% of those canals had lateral or accessory
ramifications, and at least 70% of them worked in
spite of only the primary canals being filled? How do
we explain that?

Most warm gutta percha fills are done with Kerr Pulp
Canal Sealer, a quick setting, well-tolerated sealer6-so clinicians who do techniques that fill lateral
canals routinely seldom hear a patient complain
about significant post-operative pain episodes, so
they wonder what all the fuss about surplus sealer
is about.

This mystery has an even more obvious answer

that was recently offered by Dr. Haapasalos.8 What
Dr. Haapasalos found was a significant inhibition
of bacterial growth in culture dishes around AH26
and Grossmans sealers. When single cone or cold
lateral condensation fills are done with these sealers
they are placed in primary canal spaces adjacent to
unfilled lateral and accessory canals where these
sealers toxic effects can kill bacteria left in those
side channels. You dont have to fill lateral canals as
long as all of the bugs in them are dead.

Lateral Extents of Filling

What about the lateral extent of our fills? Surprising
to me, the importance of filling lateral and accessory
canals is still controversial despite 35 years of arguing
among specialists. Those who do three dimensional
obturation techniques have historically claimed
technical and even moral superiority over those who
do techniques that only fill primary canals.5 Those
who use obturation techniques that are less effective
in filling root canal aberrations claim that there is no
credible research proving that filling lateral canals
makes a difference in clinical outcome.7

Unfortunately, many side canals are 6-7 mms in

length (Figure 1), making it unlikely that they can
be killed in this manner. So I choose to fill all canal
forms as completely as I can so that I roll a bolus of
filling material past any bacteria I have inadvertently
left in side canals to entomb them, thereby achieving
the same outcome as if I killed every bug in the
space.

Figure 1. Maxillary molar with MB2 canal bifurcating off the

MB1 canal and extending 7 mms further before bifurcating
again and exiting on the root surface. This side canal was nonnegotiable and therefore most likely not sterile before obturation.
Fortunately a bolus of sealer and warm gutta percha was rolled
through its full length, entombing any remaining bacteria and
allowing a success in spite of severe anatomic challenges.
Dentistry Today

Figure 2. Maxillary lateral incisor with wild anatomy, all of

it filled in a single Continuous Wave downpacking movement
(2.5-seconds).

November 2004

The GT Series X Obturator Technique

This technique requires a GTX Obturator of the same
size as the final GTX File used to shape the canal to
be filled (Figure 4), a scalpel for removing excess
gutta percha from the carrier, paper points, sealer,
and a GTX Obturator Oven.

Today, with Centered Condensation Techniques, it

takes less training time and less chair-side time to fill
lateral canals than it takes to do a good job of lateral
condensation.9 So for me, the question of whether to
fill lateral canals or not seems like a no-brainer. With
a Centered Condensation technique I can completely
fill a root canal system with ten accessory canals in
less than six seconds (Figure 2). Why would I work
harder to avoid the thrill of the fill?

The selected GTX Obturator is prepared by using

the scalpel to cut off the gutta percha from its tip
until approximately one and a half millimeters of
the carrier end is exposed. In canals 17 mms or
longer this tip adjustment lessens the possibility for
overfilling caused by the close fit of GTX Obturators
in GTX-cut canal shapes. The rubber stop on the
carrier is measured one millimeter short of length,
as a sealer and gutta percha front that dimension
develops and moves ahead of the carrier during its
insertion through the canal.

Centered Condensation
Centered Condensation obturation techniques
efficiently and effectively move filling materials
through root canal systems by driving the condensation
device, be it an electrically-heated plugger or a preheated carrier, through the center of a thermoplastic
material like gutta percha. The filling material,
lubricated by the sealer cement, is displaced coronally
as the condensation device moves apically, causing a
streaming effect of the material against the primary
canal walls filling lateral canals, accessory canals,
fins, loops, and isthmuses in its wake (Figure 3).

A clever supplemental technique is to measure the

distance from the reference point to the orifice level
of the canal to be filled, to transfer that measurement
from the preset stop down the shank of the carrier and
to score the gutta percha at that length. By grasping
the gutta percha on the carrier with a cotton pliers
coronal to the score mark and twisting, the coronal
surplus is removed, eliminating the need to later
clean it out of the access cavity after placement of
the GTX Obturator.

When the condensation device closely approximates

the geometry of the canal preparation, all of the lateral
ramifications off the primary canal (assuming they
have been cleaned out) are filled within 1-6 seconds,
regardless of their number or extent. The apical
accuracy of obturation is determined by the quality
of the apical resistance form of the preparation and
the fit of the filling cone in the Continuous Wave
Technique or the accuracy of the apical extent of
placement in the Carrier Technique.

The prepared GTX Obturator is placed in the

receptacle of the oven arm, hanging it by the handle,
not by the stop. The oven arm is carefully lowered

Figure 3. Schematic diagram of the streaming effect created

as the condensation device is driven through the center of the
filling material.
Dentistry Today

Figure 4. GTX Obturators sized to match the GT file shapes.

November 2004

to its click stop and the correct Obturator size button

is selected and pushed to prepare the oven for the
heating cycle. If the clinician is not finished prepping
the canal, the oven will hold a steady temperature for
sixty seconds after the first beep.
The canal is dried and its length is confirmed with
paper points, the canal is coated with sealer on a
paper point, and all of the surplus sealer is blotted
out with successive paper points. Initially the paper
points will come out of the canal coated with sealer
indicating a pool of sealer in the canal lumen, a setup for surplus sealer being squeezed out the canal
end during insertion of the GTX Obturator. When
this pool of sealer has been removed, the next paper
point will come out of the canal spotted, rather than
coated with sealer.

Figure 6. GTX Obturator further into canal showing gutta

percha moving toward its tip as it pushes though the narrowing
canal space.

Press down on the back of the oven arm and slowly

allow the arm to rise. Place the tip of the carrier into
the canal orifice and slowly, over 5-6 seconds, move
it to its final position in the canal (Figures 5-8). Rapid
insertion will result in unnecessary surplus being
expelled beyond the root canal terminus.
Once the GTX Obturator is in place the carrier shank
is cut at the orifice with a high-speed bur or ultrasonic
tip before inserting the next Obturator in a multicanalled tooth. If a post space is desired, the carrier
is cut out of the coronal aspect of the canal with a
Preppi Bur (a non-fluted high speed round bur) or
an ultrasonic tip with a round end like the BUC-1 by
Spartan Co.

Figure 7. GTX Obturator as gutta percha moves even with the

carrier tip, Note the side canal beginning to be filled.

Figure 8. GTX Obturator in its ideal final position 1 mm short

of the canal terminus showing the typical sealer and gutta
percha front extending to full length with a small puff of sealer.
Note the fill in the lateral ramification.

Figure 5. GTX Obturator, showing gutta percha cut back from

its tip, as it starts down the canal.

Dentistry Today

November 2004

A New Device for the Continuous Wave

Technique
SybronEndo has recently introduced the Elements
Obturation Unit, the next generation of their
System-B Heat Source, adding an inline motor-driven
backfilling device so that the Continuous Wave of
Condensation filling technique downpacking and
backfilling can be done with a single electronic unit
(Figure 9). The conveniently sized device can tip
forward or back for optimal viewing of the display,
it has quick-disconnect plugs on each handpiece
cord, and has hangers attached to the unit that can
be removed and mounted on a cart or cabinet. This
device is also available without the box in a faceplateconfiguration for cabinet mounting. Let me take a
moment to walk through this devices upgrades and
functionality.

Secondly, the electronic control system has been

upgraded to a much more sophisticated level. There
are selection switches for each different heating
functions; downpacking, backfilling and pulp testing
with heat. This is a big advantage, as each of these
functions requires different power and heat settings.
Downpacking is typically done at 2000 C; backfilling
at 600 C (all in touch mode), and heat testing of
pulps is done at 2000 C in continuous mode. Any of
these settings can be changed and stored differently
than the factory-set default values.
The downpacking mode has the safety feature of
an automatic shutoff after four seconds to limit the
amount of heat dialed into a root by novice dentists,
after which the dentist must re-hit the button if more
heat is needed in a long root. Also in the downpacking
mode a convenience feature has been added: a sound
is emitted at five seconds and another at ten seconds
after cessation of the heating cycle. These signals,
coming at the end of the downpack, tell dentists when
they are ready for the separation burst of heat (after
five seconds) or to tell them when they are ready to
break the plugger loose if they are doing a singlecone backfill (ten seconds into the cooling cycle).

The System-B Side of the Unit

The System-B Heat Source has been dramatically
redesigned. First off, the handpiece itself has been
enlarged to a more ergonomic diameter, similar to
other dental handpieces. It has a removable (for
sterilization) stainless steel sleeve with a silicon
cover at its plugger end to give the operator a soft,
comfortable grip. The actuating button is raised 2
mms so it is easily located by touch and there is an
indicator light just ahead of it so the operator can see
when the heat source is activated even if the sound
signal is turned off.

With those features aside, the most important

upgrades to the System-B Heat Source are the
electric heat attachments that can be inserted in the
handpiece, which include stainless steel Continuous
Wave electric heat pluggers, nickel titanium
Continuous Wave electric heat pluggers, an electric
heat pulp tester, and an electric heat tips for soft
tissue cautery during surgery. Each of these tips has
a hexagonal flange that allows quick insertion and
directional stability without tightening a collet like
the previous System-B Heat Source. This is very
helpful when obturating a four-canalled molar that
requires changing between four different pre-fitted
Continuous Wave pluggers.
The stainless steel Continuous Wave electric heat
pluggers have been around since the first introduction
of the System-B Heat Source in 1996 but the
geometry of these pluggers has been changed, and
an .04 taper CW plugger has been added for a full
range of .04 to .12 tapers in the standard shapes. In
a big improvement, the tip diameters now vary with
the tapers for more consistently ideal fitting in canals
shaped to those tapers. The plugger geometries,

Figure 9 The new System-B/Elements obturation device

by SybronEndo. Detachable sleeves allow sterile handpiece
surfaces and inline motor-driven extruder adds backfilling
capability.
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November 2004

listed with tip diameters first and their tapers second,

are 30-.04, 40-.06, 50-.08, 60-.10, and 70-.12, each
having continuous tapers (Figure 10).

avoid the void often caused by pulling the trigger to

extrude the material and inadvertently pulling the
needle out of the canal prematurely.

As in the previous System-B, an electric heat tip is

available for pulp testing. Before the System-B, heat
testing was done with flame-heated gutta percha on
a hand instrument a scary and very inaccurate
method. Consistency is everything with thermal
testing to ascertain the relative vitality of pulps.
Flame-heated gutta percha is continually cooling
after it is taken out of the flame, sometimes just
before the pulp reacts, and it is always a different
temperature for each tooth tested. The introduction
of electric heat application with the System-B Heat
Source standardized, for the first time, this important
test of pulpal vitality, allowing more dependable
results in partially necrotic cases.

The software controls for this extruder allow for the

use of synthetic gutta percha material such as RealSeal
by SybronEndo. Simply toggling the second button
down on the right until an S appears on the rightside display sets up a heating cycle that is lower in
temperature and ends in five minutes, an important
function for this excellent but heat-labile backfilling
material.
The heating cycle for gutta percha and RealSeal is
less than one minute when starting from a cold state,
and is less than 20 seconds after changing cartridges.
During this pre-heating process heat symbols animate
below the thermometer. When temperature has been
reached, the thermometer symbol is all red and the
heat symbols stay solid.

The Extruder Side of the Unit

The other handpiece on the Elements Obturation
System is the motor-driven extruder that eliminates
the need for a separate backfilling gun. The inline
configuration provides a couple of advantages, the
first being its ability to be placed in a standard hanger
alongside high and slow-speed handpieces on a cart
or cabinet. The second is the improved control this
device allows the operator: the way it can be held in
a pencil grip, so that the finger rests steady while in
use, plus the ease of a motor drive over squeezing
a trigger. With the added tactile feedback of this
handpiece over a gun-type backfilling device, it is
easier to feel the needle bumping back as the extruded
material pushes it out of the canal and it is easier to

The filling material cartridges designed for this

device are very convenient as they are one piece with
the needle and the holding nut. The sterling silver
needle is pre-bent, obviating the need for a bending
tool, and these needles come in 20, 23, and 25 gauge
diameters. Because the needle and cartridge are selfcontained there is no internal cleaning necessary
between uses, and because the extruder has the
same type of stainless steel sleeve as the System-B
handpiece, external sterility is as simple as sliding on
a clean outer covering.
The speed of extrusion is first set on the control
panel by toggling the third button down on the right
to show one or two arrows for slow or medium
speeds, respectively. The final speed is selected on
the handpiece toggle switch, with the back button for
medium speed or the forward button for the fastest
speed. After pre-heating is completed, one of the
toggle switches on the handpiece is pressed until
material extrudes out of the needle tip.
When the toggle switch on the handpiece is released
the motor slightly retracts the plunger so material
doesnt continue to extrude. If the needle is held in
the canal orifice when the toggle switch is released, a
slight suck-back of material will occur. If a coronoradicular build-up is to be placed into each orifice this
is ideal, as the backfill will end about one millimeter
short of the orifice. If the backfill is desired to the

Figure 10 Continuous Wave electric heat pluggers, in sizes.04,

.06, .08, .10, and .12 tapers (left to right), SybronEndo Co.
Dentistry Today

November 2004

orifice level the needle should be pulled out just prior

to releasing the toggle switch on the handpiece.

that canal, and by comparing the tip of the plugger to

the tip of the cone. If the plugger is too small it will
downpack too close to the end of the filling cone,
causing an unnecessary overextension of filling
material. If the plugger is too large for the canal
preparation, it wont get close enough to the end of
the canal and it may fail to plastically deform the
filling material in the apical third, possibly not filling
an apical lateral canal.

As with the Obtura II Gun backfilling device,

the Elements needle is placed in the canal for five
seconds to heat the canal wall a bit, and the toggle
switch is pressed while the needle is lightly held in
place. After the extruded material fills the backfill
space ahead of the needle, the needle will be felt to
bump back. With the extremely tactile pencil grip,
and the motor-driven extrusion, a light touch is easily
maintained, thereby holding backpressure on the
extruding material and eliminating void creation.

If the plugger fits too close to length, choose a larger

plugger. If a ML-.12 size plugger fits too close to
length, simply shorten the stop and end the downpack
short of 4 mms from full length. If the plugger
initially chosen doesnt fit close enough, choose
a smaller size until appropriate length is achieved.
Since the pluggers have continuous tapers and GTX
Files have designated maximum flute diameters that
cut canal shapes that are coronally parallel, it may
be necessary to move down a taper size or even two
sizes in long teeth.

Each cartridge holds enough material to backfill a

complex molar (four or five canals) and when the
cartridge is empty the motor automatically retracts
the plunger in preparation for placing a new cartridge
and needle in the extruder. If the operator wants to
change the cartridge before it is totally empty, the leftfacing arrow button is pressed on the control panel,
which starts the retraction cycle. When the cartridge
has emptied, an empty cartridge symbol appears
on the display as well as under the handpiece. The
cartridge nut is rotated to the left when facing the
end of the extruder and removed before inserting a
new cartridge into the heating chamber and rotating
the new nut in the opposite direction to lock the new
needle and cartridge in position.

After plugger fit is completed the canal is dried in

preparation for cone cementation. As in all filling
techniques, paper point confirmation of length allows
one more chance to adjust length prior to the fill. The
fit filling cone is buttered with sealer and the cone is
slowly inserted into the canal to length, is moved in
and out a couple of times and is seated to length.
Turn the System-B/Elements on and select the
downpack icon, which will automatically set the
power level and temperature. The cone is seared off
at the orifice and the fat, stainless steel end of the

The Continuous Wave Technique

A Continuous Wave electric heat plugger is selected
to be of the same taper as the GTX File used to shape
the canal or the same taper as the non-standardized
gutta percha cone fit in a non-GTX shaped preparation.
In multi-canalled teeth a separate plugger must be fit
for each canal. The selected plugger, placed in the
System-B / Elements Handpiece, is pushed into the
canal and wiggled back and forth until it bottoms out.
These pluggers are made of dead-soft stainless steel
and the canal will bend them perfectly. It is critical
that the selected plugger be fit into the prepared canal
prior to cementation of the filling cone, not only to
bend them but also to set the stop to a reference point
on the tooth so the downpack can be ended before the
binding point has been reached.
The final position the plugger will move to in the
canal is checked by holding the stop on the prefit
plugger adjacent to the pinch mark on the cone fit in
Dentistry Today

Figure 11 Continuous Wave Hand Pluggers, #s 1 and 2. Note

the small, flexible nickel titanium apical end and the larger
stainless steel orifice end.

November 2004

Continuous Wave Hand Plugger is used to condense

the softened gutta percha at the orifice level. If a 20,
30, or 40 Series GTX File was used to shape the canal,
a #1 Continuous Wave Hand Plugger is selected, if a
.12 Accessory GT File was used a #2 CWH Plugger
is used (Figure 11).

After the sustained condensation period is completed,

a full second of heat is applied (this is called a
separation burst), another one second pause without
heat is held and the CW plugger is removed with
the gutta percha that was displaced along its sides
(Figure 15). Shorting the separation burst of heat is
an invitation to pulling the cone out. If that happens,
just put the cone, still attached to the CW plugger,
back in the canal, do a two-second separation burst
of heat, and the apical mass of gutta percha should
stay in the root.

The cold CW plugger is placed against the gutta

percha, and after applying apical pressure the
switch is depressed, beginning the downpack.
The CW plugger immediately heats at its tip and
starts moving through the canal. When the plugger
approaches its binding point in the canal, the switch
is released while maintaining apical pressure. The
plugger slows to a halt short of the binding point
where a sustained condensation force is held for
5-10 seconds (Figures 12-14).

The small, flexible nickel titanium end of the #1 CW

Hand Plugger is used to condense and set the apical
mass of gutta percha (Figure 16). Be careful not to
penetrate the apical gutta percha creating a cylindrical
hole that will be a set-up for a void on the backfill.

Figure 12 The switched-on CW electric heat plugger begins its

movement through the cemented gutta percha cone.

Figure 14 The CW plugger is in final position just short of the

binding point, with a sustained condensation force being held.
Note the lateral canals filled with sealer and gutta percha.

Figure 13 The CW Plugger is nearing its binding point and the

switch has been released as apical pressure is maintained.

Figure 15 After a one-second separation burst of heat is applied,

the CW plugger is withdrawn, leaving the apical mass of gutta
percha.

Dentistry Today

November 2004

Alternatively, in a straight canal, the Continuous

Wave electric heat plugger can be removed by
pushing apically and rotating without the separation
burst of heat. This allows the gutta percha condensed
alongside the plugger to remain in the canal as a setup for a single cone backfill, the fastest and easiest
backfill possible.

void (Figure 17). Also important to avoid the void

is to be sure that apical pressure be maintained on
the needle during the backfill to create hydraulic
pressure on the syringed material throughout the
backfill (Figures 18, 19).
Dont Forget to Irrigate
Ironically, Ive seen more irrigation failures since
the introduction of rotary shaping than when we
only used hand instruments. If you have shaped a
root canal system in 90 seconds, it still needs 30-60
minutes of irrigation time to remove vital inflamed
tissue from lateral ramifications or it needs to be

Backfilling is done with the Extruder. A #23 gauge

needle works best in this application as long as it is
held in the canal for five seconds before extrusion.
This warms the canal wall to accept the syringed gutta
percha without prematurely setting it and creating a

Figure 16 The small nickel titanium end of the #1 CW Hand

Plugger is used to condense the apical mass of gutta percha until
cooled and set.

Figure 18 After the extruded gutta percha fills the space ahead
of the needle, it bumps the needle back. Holding a light apical
pressure on the needle throughout backfilling creates the
hydraulic force needed to eliminate voids.

Figure 17 A #23 gauge backfilling needle is placed to its binding

point and is held in place for five seconds before gutta percha
is extruded. This heats the canal wall, reducing the chances of
a void in the backfill.

Figure 19 Completed obturation.

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November 2004

filled with calcium hydroxide for two weeks to kill

the tissue left in those side spaces. Either will work
but the calcium hydroxide will hurt for 72 hours as
it fries the remaining tissue, then it will be totally
comfortable.

References
1. Buchanan, L. S., Chapter 7: (1991) Cleaning
and Shaping Root Canal Systems, Pathways
of the Pulp, 5th Ed. Cohen and Burns, Mosby
Yearbook, St. Louis.

The etiology for most failures can be diagnosed

pharmacologically it doesnt get any better on a
weeks worth of Augmentin or Clindamycin and it
feels fine 45 minutes after the patient takes an NSAID
like Naprosyn. Remove the root canal filling, soak it,
fill it with calcium hydroxide for two weeks and refill
it. In most of these cases Ive seen a lateral canal
filled on the second treatment. In most of these cases
Ive had resolution of all the symptoms.

2. Gluskin, AH, Brown, DC, Buchanan,

LS, (2001) A reconstructed computerized
tomography comparison of Ni-Ti rotary GT
files versus traditional instruments in canals
shaped by novice operators. International
Endodontic Journal 34, 476-84.
3. Sjogren, Figdor, Persson, and Sundqvist,
(1997) The influence of infection at the time
of root filling on the outcome of endodontic
treatment of teeth with apical periodontitis.
International Endodontic Journal 30.

Conclusion
It used to be difficult to fill root canal systems in
three dimensions. Now its a cinch. However, you
cannot fill what you didnt clean out. Clean it out,
and with todays concepts, instruments, techniques,
and materials 3D obturation is simple, fast, and
predictable (Fig. 20). Clean it out and experience the
thrill of the fill!

4. Seltzer, S., (1971) Endodontology, p. 317,

Saunders, New York
5. Schilder, H., (1969) Filling Root Canals in
Three Dimensions, Dental Clinics of North
America.
6. Pertot, WJ, Camps J, Remusat M, Proust
JP (1992) In vivo comparison of the
biocompatibility of two root canal sealers
implanted in the mandibular bone of rabbits.
Oral Surgery, Oral Medicine and Oral
Pathology 73, 613-20.
7. Weine, F., (1996), Endodontic Therapy 5th
Edition, p. 425, Mosby, St. Louis
8. Saleh IM, Ruyter IE, Haapasalo M, Orstavik
D, (2004) Survival of enterococcus faecalis
in infected dentinal tubules after root canal
filling with different root canal sealers in
vitro. 37 (3): 193-198.
9. Buchanan, L. S., (1996) The Continuous Wave
of Obturation: Centered Condensation of
Warm Gutta Percha in 12 Seconds. Dentistry
Today, January.

Figure 20 Mandibular molar obturated with a GTX Obturator in

the distal canal allowing a 3D fill beyond the impediment located
at the apical bend, and with the Continuous Wave technique in
the smooth, but severely curved, mesial canals.

Dentistry Today

November 2004