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Endo tips    Better Endo    Endo abstracts    Endo discussions

Squirt obturation technique

The opinions and photographs within this web page are not ours. Authors have been credited
for the individual posts where they are. - www.rxroots.com
From: Michael Moran
To: ROOTS
Sent: Wednesday, March 02, 2005 10:27 PM
Subject: Re: [roots] Question for Mark Dreyer on Squirting

Dear Mark,

Would you care to outline the relevant points of canal preparation when 
intending to use the squirt technique, or would that be letting out some 
of Joey D's and John Stropko's secrets into the public domain?

I've been using the Obtura II alone for obturation since the Roots 
discussion not long ago regarding having adequate thermoplasticity at the 
apical constriction when using the System B technique outlined by 
Dr Buchanan.  I'm making sure there is a very definite apical constriction 
to compact against, injecting GP with the Obtura, following up with the
System B technique as per Dr Buchanan (but with a slight variation here 
as I'm also using a Schilder type condenser to compact before reinjecting 
again, repeating the downpack to a slightly more coronal level with a 
System B tip to ensure there is union between the first and second increments).  
At least this way I'm confident the GP at the apex is warm when
I compact vs. a cold GP point heated with the System B tip to within 
3 - 4 mm of the working length  - Michael Moran

John & Joey have never minded that I share some of their info.  As much 
as I'íve learned online, this is one area that I feel I really benefited in 
having a hands on course.  I recommend you consider their courses.

Here I am describing what I learned from John & Joey as per the obturation 
process.  The shaping process I describe isnít exactly how they teach it but 
is pretty similar.. Mark

Squirt obturation techique

First of all prior to doing this technique, the canal should be shaped 
with gg's 1-4, or 2gg and 2 peezo.  Then the apical should be shaped so 
as to provide continuity of taper.  I use Protapers S1, S2, F1, F2, F3, 
and if the foramen is larger than 30 then I do some extra refinement with 
either .02 or  .04 taper k3 files.  I choose the appropriate k3
file based on the size of the foramen and the degree of curvature of the canal.

Needed supplies:

Obtura Gun
Sterile Fine paper points
20 gauge obtura needles
Kerr's EWT sealer
Blue/Black Dovgan niti condensor

Steps in squirt technique:

1. Canal must be as dry as possible-alcohol, evacuate, dry-paper points, 
   stropko to air dry
2. Apply Kerr's Sealer to the canal walls with a paper point then dry off 
   excess using dry paper point.
3. Introduce obtura tip into canal as far as it wants to go.  
   Obtura should be turned to maximum temperature.  Needle
   should touch canal walls, but not be firmly wedged into the canal.  
   Begin injecting.  Allow backpressure to back the    obtura needle out 
   of the canal.
4. Vertically condense with blue (size 60) Dovgan niti condenser.  
   Condense the gutta percha (called wadding-this is something that is 
   hard to describe), switching to the black condenser after using the 
   blue one initially.  Once the    gutta percha is well "wadded" place, 
   maintain firm condensing pressure on the gutta percha for 
   30 seconds/canal to help    counteract the cooling shrinkage of the 
   gutta percha.
5. Go to www.excelinendo.com if you are interested in John & Joey's
   hands on course which will help you master this technique.

Mark, do you use this technique religiously or have you hybridized it a bit.  
I've got an Obtura II sitting on a shelf because I can't get past the point 
of hot gutta percha/Resilon shrinking.  With Bill Watson and Fred's apical 
control lesson I've learned that cold material does not shrink.  In my 
untrained reasoning, the more cold gutta percha/Resilon I can put in that 
well gauged apex and the less ZOE/Epiphany I put there then the less the 
shrinkage will be and the less leakage I'm going to allow.  If I plug the 
apex with a cold point and back fill will I heat that plug/fitted clipped cone
to the point it will shrink?  I am now using System A on some cases but 
still feel that I'm heating the Resilon at the apex.

This is the problem I have with Barry Musikant's technique.  He's not 
really concerned with filling the shaped apical area with gutta percha.  
He's using the same size point on every case and slamming it home.  
He's depending on cold sealer to fill the apex and we know that shrinks...
even AH 26.  We know hot gutta percha shrinks even when held under pressure.  
I can't get past the reasoning that fitting a well shaped apex with an apically 
sized cone and very little sealer is going to give a better seal.  Could I use 
the clipped plug pushed into place with a plugger and then back fill without 
heating up the plugged apex?  Any answers will be welcomed.  Guy

Guy, I donít have all the answers for you.  I donít know that any of these 
obturation techniques represent utopia.  As much experience I have in doing 
resin bonding from my restorative years (only adhesive restorations for the 
last 5 years of practice), I still donít trust that I can effect a leak-proof 
seal in the apical third with resin bonding.  I know you feel differently.   
Have you ever treated some extracted teeth and cut them back to evaluate your
obturation technique? I'íve done it with my technique and it looks pretty 
good - Mark

Guy,

You simpify things a bit too much and lose some accuracy in the process. 
I always state that the MINIMUM preparation I create is a 35 at the apex 
and an .08 mm/mm taper. The medium point that I fit (I prefer the ones from 
Dentsply Maillefer) binds about 1 mm coronally to the most apical position of 
the preparation. You get excellent tugback consistently when you do this. 
The epoxy-resin cement that we place with the bidirectional spiral followed 
by the generous coating of the prefitted medium gutta percha point has been 
shown thru dye studies to seal the apex at least as well as any other
technique used. The gutta percha point's major function is to act as a 
carrier and a driver of the cement. it has no inherent sealing abilities 
of its own.

One of the nice things about not doing thermoplastic techniques is you have 
the luxury of completely flooding the canal and the point with cement without 
any concern for driving signficant amounts of cement over the apex. This is simply
because the coronal escape route for excess cement remains patent, unlike the 
almost immediate coronal blockage that occurs when using any thermoplastic 
technique.

Another advantage is that as the cement and gutta percha warm to body 
temperature (from 24 degrees c to 37 degrees C) they expand approximately 1.75%. 
This is not a lot. but it is headed in the right direction. Between the
bidirectional spiral and .08 mm/mm taper of the gutta percha, the cement is 
driven laterally with great efficiency. Since the viscosity of the
cement at room temperature is thinner than plasticized gutta percha it takes 
less apical pressure to drive the cement laterally into all the nooks and 
crannies of the canal in the goal of achieving a 3-dimensional fill.

When canals require further widening I do notg hesitate to create wider 
apical preparations and at times greater tapered preparations. In these cases 
i will either cut back on a medium point or place a .10 mm/mm tapered gutta 
percha point (a medium large) or a .12 mm/mm tapered gutta percha point (a large).

So there is no philosophy of one size fits all, although I would say that most
teeth are adequately shaped to a 35 at the apex and an .08 mm/mm taper. 
Certainly with the correlation of thicker rotary Niti instruments negotiating 
curved canals separating more frequently, the impetus to create these tapers 
with a rotary system encounters more risk than when done with a reciprocating 
system that shapes 95% of the canal space with tough inexpensive stainless 
steel before it uses any Niti at all. Under any circumstances we are not 
"slamming" that medium gutta percha home. We are placing it with care
after creating a shape that accepts it with predictable tugback.

In the next few days, I'll post 6 or so cases and you can judge for yourself, 
if it looks like the fills are just slammed home. I have a huge number of cases 
with lateral canals filled in the most apical 2 mm of the canal too.

Regards, Barry

Haven't had to extract any yet, thank God.  Guy

What I was talking about is doing some endo on teeth youíve had to extract due 
to perio or ortho, or non-restorability, and then cut them back and look at 
your fills - Mark

Mark, my point was not that you were not getting good fills.  I have no 
question about that.  Part of the hoopla about the new resin sealers is 
just how much they shrink and disintegrate.  I have no doubt at all that 
they do not disintegrate because that would be a very easy thing to research.  
The question is just how much they shrink on setting.  We know we
have to go to great lengths to remove all bleach before obturation and that 
is not a difficult thing to do with modern canal preps but the material still 
shrinks on setting as does hot gutta percha.  We also know that all resins 
shrink on curing whether they are self cure or light cure.

I've considering going to the Simplifills as Bruce suggests and backfilling 
with the Obtura but how much shrinkage does that add to the resin mix?  
Now I only have the sealer shrinking because I'm using a single well fitted 
cone to plug the apex and attempting to get as little sealer as possible in 
that seal.

Bruce, do you think that you get a better seal with Simplifill and back 
filling with hot Resilon or with a well fitted single cold cone alone
with sealer/well fitted cone and lateral condensation?   You have to heat 
the Simplifill with the back fill.  Guy

Guy,

I Donít have a definitive answer on what would seal better Ė Simplifill/Obtura 
or the lateral technique. There is research that suggests  that the Simplifill 
technique with an Obtura backfill may be better. Heated Resilon only shrinks 
about 0.5%, where the sealer shrinks about 2%. Whichever technique allows the 
minimization of sealer should seal better. Maybe Dan Shalkey can comment on
his experience with Simplifill with Resilon. Dan? - Bruce

Bruce, Testing with ISO standards by Gianluca Gambarini showed that Resilon 
sealer expanded 0.2% - Fred

Now that I like.  I'm staying with cold Resilon fitted to a gauged apex with 
Epiphany.  Hey, Fred, think Alvin Artz could put paraformaldehyde in Epiphany 
and do Sargenti with that since it expands rather than shrinks like ZOE?  :-) Guy

I like the Simplifill with PacMac backfill, or a well fitted cone pacmaced - DanS
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