Gutta-percha filling techniques

Each of the techniques (except where indicated) will produce acceptable clinical results if used correctly.

Proponents exist for the different techniques, although personal preference usually determines the final choice:

• single cone (not recommended as it does not seal laterally and coronally)

lateral condensation thermomechanical compaction vertical condensation

thermoplasticised gutta-percha carrier-based techniques.

Lateral condensation of gutta-percha

The objective is to fill the canal with gutta-percha points (cones) by condensing them laterally against the sides of the canal walls (Fig. 39a). The technique requires a tapered canal preparation ending in an apical stop at the working length.

There are two main types of spreading instrument for condensing gutta-percha: long handled spreaders and finger spreaders. The main advantage of a finger

spreader is that it is not possible to exert the high lateral pressure that might occur with long handled spreaders. The chance of a root fracture is reduced and it is therefore a suitable instrument for beginners.

Lateral condensation of warm gutta-percha

A modification to the cold lateral condensation technique is to perform it warm as this will soften the gutta-percha and make it easier to condense, possibly resulting in a denser root filling. The spreader may be heated by placing it in a hot bead sterilizer before insertion into the canal. Alternatively, the friction of ultrasonic

vibration may be used to introduce heat into the root filling.

Ideal root canal filling materials for primary teeth:

N Resorbs at similar rate as primary root

N Harmless to periapical tissue and permanent tooth germ

N Resorbs readily if pressed beyond the apex

N Antiseptic

N Fill canals easily

N Adhere to walls of roots

n Won’t shrink

N Easily removed if necessary

N Radiopaque

N Will not discolor the tooth

Performing pulpotomy

N Identify pulp exposure.

n Remove the roof of the pulp chamber with #330 bur or large round bur.

N Remove coronal portion of vital pulp using large round bur in slow speed or spoon excavator.

N Control hemorrhage using dry cotton pellets in the chamber.

N Place cotton pellet dampened with formocresol for 5 minutes.

N Clinically assess the condition of the pulpal tissues. Pulp stump should appear blackish brown. If bleeding occurs, check for residual pulp tissue and reapply formocresol for 2 minutes.

N Fill pulp chamber to about half its volume with IRM.