Two Great Ways to Remove Moisture from Cleansed Root Canals

 

 

 

The past ten years have seen some incredible advances in the field of endodontics.  One of the greatest, in my opinion, has been advances in obturation.

 

We no longer have the singular option of mixing up some type of "glue" and then placing multiple fibers of gutta percha in it.  Instead we have things that range from gutta percha and sealer, to obturators (gutta percha on a stick), to bondable resin sealers and obturating fibers.

 

I have chosen to utilize bondable obturation for a variety of reasons.  When the first possibilities of bonded obturation became available in the early 2000's I was fascinated by the possibilities.  As a general dentist I immediately understood & appreciated the logic & science behind the bonded concept.

Many studies, going back over 20-30 years have shown that root canal systems can be contaminated by bacteria in as little as 30 days.  Placing a temporary material in the access over a non-bonded obturation is not sufficient.  Bacteria can quickly penetrate the temporary material down to the pulpal floor and than navigate the root canal system to the apex in a month or so.  This means that the spaces previously occupied by infected pulp that have been meticulously cleansed can return to their uncleaned state quickly and without symptoms.  

This is because those materials are porous and offer no resistance to the bacteria.  However, what if you could make the root canal system impervious to this bacterial penetration?  By using a bondable point and a resin based duel cure sealer that bonds to the canal walls, this is exactly what bonded obturation does.

However, the bonded obturation process is a bit different than the standard sealer and gutta percha process.  The main difference being that traditional sealers require a dry canal while any type of a bonded process requires a bit of moisture remains in the canal system.  Frequently ethyl alcohol (ETOH) is the last irrigant used in standard obturation as it evaporates extremely fast and takes any remnants of moisture with it, leaving a dry canal to place the sealer in.

For bonded obturation it's required to do "wet bonding" and in my protocol the last irrigant is chlorhexidine because of its residual bactericidal effects.  The main question in bonded obturation becomes "how to remove the chlorhexidine without over drying the canal?"  The easiest way I have found to do this is by using some type of capillary tip that can be introduced into the canals and then removed before over drying can occur.

The  photos above are the 2 best products I've found to accomplish this.  The tip on the left is from Coltene and available through your current dental supply company.  The tip on the right is from Ultradent and can be purchased directly from the company.  Both products are *highly* recommended.

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