Root Canal Aesthetic: An Update in Modern Root Canal Obturation
You will receive 1 credit(s) of continuing education credit upon successful completion of this course. The purchase price of this course is $49.00

This lecture covers the new modern different sealers, obturation materials, instruments, machines and techniques. This course will go over the warm vertical, continuous wave and carrier-based obturation techniques, using sequential pictures and step-by-step tips.


Learning Objectives:
Upon completion of this course, the participant should be able to:

  1. Understand the importance of root canal disinfection prior to obturation
  2. Understand the goals of a root canal obturation
  3. Describe the different endodontic sealers
  4. Describe the different obturation materials
  5. Describe the different modern root canal obturation techniques
  6. Identify the pros and cons of the different new modern obturation techniques
  7. Understand how to do the warm vertical and continuous wave obturation techniques
  8. Understand how to do the carrier-based obturation technique
  9. Know the tools needed to facilitate endodontic obturation
  10. Describe post-obturation coronal leakage, the use of intra-orifice plugs and the importance of a well sealing final restoration

The obturation phase of a root canal is the final step of the treatment from which we judge the quality of our disinfection on the radiograph. Thus, the aesthetic part of our treatment comes out in this final step.

  1. Cleaning is the key to healing
  2. The goal of obturation
  3. Root surface preparation
    1. Supplemental irrigants
    2. Irrigation needles
    3. Adjunct cleaning techniques
  4. Sealers
  5. Obturation materials
  6. Obturation techniques overview
    1. Vertical compaction
    2. Continuous wave
    3. Injection technique
    4. Carrier-based
    5. Lateral compaction
    6. Warm lateral
    7. Thermomechanical
    8. Apical barrier
    9. Thermoplasticized
    10. Custom cone / solvent
    11. Pastes
  7. Carrier-based technique
    1. Size Verification
    2. Preparing the obturator
    3. Sealer application
    4. Obturator placement
  8. Continuous wave technique (Warm Vertical)
    1. Cone fitting
    2. Drying the canals
    3. Heat tip units review
    4. Heat tip fitting
    5. Plugger fitting
    6. Master cone cimentation
    7. Down pack
    8. Backfilling units reviewer
    9. Backfilling
  9. The ideal apical length discussion
    1. Apical canal anatomy
    2. Sealer puffs: Necrotic cases VS Vital cases
  10. Clinical cases
  11. Leakage
  12. Intra-orifice plugs

  1. Kakehashi S, Stanley HR, Fitzgerald RJ. The effect of surgical exposure of dental pulps in germ-free and conventional laboratory rats. OOO 1965; 20:340-9
  2. Klevant FJ, Eggink CO. The effect of canal preparation on periapical disease. Int Endod J. 1983 Apr;16(2):68-75
  3. Sabeti MA, Nekofar M, Motahhary P, Ghandi M, Simon JH. Healing of apical periodontitis after endodontic treatment with and without obturation in dogs. J Endod. 2006 Jul;32(7):628-33. Epub 2006 May 2
  4. Clark-Holke D, Drake D, Walton R, Rivera E, Guthmiller JM. Bacterial penetration through canals of endodontically treated teeth in the presence or absence of the smear layer. J Dent. 2003 May;31(4):275-81
  5. Shahravan A, Haghdoost AA, Adl A, Rahimi H, Shadifar F. Effect of smear layer on sealing ability of canal obturation: a systematic review and meta-analysis. J Endod. 2007 Feb;33(2):96-105
  6. Calt S, Serper A. Time-dependent effects of EDTA on dentin structures. J Endod. 2002 Jan;28(1):17-9
  7. Alves FR, Almeida BM, Neves MA, Moreno JO, Rôças IN, Siqueira JF Jr. Disinfecting oval-shaped root canals: effectiveness of different supplementary approaches. J Endod. 2011 Apr;37(4):496-501
  8. Abou-Rass M, Piccinino MV. The effectiveness of four clinical irrigation methods on the removal of root canal debris. Oral Surg Oral Med Oral Pathol. 1982 Sep;54(3):323-8.
  9. Ram Z. Effectiveness of root canal irrigation. Oral Surg Oral Med Oral Pathol. 1977 Aug;44(2):306-12.
  10. Nielsen BA, Craig Baumgartner J. Comparison of the EndoVac system to needle irrigation of root canals. J Endod. 2007 May;33(5):611-5. Epub 2007 Mar 26
  11. Hockett JL, Dommisch JK, Johnson JD, Cohenca N. Antimicrobial efficacy of two irrigation techniques in tapered and nontapered canal preparations: an in vitro study. J Endod. 2008 Nov;34(11)
  12. Townsend C, Maki J. An in vitro comparison of new irrigation and agitation techniques to ultrasonic agitation in removing bacteria from a simulated root canal. J Endod. 2009 Jul;35(7):1040-3
  13. Ahmad M, Pitt Ford TJ, Crum LA. Ultrasonic debridement of root canals: acoustic streaming and its possible role. J Endod. 1987 Oct;13(10):490-9
  14. Sabins RA, Johnson JD, Hellstein JW. A comparison of the cleaning efficacy of short-term sonic and ultrasonic passive irrigation after hand instrumentation in molar root canals. J Endod. 2003 Oct;29(10):674-8
  15. Van der Sluis LW, Versluis M, Wu MK, Wesselink PR. Passive ultrasonic irrigation of the root canal: a review of the literature. Int Endod J. 2007 Jun;40(6):415-26. Epub 2007 Apr 17
  16. Gutarts R, Nusstein J, Reader A, Beck M. In vivo debridement efficacy of ultrasonic irrigation following hand-rotary instrumentation in human mandibular molars. J Endod. 2005 Mar;31(3):166-70
  17. Burleson A, Nusstein J, Reader A, Beck M. The in vivo evaluation of hand/rotary/ultrasound instrumentation in necrotic, human mandibular molars. J Endod. 2007 Jul;33(7):782-7.
  18. Peters OA, Bardsley S, Fong J, Pandher G, Divito E. J Endod. Disinfection of root canals with photon-initiated photoacoustic streaming. 2011 Jul;37(7):1008-12. doi: 10.1016/j.joen.2011.03.016. Epub 2011 May 7.
  19. Kontakiotis EG, Wu MK, Wesselink PR. Effect of sealer thickness on long-term sealing ability: a 2-year follow-up study. Int Endod J. 1997 Sep;30(5):307-12.
  20. Orstavik D, Kerekes K, Eriksen HM. Clinical performance of three endodontic sealers. Endod Dent Traumatol. 1987 Aug;3(4):178-86
  21. Orstavik D. Nor Tannlaegeforen Tid. Clinical research in endodontics. 1988 Dec;98(16):646-51
  22. Augsburger RA, Peters DD. Radiographic evaluation of extruded obturation materials. Endod. 1990 Oct;16(10):492-7
  23. Kontakiotis EG, Wu MK, Wesselink PR. Effect of calcium hydroxide dressing on seal of permanent root filling. Endod Dent Traumatol. 1997 Dec;13(6):281-4
  24. Saleh IM, Ruyter IE, Haapasalo M, Ørstavik D. Survival of Enterococcus faecalis in infected dentinal tubules after root canal filling with different root canal sealers in vitro. Int Endod J. 2004 Mar;37(3):193-8
  25. Balguerie E, van der Sluis L, Vallaeys K, Gurgel-Georgelin M, Diemer F. Sealer penetration and adaptation in the dentinal tubules: a scanning electron microscopic study. J Endod. 2011 Nov;37(11):1576-9. doi: 10.1016/j.joen.2011.07.005. Epub 2011 Sep 15
  26. Marquis VL, Dao T, Farzaneh M, Abitbol S, Friedman S. Treatment outcome in endodontics: the Toronto Study. Phase III: initial treatment. J Endod. 2006 Apr;32(4):299-306
  27. Aqrabawi JA. Outcome of endodontic treatment of teeth filled using lateral condensation versus vertical compaction (Schilder's technique). J Contemp Dent Pract. 2006 Feb 15;7(1):17-24
  28. Lask JT, Walker MP, Kulild JC, Cunningham KP, Shull PA. Variability of the diameter and taper of size #30, 0.04 nickel-titanium rotary files. Endod. 2006 Dec;32(12):1171-3. Epub 2006 Oct 19
  29. Cunningham KP, Walker MP, Kulild JC, Lask JT. Variability of the diameter and taper of size #30, 0.04 gutta-percha cones. J Endod. 2006 Nov;32(11):1081-4. Epub 2006 Aug 1
  30. Pang NS, Jung IY, Bae KS, Baek SH, Lee WC, Kum KY. Effects of short-term chemical disinfection of gutta-percha cones: identification of affected microbes and alterations in surface texture and physical properties. J Endod. 2007 May;33(5):594-8. Epub 2007 Mar 12
  31. Royal MJ, Williamson AE, Drake DR. Comparison of 5.25% sodium hypochlorite, MTAD, and 2% chlorhexidine in the rapid disinfection of polycaprolactone-based root canal filling material. J Endod. 2007 Jan;33(1):42-4
  32. Zmener O, Pameijer CH, Serrano SA, Vidueira M, Macchi RL. Significance of moist root canal dentin with the use of methacrylate-based endodontic sealers: an in vitro coronal dye leakage study. J Endod. 2008 Jan;34(1):76-9
  33. Eriksson AR, Albrektsson T. Temperature threshold levels for heat-induced bone tissue injury: a vital-microscopic study in the rabbit. J Prosthet Dent. 1983 Jul;50(1):101-7
  34. KUTTLER Y. Microscopic investigation of root apexes. J Am Dent Assoc. 1955 May;50(5):544-52
  35. Chugal NM, Clive JM, Spångberg LS. Endodontic infection: some biologic and treatment factors associated with outcome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Jul;96(1):81-90
  36. Schaeffer MA, White RR, Walton RE. Determining the optimal obturation length: a meta-analysis of literature. J Endod. 2005 Apr;31(4):271-4
  37. Ricucci D, Siqueira JF Jr. J Endod. Fate of the tissue in lateral canals and apical ramifications in response to pathologic conditions and treatment procedures. 2010 Jan;36(1):1-15. doi: 10.1016/j.joen.2009.09.038
  38. Ray HA, Trope M. Periapical status of endodontically treated teeth in relation to the technical quality of the root filling and the coronal restoration. Int Endod J. 1995 Jan;28(1):12-8
  39. Tronstad L, Asbjørnsen K, Døving L, Pedersen I, Eriksen HM. Influence of coronal restorations on the periapical health of endodontically treated teeth. Endod Dent Traumatol. 2000 Oct;16(5):218-21
  40. Hommez GM, Coppens CR, De Moor RJ. Periapical health related to the quality of coronal restorations and root fillings. Int Endod J. 2002 Aug;35(8):680-9
  41. Torabinejad M, Ung B, Kettering JD. In vitro bacterial penetration of coronally unsealed endodontically treated teeth. J Endod. 1990 Dec;16(12):566-9
  42. Khayat A, Lee SJ, Torabinejad M. Human saliva penetration of coronally unsealed obturated root canals. J Endod. 1993 Sep;19(9):458-61
  43. Portell FR, Bernier WE, Lorton L, Peters DD. J Endod. The effect of immediate versus delayed dowel space preparation on the integrity of the apical seal. 1982 Apr;8(4):154-60
  44. Yamauchi S, Shipper G, Buttke T, Yamauchi M, Trope M. Effect of orifice plugs on periapical inflammation in dogs. J Endod. 2006 Jun;32(6):524-6

American Dental Association is an ADA CERP Recognized Provider.

ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.