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Gutta percha is handy. What would we do without the ability to put gutta percha in a tooth to seal everything up during the root canal?
I love closing out a root canal and after everything is nice and clean and disinfected, finishing up a job well done by filling and sealing with this naturally-derived permanent filling.
But you know what I don’t love? When your gutta percha are shorter than your canal. Major facepalm moment.
How can we troubleshoot something like that? 🤔
Issues with Gutta Percha in the Tooth
This scenario is mostly common when you’re working on a canine tooth, where, sure, you only have one canal, so treatment is typically a little easier, but this canal tends to be the longest in someone’s mouth.
But the bottom line is that you still run into issues. In this case, a common problem is that sometimes you are trying to work with a tooth that is way longer than your instruments and the gutta percha in that tooth.
This is where most of us run into some major frustration.
Getting Your Tools Right for Greater Success
We all know that hand files and rotary files are essential tools (click here to get the rundown on my favorite files of all-time) to clean and shape our root canals and create a shape that we can more easily work with.
Files tend to come in the following sizes:
✔️ 21mm
✔️ 25mm
✔️ 31mm
And if you’re like me, you invest in getting all of the lengths of every file type out there. From working with curvy canals to adding length quickly, I keep a whole lot of files handy so that I can get the job done successfully.
When it comes to working with a canine, though, I tend to reach for one length in particular—the 31mm length file. Because in this case, that length is going to make your life easier.
So, What’s the Strategy?
OK, you’re probably wondering though… “But how do I work with gutta percha in a tooth that is too long?” Let’s talk through it.
Say you don’t have that length file or your gutta percha is just too darn short for that oh-so-tricky canine canal. I mean, I’ve even run into the issue where my file is long enough, but my gutta percha isn’t.
The good news: there are things you can do to compensate for that length discrepancy. Let’s get into it.
1. I reduce the occlusion. As long as it’s not in the esthetic zone, you’re good. This will not only decrease the length of your canal, but it will also decrease your patients’ postoperative pain. That’s as much of a win-win as you can ask for. This should be standard operating procedure, if you ask me. It’s better for everyone. And, if you want my two cents: you should do this on every case before you even put the rubber dam on.
2. OK, up next, I change the location that I grab my gutta percha from and reorient my locking plier. Instead of holding it horizontally and below the tip of the point like this:
I grab the point vertically and as close to the tip of the point as I can like this:
That approach makes the canal easier to fill at its complete length. A simple tweak, but a huge difference!
3. Last but not least, I simply change my reference point. Does that sound too simple? Hear me out. Let’s say, for example, it’s the maxillary canine. Yes, it is easier just to use the cusp tip as your reference, but you can also use the cavosurface margin instead. If you just grab the gutta percha point right where it exits the tooth and use that new spot as your reference, you’ll shrink your working length instantly by a few millimeters! Goodbye struggle! Whatever you do, just make sure that your reference point is repeatable.
Getting the gutta percha in the tooth might seem like such a small detail that you don’t have to give it much thought. But it can have a tremendous impact on the outcome of your case. And that, my friends, is worth giving some thought to. Remember, endo is all about the tiny little details.
So don’t overlook this one!
As always, tell me what you think and leave a comment. I really hope this little tip saves you time and money.
Hungry for more tips and tricks from an endo pro? Check out E-School, a one-of-a-kind endo academy designed to support dentists like you in creating better outcomes for their patients and their practice.
21 Comments
Absolutely helpful
Execllent. Very helpful tips.
I’m so glad this was helpful for you, Priyanka!
-Sonia
Great! Thanks very much for reading.
-Sonia
Very helpful mam
Thanks! Glad to help!
I appreciate this tip! But there’s another problem with long canals which is the shaping with the NiTi rotary files. the latter have a length of 25 mm so it’s pretty impossible to reach the full working length!! How do you manage this situation?
Files come in 31mm length, so invest in those. You can also adjust your reference point just as I mentioned in the blog for your gutta percha. It works for your file too!!
-Sonia
This is a most informative course I have taken and it gives a great pleasure in recommending to all the general dentist to take the course.I always go to the videos when in doubt and the best part is life long access to the course..Thank you sonia once again.
Roma, I am so happy you took away so much from Eschool!!
-Sonia
I had a 36 mm wl, do you have special files for this situation ?
Wow!! That’s really long. In this situation, I would adjust your reference point to a different place on the tooth. I hope that makes sense.
-Sonia
Don’t you think occlusal reduction of all teeth would end up complicating our post Endo restoration? Sometimes we give post Endo restorations that do not involve the facial surface at all. In those cases, if we have done the occlusal reduction we have to invariably go for a crown or an onlay. So don’t you think we should reserve that for specific cases only?
Hi
Had a tooth with working length of 31 mm. I could work with protaper gold.of 31 mm but unfortunately there were no gp to March that length and I had a hard time at obturating. What could I have done
Anu,
Ususally just repositioning the college pliers works or perhaps you have to adjust your reference point. I find that most gutta percha is too short, so you have to think outside of the box like what I illustrated in this blog.
-Sonia
Roll the cone with a flat instrument such as a spatula or back end of cotton pliers to “stretch” the cone out. You can make it pretty much as long as you want it to be.
David,
There are so many ways right? Thanks for sharing your expertise.
-Sonia
Sometimes the working length that I confirm with a hand file and an X ray ends up being short with the gotta percha even after I’ve cleaned and shaped the canals to working length. I took the E school and I must say I’ve improved a lot and would love to learn more and get better.
Thank you
Great pearl! Thanks!
Sucharitha,
This happens a lot and is an endo struggle that I like to help people master. First, you should really check your working length again to make sure that it is just right. You may also have to re-instrument again, it’s possible your rubber stopper didn’t actually contact your true reference point. These are all struggles that we trouble shoot in my Eschool LIVE program. This is all hands on and on live patients. I would love to see you there.
-Sonia
Sean,
Thank you for always reading!
-Sonia