Endodontic Obturation Techniques to Use to Bring Your Obturation Back From the Brink

Even after 16 years of being an endodontist, cases still trip me up sometimes. I’m always telling my students in E-School that no matter how good at endo you get, you’ll always run into situations that don’t go the way you want or expect. It doesn’t mean you’re secretly an imposter—it’s just the endo way of life and something you need to accept! The key is not to let it bring you down and to learn how to find your way back once you’ve lost your way. 

Today’s tooth story is an example of such a case. Specifically, it covers some endodontic obturation techniques you can use to make your obturations flow… even when they haven’t gone according to plan!

Endodontic Obturation Techniques to Get Your Obturation Groove Back

Our story starts with a patient who came to my practice because their tooth was starting to give them some trouble. After conducting my diagnostic tests, I found that the tooth was tender to percussion and had no response to cold. So, the diagnosis was Necrotic Pulp and Symptomatic Apical Periodontitis #12. 

Since the tooth was a pretty straightforward premolar, I started right away with treatment. Everything was business as usual… until I got to my cone fit. It appeared short, which told me I needed to do some adjusting. 

Where to Turn When Your Cone Fit Is Off

The first thing I did to address the problem? I made sure to follow the SLOB rule to really understand what was happening and appreciate my internal tooth anatomy.  

When you really shift that x-ray tube head in a dramatic way, you can split your roots and canals—just like you see here—and get the clarity you need in the middle of treatment. 

Thanks to the good ol’ SLOB rule, I could instantly tell that I wasn’t patent in either canal, even though my apex locator was chirping at me like I was. That’s why it’s something I think ALL dentists and assistants should master. Going back to that cone fit radiograph with a new perspective is the surest way to help you get to working length, no matter what endodontic obturation technique you use!

Obturation Techniques to Save Your Obturation

At that point in the process, I started asking myself how I ended up there. (Reflection is key to improving, right?) Why was I short in the first place? Most likely, it was because the amalgam restoration wasn’t allowing my apex locator to read properly, so my working length was off from the beginning. So, I adjusted my working length to about 2 mm longer than what I initially thought it was, and then I reinstrumented.

Reinstrumentation is typically the answer any time your obturation appears short. For that reason, I recommend you always go back, confirm your length, take your master apical file, and instrument again, making sure your rubber stopper is hitting the exact reference point. Alternatively, if it’s not your instrumentation, it’s possible it could be your reference point. If your reference point wasn’t steady and repeatable, then that, too, could be the reason you might be short (or long) in any given case.  

Once I reinstrumented the canals, I dropped my cones back in to take another cone fit radiograph and check on my progress. And voilà! It had fixed the problem. By that point, I felt so much better about where my canals were hanging out. Perhaps one canal was slightly more on point than the other, but that really didn’t bother me. I knew I could still advance my obturation a bit when I started to do my warm vertical condensation. 

And spoiler: That’s exactly what I did. During my downpack, I took advantage of the heat that I applied to my gutta-percha and was able to advance it a little bit more apically in both canals. One of the biggest benefits of doing warm vertical condensation is the fact that you can actually move your obturation material more apically if you want to. In particular, I love using this technique when I’m about 1 mm from the apex. It’s such a time saver and it will give you a sexy obturation every time! You just have to feel safe enough to push on your downpack with a little more force than you’re used to.

Do you see how I managed to get the tiniest, most perfect sealer puff? At the end of the day, it didn’t matter that my obturation wasn’t perfect from the onset. Thanks to some key endodontic obturation techniques, I ended up achieving a great result, and that’s what matters!

Obturation Not Flowing? Now You Know What to Do!

Should your obturation not go according to plan, you now have some techniques you can use to get it back on track!

Let’s quickly review them:

• The first thing you should do if you’re short or long is go back to your cone fit and use the SLOB rule to get a better look at your canals. This technique can help you figure out what went wrong and get you back on the path toward a sexy obturation!
• If you’re short, there’s a good chance reinstrumentation is the issue, so make sure you go back in with your master apical file to clear out any debris or bacteria that could cause a root canal failure further down the road. (And make sure to do a patency check with a 15 file while you’re at it!)
• In addition, don’t forget to ensure your reference point is stable and repeatable. If it’s not, that, too, could lead to an obturation that’s too short (or too long).
• Finally, don’t be afraid to take advantage of your warm vertical condensation to advance that gutta-percha a little more! Just make sure you push on your downpack a little harder than usual. Warm vertical condensation is such a valuable tool to add to your endo skillset, which is why I teach it at E-School LIVE. It gives you versatility when it comes to obturation, allowing you to fill skinny canals, fat canals, canals with internal resorption, and so much more!

– Sonia