How To Run a Dental Practice Without Leaving Money on the Table
October 26, 2022
Top Tips for Apex Locator Accuracy
November 26, 2022
Key Takeaways:
- What is obturation? It’s the step of the root canal procedure during which the pulp chamber is filled and sealed with gutta-percha. It’s one of the biggest challenges in doing a root canal, no matter how long you’ve been doing endo.
- If you’re having trouble with your obturation, a good first step is to go back to your instrumentation. Often, obturation struggles occur because the canals just simply aren’t clean enough!
- If you do need to start your obturation over, a quick tip for removing gutta-percha is to use a 25/.06 ProFile rotary at 1000 RPMs. This will help you buzz your gutta-percha out of the canals quickly and get you back to another conefit radiograph in no time.
Obturation isn’t easy. From learning what obturation is in dental school to actually nailing it, most of us struggle at least a little bit. And if someone tells you otherwise, they’ve either ascended to endo enlightenment—or they’re lying!
Even after more than a decade, I still have my days. I mean, I will have cases that are going SO smoothly in the beginning, I access and find the canals fast, and instrumentation is a breeze. But then I try to fit in a cone, and it’s all downhill from there.
In fact, I recently had a “girls’ night out” with a bunch of my friends (naturally, we all happened to be dentists!), and at the end of the night, we got to talking through our struggles at work. We ALL confessed to hating the obturation step of a root canal.
All that to say, if you struggle with it, you’re not alone.
What is Obturation, Anyway?
Let’s get some definitions out of the way.
Obturation is what we call the step of the root canal procedure when the pulp chamber is filled and sealed with gutta-percha.
During obturation, you’ll heat up the gutta-percha, put it in the tooth, compact it, and seal it right up.
Making Your Obturation Step Seamless
Speaking from experience, the quality of your obturation step is so dependent on your instrumentation. If you’re encountering issues in obturation, the first thing to do is go back there and do a little more!
When you return to your instrumentation, run your master apical file, check patency, and irrigate all over again. Since the success of a root canal is more dependent on what you take out as opposed to what you put in, make sure that you have sufficiently cleaned out all the canals and created a shape that will accept your obturation.
Basically, what I’m telling you is that, if you have trouble obturating your canals, there is a possibility that your canals just aren’t clean enough. There are several reasons why your obturation may be going wonky, but improper instrumentation is such a likely culprit.
Knowing what your file is doing for you is also really important. You should understand the shape that your file is creating, as this will tell you how to fill it.
I see so many dentists matching the gutta-percha cone to the size of their master apical rotary file, and it just doesn’t fit perfectly as the company promised. When it comes to gutta-percha, there can be so much variation from cone to cone that obturating this way can be frustrating, to say the least. Ideally, we want to finish our cases in one visit when possible, and it can really leave you feeling upset when you obturate, take a radiograph, and then realize that you should start all over!
Obturation is What I Like to Call an Epic Endo Struggle!
A friend of mine (let’s keep her anonymous for the blog) graciously shared one of her cases with me so that I could turn it into a teaching point, since I know we could all use a little extra support around obturation. This way, we can nail both our instrumentation and obturation steps as often as possible.
Here’s the cone fit radiograph. At this point, all was going well:
She then did her downpack and backfill:
And took her final radiograph…
Not exactly the result we all hope for!
So let’s talk about a few things that she could have done in this case to create a better outcome.
For one, the slight overfill on the distal could have been prevented by apical gauging, and the mesial working length could be improved by focusing on patency a bit more. Now there’s also some info that I don’t have, like what equipment she was using and how it was used. But I’m pretty darn sure I could help her with that, too.
But the real question is, what should you do in this situation? Should you leave it or should you take it all out and start over?
My friend wasn’t happy with how that final obturation turned out, and I can understand her frustration. Since we’re all judging each other’s root canals by the radiograph, that final image needs to be spot on. She decided that she was going to redo the root canal, but that meant another visit for her patient—and lost chair time for her.
Naturally, that had both of us thinking: What if you could prevent this from happening in the first place? It would be better for the patient AND you!
How to Remove Gutta-Percha From the Canal
In addition to answering the question “What is obturation?”, the goal of this blog (like ALL of my blogs) is to give you a tip that will help you out as you do endo cases. So get ready, because here it comes!
My question for you is, how do you get your gutta-percha out? Tell me your way in the comments below (I’m always looking for new tips and tricks), and I will tell you mine.
I love to use a 25/.06 Profile rotary at 1000 RPMs!
This will buzz my gutta-percha out of my canals quickly and can get me back to another conefit radiograph in no time. If it’s a fresh obturation, you probably won’t even need chloroform to get your gutta-percha out. But, if you redo the root canal on another day (like my friend), then the sealer may set, and you will most likely need a solvent to get the gutta-percha out of the canal.
If you’re nervous about running the file at that speed, then don’t take the file all the way down the canal. Go about ⅔ the way down to working length, and then switch to your hand file to remove the remaining gutta-percha.
And don’t be too aggressive with your file, since it can still separate, and then you’ll have a whole new issue to straighten out. Take out only a little bit of gutta-percha at a time, and if you feel that there’s too much resistance, use some chloroform (a.k.a C solution) to help soften the gutta-percha at each increment.
Once you remove the gutta-percha, don’t forget to reestablish patency, run your master apical file again, and irrigate. And voilá! You’re back at your conefit step, ready to run your obturator and nail that final radiograph.
My friend is lucky because we work together all the time, and she has me at her disposal as her specialist. But what about all the other dentists out there who don’t have someone to go to?
When you need quick tips on stuff like what obturation is all about, how to troubleshoot your obturation step of a root canal, and tricks for mastering your instrumentation, I encourage you to enroll in E-School LIVE, my 4-day, in-person, hands-on, live patient CE training for dentists.
In the meantime, if you want to get a little more support on your instrumentation processes, why not download my free instrumentation workflow? I promise you’re gonna love it!
Frequently Asked Questions
1. What is obturation?
Obturation is the step of the root canal procedure during which the pulp chamber is filled and sealed with gutta-percha. Any dentist will tell you that it’s one of the biggest challenges in endo, and even veteran endodontists like me still struggle every once in a while!
2. What can I do if I’m struggling with my obturation?
If you’re having trouble with your obturation, the first thing you should do is go back to your instrumentation. A lot of times obturation is difficult simply because the canals aren’t clean enough! When you return to your instrumentation, run your master apical file, check patency, and irrigate all over again so you can make sure you’ve sufficiently cleaned out all the canals and created a shape that will accept your obturation.
Another important thing to keep in mind is the shape you’re creating with your file. A lot of dentists want to match the gutta-percha cone to the size of their master apical rotary file, and unfortunately that’s just not how it works out in practice.
3. What should I do if my final radiograph just isn’t the result I was hoping for? Should I leave it or start the whole thing over?
Ultimately, the decision of whether or not to start over is entirely up to you as the dentist! If you do choose to start over, that’s lost chair time and another visit for your patient. On the other hand, if you don’t start over, there’s always the chance that you could be leaving some bacteria behind in the canals, and it could lead to issues for your patient down the road.
Ideally, it’s best to prevent this kind of situation from happening in the first place with some reliable obturation troubleshooting tips (like the ones covered in this blog)!
4. What’s the best way to remove gutta-percha if I want to start from scratch?
While there may be several different ways to do this efficiently, I’ve found that what works for me is to use a 25/.06 Profile rotary at 1000 RPMs. If you’re nervous about running the file that fast, don’t take it all the way down the canal. Instead, go about ⅔ the way to working length, and then switch to your hand file to get rid of the remaining gutta-percha.
Additionally, make sure you’re only removing a little gutta-percha at a time! You don’t want to be too aggressive with your file, as it can still separate and cause a whole new situation to straighten out. Once it’s all out, don’t forget to reestablish patency, run your master apical file again, and irrigate. Follow all these steps and you’ll be ready to run your obturator again!
– Sonia
33 Comments
I’m General Dentist. N love joy doing root canals . I want to explore or master my skills on how to not miss MB2 almost 99% . I need your guidance on that .
hello, how do you get out the gutta percha that passed the apex ?
Hi Anuradha!! This is a great question. If you love endo so much, have you ever thought about investing in a microscope? I hate to say it, but even after 10 years of being an Endodontist, I still have trouble finding this canal sometimes on 1st AND 2nd maxillary molars. In fact, it’s the last tooth I encourage people to try because without high magnification it’s easily missed. I tend to find this canal more apical to the main MB canal, so I have to trough down and be very careful not to perforate. The microscope helps me be very selective with my dentin removal and therefore more conservative. I know that this isn’t the most helpful answer, but it’s the truth. There is no magical way to find them, but you should be finding them almost every single time. So really consider if you are helping your patient by doing this particular tooth yourself. And consider your amount of chair time too — could you be more productive doing another procedure. I know that sometimes I need two visits for a maxillary molar and I prefer one visit if I can. But, some people love endo and the best thing you can do is invest in a microscope. It will change your life😊!! Hope this helps.
My best,
Sonia
Hi Varvara! This can be done one of two ways: first, and probably the best for this case is to use chloroform at the apex and then use a paper point slightly long and “wick” up the dissolved gutta percha. Another option is to use a hedstrom file to engage the gutta percha and to pull the gutta percha out of the canal. You will have to sort of “yank” the file once it’s engaged so be careful😊. This second technique I use when the gutta percha is longer than what you see in this case.
-Sonia
Hello friends, fastidious article and nice arguments commented
at this place, I am really enjoying by these.
Thank you for following along!
-Sonia
Hello maam,i am a general dentist and love endo.would love to master it.
Practising dentistry since 18 yes and live doing endo the most….but still I follow the traditional obturation technique of master cone ,lateral condensation and accessory cones..happy with the outcome….do I need to shift to warm vertical condensation …which machine is best?
Switching is totally up to you, just remember that there is a learning curve. I love the System B for doing my downpack and the Hot Shot for my backfill. Hope this helps!!
-Sonia
Hello Dr Sonia!
This is definitely what everyone has gone through at least once in their practice. I am sure many still go through, including me. Thank you for the tips!
I would like to discuss about sealers. They do play an important role in obturation, as well. Would you agree to that? What’s your favorite Sealer?
Hey Gaurav,
I totally agree that sealer is important too. There are a ton of good options out there, but my go to these days is AHPlus. I haven’t played much with the BC sealer, but I plan on it. Roth’s 801 and Kerr EWT work well too.
-Sonia
Then I am so glad you are following my blogs! Be sure to check out E-School, my endo course that’s launching soon. You can get more info here: https://soniachopradds.mykajabi.com/
-Sonia
I’m a general dentist. Love doing endo. So happy to have found your blog. Got so much to learn here.
Thank you Dr. – I am happy you found it, too! More content to come.
-Sonia
Hi Dr. Chopra,
Just love reading your blogs.
What are the consequences of overobturation & how would be the prognosis of that tooth ?
Thank you for all your valuable tips
I can already see myself improving with reading the material from your blog
I have a question while doing Re RCT can I use my wave one rotary file to remove the Old GP
I know u use protaper at 1000rpms
If I can use wave one what specific speed should I use it at ? And what file should I use ?
Thanks
Thanks a lot for all your lovely tips n tricks
If I am doing are RCT can I use my wave one rotary file to remove GP
If yes , which file and what speed
Thanks
Hi Richa,
Thanks for reading. As long as the bacteria is completely removed from the canals, a little overfilling should not really hurt anything. I am not advocating it, but I wouldn’t try to surgerize every overextension that occurs. The key is disinfection. -Sonia
Hi Ummesalma,
Thanks for your notes and questions. This is a reply to both of your questions. I would not use a gold file to remove gutta percha. You would need a file that has a stiffer metal in order to be more efficient at removing the gutta percha. -Sonia
Hi again Ummesalma,
Thank you for your question. I would try using something like a Profile 25/.06 at 1000 rpm. -Sonia
Hi, how to get obturation for a canal with separated file at 1/3 at apex that canal can’t treat by bypass or remove the separated file ? To this type of case for get excellent apical seal and puff .!!
Thanks for your answer ….
Hidayat,
It sounds like this tooth will need an apicoectomy in order to complete treatment.
-Sonia
hello thanks for sharing tricks.
Sometimes after bmp when i proceed for obturation in next appointment patient feels pain when gp is inserted in canal .
why is that so? and also how to decide when obturation can be done
If your patient feels your gutta percha while obturating it tells me that their anesthesia is wearing off or the gutta percha is too long and is sticking out of the tooth! Hope that helps!
-Sonia
If endo was done just couple days ago…….and on post restoration radiograph you notice under filling laterally where you could have fitted some accessory cones but you did not then Would you recommend using profile 25.06 with chloroform to retrieve that GP or would you be able to remove the restoration and warm the existing GP followed by lateral compaction to fit accessory cones?
Priyanka,
I feel that there are many ways to remove the GP in this situation. You could use a small gates glidden, a heated plugger or the 25/.06 you just mentioned.
-Sonia
I want to express my appreciation for your great information! I know it takes a lot of time. I have been using Guttacore for the last 11 years with excellent success. Of course it is not without its occasional challenges. In my 50 years of dentistry I have used every technique and find the Guttacore technique to be predictable. Thanks!!
Hi Sonia
As always, grateful for sharing all the marvelous tips.
Do you have any experience using gutta condenser?
I think you are referring to GuttaCore and no I don’t have experience with that.
-Sonia
Hi Dr Sonia,
Thanks for the informative article.
I have recently encountered issues with discrepancies between a perfect master cone X-ray to one which is short by 1.5-2 mm on post obturation.
Any tricks to avoid that as it is really frustrating.
Thanks for reading this.
This is usually an instrumentation problem, from what I think your question is asking. If your obturation is short, try re-instrumenting and see if your cone goes down to proper working length after that.
Hi Dr. Chopra,
What could be the reason why master cone xray looks great and to length but as soon as I put sealer on and seat it, it’s short? Would it be a sealer issue or instrumentation issue? Thank you!
Hi Anna, it’s possible that your cone bent upon reinsertion.