Dentaltown February 2020 - 88

Fig. 13

more of a hybrid warm vertical/single-cone
obturation technique-warm vertical in the
coronal/middle two-thirds and single-cone
in the middle/apical third. In other words,
the heat does not transfer from the heat tip
through the gutta-percha more than 4-5mm.
If in a tighter or curvy canal the heat tip
advances only within 7mm of the working
length, then it is in effect a single-cone
obturation in the apical third. This happens
often, and despite this deficiency, in my
opinion there is still good clinical success.

Fig. 11

Backfill
After the heat tip has extended to within
4-5mm of the working length, or as close
to that as possible, then the canal is ready
for the gutta-percha backfill. I call this
the "hot glue gun portion" of obturation,
and for years have used heated backfill
devices such as Obtura and Calamus. My
new favorite backfill system is the cordless
GuttaSmart from Dentsply Sirona; the needle
fits well into the canal space in a pen-grasp
method, which allows accurate and efficient
placement of heated gutta-percha. I have
noticed few voids and an excellent, dense
fi ll. This heat tip and backfi ll device has
made warm vertical obturation extremely
efficient, taking only two or three minutes
longer to perform than when I perform the
single-cone obturation technique.

Fig. 12

FEBRUARY 2020 // dentaltown.com

Place the tip of the chosen backfill
device into the canal and as close to the
gutta-percha plug as possible (preferably
right on top and touching the gutta-percha
in the canal). Allow the backfill tip to sit
for a few seconds to heat the canal and
gutta-percha, then slowly extrude the hot
gutta-percha. The hot gutta-percha will
slowly displace the backfill device right
out of the canal (Fig. 11). I usually perform
the backfill in one increment, especially if I
am using GuttaSmart, but an incremental
backfill is also fine.
Fill the canal up to the orifice level, right
at the pulpal floor junction (Fig. 12). Use a
larger plugger, such as the black or blue end
of the Dovgan pluggers, and gently pack
the extruded gutta-percha into the canal.
The root canal is now completed (Fig. 13).
If I used ThermaSeal Plus Ribbon sealer
or AH-Plus, then I clean the pulp chamber
with an alcohol pellet and place a composite
core. If I used Pulp Canal Sealer EWT, I
first use a chloroform pellet, followed by an
alcohol pellet and then can place a bonded
core composite.

Conclusion
Warm vertical obturation is a technique
favored by many endodontists and general
dentists. It is a tried-and-true technique that
has had great success for many years. The
disadvantage of this fi ll technique is that
it can be considered technique-sensitive
and time-consuming. But once a clinician
learns the fi ner points, it is an excellent
way to achieve a dense root canal fill and
hermetic apical seal. ■
References
1.
2.
3.

Calt, S and Serper, A. Time-Dependent Effects of EDTA on
Dentin Structures. J Endod 2002; 28: 17-19.
Schilder H. Filling root canals in three dimensions. Dent
Clin North Am 1974;1: 723-44.
BuchananLS. The Continuous Wave of Obturation Technique: 'Centered' Condensation Warm Gutta-Percha in 12
seconds. Dent Today 1996;15:60 -7.

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