Figure 7-18.Placement of dry medicated cotton pellet.
debris between appointments. Amalgam, zinc oxide
and eugenol (ZOE), or. a commercially ready-made
cement may be used for this purpose.
ROOT CANAL FILLING
If a medicated cotton pellet or temporary filling
materials have been placed, these items must be
removed and the canals irrigated and dried with paper
points before proceeding to fill the root canal.
Gutta-percha points or cones, available in various sizes
are the most common filling material for a prepared
An appropriate sized gutta-percha point is selected
and may be shortened slightly to blunt the tip. The
point is placed into the canal to a depth where the point
seems snug when gently tugged. This point is referred
to as the master cone. A radiograph with either the
apical tile, or master cone point in place is exposed to
verify the proper length. The tip of the master cone
should provide an adequate seal of the apical foreman.
This radiograph often is referred to as a master cone
radiograph. If adjustments are needed to achieve the
proper length of the master cone, additional
radiographs may be exposed to verify the propel
length. A properly titted master cone also allows space
between the point and the walls of the prepared canal.
Before the master cone is removed, a slight mark is
placed on the point at the line where it is even with the
opening of the tooth by squeezing the cotton forceps on
the gutta-percha. The master cone is now ready for
Mix the cement according to the manufacturer's
instructions. The master cone is removed and a paper
point is placed in the canal to absorb moisture that may
accumulate. The consistency of the cement should be
creamy but quite heavy. The dentist may choose to dip
a lentulo spiral or reamer into the cement mix, insert it
approximately halfway into the canal, and rotate it to
distribute the cement onto the dry walls of the canal.
With the master cone placed into the cotton pliers, the
apical third of the cone is coated with cement. The cone
is then inserted into the canal and seated to the mark
made on the cone.
The space between the cemented master cone and
the walls of either the root canal or pulp chamber is
tilled with additional gutta-percha points (accessory
cones) of smaller diameter alongside the master cone.
Filling the canal with additional gutta-percha points is
done by inserting an endodontic spreader beside the
master cone and applying lateral pressure to condense
the cone against the walls of the canal. As the spreader
is removed from the canal, a smaller additional
gutta-percha point in inserted in the space. The process
of lateral condensation and addition of gutta-percha
points continues until the canal is filled completely.
Figure 7-19 illustrates the steps in filling a root canal
with the master and accessory cones.
The excess length of gutta-percha is removed with
a heated instrument. An endodontic plugger, also
known as a vertical condenser, is used to condense the
still warm gutta-percha vertically toward the apex of
the tooth. More gutta-percha can be added if needed,
and the process of vertical condensation continued
until the canal is filled completely.
When a tooth has more than one root canal, each
canal is filled individually and each requires a properly
fitted gutta-percha point sealing in it. A perfect sealing
of the apical foramen in the roots of the teeth is
essential to eliminate irritation of periapical tissue.
Any excess gutta-percha and cement are removed from
the pulp chamber and the chamber then sealed with a
Amalgam or composite materials may be placed to
fill the carnal opening and restore the tooth permanently
(fig. 7-20). Teeth successfully treated endodontically
may also be restored with prosthodontics treatment,
such as onlays and artificial crowns. As a rule,
follow-up appointments are scheduled periodically for
radiographs of the restored tooth. The dentist uses the
post-treatment radiograph as an aid to determine the
elimination of infection and progress of bone
STEPS IN APICOECTOMY (ROOT END
The apicoectomy (root end resection) requires
teamwork between the dentist and his/her assistants.