Root Canal Obturation: No Stress! There’s an Optimal Solution

Endo procedures can be stressful for all dentists, no matter their expertise level. Many difficulties come into play, especially during the root canal obturation procedure. We asked endodontists to share their experiences with RCT with a focus on the obturation procedure. What are the main challenges and how can dentists overcome them for easier, stress-free root canal obturation?

 
Endo causes stress, even for specialists  

Most dentistry practices perform endo procedures. While the average endo specialist will perform up to 20 a week, or an estimated four to five RCTs each day. Meanwhile, most general practitioners will face two or three endo procedures a week on average. 

A sample of endodontists was asked about their comfort level with endodontic procedures. The results were surprising! While 44% said they were “very comfortable,” they still recognized that it’s complex and challenging, requiring a lot of practical experience. The rest responded “somewhat comfortable” and “uncomfortable,” which means a majority of 56% of endodontists are facing difficulties in endo and potentially feeling stressed during their practice. When it comes to general dentists, the comfort level with RCT dips even lower. However, some large variations must be accounted for, as some may feel comfortable with single-rooted teeth and not with molars. 

While dentists receive training during their studies, the only way to gain mastery is through real-life practice experience and sometimes, additional training is needed. As you know, real patients bring many more challenges and unpredictable factors compared to the safe environment of schooling. 

Which techniques do dentists prefer?

Dentists have many techniques to choose from when performing RCT. An international survey of dentists revealed a pattern according to dentists’ specializations. General practitioners generally favor cold techniques by 56%, while endo specialists overwhelmingly favor warm techniques at 84%.^[1] 

Regardless of cold or warm technique, RCT is a time-consuming procedure, with obturation taking up an average of 10 min for a single-rooted tooth and 25 min for a molar. Not to mention, some practitioners prefer to take extra steps; for example, some endodontists prefer to make a master cone radiograph and one single radiograph at the end of the obturation, while others also perform mid-fill obturation, etc. 

According to endo specialists, “once the warm technique is learned and mastered, it’s not that difficult to use. However, doctors who are less experienced or practice fewer endo procedures each week will be tempted to pick cold techniques because it presents several advantages: faster, easier, more simple, cost-efficient.” And practitioners familiar with new sealers agree that single cone technique and obturation with calcium silicate sealer is much quicker than a cold lateral technique, while recent clinical trials affirm that they are as effective as warm vertical condensation with conventional sealers.^[2] 

Main challenges of root canal obturation

Root canal treatment already presents many challenges, such as root canal preparation and drilling. Cleaning, disinfecting, and preparing the canal is an essential step, as poor disinfection can lead to future retreatment due to bacteria proliferation. Today, our focus lies on root canal obturation, as practitioners say it is one of the most challenging parts of endo procedures, along with gutta-percha placement. Good obturation is a key to successful treatment: if the gutta-percha is not properly placed or if the obturation has failed due to sealer shrinkage, for instance, specialists must perform retreatment to fix the previous dental work. 

Many different factors can complicate obturations. Patient anatomy such as curved canals can make obturation quite difficult for dentists, who spend extra time fitting the GP and cones to achieve the best fit possible. One dentist specifically mentioned the difficulty in obturating very large canals with no apical constriction. Another practitioner specifically mentions anatomy: “In some cases when the canal is curved, for example, it is difficult to place the GP properly and not to damage the apex area.” 

Dentists also mention lack of visibility, which can affect how difficult obturation can be, such as when dentists are working blindly in difficult areas. Experienced dentists must learn to rely on tactile sense, and visual aids are expensive, so costs can also become an issue to perform comfortable obturations.  

Furthermore, even in capable hands, the obturation procedure presents many risks, including fractures from excessive compaction, and the risk of sealer extrusion. One dentist recalled an early lateral condensation where too much confidence nearly led to disaster: the obturation had almost come into contact with the inferior alveolar nerve and “a minimal extrusion of sealer would have been enough to irreversibly damage the [nerve].” 

So how can we lessen the risks involved in root canal obturation and simplify the procedure so dentists feel more comfortable performing it daily? 

How to facilitate and make endo procedures stress free

Using patented technology, Septodont has developed a new and effective tricalcium hydraulic sealer called BioRoot™ RCS, which all dentists – both GPs and endo specialists – can use without extra training during endodontic procedures. BioRoot™ RCS is designed to facilitate endodontic care, as it provides reliability and a high-sealing quality, even with single cone root canal obturation techniques and cold techniques. 

Performing a root canal obturation with BioRoot™ RCS is very straightforward. Once the canal is prepared, cleaned, and dried, dentists mix the product and coat the gutta-percha with it, delivering it to the apex. As soon as gutta-percha is fixed in the canal, dentists can place any additional amount of sealer necessary. The gutta-percha is cut to finish off the procedure. BioRoot™ RCS does not shrink and acts as both a sealer and a filler, so the gutta-percha, beyond being the carrier, serves also for easy retreatment. 

Lower chances of retreatment

When asked about what could make obturation easier, practitioners said one main improvement they’d like to see would be easy retreatment. In fact, retreatments were quite frequent when using traditional sealers. However, dentists who use the latest generation of hydraulic, mineral-based, and bioactive sealers see comparatively few cases of retreatment. More long-term research is needed, but one recent retrospective clinical investigation looked at hundreds of teeth treated with bioceramic sealer using single cone technique, at an average follow-up time of 30 months and found an overall success rate of 90.9%.^[3] 

BioRoot™ RCS features a bioactive formula with high alkaline pH that limits bacterial growth. Its ability to heal the apical area makes it an ideal candidate for obturation that supports long-term results, lowering the risk of clinical failure and allowing easy retreatment.  

So whether you’re among the general practitioners with a penchant for cold technique, single cone technique, or among endo specialists looking to optimize their obturations, BioRoot™ RCS can help you perform obturations quickly, effectively, and therefore at a lower cost.