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Coltene Whaledent
Experience from the practice using a new root canal filling material:
A flowable Gutta-Percha Silicone Sealer provides a new option using a cold-filling technique
Endodontics in dental practices throughout Germany is very familiar with two wellestablished things: guttapercha
and lateral condensation. One reason for this might be that both are commonly taught as the standard endodontics procedure at universities throughout Germany. However, its well-documented, long-term success is much more important.
Dr. Rolf Herrmann
(born in 1944) completed
his dental medical
studies in 1969 with
examination and a doctorate
in Marburg. He
spent a period of time as
the assistant in the oral
surgery department of
Dr. Hemmerich in Munich
and Dr. Strobel in
Ulm. In 1972, he set up a dental practice
together with Dr. Anke Herrmann in
Günzburg; and established a joint practice
with its own dental laboratory. Aside
from organising training courses and
larger events with well-known lecturers,
Dr. Herrmann lectures in the field of
prosthetics, practice organisation, and
endodontics (among others in Boston,
Tel Aviv, Postgraduate course); and holds
training courses with an emphasis on
endodontics, bone regeneration (PRGF),
and implantology.
He is a member of the Neue Gruppe, in
which he was President in 2000 and
2001. From 1996 to 2000, he was responsible
for the management committee
for continuing education. He has also
served several years as a consultant to
the dental industry in the area of research
and development.Warm-filling techniques are good, but technique-sensitive
Adhesive technology has brought dental medicine a long way – at least in the filling therapy. This however does not automatically
mean that such systems will always function in the root canal. Some
scepticism should be considered appropriate. How can a primer, for example, and a polymer (polyester base with bioactive glass) be safely introduced into the complex anatomy of the root canal? This factor will play a major role in regards to the sealability of the filling and its long-term success. Of equal importance, is the fact
that a re-entry into a root canal prepared using adhesive technology can also be very difficult (Retreatment).
Despite cold-filling techniques being the most commonly practiced technique in Germany, some clinics are still teaching warm-filling techniques at training courses. Shrinkage of the heated gutta-percha
can be expected when using these systems, which can only be compensated for by using complicated techniques.
Fig. 1: An access cavity is created to provide a good view of the entrances in the canal.
This is demonstrated by the good fillings within the accessory canals and usually a slight apical over-pressing of the sealer and/or gutta-percha. Thus, an optimal sealing of the root canal should be achieved. The homogeneity and the density of the root canal fillings are very good– compared to cold-filled, lateral condensation.
The main reasons that warm-filling techniques have not prevailed are due to the high investment costs and techniquesensitivity, without achieving better therapeutic success.
Fig. 2: Length and size of the gutta-percha master points is determined.
Based upon the results from scientific studies, published clinical articles, and personal clinical experience, I see no alternative to the classical sealer/gutta-percha obturation technique. Naturally, there is still development potential for the sealer/ gutta-percha obturation technique. Such development should ideally facilitate reliable
treatment of root canal; and at the same time, provide improved application.
Fig. 3: The GuttaFlow canal tip is introduced
deep into the canal. The canal tip is slowly removed from the canal as the material is dispensed.
Our practice had the opportunity to test this material very early on. Our experience with silicone sealers dates back to 1999; and since 2003, we have been working with the gutta-percha silicone-sealer combination (GuttaFlow®, Coltène/Whaledent GmbH + Co. KG, Langenau/Germany). The basic idea behind the development of GuttaFlow was to make the sealer-togutta- percha ratio as close as possible to gutta-percha; and at the same time; reduce the number of gutta-percha points. Even if the studies show a dense root filling with only one or even entirely without master points – in our practice, we always introduce GuttaFlow with at least one master point, and two to three accessory point for stabilisation. By carefully pushing the gutta-percha points into the canal, improved condensation of the root canal filling in the apical segment, especially in curved canals, can be achieved with improved sealability.
Access to the cavity with a good view of the canal openings
Fig. 4: The gutta-percha master point is introduced.
The first step for a definite root canal filling is to mix the GuttaFlow capsules. The mixing process is complete after 30 seconds. The capsule is snapped into the dispenser with the canal tip attached, which is then introduced deep into the canal (Fig.3). As the material is dispensed, the canal tip should be slowly removed from the canal.
Fig. 5: Accessory points are introduced to stabilize the master point and build-up pressure inside the canal.
If the filling is too short, vertical condensation is possible
A control x-ray is then taken. Using a touch-and-heat technique, the guttapercha points are seared off, and at the
same time, the GuttaFlow will superficially cure due to the heat (Fig. 6). Caution should be taken when using a hot instrument, as the faster cooling adhesion to the point may cause sticking, which could possibly pull it out.
Fig. 6: Searing off the gutta-percha points.
It is essential to obtain a good seal (Fig.7) in order to avoid coronal leakage. This is best performed using glass-ionomer cement. There are no studies that show the correct timing of a post preparation in relation to the overall success of the endodontic treatment. The possibility of retreatment provides argumentation against an immediate preparation; and it is recommended that the setting time of Gutta-
Fig. 7: Sealed root canal filling using Gutta-
Flow: radiopaque and biocompatible.
be followed.
From my experience, GuttaFlow has value in our practice. It meets my requirements for a root canal filling material: Simple to dispense, homogeneous mix, fast and easy-to-use, flows well into intermediate spaces, cures within a wet and dry environment, insoluble, dimensionally stable, good adhesion to dentine and guttapercha, retreatment is possible, post preparation is possible, radiopaque and biocompatible.
Dr. Rolf Herrmann, Günzburg
Source: DZW – Die Zahnarzt Woche 23/06
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