Root canal obturation and root integrity

The American Association of Endodontists defines root canal obturation as the complete, three-dimensional obturation of the root of canal system, as close as possible to the cemento-dentinal junction without overor underfilling. Moreover, obturation should be carried out using a minimal amount of biocompatible sealer and the obturated canal should demonstrate a radiographically dense filling extending as close as possible to the cemento-dentinal junction (AAE Appropriateness of care and quality assurance guidelines, 1994; Gutmann JL, 1992). However, this definition overlooks an important requirement in three-dimensional obturation, i.e. the need to maintain the integrity of the root canal walls (Cantatore G, 2000; Cantatore G, 2001; Ruddle CJ, 2002). The clinician should carefully consider the anatomy of the root and the thickness of the residual dentinal walls, in order to choose a minimally invasive canal preparation technique with the least dental tissue loss. This article describes two obturation techniques that make it possible to treat a higher number of clinical cases successfully while respecting radicular integrity. The description is preceded by a short discussion on various issues related to endodontic rationale and an understanding of the current root filling material of choice, gutta percha, which is essential to an appreciation of obturation techniques.