The process of cleaning and shaping facilitates obturation, a concept emphasized by the late Dr. Herbert Schilder for years.
In this clinical concept submission that point will be highlighted by cleared root images and a discussion.
The presented cleared tooth images were processed and photographed by Dr. Craig Barrington and the first image shows the actual root canal system anatomy of an extracted tooth which had been cleared. The subsequent color overlays show graduated representations of root filling: main system to complete system debridement and filling. It is virtually impossible to achieve the last complete representation of root canal system space cleaning and sealing with a filling.
Obturation is not really a separate, distinct phase of root canal treatment and the degree to which a root canal system space is filled depends upon the clearing of the space before hand. Obturation just simply shows the space created by cleaning and it isn’t an “either/or” phase of treatment.
If you spend time cleaning you’ll have more of the significant space decontaminated reducing the communicating space to a minimum that is least likely to cause recurrent clinical and “subclinical” disease.
If adequate time is not spent cleaning and shaping (debridement) the gross root canal system space then endodontic disease will not be PREDICTABLY eliminated.
There is a current focus on marketing products which simplify and make endodontic treatment less technique sensitive but not better. Carrier obturation provides the less experienced clinician with a rigid core material that can be placed to the length of the root before the tedious process of exploring and smoothing away lateral irregularities occurs. This means that a desired radiographic result can be achieved in advance of the traditional sequential steps that are required to fit a less rigid cone, thus incomplete exploration, disinfection, and clearing of the complex lateral anatomy occurs.
The combination of expeditious rotary file shaping and placement of a rigid cone simplifies the process but ignores the necessity to treat and disinfect complex lateral root anatomy which can only be addressed with copious, activated flushing of irrigant combined with precurved hand-file exploration. The key is patience, time, and skillful exploration of root canal system anatomy.
At some time in the near future technological development of a less technique sensitive treatment process will occur, but those advocating constricted access limiting visibility and preventing mechanical exploration and flushing of debris from the root are ineffectually performing endodontic therapy which leads to an unpredictable outcome.
The PDL clinical endodontic technique webinars highlight the concepts and specific procedural details for achieving predictable treatment success.