Comparing Carrier Obturation versus Traditional RCT: Side by Side

Terry Pannkuk, DDS, MScD Clinical Endodontic Technique Instruction, Obturation

This patient's treatment offered a nice contrast between expedient root canal treatment performed with a carrier and traditional time-consuming root canal therapy on a calcified molar which had been previously pulp-capped. It's very easy to quickly place a rigid plastic carrier to the apex of an unclean system and show a fake radiographic presentation of having performed adequate endodontic treatment. In this author's opinion, it is the main reason carrier obturation is so popular with dentists only concerned with production and not patient-centered quality health care. It's not really the material per se but rather the wide-spread abuse of patients it promotes.

Note the unusual fin that was discovered toward the buccal aspect of the distobuccal canal orifice. The fin was cleared with copious flushing of irrigant with passive ultrasonic action (Sonofile) which is one of the best evidence-based strategies for irrigant activation. The strategically extended endodontic (SEE) access removed only the necessary dentin to create a direct line convenience form to the apical third and create opportunities to discover unanticipated anatomical entities like the unusual DB fin. A preparation that results in consistently filled presentations having the same geometric dimensions of the fit gutta percha cone is a sign that inadequate time is spent cleaning and shaping the root canal system and/or improper molding and apical deformation of the gutta percha cone during obturation.

What is being currently touted as "minimally invasive" endodontics through a blind small occlusal hole is in reality "minimally effective' endodontics which fails to debride and demonstrate cleaned root canal system space. Two dimensional radiography belies the true conservation of remaining root dentin which is more accurately demonstrated in 3D, especially with a CBCT scan having the slices shown as expanded wider than the currently viewed 76 micron width causing beam hardening and scatter (expand the slices to 4mm and rotate in the transverse plane to see undistorted canal preparation dimensions)

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