The Need to Obturate

At the time of patient's appointment for obturation, many times it comes in our mind during the treatment that, well all is well now, patient is asymptomatic and using his teeth to eat. Why to further try to do some thing in the tooth, which can give him pain during the procedure or after wards.Why not let it be like this and just “wait and watch”? This just “wait and watch” is a dangerous line in endodontics. This line is used when

1) The operator is fixed and doesn't know what to do next.

2) The operator is too busy to do some thing else or

3) The operator is tired of treating a mischievous tooth not getting “ok hundred percent”

Many failures may result with this wait and watch attitude.

So let us keep this attitude at the back and start understanding the real thing. Now let's be serious about the objectives.

Yes, you don’t need to do a filling, provided the canals and the internal area of the tooth remains clean and microbe free.

In gum treatments, once you have made the area clean and healthy, you recommend regular plaque control, irrigation and perhaps root planning as maintenance. Similarly in the root canal treatment once the canal system has been prepared, it has to be maintained like that. Repeated entry for maintaining the environment in the canal is not possible since root canal treated tooth needs to be restored with a crown. It is therefore difficult to imagine, practically, how a clean canal system can be preserved without filling it.

Researches also indicate that nearly 60% of endodontic failures are apparently caused by incomplete obturation of canal space. The prognosis will be poor unless a dense well adapted root canal filling is

achieved, regardless of all you have done in the canal. To achieve this well adapted filling, there are various techniques and various things to fill the canal with, which we will follow-up later as we move on.

The dense well adapted filling does 3 things as described below: 

1) Prevents micro leakage of periapical exudates into the root canal space: The fluid percolates into the unfilled canal space and stagnates. The stagnated fluid break downs and diffuses into the periapical area. The exotoxins, irritants released by breakdown of fluid causes periapical inflammation.

2) Prevents reinfection: Thorough sealing of the root canal till the apical foramen prevents micro-organisms and exotoxins to reinfect the periapical area.

The idea of root canal treatment is to create an environment in the periapical area so that favourable process of tissue healing can take place.

3) Imprisons, deny nutrients and space to multiply for any organisms left after bio mechanical preparation.

Dense well adapted root canal filling

The coronal restoration is also as important as the root filling in achieving these goals, neither will deliver alone.