how do you obturate upper molars?

[razor1911]

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Any tips for obturating maxillary molars?

My biggest problem so far is aiming the gutta percha into the canals. ( The tooth is so far back and is on the upper arch - I simply can't see where I'm at ) I keep missing and my gutta percha ends up being bent. My hand mirror isn't helping much at all.

I would gladly accept suggestions on how I should go about in obturations.
( I didn't have problems with instrumenting, since the hand files are rock hard and is not a problem to tactily insert them into the right canal )

Thanks in advance.

 

[Zzzdentist]

Have you tried cutting the master cone to length and taking it to place with a pair of cotton forceps? Usually you get a feel for the angle using the file, and basically you match it going in with the gutta percha. Use your mirror to try to catch a peek into the pulp chamber. Use a light touch and feel your way into the canal.

It shouldn't be that hard if your access opening is the correct size and the orifices are adequately opened up. Just keep at it.

 

[Elipar]

You may also want to consider shaping more. If your tip is that wimpy, it's likely that you're only shaping to fairly small sizes with small tapers. But for the solution you're looking for, buy small mirrors. The one I use is about 1/2 cm and it easily slides back to a second molar without inhibiting the view.

 

[razor1911]

You may also want to consider shaping more. If your tip is that wimpy, it's likely that you're only shaping to fairly small sizes with small tapers. But for the solution you're looking for, buy small mirrors. The one I use is about 1/2 cm and it easily slides back to a second molar without inhibiting the view.

To what extent should the canal be shaped?

Even if I shaped the canal more, after I condense the gutta percha, wouldn't I still have to use wimpy gutta percha to fill in the voids?

Again, it's only the maxillary molars where this is occurring. I don't have an issue with the other teeth since they are highly visible.

 

[razor1911]

Have you tried cutting the master cone to length and taking it to place with a pair of cotton forceps? Usually you get a feel for the angle using the file, and basically you match it going in with the gutta percha.

I know what you mean but that never worked. Files are much stronger and, even if I'm aiming at the wrong place, I can eventually feel where the files are and easily locate the canals.

Even if I'm angling correctly with gutta percha, I keep missing and the gutta percha ends up being crushed when you're hitting the wrong area even once.

 

[Zzzdentist]

Have you tried taking a size 2 or 3 gates glidden and pivoting that around at the canal to open up the orifice? That might create a slightly easier funnel entrance for your gutta percha to enter. Generally a 25 size apical seat is what I aim for. I step back from 25 to about 45 or larger depending on the tooth.

You can also just try inserting a larger sized gutta percha point first just to get a feel for the entry angle. Get a feel of where you want to be and then you can switch back to the proper sized main point.

There's no magic way to do it. It's just practice, visualization, and proper orifice access. Everyone gets bent points doing lateral condensation.

 

[DrJeff]

Is your access prep large enough?? Most of the time when I'm obturating I find if I'm having difficulty with accessing the canals for obturation that I've underprepped my access. I know everyone wants to conserve as much tooth structure as possible, BUT you will be crowning that tooth when you're done with the endo, and what's going to be better for long term success, complete, solid obturation to length, or a little extra natural tooth structure under that crown???

Plus, a little trick I've learned that helps with access without grinding away too much extra tooth structure. Think about your access prep like its an inlay prep with DIVERGENT axial walls (and I'm talking about 15 to 20 degrees of divergence). Lastly when I have adequate straightline access, I'll often with a bur cut a small guide notch" in the axial wall adjacent to the straightline access. That way when I goto either work the canal with another file, or obturate, I use that notch for positional orientation, almost like a path of insertion for a RPD.

 

[Elipar]

To what extent should the canal be shaped?

Even if I shaped the canal more, after I condense the gutta percha, wouldn't I still have to use wimpy gutta percha to fill in the voids?

Again, it's only the maxillary molars where this is occurring. I don't have an issue with the other teeth since they are highly visible.

There seems to be two philosophies on canal shaping. Either keep the apex small but use a .06 or larger taper, or make the apex large (#40 minimum) and use a smaller .04 taper. If you're doing warm vertical, that means you're using a thick cone, so it's less likely to ding the tip. If you're doing lateral condensation, that's where it gets trickier. The accessory points do have very thin tips that require care. As I said earlier, buy small mirrors. The smallest commonly used mirror is I *think* 3/4 of an inch. But you can buy them as small as 5mm in width! EXTREMELY useful in cases where mouth opening is limiting.

 

[Elipar]

I know what you mean but that never worked. Files are much stronger and, even if I'm aiming at the wrong place, I can eventually feel where the files are and easily locate the canals.

Even if I'm angling correctly with gutta percha, I keep missing and the gutta percha ends up being crushed when you're hitting the wrong area even once.

This means you're not looking at the cone going to place, probably because you can't get a mirror in place without blocking everything else. By using a small mirror you should be able to see the cone go to place. It's important because you not only want to see an unbent cone go in, but you need to make sure it's going in the right canal. And when you go to put accessory points in, it's important to get them in the same spot the spreader vacated.

 

[Dental916]

Is your access prep large enough?? Most of the time when I'm obturating I find if I'm having difficulty with accessing the canals for obturation that I've underprepped my access. I know everyone wants to conserve as much tooth structure as possible, BUT you will be crowning that tooth when you're done with the endo, and what's going to be better for long term success, complete, solid obturation to length, or a little extra natural tooth structure under that crown???

Plus, a little trick I've learned that helps with access without grinding away too much extra tooth structure. Think about your access prep like its an inlay prep with DIVERGENT axial walls (and I'm talking about 15 to 20 degrees of divergence). Lastly when I have adequate straightline access, I'll often with a bur cut a small guide notch" in the axial wall adjacent to the straightline access. That way when I goto either work the canal with another file, or obturate, I use that notch for positional orientation, almost like a path of insertion for a RPD.

Side note..Dr. Jeff...I thought you were an orthodontist...or am I mistaken?

 

[Istr8nthem]

Side note..Dr. Jeff...I thought you were an orthodontist...or am I mistaken?

I believe his wife is an orthodontist... purely based on previous posts.

 

[ElDienteLoco]

I think Dr. Jeff is right on. I've found that I bend less GP if my access prep is really good. I like to drop into the chamber and then use an endo-z to unroof the chamber. This usually makes an access that is not too small (visualization problems) or too large (ledges that I hang up on with every instrument, cone, etc.) If you make an access like this and then use your gates towards the line angle of whatever canal you're working on (DB with pressure towards the DB) you'll avoid perforating your furcation and you'll improve your straight line access that will make everything slide in so much easier. I think this is also one of the most important keys to efficient endo. Nothing worse than poking around and never seeming to get the files, cones to go into the orifice...

 

[endoking]

There seems to be two philosophies on canal shaping. Either keep the apex small but use a .06 or larger taper, or make the apex large (#40 minimum) and use a smaller .04 taper. If you're doing warm vertical, that means you're using a thick cone, so it's less likely to ding the tip. If you're doing lateral condensation, that's where it gets trickier. The accessory points do have very thin tips that require care. As I said earlier, buy small mirrors. The smallest commonly used mirror is I *think* 3/4 of an inch. But you can buy them as small as 5mm in width! EXTREMELY useful in cases where mouth opening is limiting.

Good point about cold lateral--an easy trick I do when adding accessory points is when you place your spreader into the canal, slide it down the master cone, then when you place your accessory point, slide it down the same side of the master cone and it will drop right in. Also, use those Gates until a blind man could obturate it.

 

[DrJeff]

I believe his wife is an orthodontist... purely based on previous posts.

Exactly, I'm just a "lowly" GP😉😀 My wife's the flashy specialist "wire bender"😉

 

[doc toothache]

Any tips for obturating maxillary molars?

My biggest problem so far is aiming the gutta percha into the canals. ( The tooth is so far back and is on the upper arch - I simply can't see where I'm at ) I keep missing and my gutta percha ends up being bent. My hand mirror isn't helping much at all.

I would gladly accept suggestions on how I should go about in obturations.
( I didn't have problems with instrumenting, since the hand files are rock hard and is not a problem to tactily insert them into the right canal )

Thanks in advance.

If you get desperate you may want to try/modify file holders available from Pearson (800-535-4535) pf www.pearsondental.com.

 

[razor1911]

and suppose you screwed up on an obturation, with gutta percha cemented in.

What are the most effective procedures in moving them and starting from scratch?

 

[OceanDMD]

and suppose you screwed up on an obturation, with gutta percha cemented in.

What are the most effective procedures in moving them and starting from scratch?

Chloroform, #8-#15 files, Small diam rotary files, and lots of time and care.