Thermafill System

[Visceral]

Opinions? Does anyone use it?

There seems to be some controversy with this system but literature generally claims no significant difference to other obturation techniques.

We are being taught this technique in preclinical and I think we are one of the few schools in North America that might do it. I hear most people learn vertical and lateral compaction which we will learn in third year as a secondary technique.

Only downside is it may make some GPs less reluctant to perform some difficult cases beyond their ability, so they might mess up on the more important shaping and cleaning resulting in a retreat. But that isn't the technique's fault per se.

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[Guy Smiley]

Opinions? Does anyone use it?

There seems to be some controversy with this system but literature generally claims no significant difference to other obturation techniques.

We are being taught this technique in preclinical and I think we are one of the few schools in North America that might do it. I hear most people learn vertical and lateral compaction which we will learn in third year as a secondary technique.

Only downside is it may make some GPs less reluctant to perform some difficult cases beyond their ability, so they might mess up on the more important shaping and cleaning resulting in a retreat. But that isn't the technique's fault per se.

We didn't learn it in school, but I have used it a few times but stopped using it because it seemed like everyone I used it on had a lot of post-op pain for about 3 days after obturation.

 

[crazy_sherm]

It's very fast, but very expensive. Easy to overfill if you aren't careful or get to practice enough.

 

[tinman831]

It's very fast, but very expensive. Easy to overfill if you aren't careful or get to practice enough.

I've heard that getting voids during the fill seems to be pretty common as well. Any experience with that? Seems like a pretty novel concept though.

 

[DrJeff]

My partner and I have used Thermafil almost exclusively for close to 10 years now with very good results and very happy docs using it!

The key to thermafil, just like with ANY obturation technique, isn't what you're using to fill the canals, but HOW YOU PREPARED the canals in the 1st place IMHO.

With a nice consistently tapered canal enlarged to an adequate width, your chances of getting a good long term endo result are quite good no matter what obturation technique you choose to use.

Personally, for my partner and I, thermafil obturators give us consistant, predictable results, that atleast in our hands seem to perform very well long term for our patients, and for refernce sake, last year between the two of us we obturated over 250 teeth.

Just like with most dental systems(and this goes for restorative systems, impression systems, obturation systems, etc), after using them for a while you may find that your comfort level will involve a little trick that deviates slightly from the manufacturers instructions for its use. Personally what works for me when I'm obturating with thermafil, is I'll choose a obturator that is 1 size larger then my final rotary file size (i.e. if my final rotary file was a size 40, I'll obturate with a size 45 obturator) and I set the stopper on the thermafil obturator 1mm short of what my final working length was. For me this gives consistent obturation. My partner will usually use an obturator size that is 1 size smaller than his final rotary file and set the stopper to full length. To each his own.

Post op sensitivity wise, what I tell my patients when I finish a case, is that to biting pressure, they should expect a MILD bruise like tenderness on that tooth while chewing for a couple of days, and that they "might need a couple of whatever you take for a headache atmost" - this covers all but 2 or 3 people a year post-op pain wise. Also, I personally don't worry if I see a small amount of sealer extruded from the apex after obturation, nor in my practice do I see any correlation between sealer extrusion and post op sensitivity - for my patients atleast it seems to be consistant whether there's a little sealer "poof" out the apex or if there's a clear apex.

 

[Visceral]

Sounds like it looks to be a good technique, as long as it is performed properly and there's good cleaning/shaping of the canal. I guess it makes sense that they teach us Thermafil at school to ensure we do things properly if many of us might use it in the future.

I'll see how patients take it next year since I think our endo clinic is Thermafil-based now (due to a handsome donation of course haha).

I think what might be a problem, from reading up online, is Thermafil seems to buy into a culture of taking perceived shortcuts. So if a dentist would try to take a shortcut on the cleaning/shaping too and results in an inadequate job then the Thermafil-obturated canal would fail. However shortcuts are one thing, but efficient advances in dental practice are others.

 

[DrJeff]

Sounds like it looks to be a good technique, as long as it is performed properly and there's good cleaning/shaping of the canal. I guess it makes sense that they teach us Thermafil at school to ensure we do things properly if many of us might use it in the future.

I'll see how patients take it next year since I think our endo clinic is Thermafil-based now (due to a handsome donation of course haha).

I think what might be a problem, from reading up online, is Thermafil seems to buy into a culture of taking perceived shortcuts. So if a dentist would try to take a shortcut on the cleaning/shaping too and results in an inadequate job then the Thermafil-obturated canal would fail. However shortcuts are one thing, but efficient advances in dental practice are others.

The entire shortcuts thing I think is a bit funny nowadays with rotary endo files. From what I see in my own patient's mouths, with an apex locator and a rotary system that you feel comfortable using, once you locate a canal, under most circumstance, you can have it cleaned and shaped in a mater of minutes! Heck, in many cases nowadays, the "longest" part of completing a case is ensuring that there's enough hypochlorite soaking time in the canals to get all the accessory tissue and bugs out of the canal system.

If someone nowadays is taking shortcuts with endo, they're either not getting to length(if you can't for whatever reason, refer to someone that can), or, well I have a tough time thinking of any other real shortcut issues with modern systems.😀

 

[OceanDMD]

My concern with thermafill was two things (I used it for about a year), first, if you dont seat that carrier right on line with the canal, and it bumps a wall on one side a little heavier than the other, I feel you inherently will have a void/less dense fill right at the apex. That heated gutta percha will just slide up the side making the MAF of the cone smaller than the prepared MAF. My second concern is the potential for retreatment. 5% of these guys will probably need to be retreated in the future, these carrier make retreatment much more difficult.

On a side note, the thermafill always makes the fills look super dense, and you almost always get a nice poof.

 

[DrJeff]

My concern with thermafill was two things (I used it for about a year), first, if you dont seat that carrier right on line with the canal, and it bumps a wall on one side a little heavier than the other, I feel you inherently will have a void/less dense fill right at the apex. That heated gutta percha will just slide up the side making the MAF of the cone smaller than the prepared MAF. My second concern is the potential for retreatment. 5% of these guys will probably need to be retreated in the future, these carrier make retreatment much more difficult.

On a side note, the thermafill always makes the fills look super dense, and you almost always get a nice poof.

On the retreatment note. Ocean, atleast with the rotary system I use, Brasseler's Sequence files, when a retreatment case shows up, once I start the progression down the canal next to the PLASTIC carrier stick with a gates-glidden bur(all I find I need is a 3 to atmost 5mm channel), the Sequence files tend to "eat" through the GP/carrier PLASTIC stick very easily. I wasn't able to make the same statement when I was using my previous rotary system, Tulsa's GT files.

If it was a real "old school" thermafil obturator with the metal carrier sticks, a) it would definately be more of a challenge and b) I would know that it WASN'T my endo that failed as I've only used the plastic carriers in my career😀

 

[teeth63a]

As mentioned before, one problem is retreatment of the canals...it can be a bear with the plastic carrier. Second is post space creation, for the same reason.

I use Brasseler's Sequence from start to finish. The appeal to it is that after shaping, I use the paper points that are exactly the same size as the master cone (only takes me 1-2 points to dry a canal), and then one master cone is most times enough to obturate the whole canal (sometimes I'd need one or two accessory points).