GuttaFlow® for the Permanent Obturation of Root Canals: A Technique Review
One of the greatest challenges to dentists today is the successful obturation of the delicate anatomy found within the root canal system of teeth. The intricacies of the canals, accessory canals, fins, etc, have stretched the limits of the available materials to successfully accomplish this procedure. The task goes well beyond the accurate filling of the 3-dimensional space within the canal. It is essential to create an impervious seal along the length of the root canal, including both the apical and coronal ends of the root canal system, to prevent bacterial recolonization. This article will review a new material, GuttaFlow® (Figure 1), that has been developed for the efficacious obturation of root canals.
GuttaFlow was developed by Coltène/ Whaledent using modern expertise in silicone polymer technology. It is composed of a unique mixture of finely ground gutta percha, RoekoSeal® root canal sealer, and nano-silver. This provides the dentist with a filling material and sealer combination that is easily dispensed and provides an excellent 3-dimensional filling of the root canal.
The physical properties of GuttaFlow are ideal for a root canal obturation. The sealer part of GuttaFlow is highly thixotropic, and with its fine grain size (<9 µm), the material flows well under slight pressure into the finest lateral canals. The GuttaFlow also has another property that is quite useful in its sealing ability. In contrast to other obturation materials, GuttaFlow expands very slightly (0.2%) when it sets, and this expansion is beneficial in the material’s ability to create an impenetrable seal of the apical and coronal aspects of the root.
GuttaFlow provides the dentist with a simplified obturation technique that is fast, efficient, and easy to learn and use. GuttaFlow is flowable at room temperature and does not require the expensive equipment sold with heated gutta percha systems. The only equipment needed for a GuttaFlow obturation is the typical triturator found in most offices. There is also no condensing required with a GuttaFlow obturation. It is a straightforward place and backfill process.
GuttaFlow Obturation Technique
Instrumentation and Drying
GuttaFlow is designed for the permanent obturation of the root canal. Before obturation, meticulous cleaning and shaping of the root canal to a confirmed working length must be completed. There are numerous file systems available for completing the instrumentation of the root canal and any type of instrumentation selected can be applicable to a GuttaFlow obturation. Copious irrigation should accompany the instrumentation, followed by a thorough rinsing and drying of the root canal.
Fit the Master Cone
The first step in a GuttaFlow obturation is to fit a master cone (MC) (Figures 2 and 3). Select the largest MC that will fit to the confirmed working length (CWL). The MC will typically correspond in size and taper to the last apical file. The adequacy of the fit of the MC can be gauged in 3 ways. First, visually observe that the MC slides easily and completely to the CWL. A reference indentation made on the MC with cotton pliers should confirm a seat to the predetermined length. Second, tactile sensation should be used to confirm the fit of the MC. A definitive apical stop should be felt when the MC is seated to the CWL. Some slight resistance to removal should be felt. Third, a radiograph may be used to confirm the seating of the MC when it cannot be comfortably confirmed by visual or tactile means.
The GuttaFlow is provided in single-dose capsules that are mixed in a triturator. The capsules contain enough GuttaFlow to obturate a multi-rooted tooth, and the use of single-dose capsules is desirable in that it eliminates hand mixing and greatly reduces any chances for cross contamination.
Mix the GuttaFlow capsule following the manufacturer’s instructions and place the canal tip onto the capsule, and the capsule into the dispensing gun. Always dispense a small amount of the mixed GuttaFlow onto a pad to confirm that the color is pink, ensuring a complete mix.
Final Obturation of the Root Canal
The final obturation of the root canal consists of applying a small amount of the GuttaFlow into the root canal, seating the MC, and backfilling with GuttaFlow. As mentioned earlier, there is no heated material involved, no special equipment required, and no condensing. The MC will make up the bulk of the root canal filling. There is an adequate condensation effect from seating the MC to force the GuttaFlow material out into the fine anatomy in the root canal.
Applying the GuttaFlow into the root canal is easily accomplished via well known techniques. The GuttaFlow can be placed directly into the root canal using the dispensing gun and canal tip (Figure 4) or the GuttaFlow may be placed into the root canal with a lentulo. Another option is to coat the walls of the root canal by applying GuttaFlow with the last apical file or with the MC.
The MC is now ready to be seated in to the root canal. It should be coated with additional GuttaFlow (Figure 5). This can be done by applying GuttaFlow directly from the dispensing gun or dipping the MC into material on a pad. Slowly (and the key word here is slowly) insert the MC and gently proceed toward the CWL (Figure 6). Twist the MC back and forth as you proceed into the canal to a positive seat at the CWL. Use the GuttaFlow dispenser to backfill any additional space that may exist in the canal (Figure 7). Sear off the MC at the canal orifice with a heated instrument as far down as possible (Figure 8).
The mixed GuttaFlow has a working time of 15 minutes and will completely set in 25 to 30 minutes. The GuttaFlow is radiopaque and a final radiograph should be taken of the completed root canal obturation (Figures 9 and 10).
There are a few technique tips to observe for a successful GuttaFlow obturation. Initially, only a small amount of GuttaFlow is required in a canal. Placing an excessive quantity will impede your vision, make a mess of the work area, and require clean-up time. When seating the MC, insert it slowly. There is plenty of working time. Also, the MC acts as a condenser of the GuttaFlow material. As the MC is inserted in the root canal it will force the thixotropic GuttaFlow material to flow. This is desirable as the GuttaFlow should flow into the fine anatomy within the root canal. Slow insertion will allow any excess GuttaFlow to flow in the path of least resistance, which is coronally, out of the canal.
The tips above are very important when using the dispenser gun and canal tips to inject GuttaFlow directly into the root canal. The canal tip must always sit loosely in the root canal. Place the canal tip into the root canal to the predetermined filling depth set with the rubber stop (as per manufacturer’s directions). Gently dispense a small amount of GuttaFlow into the canal. It should be seen rising up around the canal tip. When you see the GuttaFlow rising in the canal, cease dispensing. Only a small amount is required.
The precise filling and sealing of the complex anatomy of the root canal can now be completed with a new material—GuttaFlow. The ease of its application technique along with the material’s ability to expand, flow, and fill the 3-dimensional space in the canal makes GuttaFlow an excellent choice for the permanent obturation of root canals.
This article was written by Robert Geller, DMD, and submitted by and printed with the permission of Coltène/Whaledent, Inc. Dr. Geller is the Director of Professional Relations for Coltène/Whaledent, Inc.
|Figure 1 The GuttaFlow® obturation system.||Figure 2 The first step in a GuttaFlow obturation is to fit a MC.|
|Figure 3 The largest MC that will fit to the confirmed working length should be selected.||Figure 4 The GuttaFlow can be placed directly into the root canal using the dispensing gun and canal tip.|
|Figure 5 The MC should be coated with additional GuttaFlow, which can be done by applying the GuttaFlow directly from the dispensing gun.||Figure 6 The MC should be slowly inserted toward the CWL.|
|Figure 7 The GuttaFlow dispenser can be used to backfill any additional space that may exist in the canal.||Figure 8 The MC is seared off at the canal orifice with a heated instrument.|
|Figure 9 The mixed GuttaFlow has a working time of 15 minutes and will completely set in 25 to 30 minutes.||Figure 10 The GuttaFlow is radiopaque and a final radiograph should be taken of the completed root canal obturation.|