Endodontic Predictability: “Are You Making the Right Decisions?”

[drsushant]

 Decision No. 10: What Should You Do About the All-Important Coronal Seal (Figures 5a to 5d)? Q: Should you use the new resin bonding endodontic obturation methods or is this a complicated solution to a nonexistent problem?
A: The idea of bonding the endodontic obturation is truly desirous. However, the literature does not yet suggest the science sufficiently warrants a change in obturation material or technique. In addition, resin-bonding materials, regardless of manufacturers’ earlier claims, requires a change in gutta-percha obturation technique. Furthermore, there is concern that resin endodontic materials wash out over time. There has never been a magic bullet in endodontics, and resin obturation will not be the first. The astute endodontic clinician should, however, keep current with the endodontic literature because much effort is being given to improve the more than 100-year-old gutta-percha medium.
Lastly, if gutta-percha is sealed 1 to 2 mm short of the chamber, then the risk of coronal leakage is a moot point. If a superb coronal seal is made then there is no coronal leakage. So in the vertical compaction of warm gutta-percha and continuous wave techniques, stop backpacking 1 to 2 mm short of the chamber floor, clean away any visible endodontic sealer, etch, bond, and restore access in preparation of foundation and restoration. In carrier-based and lateral condensation techniques, gutta-percha will need to be removed 1 to 2 mm down into the canal after obturation.
Guideline No. 10: Be sure to finish your endodontic obturation by making a coronal seal. Coronal seal is essential to endodontic predictability.

SUMMARY
This article has presented ten key decision moments that influence endodontic predictability: (1) the roles of understanding the game, (2) seeing, (3) access, (4) following, (5) GlidePath, (6) shaping, (7) cleaning, (8) conefit, (9) obturation, and (10) coronal seal have been reviewed. The intention of this article has been to emphasize the importance of clear thinking, decision-making, and properly sequencing skills when treating patients with endodontic disease. Study your choices carefully. Make the right decisions.