Hello.
I'm Dr. Manor Haas.
I'm a certified endodontist from Toronto, Canada.
In this segment, I would like to review the delivery
of GuttaCore® into the canals.
This important step is easier than you might think,
especially when the canals and pulp chamber
are prepared as discussed in my other segments.
So by now you've easily used your size verifier
and lined the canal walls with a bit of sealer,
which means you're ready to obturate.
If you're new to using GuttaCore,
I strongly recommend that prior to warming the GuttaCore,
you practice the placement of a GuttaCore into the oven
and its removal from the oven.
This video shows a trial run with the oven off.
Please place the rubber stopper to your working length
as per the markers on the GuttaCore.
Place the GuttaCore into the oven's GuttaCore holder
and press down.
To remove the GuttaCore from the oven,
press down on the holder
and with one hand grab the GuttaCore handle
and with cotton pliers in the other hand,
grab the GuttaCore just above the rubber stopper.
Break off the handle
and now you're ready to carry this GuttaCore obturator into the canal.
The ability to break off the GuttaCore handle
and turn the obturator into a shorter and easily maneuverable
gutta-percha, separates this from other warm obturation
systems on the market.
Just don't take too long to carry the warmed obturator
into the canal.
Doing so will cool the gutta-percha
and alter its characteristics and affect the obturation.
As for setting the GuttaCore obturation length,
please do not do so with a ruler.
Only use the markers on the obturator.
These markers coincide with the markers on the files.
They're 18 mm,
19 mm,
20, 22, 24.
And on the handle it's 27 and 29 mms.
Do not use a ruler to measure the working length
for the obturator.
Use only the GuttaCore markers.
Once ready to obturate, ensure the oven is set properly.
Place the cold GuttaCore in the oven
and wait until it blinks.
This signals the GuttaCore is sufficiently warmed
and ready for insertion into the canal.
Remove the GuttaCore from the oven
and grab it with a cotton plier
at the working length
as indicated by the markers on the GuttaCore.
Break the GuttaCore handle
above the length of the marker
and place into the canal.
As I recently mentioned,
the delivery of the warm GuttaCore from the oven
to the tooth should not take too long.
To maintain the intended gutta percha characteristics,
this should be done in less than about 10 seconds or so.
It may sound like very little time,
but it's actually more than enough.
If you spend any longer,
the GuttaCore will cool down too much
and this will affect the insertion flow
of the GuttaCore into the canal and a final obturation.
The ability to break off the handle of the GuttaCore is one of the beauties of this system.
Doing so turns the obturator
into a short gutta-percha.
This is a huge advantage,
especially in teeth that are difficult to access such as posteriors.
Having said that,
if you wish to keep the handle in place,
then you may do so.
But I don't see the benefit of doing so.
You'll have much more control using cotton pliers than your fingers.
Also, while obturating, please do not turn the obturator
as if you're placing a file into the canal.
It should simply be placed in an inward direction into the canal.
Something you may want to consider
is cutting the rubber stopper off
the cold GuttaCore obturator
prior to placing it in the oven,
as you can see in this video.
It's nice to have the rubber stopper as a marker,
but I personally find that removing it
makes visibility even easier.
The placement of the warm GuttaCore
from orifice to apex should be done in about 7 seconds.
I cannot stress this enough
as this is one of the most important aspects of obturating with GuttaCore.
It seems so simple,
but I find that all too often
dentists insert the GuttaCore too quickly.
During this step, remember not to touch the pulp chamber walls.
I recommend that you count as you insert the GuttaCore into the canal.
You, and even your assistant,
should count while inserting into the canal.
Engaging your assistant in this simple but most crucial step,
can only help.
As Dr. Sergio Kuttler recommends,
count during insertion as follows:
1 elephant,
2 elephants,
3 elephants,
4 elephants,
5 elephants,
6 elephants,
7 elephants.
And now you're done.
The canal is obturated.
That's it.
Remember that this step is similar to what we do
when drying canals with paper points.
Except here it should be done in about seven seconds.
In fact, while drying the canals prior to obturation,
practice doing so in seven seconds.
If you insert the GuttaCore too slowly or too quickly,
you will not obtain a good obturation.
I'll tell you from experience
that at times a GuttaCore obturator may break or buckle during insertion.
You can see this in this video
as I obturate the second of two converging mesial canals.
This may occur due to the following main reasons.
First, the GuttaCore was not sufficiently warm
or it cooled off too much prior to insertion into the canal.
In turn, trying to insert a GuttaCore that is not soft enough
will likely lead to breakage or buckling of the carrier.
Second, inserting the GuttaCore too quickly
or with too much pressure. And thirdly,
this might happen when the GuttaCore reaches an apical obstruction,
yet you keep pressing it into the canal.
This often happens in cases with apically converging canals
as seen in this radiograph.
Once one mesial canal is obturated,
the apical third of the second mesial canal is also obturated.
But as seen in the video, as I continue to insert the warm GuttaCore,
it reached the apical third of obturation
and buckled under the pressure.
This is actually an advantage of the system.
Using other carrier-based obturations
may allow the dentist to continue inserting
by forcing the stiff plastic carrier to working length.
But with the apical and converging part of the root canal already obturated,
doing so could easily lead to apical extrusion of sealer and gutta-percha.
Not a welcomed outcome.
With GuttaCore, this is extremely unlikely to happen
since added pressure will simply result in the coronal,
and not apical, flow of excess gutta-percha.
So remember,
GuttaCore obturation is the same as paper point drying of canals,
except that here you have the luxury of doing so
in more time and slower.
And so to recap,
obturation comes down to the following:
take the warm GuttaCore from the oven with cotton pliers,
break off the handle,
and insert into the canal, without touching the pulp chamber walls.
This simple process, including the GuttaCore time in the oven,
should take maybe about 30 seconds or so in total.
That's it.
Fully obturating a canal is indeed that simple and quick.
Finally I should add that the use of enhanced magnification
and illumination will only make the obturation easier,
and I strongly encourage it.
I hope you found this useful.
Good luck and thank you for your time.