Here we're fitting a cone, a gutta percha cone.
And anybody that's done any significant amount of warm gutta percha realizes that, based
upon the size of the apical foramen and your various clinical skills based on experience,
it's important to take that gutta percha cone & cut it back, creating what we refer to as
apical tug-back.
That allows us to not only gauge the size of the apical foramen, but it also lets us
determine how far back we want to cut our cone because as we heat that gutta percha
& condense it vertical, vertically, it's actually going to move closer to the apical foramen.
So, in essence, the larger the size of the apical foramen, the closer that we want to,
the FURTHER that we want to be from that & more, that we want to cut off the cone more.
Here's an illustration of using Kerr extended working time sealer.
I like that mixed to a certain consistency and then place my gutta percha cone right
on the edge of the mixing pad so that I can literally roll it.
And as I roll it, I make sure that it's circumferentially all the way around the gutta percha cone.
In this particular illustration, what I'm trying to show is I'll take a gutta percha
cone, instead of placing my sealer in the root canal system with a paper point which
sometimes leave little bits of paper fibers in the root canal system.
I like to place my sealer in there with a cone that I refer to as a 'sealer cone'.
But I like to do that first and then place my master cone.
In this particular case, because of the size of this particular tooth, I believe this tooth
is like a #10, #7, something like that.
It's a very large root canal system, anterior tooth, and so I've placed more than one gutta
percha cone in there so that when I sear it off, I'm capturing more rubber as I condense
it vertically.
Here's the Calamus heat tip and the plugger tip.
I'm going to sear that off right at orifice level.
There are primarily three sizes of Calamus Heat Pluggers.
There's a 40/.03, a 50/.05 and a 60/.06.
For the most part, in most systems, as I treat them, and as you become familiar with this
technique and realize the simplicity of it, rarely do I need to use anything besides a
40/.03.
And the reason for that is, number one, I can see very well through the operating microscope
but also, most of the time, my systems are kept as small as practical.
I try to conserve as much dentin as possible, both coronally and radicularly, and certainly
apically.
So I'm not opening my systems much larger than the 25 on average.
So with that in mind, a 40/.03 Calamus Heat Plugger works exceptionally well in my hands,
nearly every system.
There are occasions when I'll go to a larger heat tip, but most of the time it's unnecessary.
And then I'm going to take a larger size Calamus plugger and immediately capture that gutta
percha and condense it vertically.
Obviously there is a little bit of sealer with it.
My assistant will take that cone from me here and just, pardon me, that Calamus plugger
might go to a smaller one, might go to a larger one.
With the vivid illustration, being able to see it so well through a microscope, gives
you a tremendous amount of confidence in making certain that you're capturing all of the rubber
in that access cavity and condensing it vertically.
Now we're going to take the Calamus Heat Plugger tip and we're going to drive it down into
the root canal system, condensing it vertically.
And also creating tremendous hydraulic pressure and then immediately following it up with
another Calamus plugger, a hand plugger, that allows us to, again, condense that gutta percha,
that warm gutta percha apically and vertically, and allows us to capture the maximum amount
of three dimensional anatomy in the root canal system.
Now we're removing with the Calamus heat tip another aliquot of gutta percha.
Then going to a smaller Calamus plugger and condensing that gutta percha again vertically,
capturing the maximum amount of lateral and tertiary anatomy in the root canal system.
Sometimes you think a system will be relatively simple because it's a single canal and if
we've done a great job of disinfection, if we've done a great job of being able to digest
all of the anatomy out of the root canal system, it's amazing what we find when we take a final
radiograph.
And that's where the thrill of the fill comes in.
We're able to see some anatomy there that we just never thought possible.