Endod Dent Traumatol 2000; 16: 128131 Copyright C Munksgaard 2000

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Endodontics &
Dental Traumatology
ISSN 0109-2502
Case report
Utilization of gutta-percha for retrograde
root llings
Sauveur G, Sobel M, Boucher Y. Utilization of gutta-percha for G. Sauveur, M. Sobel, Y. Boucher
retrograde root llings. Endod Dent Traumatol 2000; 16: 128131.
Service dOndontologie de lHotel Dieu, UFR
dOndontologie, Universite Paris 7, Paris, France
C Munksgaard, 2000.
Abstract Just as gutta-percha used with a root canal sealer is a
recommended material for orthograde root llings, it could simi-
larly be the material of choice for retrograde llings. Unfortunately,
clinical accessibility and visibility do not always facilitate such a tech-
nique. The aim of this article is to present a new technique which
enables retrograde llings to be achieved with gutta-percha and a
sealer. After the apex had been resected, a hole was drilled perpen-
dicular to the plane of section of the apex about 1 mm coronally.
The bucco-lingual depth required to reach the main canal was
Key words: endodontic surgery; gutta-percha;
calculated. The cavity was then dried, coated with the sealer, and
periapical healing; retrograde lling
obturated with gutta-percha in accordance with thermo-mechan-
Yves Boucher, Service dOdontologie de lHotel
ical compaction techniques. After excess lling material had been
Dieu, 5, Rue Garancie`re, 75006 Paris, France
removed, the gutta-percha was cold burnished and the angles of
Tel/fax: 33 1 44 27 81 23
e-mail: ybou/ccr.jussieu.fr
the root were smoothed. Clinical cases illustrating healing of the
periapical tissues are shown. Accepted August 26, 1999
Clinical success in endodontic surgery depends on nu-
merous factors such as disinfection and debridement
of the root canal and its hermetic seal with well-toler-
ated materials (1). These parameters are interde-
pendent, for example, in cases where the choice of a
root-lling material determines the type of prepara-
tion. Among the materials which are used for retro-
grade root llings, amalgams have been the most
prevalently employed (2), but their use is questioned
today because of their disadvantages, which include
possible scattering of amalgam particles in the sur-
rounding tissues, corrosion, and poor sealing prop-
erties. Other materials have been proposed (see 3, 4
for review). The most popular materials currently are
zinc oxide-eugenol cements either alone or reinforced
with various components such as resin (IRM, EBA,
super EBA) (5), composite resins (6) and glass ionomer
cements (7). A number of other materials are oc-
casionally used, such as ceramic pins, aluminium ox-
ide, or are still in their evaluation phase such as MTA
(8).
128
Gutta-percha, which is the material of choice for
orthograde root llings, has been only marginally
used for retrograde llings. Its use is limited to several
animal studies (9, 10) and only a few clinical cases
(1113) have been reported. This is surprising since
its plasticity enables it to ll the root canal three-di-
mensionally and, when used with a sealer, results in
a hermetic seal of the root canal. Its utilization has
been substantially documented, either for cold com-
paction or for heat compaction (see 14 for review).
Therefore, it might appear desirable to use such a
material for retrograde obturation of the root canal.
The main problem of gutta-percha utilization in
retrograde procedures is technical and related to dif-
culties with its insertion since accessibility and visi-
bility may be limited. The ideal situation would be to
prepare and obturate the canal through its long axis,
but in practice, the lack of accessibility may make a
buccal or lingual approach necessary. Numerous
authors recommend cutting the apex with a bevel of
45 to 60 from the long axis, depending on the clin-
Retrograde llings using gutta-percha
Fig. 1. Schematic drawing showing the technique described. Upper
diagrams represent a lateral view of the tooth. A. Intact root. B.
The apex is resected perpendicularly to the long axis of the tooth.
C. A cavity is drilled parallel to the sectioning plane of the root in
order to reach the root canal. D. After drying the cavity and coat-
ing with a sealer, a cone of gutta-percha calibrated to the diameter
of the drill is compacted into the cavity. E. Excess lling material
is removed with a bur under irrigation. The angles of the prepara-
tion are smoothed and the gutta-percha is exposed apically. Lower
diagrams illustrate the same steps of the procedure in a 3-D rep-
resentation.
ical situation (1517). A bevel permits a direct view
of the preparation, and makes it possible to debride
the canal and insert the lling material under optimal
visibility. However, these types of preparation may
not be ideal from a mechanical point of view. Sauveur
et al. (18) have shown that resecting the apex perpen-
dicular to the long axis of the tooth generates less
stress under loading than bevelled preparations.
This article proposes a new type of preparation
which permits both the the root end to be sectioned
perpendicular to the long axis of the tooth and a
retrograde root lling to be achieved with gutta-per-
cha. A schematic drawing of the procedure is given
in Fig. 1.
Case report
A 46-year-old man, in good health, presented for con-
sultation because of sensitivity under a bridge during
mastication. Extraoral examination showed normal
appearance of the head and neck. Occlusion was nor-
mal. A bridge covering teeth 4447 (4546 missing)
was in place. The intraoral soft tissues were normal.
Tooth 44 presented sensitivity to percussion and pal-
pation. No periodontal pocket was discovered. Radio-
logic examination showed evidence of a periapical
lesion at tooth 44 (Fig. 2).
After surgical exposure of the root end and elimin-
ation of the granulation tissue, the root end was cut
perpendicular to the long axis of the tooth and the
apex removed. A drill was chosen according to the
129
Fig. 2. Tooth 44, which was sensitive upon mastication and mech-
anical mobilization, presented an unsatisfactory root lling and evi-
dence of a radiolucency at the apex. The presence of a post
oriented the therapeutic approach towards surgical retrolling pro-
cedure rather than conventional retreatment.
Fig. 3. After exposure and resection of the apex perpendicular to
the long axis of the tooth, a cavity was drilled parallel to this plane
of sectioning. Its diameter corresponded approximately to one-
third of the mesiodistal radicular diameter. The drills penetration
was calculated to be 1.0 to 1.5 mm less than the bucco-lingual
dimension. The cavity preparation was begun 1 mm coronally to
the at root-end surface and drilling was performed parallel to this
surface. The cavity reached the main root canal and extended a
little further without perforating the lingual side.
Sauveur et al.
mesio-distal diameter of the root and mounted in a
slow-speed contra-angle handpiece. This diameter
corresponded approximately to one-third of the mesi-
odistal radicular diameter. The bucco-lingual diam-
eter was measured with a periodontal probe gradu-
ated in millimeters and the drills penetration was cal-
culated to be 1.0 to 1.5 mm less than the bucco-
lingual diameter. The cavity preparation was begun
1 mm coronally to the at root-end surface and the
drilling was performed parallel to this surface. The
cavity reached the main root canal and extended a
little further without perforating the lingual side (Fig.
3). A mixture of bone wax and calcium alginate bres
was then applied to the bone cavity to insulate the
root end from the surrounding tissues (19). The retro-
grade cavity was cleaned, dried with paper points and
a small quantity of sealer was introduced into the cav-
ity with an endodontic le. A gutta-percha cone, cali-
brated to the diameter of the preparation, was in-
serted into the cavity. The gutta-percha was warmed
with a heat carrier and compacted with a plugger
whose diameter corresponded to the diameter of the
prepared cavity. The gutta-percha was cooled with
physiologic saline and excess material was removed
with a round bur at high speed. The root-end lling
was then rinsed again with physiologic saline. The
root lling was nally cold burnished (Fig. 4). After
these obturation steps, the bone wax-alginate bre
mixture was removed and the preparation rened.
Fig. 4. After coating the cavity with a sealer, gutta-percha was heat-
compacted into the cavity, refreshed and cold burnished. Excess
lling material was removed and the tooth and bone cavity were
cleaned before suturing.
130
Fig. 5. Radiograph taken after 5 years. The tooth is asymptomatic
and there is radiographic evidence of healing.
This nishing process consisted of rounding the
angles of the preparation, and removing the apical
zinc oxide-eugenol cement with a small round bur.
The osseous cavity was rinsed with physiologic sa-
line and lled with Biocoral, a calcium carbonate re-
sorbable material (Pharmadent, Paris, France) and
covered with a resorbable membrane. The ap was
repositioned and sutured. An antibiotic (Amoxicillin
2 g/day for 6 days), an antiinammatory agent (Tiap-
rofenic acid 600 mg/day for 4 days), and a mouth-
wash (chlorhexidine 0.2% 3 times/day), were pre-
scribed. Post-operative radiographs at 30 days, 6
months, 1 year and 5 years (Fig. 5) showed evidence
of healing.
Discussion
There were advantages to using this procedure to per-
form retrograde root llings. The rst advantage was
that the technique is compatible with sectioning of
the root end perpendicular to the long axis of the
tooth. Mechanical stresses transmitted to the peri-
apical tissues are thereby decreased (18). The second
advantage was that gutta-percha associated with a
sealer could be used. Recent studies indicate excellent
biological tolerance of gutta-percha associated with a
cement as a retrograde root-lling material (10). The
quality of the seal has also been examined in vitro with
dye leakage after retrograde llings were placed, and
Retrograde llings using gutta-percha
the results have indicated acceptable properties of
gutta-percha when used with a sealer compared with
amalgam (20, 21).
The technique described in this article can be ap-
plied to cases, both in the mandible and in the max-
illa.
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