Endodontics Resident University of Washington Seattle, Washington, United States
A large apical foramen poses a significant challenge to clinicians during frequently whether to obturate traditionally with gutta-percha and sealer or place a bioceramic apical plug. Previous studies have demonstrated a significant increase in apical leakage of gutta-percha/sealer obturations when the preparation size exceeded 60. While apical plugs are popular and predictable treatment option with a high success rate, they may be difficult to place. It has also been shown that apical foramina in general are rarely circular and instruments are limited in their ability to shape oval or irregular apices. Some studies have found that over 25% of teeth have oval-shaped canals in the apical 5 mm. The custom cone technique using chloroform-softened gutta-percha was developed to address this concern. Instead of enlarging the canal to fit a pre-existing round master cone, the cone is customized to the shape and size of the existing canal. Benefits include better adaptation of the cone to the canal wall, thereby reducing the potential for extrusion and improving apical seal. While some have cited a potential for shrinkage, the proper use of this technique should eliminate this risk. The reported expansion of newer bioceramic sealers could also help compensate for this phenomenon. The purpose of this table clinic is to present a technique that aids clinicians in obtaining proper apical seal in an efficient and practical manner in canals with large apical foramina.
