The Sealer-Puff After the Root Canal Obturation, the Relationship Between Root Canal Irrigation

 

The sealer-puff is a characteristic appearance of sealer overflow outside the apical foramen on the confirmatory dental photograph after root canal filling. 

This is caused by a small amount of sealer overflowing outside the apical foramen when the dentists pressurize the area around the apical constriction to achieve a tight root canal filling. It is also caused by sealer penetrating the lateral branches of the apical-delta due to pressure at the apex.

The sealer puff is, after all, an overflow of foreign material into the periapical tissue of the root apex.

Of course, dentists must always try to prevent foreign material to overflow from the root apex into the apical periapical tissue.

However, if we take into account the cause of sealer puffs, we can evaluate them from a different perspective.

Sealer puffs are...

The area around the root apex is properly cleaned and free of debris, ensuring the patency of the root canal.

And

Be caused by the application of a good flow of sealer to the apex and the achievement of proper pressure.

Hence, it can be considered as evidence that the root canal was properly cleaned before root canal filling. 

Root canals with sealer puffs observed on confirmatory X-ray film can be evaluated as having a good prognosis.

Therefore, when sealer puffs are seen on dental photographs, the dentist feels a little proud. So do I.

Endodontists around the world often proudly display "beautiful" photos of their root canal fillings, but these photos show the sealer puff. 

Wouldn't you also like to get a sealer puff after root canal filling?

I think the mainstream of root canal filling these days is vertical condensation with a standard GP as the master point in a root canal formed by NiTi file. 

Some dentists may use “BC-sealer“ as a sealer that expands slightly after the cures, and hydraulic condensation as a single-point technique.

In any case, it is not so difficult to achieve proper pressure at the root apex once you are familiar with the technique of root canal treatment using NiTi files.

What is important is just proper cleaning of the root apex and root canal.

So, how should we perform root canal cleaning?

Many dentists, including myself, mainly use positive pressure root canal irrigation with a combination of a disposable syringe and an irrigation needle. It is true that the latest generation of irrigation needles are thin and have rounded tips, making them easy to insert into root canals. Using these needles, it seems very easy to wash the inside of the root canal with cleaning irrigants. 

However, this positive pressure irrigation is not powerful enough to eliminate debris in the root canal.

Recently, I have been using “EDDY (VWD)“ for root canal irrigation.

Ultrasonic irrigation is "effective root canal cleaning using ultrasonic waves" that has been used in the field of root canal cleaning for a long time.

Initially, it was combined with a metal endo-tip like a SS hand file. Metal tips are straight and always cut the root canal dentin and produce a smear layer if they come in contact with the root canal wall. Besides, the risk of tip fracture is also high.

On the other hand, EDDY is characterized by its flexible polyamide tip. It is an attachment for the handpiece ultrasonic scaler, so it is easy to introduce and handle. 

If you insert it into the apex of a root canal filled with irrigants and operate it, you can cause powerful agitation of the cleaning solution. This can be achieved in a very short time.

The first important step in root canal cleaning is to wash away the debris that needs to be removed from the canal. The next step is to remove the smear layer with, for example, 17% EDTA, dissolve the organic material with sodium hypochlorite solution, and disinfect the root canal to make it sterile. Both end tips and EDDY may be useful for this purpose.

However, when comparing the characteristics of the two, you can easily imagine how safe and effective EDDY can be in cleaning root canals in a short time.

A simple agitation experiment using EDDY are shown below.

*Pay attention to volume