One Cone Fits All, or Does It?

“After about ten years of first appearing on the market, currently Thermafil obturators are completely modified and form an integral part of a complete and sophisticated system of root canal obturation that, when used correctly, can give optimal results.   — W. Ben Johnson”

The reported advantages of Thermafil include: shortness of learning curve, speed of clinical application, apical control of fill, conservative enlargement of root canal (when compared to other warm gutta percha compaction techniques), three-dimensional obturation and apical sealing ability, etc.

In my opinion, shorter treatments do not allow for adequate disinfection of the canal system, speed compromises the quality, apical control of fill is nonexistent with this technique, and conservative enlargement of root canal is not always beneficial since some degree of apical enlargement is necessary to allow for proper disinfection by irrigants.

If used correctly (proper size obturator in a single, adequately-instrumented canal and following the manufacturer’s recommendations), 3-D obturation and apical sealing ability are the major advantages of this obturation technique.

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Inappropriate case selection for the use of Thermafil obturation technique is demonstrated above.  This case shows how Thermafil would give us a false sense of achieving an “optimal” obturation in challenging cases such as this.  There was only one obturator used in the canal system that splits into three apically.

As I mentioned in my previous post I Love Sealer Puffs!, extrusion of obturation material into the uncleaned and unshaped portion of the canal system (lateral canals, fins, isthmus, irregular areas, etc.) does not translate into success.  The prerequisite for any obturation technique is adequate shaping and cleaning of the entire system, and the only reason for endodontic failure is the presence of micro-organisms.


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