Many clinicians are interested in techniques that produce sealer puffs and show off apical ramifications. Here is a brief summary of an article that I had read a couple of years ago and it pretty much explains my stand on this issue:
“Chemomechanical preparation partially removes necrotic tissue from the entrance of lateral canals or apical ramifications, whereas the adjacent tissue remains inflamed, sometimes infected, and associated with periradicular disease. Vital tissue in lateral canals or apical ramifications is not removed by preparation. In cases in which lateral canals appears radiographically ‘‘filled,” they are actually not obturated, and the remaining tissue in the ramification is inflamed and enmeshed with the filling material… The belief that lateral canals must be injected with filling material to enhance treatment outcome is not supported by literature.”
So, clinician’s skill or the technical ability of producing sealer puffs will not necessarily result in successful endodontic therapy. In many cases, extrusion of sealer into lateral canals and ramifications as a result of specific techniques (use of patency files, removal of smear layer, use of warm vertical compaction technique, etc.) is unavoidable, but this should not be the aim in obturation.