Root Canal Fi l l i ng

Pri nci pl es & Techni ques

David E. Witherspoon
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Understand the general principles of root canal obturation
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Discuss the various option available for root canal obturation
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Understand the application of various root canal filling techniques
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Compare and contrast various root canal filling techniques

Cleaning & Shaping

Bacteria

Remove Debris

Obturation 3D

Creating a barrier from the oral environment

Length of the root canal system

Coronal seal (Restoration)

Successful Endodontics

Cleaning & Shaping

Bacteria

Remove Debris

Obturation 3D

Creating a barrier from the oral environment

Length of the root canal system

Coronal seal (Restoration)

Successful Endodontics
Obturation
DEFINITION: The complete lling and closing of a
cleaned and shaped root canal using a root canal
sealer and core lling material

Objectives:
1. Eliminate of all avenues of leakage from the oral cavity and
periradicular tissues into the root canal system
2. Seal within the system any irritants that are not fully
removed during cleaning and shaping
Ideal Obturation Material

Biocompatible

Bactericidal

Seal

Bacteria

Bacteria by products

Biologic

Stability

Workability

Easily placed and distributed

Reasonable setting time

Enhance tooth structure

Homogeneous

Radiopaque
Obturation Techniques
United States Dental Schools
Cailleteau JG. Mullaney TP. J Endod 23:394-6, 1997

89.6% teach lateral compaction is the primary

obturation technique

Most common material is gutta percha

One school teaches core carrier system

One school use Resilon in the undergraduate

Issues Related to Obturation

What is the role of obturation in outcomes?

What is an appropriate means of testing ?

Obturation techniques

Obturation materials

Going RE. Myers HM. Prussin SG. Quantitative method for

studying microleakage in vivo and in vitro. Journal of Dental
Research. 47(6):1128-32, 1968 Nov-Dec.

Wayman WH. Mullaney TP. A comparative study of apical

leakage with endodontic implant stabilizers. J Endod. 1(8):
270-3, 1975 Aug.

The apical seals of 75 extracted teeth that were treated with

three methods of endodontic implant stabilizers were
compared with the seals of 25 teeth filled with silver cones
and 25 teeth filled with laterally condensed gutta-percha.
Apical leakage was measured with the use of methylene blue
dye solution. Statistical analysis showed that there were
significant differences between the apical leakage obtained
from the teeth treated with endodontic implant stabilizers
and those teeth filled with silver cones and with laterally
condensed gutta-percha.
What is the role of obturation in outcomes?

Klevant FJ. Eggink CO. Int Endod J 16:68-75, 1983

Exp grp 86 Teeth C&S - Obturation

Control grp 336 teeth C&S + Obturation

Over 2 years the outcome was similar

What is the role of obturation in outcomes?

Vernieks AA. Messer LB. Calcium hydroxide

induced healing of periapical lesions: a study of 78
non-vital teeth. J Brit Endod Soc 11:61-9, 1978

C&S "Ca(OH)2 " 3-48 mths

55/78 complete healing (70.5%)

20/78 some healing (25.6%)

3/78 no healing (3.9%)

What is the role of obturation in outcomes?

Peters OA. Barbakow F. Peters CI. Int Endod J

37:849-59, 2004

179 pts NSRCT

Lightspeed + LC GP AH Plus

ProFile .04 + LC GP AH Plus

ProFile .04 & .06 or GT

System B, Obtura II & Roth's 801

86% healing

Outcome was not signicantly affected by

instrumentation or obturation system.
What is the role of obturation in outcomes?
What is the role of obturation in outcomes?
What is the role of obturation in outcomes?
LC+ Sealapex
92.5%
77%
What is the role of obturation in outcomes?
LC+ Sealapex
92.5%
77%

Augsburger RA. Peters DD Radiographic evaluation of

extruded obturation materials. J Endod. 16:492-7, 1990

Abstract

The radiographic appearance of lling material extruded into

periradicular tissues during obturation of root canals was
studied over time. Recall radiographs for up to 6 1/2 yr. were
compared with immediate postoperative lms. Consistently, less
material was evident at successive postoperative periods. This
study indicated that given time, the two zinc oxide and eugenol-
based sealers studied will be removed from periradicular
tissues. It also indicated that sealer is removed from
periradicular tissues more rapidly than gutta-percha.

Obturation is important

Obturation is a function of cleaning and

shaping

It is difficult to identify any one technique

as being superior
Ma t e r i a l s
Core + Sealer

Gutta percha

Core carrier Niti/SS/Plastic

Additives or modied GP

EndoRez system

GuttaFlow

ActiV GP

Silver cones

MTA

Resilon

Paste

Sealer

Cement/Bonding Agent
Specialized sealer
Sealer
# ZOE
# Rickerts
# Pulp Canal Sealer /EWT
# Wachs Sealex-Extra
# Endo-Fill
# MCS Canal Sealer
# Iodoform
# Endomet
# Thymol Iodide
# Pulpdent
# Canals
# Canals-N
# Grossman - Type
# Roth 801, 811, 601, 511, 515
# Procosol
# Endoseal
# Tubliseal /EWT
# Not recommended with heat
# Formaldehyde
# N2
# Endomethasone
# SPAD
# Ca(OH)2
#Not recommended with heat
#CRCS
#Acroseal
#Sealapex
#Apexit
#Sealer 26
#Resin
#AH26
#Sealer 26
#AH Plus
#EndoREZ
#Topseal
#Silicone
#Lee Endo-Fill
#Roeko Seal Automix
#RoekoSeal
#Not recommended with heat
# GIC
#Ketac-endo
#ActiV GP
#Not recommended with heat
#Other
#Nogenol root canal sealer
#Salicylic Acid
#Not recommended with heat
Sealer

All GP obturation techniques routinely

preform better in leakage studies when a
sealer is used

Evans JT. Simon JH. J Endod 12:100-7, 1986

Tagger M. Katz A. Tamse A. Oral Surg Oral Med Oral Pathol 78:225-31, 1994

Wu, MK; van Der Sluis, LWM Wesselink, PR Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 97:257-262,2004.

Wu, M K; Fan, B; Wesselink, P R. Int Endod J. 33:121-5, 2000

Issues Related to Sealer

Amount / Thickness

Stability

Solubility

Dimensional change

Adhesion

Tissue Tolerance / cytotoxicity

Bacteria

Application
Sealer Thickness

Kontakiotis EG. et al Int Endod J 30:307-12, 1997

2 yrs. " 0.05 mm (thin layer) and 0.3 mm (thick layer)

Roth and Pulp Canal Sealer EWT

Thick layers of allowed more leakage

AH26, Ketac-Endo, Sealapex

No sig diff was found between the thin and thick layers

Wu MK. et al Int Endod J 28:185-9, 1995

AH26, Ketac-Endo, Tubli-Seal & Sealapex

1 yr. thinner was better

Wu MK. et al Int Endod J27:304-8, 1994

AH26, Ketac-Endo, Sealapex & Tubli-Seal " thickness of 0.05, 0.25 or 3 mm

AH26, Ketac-Endo, & Sealapex sealed better than Tubli-Seal @ 0.25 mm

Ketac-Endo sealed better the other three sealers @ 0.05 mm

Hall MC. Clement DJ. et al. J Endod 22:638-42, 1996

No methods exceeded an AV of 62.5% wall coverage of sealer after obturation

Complete wall coverage after obturation may not be possible.

Sealer Application

Hand File (type of le)

Rotary le

Forward vs. reverse

Master cone

Paper point

Lentulo spirals

Ultrasonic

Specialized instruments
Sealer Application

Facer SR. Walton RE. J Endod. 29:832-4, 2003

Distribution patterns of sealers after lateral compaction

Roth's, Sealapex, AH 26 "" Sealer placed with a file

No sealer group demonstrated complete coverage

Wiemann AH. Wilcox LR. J Endod. 17:444-7, 1991

File, lentulo spiral, ultrasonic files, and master gutta-percha cone " AH26

No statistically significant differences among the four groups.

The greatest variation in sealer coverage was found in the apical level

Kahn FH. Rosenberg PA. et al. Int Endod J 30:181-6, 1997

lentulo spiral =Max-i-Probe >ultrasonic = sonic files >paper point = K file.

Aguirre AM. el-Deeb ME. Aguirre R. J Endod. 23:759-64, 1997

Ultrasonic and hand methods of sealer placement

Sultan "Grossman's formula," AH-26, and CRCS.

Ultrasonics was superior to manual placement only for CRCS.

Method of sealer placement had no effect on apical leakage

Stamos DE. Gutmann JL. Gettleman BH. J Endod 21:177-9, 1995

In vivo evaluation " Master gutta-percha cone or an ultrasonic file.

Sig. more radiographically visible accessory canals "" ultrasonic

Sealer Application
Distribution

Hall MC. etal J Endod 22:638-42, 1996

Curved canals

AH26 sealer K-le, lentulo spiral, or master gutta-percha cone.

No statistical difference in canal wall coverage

Average of 62.5% wall coverage of sealer after obturation

Complete wall coverage after obturation may not be possible.

Hugh CL. Walton RE. Facer SR. Quint Int 36:721-9, 2005

WVC, Obtura II, System B, SimpliFill, Thermal, LC

SimpliFill had the most samples with complete coverage in both

the coronal and the apical portions.

No technique had sealer forming a continuous layer

""between the gutta-percha and canal wall.
Sealers
Tissue Tolerance & Bacteria

All sealers are initially cytotoxic in the unset form

Double edge sword

Chemical agent that have a bacteria effect have a

tendency to be cytotoxic

Huang FM. Etal J Biomed Mat Res 59:460-5, 2002

Cytotoxicity !! order of N2 > Endomethasome > AH Plus > Sealapex.

Lai CC. Etal Clin Oral Invest 5:236-9, 2001

N2 was the most effective against the microorganisms

The concept of Ca(OH)2 sealers

" Stimulate hard tissue formation

Tagger M. Tagger E. Endod & Dent Trauma 5:139-46, 1989

Sonat B. et al Int Endod J 23:46-52, 1990

Holland R. etal Revista de Odontologia Da Unesp. 19:97-104, 1990

Sealapex stimulated hard tissue

Sealer: Formaldehyde Release

Cohen BI. Pagnillo MK. et al Oral Health. 88:37-9, 1998

Formaldehyde release

AH-Plus 3.9 ppm

EZ-Fill 540 ppm

AH-26 1347 ppm

Spangberg LS. etal J Endod 19:596-8, 1993

Spangberg L. etal OOO 36:856-71, 1973

Sealers: E. faecalis

Saleh IM. Etal Int Endod 37:193-8, 2004

CFU recovered from infect RCT

AH Plus = Grossman killed bacteria (mean CFU = 0) < Ca

(OH)2 (0.53)< RoekoSeal Automix (1.36)< Apexit (1.40) <
Ketac-Endo (1.94)

Mickel AK. etal J Endod 29:257-8, 2003

Zones of inhibition

Roth 811 (1.1 mm), > Sealapex (0.8 mm) > Kerr EWT
(0.5 mm), > AH-Plus (0.0 mm)

Kayaoglu G. etal Int Endod J. 38:483-8, 2005

Direct contact test, MCS = AH Plus (greatest kill) >

Grossman's sealer, > Sealapex > Apexit.

Membrane-restricted contact test, MCS > AH Plus

>Grossman's sealer > Apexit > Sealapex
Sealers: E. faecalis

Sipert CR. etal Int Endod J. 38:539-43, 2005

Sealapex and Fill Canal antimicrobial activity E. faecalis

EndoRez no antimicrobial activity

Fuss Z. etal Int Endod J 30:397-402, 1997

1-hour CRCS = Roth > Sealapex

24-hour, Roth best

7-day Sealapex best

Shalhav M. etal J Endod 23:616-9, 1997

Ketac Endo " very potent short-acting effect

Roth " effect over 7 days after setting.

Sealers: E. faecalis

Sipert CR. etal Int Endod J. 38:539-43, 2005

Sealapex and Fill Canal antimicrobial activity E. faecalis

EndoRez no antimicrobial activity

Fuss Z. etal Int Endod J 30:397-402, 1997

1-hour CRCS = Roth > Sealapex

24-hour, Roth best

7-day Sealapex best

Shalhav M. etal J Endod 23:616-9, 1997

Ketac Endo " very potent short-acting effect

Roth " effect over 7 days after setting.

Sealer:Solubility

Peters DD. Endod. 12:139-45, 1986.

Procosol + GP

LC, WVC ,Thermomechanical, Chloroform Dip

Sealer loss Stored in H2O for 2 yrs.

LC >WVC >Thermomechanical >Chloroform Dip

McComb D. Smith DC. J Endod. 2:228-35, 1976

Only AH26 adhered to dentin

Solubility

Pulp Canal Sealer>Roth 801 > Procosol >

Pulpdent > AH26 = Roth 511 = Tubliseal >
Diaket
Tronstad L. et al Endod Dent Trauma 4:152-9, 1988

Kazemi RB. etal OOO 76:766-71, 1993

ZnOE , AH26, Endo-Fill " 0-180 days

AH26

Little water sorption /no disintegration

Endo-Fill

No water sorption/ Little disintegration

ZnOE

Dissolved during setting

Greatest dimensional change overtime (shrinkage)

Sleder FS. etal J Endod. 17:541-3, 1991

Sealapex, Tubli-Seal

Immersed in a saline solution for 2 and 32-wk

Linear ink penetration leakage study

No Sig Dif

Schafer E. Zandbiglari T. Int Endod J. 36:660-9, 2003

AH 26, AH Plus, RSA RoekoSeal, Apexit, Sealapex, ZnOE, Ketac Endo,

Diaket

Solubility in water or articial saliva " 30 s " 28 days.

Most sealers had low solubility

Sealapex, ZnOE and Ketac higher solubility

Sealapex greatest

AH 26, AH Plus, RSA RoekoSeal, and Diaket had low solubility

AH Plus lowest

McMichen FR. etal. Int Endod J. 36:629-35, 2003

Roth 801, Tubli-Seal EWT, AH Plus, Apexit and Endion

AH Plus was the least soluble

Apexit was the most soluble

AH Plus < Tubli-Seal EWT< Endion < Apexit

Roth 801 did not set sufciently to test soluble

Kaplan AE. etal J Endod. 23:439-41,1997

Ketac-Endo, Tubli-Seal, AH26

Immersed in water for 48 h, 7d 45d

Statistically no diff

Ketac endo looked the worst

Sealers: Adhesion
Sealers: Adhesion
Sealers: Adhesion
Sealers: Adhesion
Sealers: Adhesion
C o r e M a t e r i a l s

Gutta percha

Core carrier Niti/SS/Plastic

Additives or modied GP

EndoRez system

GuttaFlow

ActiV GP

Silver cones

MTA

Resilon
Specialized sealer
Silver Cones

Corrosion

Silver suldes, silver sulfates, silver carbonates,

silver amine sulfate amide hydrates.

Seltzer S. Green DB. Weiner N. DeRenzis F. J Endod 30:463-74; discussion 462,

2004

Koren LZ. Yesilsoy C. Sinai IH. Chivian N. Oral Surg Oral Med Oral Path
66:86-92, 1988

Zmener O. Dominguez FV. Oral Surg Oral Med Oral Path 65:94-100, 1988

Zielke DR. Brady JM. del Rio CE. J Endod 1:356-60, 1975

Brady JM. del Rio CE. J Endod 1:205-10, 1975

Seltzer S. Green DB. Weiner N. DeRenzis F. Oral Surg Oral Med Oral Path
33:589-605, 1972

Zmener O. J Endod 15:319-22, 1989.

Gutta percha most common root canal lling material

It is not inert

Sjogren U. Sundqvist G. Nair PN. Euro J Oral Sci 103:313-21, 1995

Fine particles evoked an intense, localized tissue response $ macrophages

Sjogren U. Ohlin A. et al. Eur J Oral Sci 106:872-81, 1998

Stimulated macrophage release PG E2 & I2

Pascon EA. Spangberg LS. J Endod 16:429-33, 1990

Leonardo MR. Utrilla LS. et al Int Endod J 23:211-7, 1990

Moderate to severe inammatory response

No contemporary root canal lling material or

technique is impervious to leakage

Coronal restoration%& Coronal leakage

Gutta Percha
ProRoot MTA

Seal/Leakage/ Marginal Adaptation

Prevents leakage

Super EBA, IRM & Amalgam

Sets in the presence of blood

Marginal adaptation

Super EBA, IRM & Amalgam

Prevents leakage = resin based materials

ProRoot MTA
Cellular Response

Histologically better than Super EBA, IRM & Amalgam

Torabinejad et al. J Endod 1995
Torabinejad et al. J Endod 1998
Moretton et al. J Endod 1997 (abs)

Appears to form cementum tissue over the root-end

lling material in the periradicular region

Torabinejad et al. 1997

Issues Related to Obturation

Instrument dimensions

Ca(OH)2

Canal drying

Pulpal oor

Root fracture

Spreader / Plugger penetration

Heat generation

Open apex teeth

Instrument Dimensions
LC
D11T spreader !!!.34 mm !!! 1.01
~0.04 Taper
D11TS spreader !!!.25 mm !!! 1.01
~0.05 Taper
WVC
Smallest plugger !!! .33 mm !!!.66
~0.02 Taper
Typical plugger !!!.40 mm !!! 1.09
~0.04 Taper

System B

Tip size is 55
Ef f ect of Ca( OH) 2

Rococo D. Langeland K. Int Endod J 30:418-21, 1997

Case report

Incomplete Ca(OH)2 removal resulted in Tx Failure

Holland R. et al Endod Dent Trauma 11:261-3, 1995

H2O +les #40 up to #70 "ZnOE+GP

Signicantly less leakage Ca(OH)2

Porker P. etal. J Endod 16:369-74, 1990

Ca(OH)2, Calasep, Vitapex, control group

Removed NaOCL+File "ZnOE+GP

Ca(OH)2

leakage not sig dif

sig less than the control group

Ef f ect of Ca( OH) 2

Lambrianidis T. etal J Endod 25:85-8, 1999

Saline + le+ saline

NaOCL + le + NaOCL

NaOCl + le + EDTA

None of the methods efciently removed all Ca(OH)2

25-45% of canal walls had Ca(OH)2

Caliskan MK. etal. Int Endod J 31:173-7, 1998

NaOCl + K le " CRCS, Diaket sealer +GP

Diaket + Ca(OH)2 leaked the least

Margelos J. etal J Endod 23:43-8, 1997

NaOCl

NaOCl+le

NaOCl +EDTA +le "Removed the most Ca(OH)2

ZnOE +Ca(OH)2

Rapid set reaction at the interface

"brittle granular
Effect of Ca(OH)2

Lambrianidis, T. Kosti, E. etal Int Endod J 39:55-61,2006.

NaOCL+EDTA -/+ size 10 H-le

Ca(OH)2+CHX) (gel), Ca(OH)2+CHX (sol) and Ca(OH)2+saline

None of the techniques removed all Ca(OH)2

File helped

Hosoya N. etal Int Endod J 37:178-84, 2004

Calcipex,Vitapex,Calkyl,Ca(OH)2

Canals, Canals-N, Ketac Endo, Sealapex

Removed NaOCL H2O2

Working time decreased in all except Canals+Calcipex

Sealapex extremely variable

Sealing ability of all four sealers was affected

Sealapex improved with all combinations

Sevimay S. Oztan MD. Dalat D. J Oral Rehab 31:240-4, 2004

NaOCl

NaOCl + File

EDTA + NaOCl + File removed the most Ca(OH)2

AH 26+GP" Ca(OH)2 had no effect on coronal leakage

Ef f ect of Ca( OH) 2

Kim SK. Kim YO. Int Endod J 35:623-8, 2002

NaOCl + EDTA + les

NaOCl + les

ZnOE+ GP

Ca(OH)2 leaked more than no Ca(OH)2

No sig dif between removal method

Goldberg, F. etal J Endod. 28:99-101,2002

NaOCl + File

Difcult to remove Ca(OH)2 from lateral canals

Calt S. Serper A. J Endod 25:431-3, 1999

NaOCl alone

Did not completely remove Ca(OH)2

EDTA + NaOCl

Completely removed Ca(OH)2

Engel GT. Goodell GG. McClanahan SB. J Endod. 31:620-3, 2005
Leakage or sealer penetration
Final rinse 70% isopropyl alcohol, Peridex, 6% NaOCl
Roth's 801 lateral compaction
No significant differences between groups for microleakage or sealer penetration
Hosoya N. Nomura M. etal J Endod. 26:292-4, 2000
Grp 1,one paper point, Grp 2, four paper points, Grp 3 four paper points+ gentle
burst of warm air, Grp 4 four paper points, + internal 200 degrees C heat probe.
Zinc oxide-eugenol sealer vs glass ionomer sealer
Glass ionomer sealer appeared more susceptible to moisture
Group 4 Best
Horning TG. Kessler JR. J Endod 21:354-7, 1995
Procosol, Sealapex, Ketac-Endo
Saline as a moisture contaminant
Procosol <Sealapex <Ketac-Endo.
No significant difference in the amount of dye penetration after 9 months
Wilcox LR. Wiemann AH. J Endod. 21:256-8, 1995
Alcohol or NaOCl
lentulo spiral or file
AH26 laterally
no significant differences among the four groups
all areas had sealer present middle and apical thirds showed the most variability
Kuhre AN. Kessler JR. J Endod. 19:277-80, 1993
Apical seal of laterally condensed gutta-percha
Proco-Sol root canal cement
Prior to obturation
Dried
NaOCl
Saliva
No significant differences were found among the groups.
Pulpal Floor

Accessory canals in the furcation region

Gutmann JL. J Period 49:21-6, 1978

29.4% mandibular molars

27.4% maxillary molars

Haznedaroglu F. Ersev H. et al Int Endod J 36:515-9, 2003

24% maxillary rst molars

16% maxillary second molars

24% mandibular rst molars

20% mandibular second molars

Blaskovic-Subat V. Acta Stomat Croatica. 24:85-95, 1990

32.0% of all furcations

Pulpal Floor:Sealing
Barrieshi-Nusair KM. Hammad HM. Quint Int 36:539-45, 2005
de Souza FD. Pecora JD. Silva RG. Oral Surg Oral Med Oral Path Oral Radiol & Endod 99:125-8, 2005
Shindo K. Kakuma Y. et al Dent Materials J 23:419-23, 2004
Wells JD. DH. et al. J Endod. 28:443-7, 2002
Zaia AA. Nakagawa R.et al Int Endod J. 35:729-34, 2002
Kijsamanmith K. Timpawat S. et al Int Endod J 35:833-9, 2002
Belli S. Zhang Y. Pereira PN. Pashley DH. J Endod. 27:521-6, 2001.
Wolcott JF. Hicks ML. Himel VT. J Endod. 25:589-92, 1999
Pisano DM. DiFiore PM. et al J Endod. 24:659-62, 1998
Chailertvanitkul P. Saunders WP. Saunders EM. MacKenzie D. Int Endod J. 30:318-22, 1997
Saunders WP. Saunders EM. Int Endod J. 23:28-33, 1990

In all studies a second seal was benecial

Intraorice vs pulpal oor

2-4 mm

Little difference

Sealing the entire pulpal oor is easier

Flowable adhesive materials may be better

Bond to pulpal oor weaker ! coronal dentine

Teeth should be restored as quickly as possible

Super Bonder

Single Bond

Protect Liner F

Panavia F

DC core-Light cured

DC core-Chemically cured

Principle

C&B Metabond

Clearl SE Bond

One-Step

Cermet cement

Cavit

Amalgam

IRM

Super-EBA

Coltosol

Vidrion R

Scotch Bond

MTA

Glass ionomer

Ketac

Vitrebond

GC America

Ketac-Bond

Cold compaction

Compaction of heat-softened gutta-percha

Non-injected
Injected
Core carrier
Mechanical compaction
Compaction of Gutta-percha
Lateral Compaction:Technique

Master cone selection

Fits to or within 0.5 mm of the working length

Snugness of t in the apical 1 to 3 mm

Radiograph space lateral to the master cone in mid and coronal third

Spreader selection

Sealer placement

Compaction

Spreader place lateral to the master cone to within 0.5-1 mm of WL

Accessory cone is lightly coated with sealer

Add accessory cones until the spreader can penetrate only 2 to 3 mm

Spreader selection

Spreader needs to be 1-2 mm of WL

Walton RE Johnson WT 1996

Johnson WT Gutmann JL 2006

Spreader needs to reach WL

Gutmann JL Witherspoon DE 2002

Spreader needs to be 2 mm of WL with GP in place

Allison DA. Michelich RJ. Walton RE. J Endod 7:61-5, 1981

Spreader Diameter
1 mm from the Tip

RCS3 0.35

RCSD11 0.50

RCSD11S 0.28

RCSD11T 0.34

RCSD11TS 0.25

RCSGP1 0.24

S20 0.23

S25 0.30

S30 0.33

S40 0.44

S50 0.42

S60 0.55

RCSGP2 0.24

RCSGP3 0.30

RCSMA57 0.22

RCSW1S 0.36

RCSW2S 0.39

RCS30 0.30
Need To Shape to Accommodate the Spreader
RCSD11T 0.34
RCSD11TS 0.25
Lateral Compaction: Spreader Penetration

Spreader penetrate more tapered canal systems

Dulaimi, S. F. 1; et al Int Endod J 38:510-515, 2005.

Finger spreaders appear to be better than hand spreaders

Simons J. Ibanez B. etal J Endod 17:101-4, 1991

Niti Vs stainless steel

Sobhi MB. Khan I. J College Phys & Surg Pak 13:70-2, 2003

In vivo curved root canals.

Nickel-titanium nger spreader was signicantly deeper

Stainless steel penetration decreased with increasing angle

of curvature of the canal.

Berry KA. Loushine RJ. et al. J Endod 24:752-4, 1998

NiTi spreaders penetrated to a signicantly greater depth

than SS spreaders in curved canals

Gharai SR. Thorpe JR. et al J Endod 31:198-200, 2005

Curved canals NiTi nger spreaders produce sig less force than SS nger spreaders

No signicant difference in microleakage between spreaders

Blum JY. Esber S. Micallef JP. J Endod 23:340-5, 1997

Warm vertical compaction lateral condensation thermomechanical compaction

Vertical forces WVC, 2.5 +/- 0.4 kg, LC 1.1 +/- 0.3 kg, and TMC 1.65 +/- 0.2 kg

Lateral forces WVC, 0.85 +/- 0.2 kg, LC 0.35 +/- 0.1 kg, and TMC 0.5 +/- 0.2 kg

Lertchirakarn V. Palamara JE. Messer HH. J Endod 25:99-104, 1999

Max loads and strains generated by nger spreaders were sig lower than D11T

Joyce AP. Loushine RJ. West LA. Runyan DA. Cameron SM. J Endod 24:714-5, 1998

Stress in canal walls

Stainless-steel spreaders created three areas of concentrated stress

Nickel-titanium spreaders stress spread out along the surface of the canals

Dang DA. Walton RE. J Endod 15:294-301, 1989

D11 spreaders or B-nger pluggers

D11, produced vertical root fractures and caused greater root distortion

Schmidt KJ. Walker TL. et al. J Endod 26:42-4, 2000

Nickel-titanium spreader " sig less force than a stainless-steel spreader

Lateral Compaction: Spreader Force
NiTi vs Stainless Steel; Hand Vs Finger Spreaders
Spreader Loads: Vertical Root Fracture
Holcomb JQ, Pitts DL, Nicholls JI. J Endod 13:277-284; 1987
Lindauer PA. Campbell AD. Et al J Endod 15:345-9, 1989

Force required to cause vertical fracture during LC

DIIT spreader

Smallest fracture load was 1.5 kg (3.31 lb.)

Mainly buccolingual direction

Incomplete fracture was seen in 26%.

Positive linear correlations were found between fracture load and root
width, canal width, canal taper, ratio of canal width to total root width,
and number of accessory cones placed.

Obturated using forces " 1 to 3 kg or 4.5 to 7.5 kg.

3 teeth obturated using 7.0 to 7.3 kg of force demonstrated

vertical root fractures.

Up to 4.9 kg are safe

Chloroform, methychloroform, halothane,

rectied white turpentine and eucalyptol

Dip " softened paste of gutta-percha

(chloropercha Kloropercha)

Removal of the excess solvent with alcohol

Dimensional change

Compact GP within 15 - 30 sec

Dissipation of the chemical solvent

Irritation / toxicity of solvent

Barbosa SV. Burkard DH. et al. J Endod. 20:6-8, 1994

Cytotoxicity of chloroform, halothane, or turpentine

All solvents were toxic

Turpentine > halothane >chloroform

Allard U. Andersson L. Endod Dent Trauma 8:155-9, 1992

Chloroform - Kloroperka " open medical cups

Exposure levels close to the accepted limit values in Sweden, more then one
NSRCT per day may lead to unacceptably expose

Evacuation signicantly reduced expose

McDonald MN. Vire DE. J Endod. 18:301-3, 1992

FDA banned drugs & cosmetics containing chloroform

No negative health effects to the dentist or assistant and air vapor levels well
below OSHA mandated maximum levels.

Chutich MJ. Kaminski EJ. Et al J Endod. 24:213-6, 1998

Chloroform, xylene, or halothane.

Residual volume of solvent expressed through the apex during Re:Tx was well
below the permissible toxic dose.

Pose negligible risk to the patient.

SimpliFill

Recommend for Lightspeed prep

Trial t an GP Plug, 2 mm short of WL

Bind

Place Sealer in the apical 1/3

AH Plus

Advance the GP Plug to WL

Disengage GP plug at WL

Rotate Counter Clockwise

Backll

Available in GP and Resilon

Warm Vertical Compaction

Pluggers

Pre-tted non-binding

Smallest plugger within ~ 4 mm of WL

Incrementally t larger plugger

Non-standardized gutta-percha cones

F, FM, M, ML

Fitted 0.5-2 mm short of WL

Heat source
Warm Vertical Compaction

Pluggers

Pre-tted non-binding

Smallest plugger within ~ 4 mm of WL

Incrementally t larger plugger

Non-standardized gutta-percha cones

F, FM, M, ML

Fitted 0.5-2 mm short of WL

Heat source
Continuous Wave: Concept
System B
GP Simultaneously
Thermoplasticized
Compacted
System B: Distance to WL

4 to 6 mm from WL

5 to 7 mm from WL

Buchanan LS. Endod Prac 1998; 1: 710, 136, 18.

Buchanan LS. Dent Today 1994; 13: 805.

System B

2 to 4.5 mm from WL

Guess GM. et al J Endod 29:509-12, 2003

Villegas JC. Yoshioka T. et al Int Endod J 38:218-22, 2005

Jung IY. Et al Oral Surg Oral Med Oral Path Oral Radiol &
Endod 96:453-7, 2003
System B Tip Dimensions
.04 Taper /30
.06 Taper/55
.08 Taper/55
.10 Taper/55
.12 Taper /55
92
.04 Taper/30
.06 Taper/40
.08 Taper/50
.10 Taper/60
.12 Taper/70
30 prep to .06 taper
25 prep to ~.08 taper
ULTRAFIL

GP cannulas 22 Gauge needle 21 mm long

Low viscosity material

Regular set ' 30 min

Firm set ' 4 min

High viscosity material

Endo set ' 2 min

Heating unit preset to 90 C

Injection syringe

GP ows for ~ 45-60 sec

Inject-R Fil

GP backll in a system

Single use device made with a stainless-

steel carrier that is packed with GP

Heating unit

Heat-R remains at a constant 150C

Prepare up to six Inject-R Fills

Core Carrier Techniques

Thermal

Soft-Core

Successl
Cor e Car r i er Techni que

Select obturator to match the C&S technique

GT

Protaper

Prole

Size veriers

Conrm canal size before placement of core carrier

Fine adjustments to apical prep

Sealer "" canal walls "" carrier insertion

AH Plus

File or paper point

Heated obturator inserted into canal system

Pre-determined length "" ~ WL

Cool for 2-4 min

Remove excess with prepi bur

SuccessFil Syringe must be warmed 3-10 min

SuccessFil Titanium Cores

Implant-grade titanium alloy

Non-cutting tips highly exible

25 mm lengths " ISO sizes 20-80

Notch the core with a ssure bur where severing

along the shaft is desired
Successl

McSpadden Compactor

Microseal Condenser

Quick-ll
Thermo-Mechanical Compaction
Microseal System

Spreader within 2-3 mm of WL

Avoid sealer effected by heat

Place a cone to WL

Microseal Spreaders

NiTi engine spreaders 350 rpm

Microseal Condensers

NiTi engine condensers " reverse-helix design 5000-6000 rpm

Load with Microseal Low-fusing GP

Place in space made by engine spreader

Activate
Quick-Fill

Thermo mechanical

Alpha phase GP on an inverted K type le

Two sizes smaller than the last le used to WL

1 mm short of the apex

Lightly coat or dip Quick-Fill in sealer of choice

Position the Quick-Fill at the orice of the canal

Clockwise rotate @ 3000-6000 rpm, and

Apply light pressure

Heat Generation: Obturation Systems

Warm vertical

System B

Touch n Heat

Injection systems

Thermo-mechanical compaction

Ultrasonic

Rotary

Core carrier systems

Heat
Eriksson A, Albrektsson T, et al. Int J Oral Surg 11:115, 1982.
Eriksson AR, Albrektsson T, J Prosthet Dent 50:101, 1983.
Eriksson AR, Albrektsson T, et al. Acta Orthop Scand 55:629, 1984.
Eriksson RA, Albrektsson T, et a. Scand J Plast Reconstr Surg 18:261, 1984.
Matthews LS, Hirsch C, J Bone Joint Surg Am 54:297, 1972.

Heating bone to 117 to 122 F (47 to 50 C) for 1 min

Reduces bone formation

Irreversible cellular damage

Fatty cell inltration

Increased blood ow

Stagnation

Deactivation alkaline phosphatase

Temperature increase and length of increase

117 F (47 C) for 1 min = 118 F (48 C) for 30 sec

Temps > 127 F (53 C) for < 1 sec adversely affect osteogenesis
Heat Generation: Core Carrier Systems

Lipski M. J Endod. 30:441-3, 2004

Thermal 3.87 C

Soft-Core 3.67 C

Ultral 2.14 C

Trifecta low-temperature 2.03 C

Behnia A. McDonald NJ. J Endod. 27:203-5, 2001

Thermal Plus

Mean temp rise of the external root surface

4.26 - 4.87 C
Heat Generation: Warm Vertical
Lee FS. Van Cura JE. BeGole E. J Endod. 24:617-20, 1998

System B (SB) Touch 'n Heat (TH) Flame-heated carrier (FH)

Mx incisor, premolar, and Md incisor

2 mm below the cementoenamel junction

SB temperature rise < 10 C for all teeth

TH temperature rise

< 10 C Mx incisors and premolars

> 10 C Md incisors

FH temperature rise < 10 C for all teeth

Heat Generation: System B

Floren JW. Weller RN. et al J Endod. 25:593-5, 1999

250, 300 , 350, 400, 450, 500, 550 , and 600 C.

5 mm from the apex temperatures 8.85-12.06 C

Romero AD. Green DB. et al J Endod. 26:85-7, 2000

Temperature at the apex and 5 mm from the apex

Av temperature " ~1 C at the apex and ~2 C at 5 mm

Lipski M. OOOOE. 99:505-10, 2005

Mx central incisors and canines temperature "< 10 C

Md central incisors temperature " by more than 10 C

Sweatman TL. Baumgartner JC. et al J Endod. 27:512-5, 2001

Highest mean internal temperature 74.19 C at the 6 mm from WL

FM set at 300 C

Lowest mean internal temperature change was 2.09 C at WL

F set at 200 C

Did not ! external root surface 10 C

Heat Generation: Injection System

Donley DL. Weller RN. et al. J Endod. 17:307-9, 1991

Obtura ( Mean temperature of the extruded GP was 137.81 C

Ultral ( Mean temperature of the extruded GP was 62.88 C

Weller RN. Koch KA. Int Endod J. 28:86-90, 1995

Obtura II set at 160, 185, and 200 C

mean intracanal temperatures ( 40.21 to 57.24 C

mean root surface temperatures ( 37.22 to 41.90 C

Weller RN. Koch KA. Int Endod J. 27:299-303, 1994

Obtura II @ 160, 185, and 200 C intracanal temp ( 38.52 C- 61.58 C

GP decreased heating chamber ~ 20 C

Extruded GP was ~ 100 C < GP in the heating chamber

Sweatman TL. Baumgartner JC et al. J Endod. 27:512-5, 2001

Obtura II did not ! external root surface 10 C

lowest mean internal temperature change was 5.22 C at WL,

highest mean internal temperature change was 26.63 C at 6 mm from WL

Heat Generation: In Vivo

Slight inammatory reaction

Does not appear to be at clinically deleterious levels

No long-term effect

Temperature " mid-point on the root

Castelli WA. Caffesse RG. et al. Oral Surg Oral Med Oral Pathol 71:333-7, 1991

Molyvdas I. Zervas P. et al. Endod Dent Trauma. 5:32-7, 1989

Gutmann JL. Rakusin H. et al. J Endod. 13:441-8, 1987

Gutmann JL. Creel DC. Bowles WH. J Endod 13:378-83, 1987

Hand RE. Huget EF et al Oral Surg, Oral Med Oral Pathol 42:395-401, 1976

Saunders EM. Int Endod J. 23:263-7, 1990

No sig diff between temperature " recorded in vitro and in vivo.

Temperature elevations dissipated more rapidly in vivo than in vitro

Hea t Gener a t i on:
Thermomechanical Compaction

Lipski M. J Endod. 31:297-300, 2005

Mean " temp LC + Engine Plugger 23.8 9 C

Mean " temp Microseal 5.5 3 C

Bailey GC. Cunnington SA. et al. Int Endod J. 37:447-54, 2004

Ultrasonic power setting 5 for 15 s

Temperature " > 10 C mid-root level

Sweatman TL. Baumgartner JC. et al J Endod. 27:512-5, 2001

Ultrasonic lateral compaction " external root surface not > 10 C

lowest mean internal temp change 5.01 C WL

highest mean internal temp change 28.95 C 6 mm from WL

McCullagh JJ. Biagioni PA. et al Int Endod J. 30:191-5, 1997

Thermomechanical obturation Gutta Condensor

Surface root temperature rises of > 97 C were recorded during all three speed

Saunders EM. Int Endod J. 23:268-74, 1990

Thermomechanical compaction of gutta-percha Ferret canine @ 24 hrs, 20d & 40d.

PDL damage in a minority of the experimental specimens 20 and 40 days

EZ-Fill

Bi-Directional Spiral Filler

EZ-Fill Epoxy Root Canal Cement " AH plus

Single cone of GP
EZ-Fill

Fit a single GP cone to WL " binds apically

Fit EZ-Fill bi-directional spiral 1 mm short of WL

Coat the bi -directional spiral with the cement

Place into the canal

Run at ~ 1000 RPM

Use a slow up & down circular motion

For approximately 5 seconds

Seat the pre-tted GP cone

Sear off the end of the Gp with a heated plugger

Ez-Fill

How too articles

Weathers AK. Denti Today. 23:100, 102-3, 2004

Musikant BL. Cohen BI. Deutsch AS. The evolution of instrumentation and obturation
leading to a simplied approach. Comp Cont Edu Dent 21:980-6, 988, 990, 2000

Musikant BL. Cohen BI. Deutsch AS. Rethinking endodontics: attaining total obturation
of the root canal system with a simplied system. Gen Dent 47:73-82, 1999

Musikant BL. Cohen BI. Deutsch AS. Report of a simplied endodontic technique.
Comp Cont Edu Dent. 20:1088-90, 1092-4, 1999

Seidman D. A general dentist's viewpoint of two new endodontic techniques. Comp

Cont Edu Dent. 20:921-4, 926, 928 passim; quiz 934, 1999

Musikant BL. Cohen BI. Deutsch AS. Simplied obturation of tapered canal
preparations. Comp Cont Edu Dent. 19:1152-5, 1998

Musikant BL. Cohen BI. Deutsch AS. A two-and-a-half year perspective on simplied
endodontic techniques Comp Cont Edu Dent. 24:46-8, 50, 52 passim, 2000

Musikant BL, Cohen BI, Deutsch AS. Traditional, modern and post modern
endodontics: part two. Endod Prac March:6-17.
Ez-Fill: leakage

Cohen BI. Pagnillo MK. et al Gen Den 46:618-23,1998

Lateral compaction EZ Fill sealer

Thermal with Thermaseal

EZ-Fill Bi-directional spiral EZ Fill sealer

No sig diff

Hata G, Imura N, et al; J Endod 28[absPR31]:261, 2002

EZ-Fill

System B

Lateral compaction

EZ-Fill technique showed the least dye penetration.

Additives or Modied GP

GuttaFlow

EndoREZ System

Activ GP System
GuttaFlow

RoekoSeal Automix silicon-based sealer

Contains gutta-percha particles < 30 m as a ller

Approximately 50 % gutta-percha and 50 % sealer

Nano-silver

Flowable and sets within 10 min

Material expands slightly on setting

Cannot be dissolved with chloroform

Thoroughly rinse with sterile water or alcohol

Dry with paper points

Remove all residues of NaOCl, H2O2

GuttaFlow
Elayouti etal. J Endod 31:687-90, 2005
GuttaFlow completely lled the prepared
root canal, but small voids were frequently
present within the core of the lling
material.
EndoREZ System

Resin Coated Gutta Percha Points

Polybutadiene-diisocyanate-methacrylate

Resin coating bonds chemically to EndoREZ

Standard ISO-sized points

Resin sealer EndoRez

Create a monoblock in the canal

Works with all resin-based sealers

EndoREZ Sealer

Dual cure; self-priming; hydrophilic sealer

Methacrylate-based resin

~30% Urethane dimethacrylate

Radiopacity similar to as gutta percha

~ 50 wt% lled;contains bismuth oxychloride, calcium

lactate pentahydrate, silicon dioxide as llers

Peroxide-based lubricants and NaOCl effect bond

EDTA nal rinse

Sets harder than ZOE but not as hard as restoratives

resin

There is no chemical solvent

EndoREZ System

Endorez sealer

Injected into the root canal via a 30-gauge Tip

2 to 3 mm short WL

Place pre-tted master cone

Passive place multiple 0.02 taper resin-coated GP

accessory cones
EndoREZ

Bouillaguet S. etal Eur J Oral Sci. 112:182-7, 2004

Cytotoxicity & leakage

Kerr PCS, RoekoSeal, TopSeal and EndoREZ

All cytotoxic " particularly when freshly mixed

Roeko Seal

Least cytotoxic

More effective in sealing root canals against LPS

Kardon BP. etal J Endod. 29:658-61, 2003

Leakage

EndoRez + single cone of GP > AH Plus + single cone

of GP = WVC + AH Plus
EndoREZ

Bouillaguet S. etal Eur J Oral Sci. 112:182-7, 2004

Cytotoxicity & leakage

Kerr PCS, RoekoSeal, TopSeal and EndoREZ

All cytotoxic " particularly when freshly mixed

Roeko Seal

Least cytotoxic

More effective in sealing root canals against LPS

Kardon BP. etal J Endod. 29:658-61, 2003

Leakage

EndoRez + single cone of GP > AH Plus + single cone

of GP = WVC + AH Plus

Sipert CR. etal Int Endod J. 38:539-43, 2005

EndoRez does not have antimicrobial activity

Eldeniz AU. etal J Endod. 31:293-6, 2005

Bond strength Diaket, AH Plus and Endo-REZ

AH Plus " highest bond to dentin +/- smear layer

Sevimay S. Kalayci A. J Oral Reh 32:105-10, 2005

LC and either AH plus vs EndoRez

AH Plus leaked less

AH plus "better adapted to dentine

Zmener O. Pameijer CH. Amer J Dent. 17:19-22, 2004

145/180 patients LC+ EndoRez

91%. overall success rate " NSRCT adequately lled WL

6.9% Extruded sealer

Glass ionomer particles incorporated into the GP

8%

Adhesive coating of particles to the surface of GP

2 microns

Activ GP glass ionomer sealer

Working time 15 min if use a chilled glass slab

Highly radiopaque

Cones match to the Endosequence

Single Cone Technique

Sever with heat

Activ GP System
PULPDENT PRESSURE SYRINGE

Fit needle snugly 1-2 mm from the apex

Turn the screw plunger 1/4 turn clockwise.

Wait 5 seconds

This lls the 1-2 mm at the apex.

disposable needles 18, 22, 25, 27 & 30 gauge

Pulpdent Root Canal Sealer

Open Apex Obturation
Open Apex Obturation
Gutta-percha

Apexication with Ca(OH)

2

MTA
Pulp Necrosis:Apexication
A method of inducing a calcied apical
barrier or continued apical
development of a an incompletely
formed root in which the pulp is
necrotic.
Ca(OH)
2
: Non Setting Form
Calyx
Calasept
Pulpdent
Tempcanal
Hypo-Cal
Reogan
Ultracal
Self Mixed
Methyl Cellulose
+ or - Water
Apexication: Ca(OH)
2

Kinirons MJ Srinivasan V et al Int J Paed Dent 11:447-51,2001
Barrier formation in apexication

Effect of the frequency of change of Ca(OH)

2

" barrier detection times
Retrospective study
107 teeth
Barrier detection

Earlier with frequent change in Ca(OH)

2
Barrier detection time of less than 9 mths
60.7% were changed more frequently than every 3 mths
39.1% with longer change times
mean time of barrier detection " 43.3 weeks
Apexication: Ca(OH)
2

Chosack A. Sela J. Cleaton-Jones P. Endod Dent Traum 13:211-7, 1997
Single packing of Ca(OH)2 paste
Replacement of the Ca(OH)2 paste at 3 months
Replacement of the Ca(OH)2 paste monthly
48 non-vital maxillary incisors from 12 monkeys
Killed after 6 months
Histomorphometric evaluation of the volume of
new primary osteocementum showed no
signicant difference between the three groups
Issues: Ca(OH)
2

Apexication
Temporization
Long-term
Patient compliance
Multiple appointments
Predictability
Radiographic interpretation
Long-term Ca(OH)2
Fracture Strength
Andreasen, JO etal Dent Trauma 18:134-137, 2002
In Vitro
Ca(OH)2 " 0.5, 1, 2, 3, 6, 9, or 12 mths
Tested for fracture strength
"" in fracture strength with !!! time
Technical Application:
Apexication
NSRCT
Moderate curve &Size 40 & up
Plugger t
Similar to warm vertical compaction of GP
~ 0.5 - 1 mm short of WL
Mixing
Compaction
Enhanced with an ultrasonic
Obturation:MTA
Lawley GR. Schindler WG. Walker WA 3rd. Kolodrubetz D. J Endod 30:167-72, 2004
4 mm, +\- ultrasonic vibration
Composite resin or GP
Bacterial leakage at 90 days
6 / 18 in the non-ultrasonic MTA
2 / 18 in the ultrasonic MTA
1 / 18 in the ultrasonic MTA-composite group.
no signicant differences
signicant differences @ 45 days
Fracture resistance
Intracanal composite resin demonstrated a signicantly greater
resistance to root fracture than MTA followed with GP + sealer
Aminoshariae A. Hartwell GR. et al J Endod 29:679-82, 2003
Hand condensation vs ultrasonic condensation
Hand condensation resulted in better adaptation to the tube walls and
less voids than the ultrasonic method.
Obturation:MTA
MTA more resistant to human saliva
leakage than vertically condensed
gutta-percha and sealer
Al-Hezaimi K. Naghshbandi J et al J Endod 31:453-6, 2005
4-5 mm apical MTA plug
Matt GD. Thorpe JR. et al. J Endod 30:876-9, 2004
Lawley GR. Schindler WG. Et al J Endod 30:167-72, 2004
Case reports + how too articles
Castellucci A. Dent Today. 24:78, 80, 82 passim; quiz 87, 2005
Villa P. Fernandez R. Dent Trauma 21:306-8, 2005
Tait CM. Ricketts DN. Higgins AJ. Brit Dent J. 198:609-17, 2005
MTA + dentine bonding agents and composite resin
Linsuwanont P. Aust Endod J 29:45-9, 2003
Steinig TH. Regan JD. Gutmann JL. Aust Endod J 29:34-42, 2003
Lynn EA. Einbender S. New York State Dent J 69:30-2, 2003.
Giuliani V. Baccetti T. et al Dent Trauma 18:217-21, 2002
Levenstein H. SADJ. 57:270-3, 2002
Bishop BG. Woollard GW. Gen Dent. 50:252-6; quiz 257-8, 2002
Witherspoon DE. Ham K. Prac Proc & Aesth Dent 13:455-60; quiz 462, 2001
Clinical Experience
60/169 pts
Ave recall 595 days
43/60 (71.7%)healed
Ave. recall 714 days
16/60 (26.6%)healing
Ave. recall 281 days
1/60 (1.7 %) persistent disease
Ave. recall 62 days
165
Thank You
H15060340I
0
1
3
2
5
4
7
6
8
SB .04 .06 GT B GT R GT G
30
35
40
45
50
52
54
56
58
20 20 20 30 30
28 34 36 30 32
38
42
46
50
54
58
62
42
48
54
60
66
72
78
40
50
60
70
80
90
100
36
44
52
60
68
76
84
44
56
68
80
92
104
104
10 62 68 90 100 100 104
12 66 76 102 100 100 104
14 70 84 114 100 100 104
16 74 92 126 100 100 104
.04 .06
35 35
39 41
43
47
51
55
59
63
67
47
53
59
65
71
77
83
75 95
83 107
91 119
99 131
19
23
27
33
39
48
59
73
90
111
115
119
119
SX
20
27
34
41
46
52
58
63
69
80
91
102
113
25
33
41
49
55
61
67
72
78
89
100
111
120
30
39
48
57
64
71
76
81
68
96
106
116
120
F1 F2 F3
@ 8mm = 95 @ 12mm = 105
@ 8mm =111 @ 12mm = 139
FM
M
@ tip= 55
@ tip= 55