Copyright C Munksgaard 2000

Endod Dent Traumatol 2000; 16: 128131

Printed in Denmark . All rights reserved

Endodontics &
Dental Traumatology
ISSN 0109-2502

Case report

Utilization of gutta-percha for retrograde

root fillings
Sauveur G, Sobel M, Boucher Y. Utilization of gutta-percha for
retrograde root fillings. Endod Dent Traumatol 2000; 16: 128131.
C Munksgaard, 2000.
Abstract Just as gutta-percha used with a root canal sealer is a
recommended material for orthograde root fillings, it could similarly be the material of choice for retrograde fillings. Unfortunately,
clinical accessibility and visibility do not always facilitate such a technique. The aim of this article is to present a new technique which
enables retrograde fillings to be achieved with gutta-percha and a
sealer. After the apex had been resected, a hole was drilled perpendicular to the plane of section of the apex about 1 mm coronally.
The bucco-lingual depth required to reach the main canal was
calculated. The cavity was then dried, coated with the sealer, and
obturated with gutta-percha in accordance with thermo-mechanical compaction techniques. After excess filling material had been
removed, the gutta-percha was cold burnished and the angles of
the root were smoothed. Clinical cases illustrating healing of the
periapical tissues are shown.

Clinical success in endodontic surgery depends on numerous factors such as disinfection and debridement
of the root canal and its hermetic seal with well-tolerated materials (1). These parameters are interdependent, for example, in cases where the choice of a
root-filling material determines the type of preparation. Among the materials which are used for retrograde root fillings, amalgams have been the most
prevalently employed (2), but their use is questioned
today because of their disadvantages, which include
possible scattering of amalgam particles in the surrounding tissues, corrosion, and poor sealing properties. Other materials have been proposed (see 3, 4
for review). The most popular materials currently are
zinc oxide-eugenol cements either alone or reinforced
with various components such as resin (IRM, EBA,
super EBA) (5), composite resins (6) and glass ionomer
cements (7). A number of other materials are occasionally used, such as ceramic pins, aluminium oxide, or are still in their evaluation phase such as MTA
(8).
128

G. Sauveur, M. Sobel, Y. Boucher

Service dOndontologie de lHotel Dieu, UFR
dOndontologie, Universite Paris 7, Paris, France

Key words: endodontic surgery; gutta-percha;

periapical healing; retrograde filling
Yves Boucher, Service dOdontologie de lHotel
Dieu, 5, Rue Garancie`re, 75006 Paris, France
Tel/fax: 33 1 44 27 81 23
e-mail: ybou/ccr.jussieu.fr
Accepted August 26, 1999

Gutta-percha, which is the material of choice for

orthograde root fillings, has been only marginally
used for retrograde fillings. Its use is limited to several
animal studies (9, 10) and only a few clinical cases
(1113) have been reported. This is surprising since
its plasticity enables it to fill the root canal three-dimensionally and, when used with a sealer, results in
a hermetic seal of the root canal. Its utilization has
been substantially documented, either for cold compaction or for heat compaction (see 14 for review).
Therefore, it might appear desirable to use such a
material for retrograde obturation of the root canal.
The main problem of gutta-percha utilization in
retrograde procedures is technical and related to difficulties with its insertion since accessibility and visibility may be limited. The ideal situation would be to
prepare and obturate the canal through its long axis,
but in practice, the lack of accessibility may make a
buccal or lingual approach necessary. Numerous
authors recommend cutting the apex with a bevel of
45 to 60 from the long axis, depending on the clin-

Retrograde fillings using gutta-percha

Fig. 1. Schematic drawing showing the technique described. Upper

diagrams represent a lateral view of the tooth. A. Intact root. B.
The apex is resected perpendicularly to the long axis of the tooth.
C. A cavity is drilled parallel to the sectioning plane of the root in
order to reach the root canal. D. After drying the cavity and coating with a sealer, a cone of gutta-percha calibrated to the diameter
of the drill is compacted into the cavity. E. Excess filling material
is removed with a bur under irrigation. The angles of the preparation are smoothed and the gutta-percha is exposed apically. Lower
diagrams illustrate the same steps of the procedure in a 3-D representation.

Fig. 2. Tooth 44, which was sensitive upon mastication and mechanical mobilization, presented an unsatisfactory root filling and evidence of a radiolucency at the apex. The presence of a post
oriented the therapeutic approach towards surgical retrofilling procedure rather than conventional retreatment.

ical situation (1517). A bevel permits a direct view

of the preparation, and makes it possible to debride
the canal and insert the filling material under optimal
visibility. However, these types of preparation may
not be ideal from a mechanical point of view. Sauveur
et al. (18) have shown that resecting the apex perpendicular to the long axis of the tooth generates less
stress under loading than bevelled preparations.
This article proposes a new type of preparation
which permits both the the root end to be sectioned
perpendicular to the long axis of the tooth and a
retrograde root filling to be achieved with gutta-percha. A schematic drawing of the procedure is given
in Fig. 1.
Case report

A 46-year-old man, in good health, presented for consultation because of sensitivity under a bridge during
mastication. Extraoral examination showed normal
appearance of the head and neck. Occlusion was normal. A bridge covering teeth 4447 (4546 missing)
was in place. The intraoral soft tissues were normal.
Tooth 44 presented sensitivity to percussion and palpation. No periodontal pocket was discovered. Radiologic examination showed evidence of a periapical
lesion at tooth 44 (Fig. 2).
After surgical exposure of the root end and elimination of the granulation tissue, the root end was cut
perpendicular to the long axis of the tooth and the
apex removed. A drill was chosen according to the

Fig. 3. After exposure and resection of the apex perpendicular to

the long axis of the tooth, a cavity was drilled parallel to this plane
of sectioning. Its diameter corresponded approximately to onethird of the mesiodistal radicular diameter. The drills penetration
was calculated to be 1.0 to 1.5 mm less than the bucco-lingual
dimension. The cavity preparation was begun 1 mm coronally to
the flat root-end surface and drilling was performed parallel to this
surface. The cavity reached the main root canal and extended a
little further without perforating the lingual side.

129

Sauveur et al.

mesio-distal diameter of the root and mounted in a

slow-speed contra-angle handpiece. This diameter
corresponded approximately to one-third of the mesiodistal radicular diameter. The bucco-lingual diameter was measured with a periodontal probe graduated in millimeters and the drills penetration was calculated to be 1.0 to 1.5 mm less than the buccolingual diameter. The cavity preparation was begun
1 mm coronally to the flat root-end surface and the
drilling was performed parallel to this surface. The
cavity reached the main root canal and extended a
little further without perforating the lingual side (Fig.
3). A mixture of bone wax and calcium alginate fibres
was then applied to the bone cavity to insulate the
root end from the surrounding tissues (19). The retrograde cavity was cleaned, dried with paper points and
a small quantity of sealer was introduced into the cavity with an endodontic file. A gutta-percha cone, calibrated to the diameter of the preparation, was inserted into the cavity. The gutta-percha was warmed
with a heat carrier and compacted with a plugger
whose diameter corresponded to the diameter of the
prepared cavity. The gutta-percha was cooled with
physiologic saline and excess material was removed
with a round bur at high speed. The root-end filling
was then rinsed again with physiologic saline. The
root filling was finally cold burnished (Fig. 4). After
these obturation steps, the bone wax-alginate fibre
mixture was removed and the preparation refined.

Fig. 5. Radiograph taken after 5 years. The tooth is asymptomatic

and there is radiographic evidence of healing.

This finishing process consisted of rounding the

angles of the preparation, and removing the apical
zinc oxide-eugenol cement with a small round bur.
The osseous cavity was rinsed with physiologic saline and filled with Biocoral, a calcium carbonate resorbable material (Pharmadent, Paris, France) and
covered with a resorbable membrane. The flap was
repositioned and sutured. An antibiotic (Amoxicillin
2 g/day for 6 days), an antiinflammatory agent (Tiaprofenic acid 600 mg/day for 4 days), and a mouthwash (chlorhexidine 0.2% 3 times/day), were prescribed. Post-operative radiographs at 30 days, 6
months, 1 year and 5 years (Fig. 5) showed evidence
of healing.
Discussion

Fig. 4. After coating the cavity with a sealer, gutta-percha was heatcompacted into the cavity, refreshed and cold burnished. Excess
filling material was removed and the tooth and bone cavity were
cleaned before suturing.

130

There were advantages to using this procedure to perform retrograde root fillings. The first advantage was
that the technique is compatible with sectioning of
the root end perpendicular to the long axis of the
tooth. Mechanical stresses transmitted to the periapical tissues are thereby decreased (18). The second
advantage was that gutta-percha associated with a
sealer could be used. Recent studies indicate excellent
biological tolerance of gutta-percha associated with a
cement as a retrograde root-filling material (10). The
quality of the seal has also been examined in vitro with
dye leakage after retrograde fillings were placed, and

Retrograde fillings using gutta-percha

the results have indicated acceptable properties of

gutta-percha when used with a sealer compared with
amalgam (20, 21).
The technique described in this article can be applied to cases, both in the mandible and in the maxilla.

10.

11.
12.

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