Un approccio critico alle tecniche di otturazione canalare

Aim: The root canal obturation is one of the most important phases of the endodontic treatment. In fact, it will have the important task of creating an airtight and three-dimensional seal of the root canal system thus preventing the percolation of periapical fluids and of neutralizing the microorganisms survived after the procedures of cleaning and shaping. Many obturation techniques have been suggested and choose the most appropriate according to the treatment plan can be difficult. The purpose of this article is to describe indications, limitations and operating sequences of the most popular techniques for root canal filling. Methodology: Over 130 articles on Medline were selected, all on the topic of the root canal obturation. The studies, chosen following the requirements of the "evidence based medicine", were divided into clinical studies, studies in vitro and case reports and matched in a comparative analysis to identify advantages and limitations of the methods considered. Results: When considering the clinical studies on the long-term outcome, there are no significant differences in the success rates obtainable with the different methods. On the contrary, there is a strong scientific evidence that demonstrates a superior capability of the techniques based on thermo-plasticized gutta-percha of filling three-dimensionally even the most complex root canal systems with a reduced amount of sealer. Conclusions: The root canal filling techniques based on the vertical condensation of warm guttapercha show a greater ability of creating airtight fillings. The choice between them will depend on the characteristics of the clinical case. In the long and curved root canals it will be advisable to use the carrier-based techniques that result easier and that allow a more conservative root canal preparation, whereas the techniques of continuous wave or the classic Schilder technique will give better results in straight or wide canals or in case of internal resorptions.