ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Warm Gutta Percha Versus Cold Lateral Condensation In Root Canal Therapy
Clinical Question Does warm gutta percha or cold lateral condensation provide a more effective result (long-term outcome) in the obturation of root canals?
Clinical Bottom Line While both methods show statistically similar levels of postoperative pain, long-term outcome, and obturation quality, warm gutta percha results in significantly higher rates of over extension. Steps should be taken to minimize that over extension or cold lateral condensation should be performed. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 17258624Peng/200710 clinical studies were included with a total of 1748 previously-untreated teethSystematic Review & Meta-analysis
Key resultsOver extension was more likely for warm than cold condensation (relative risk 1.93, 95% confidence interval 1.3, 2.93). The other three outcomes studied (postoperative pain, long-term outcome, and obturation quality) did not differ between the two treatments.
Evidence Search Search PubMed for "Gutta-Percha"[Mesh] AND "Root Canal Obturation"[Mesh] LIMIT Meta-analysis
Comments on
The Evidence
Ten clinical studies, of which nine were randomized, were included in this meta-analysis, and 1,748 previously untreated teeth were treated with either warm or cold lateral condensation. Pain was recorded if it lasted more than 48 hours and long-term outcome was evaluated between one and five years. Not all studies included all outcomes. Only two of the ten studies included blind outcome assessment.
Applicability The results of this study highlight the evidence that endodontic success is not solely related to the obturation technique, but more directly related to the disinfection and resolution of the inflammatory process. In addition, the finding that warm vertical compaction has a greater incidence of over extensions is not surprising, since it is regarded as a more technically sensitive technique. Each obturation technique has its advantages and disadvantages, and should be thoughtfully selected according to the case being treated (indication) and the level of the provider training.
Specialty/Discipline (Endodontics)
Keywords root canal; gutta percha; endodontics; obturation; cold lateral condensation
ID# 886
Date of submission: 05/03/2011spacer
E-mail francisj@livemail.uthscsa.edu
Author J. Christian Francis
Co-author(s) Anibal Diogenes, DDS, MS
Co-author(s) e-mail
Faculty mentor/Co-author Mark Littlestar, DDS
Faculty mentor/Co-author e-mail littlestarm@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Joseph Jones, DDS (Center,TX) on 06/22/2011
My own clinical experience is that the danger of over extension does indeed occur with warm gutta-percha, so I would have to agree with the findings of this CAT.
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