Seal the access cavity just after the root canal filling is a good point especially to prevent a potential reinfection. you can do it easily if you have used a wide volume of gutta and just a small quantity of cement for many reasons but especially to limit the flowing of the endodontic cement in the access cavity. It seems very important to clean the access cavity best a possible by removing all the gutta or cement debris especially if the latter contains eugenol which influences the composite polymerization. rubber dam, magnifying tools and ultrasonics are very useful to do it. Depending on the kind of restoration, you can decide to perform a sandwich restoration by placing a glass ionomer cement in contact with the pulp floor. If you have to use fiber post, the cleaning process is also crucial. To summarize, the key point are:

- the filling technique: gutta condensation with a small quantity of cement. For exemple, if you used a lentulo with a lot of cement it seems not reliable to perform a permanent restoration just after the RCT.

- the mechanical and chemical cleaning process in order to bond on clean surfaces and prevent interferences between eugenol and composite restoration.

There is a very good paper of a collegue wich could help:

Article Clinical Adhesive Sealing of the Pulp Chamber Following Endo...

Hi Dr. Amit,

In my opinion, it is always better to do the permanent restoration immediately after completing RCT. Orifice barriers (Pink GIC or Permaflo Purple) can be used to prevent against any microleakage. Followed by placing a Composite restoration. I agree with Dr. Frédéric Bukiet regarding the Sandwich technique. I usually use EDTA solution to clean the pulpal floor of the remnants of sealer/cements. 

Dr.Nasil Can you reccomend any studies related !

Often the endodontic treatment is performed through a crown having a porcelain veneer (porcelain-to-metal) or a monobloc Lithium Disilicate or Zirconia substrate. After thorough cleaning with EDTA I use GIC at the base covering the gutta percha, then use 9% Hydrofluoric acid for 40 seconds to etch the porcelain. A dual-cured buildup is followed by a thin layer of high value opaque such as pink opaque then allows placement of a final layer of composite resin that is undetectable - no dark shadow and a resin- bonded seal to the porcelain.

Yes you should place access restorative immediately after you have finished obturation .At first remove all guttapercha and sealant material from access cavityand try to c

Dear All, interesting statements and suggestions. What exactly is the particular reason GIC seem to still be so popular? Scientific evidence can hardly be the reason.... 

By all suggestions till now, my asessment is: to place immediate access restoration after obturation but also to make sure that residual sealer is removed by the use of etchant or EDTA.

Dear Amit

We are not able to remove endodontic cement totally with cleaning cavity step because always will remain cement into the dentin tubules and it will result in a poor sealing of cavity when you place composite resin. Applying GIC immediately after endontic obturation you will reach a good sealing of cavity.To clean the cavity wall completely you need wait for complete set of GIC and then you use a low speed round bur to remove a thin layer of dentin and after that you can make dentin hybridization properly. In resume, I suggest you seal the cavity with GIC and then make in a sandwich restoration: remove 1 mm of GIC and fill with composite resin.

Dear Isabel,

Is there  any reference available on that? IMHO resin tags in dentin tubules account for 15% of adhesion strenght. Considering the simillarity of adhesion  principle between self-etch adhesives and GIC,  would GIC be that better?

Yes the access restorative has to be plac

It should be done. Quality of  obturation is precautionary measured.

The important thing is the coronal seal. Three to four mm of Cavit gives the best seal against bacterial contamination. Presence of traces of RC sealer on walls of the pulp chamber and rim of the access cavity can compromise the bond and seal of the restoration.

The permanent access restoration should be placed whenever possible to prevent any chances of reinfection. If it cannot be placed in the same appointment, a Double seal using Cavit 3mm followed by IRM should be used to maintain the coronal seal.

Just a few clinical considerations:

First of all, the literature showed that the Cavit leads to a better seal than IRM. But the IRM has better mechanical properties. Thus, the thickness of the temporary restoration is very important as previously mentioned by Nasil and Roger. But don't you think that Cavit can behave like a bacteria sponge if the setting of the material is triggered under saliva ?

I'm used to trigger cavit setting under rubber dam with sterile water but i'm not sure that's useful.

Certainly, always place the Cavit while the dam is in place. I also like to use IRM over the Cavit as a temporary, because the geographical nature of my practice means I often have to leave them in place for some time.

Remember this thread was about a permanent restoration, and I assume talking about anterior teeth. Posteriors really need a crown, and therefore a temporary restoration is required until the crown is provided.

The main problem with Cavit alone, is that as it wears, the patient feels the temporary has been lost because they can feel the rim of the access cavity with their tongue.

We (our University) recommend the following procedure (immediately after placement of the root canal filling!): etch-and-rinse without the previous use of a bur (!), use of a good dentin bonding agent (we use Syntac), placement of a flowable composite (SDR, for reduced shrinking stress, or a white-opaque flow, like GrandioSO flow WO, when you need a colour mismatch). We do this even over an intracanal medicament (with additional gutta percha points and/or Cavit, when no points are present). There is enough literature to support this. Other materials bear the risk of leakage over time.

Yes, this is a correct approach according to the evidence.

Yes. Permanent access restoration can be placed immediately after the root canal system is "satisfactorily" obturated. It is better to relieve the occlusion to prevent the postoperative pain. 

According to the literature, after obturation of the teeth permanent access restoration should be placed for the success of the endodontic treatment.

Cotton pellet soaked in alcohol or acetone will remove most eugenol based sealer, if this step is followed by sandblasting the pulp chamber this will allow for immediate permanent composite restoration. 

Definitely, should place a temporary restoration after obturation.

According literature, it’s prefer to put final restoration immediately after final obturation in order to prevent microleakage

But in some case you can put Semi-permanent temporary (GIC)” such as Compromised prognosis (calcified canals, procedural accidents), Guarded prognosis (abutment) and Suspecting retreatment or surgical procedure. The Semi-permanent temporary (GIC)” must last as long as necessary (up to 1 year)