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Resin based obturation   / /certified fixed orthodontic courses by Indian dental academy
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Resin based obturation / /certified fixed orthodontic courses by Indian dental academy



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Resin based obturation / /certified fixed orthodontic courses by Indian dental academy Presentation Transcript

  • 1. Resin Based Obturation INDIAN DENTAL ACADEMYLeader in Continuing Dental Education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. INTRODUCTION Evolution of Specialty of endodontics over the years Endodontic Triad TRADITIONALLY DEBRIDEMENT SUCCESS IN R.C.T STERILIZATION OBTURATION www.indiandentalacademy.com
  • 4. Final step in endodontic treatment – OBTURATIONMain objective – substitution of pulp tissue space with an inert filling materialPulp remnants, necrotic tissue, bacteria and its byproducts –Inaccessible areas of cleaned and shaped canal – poor defense ofHost – LesionOBTURATION – Must to prevent coronal leakage, bacterial Contamination, sealing of bacteria from p.a tissue fluids and sealing remaining irritnats in canals. www.indiandentalacademy.com
  • 5. Study by Ingle and Beveridge (1985) :58% Endodontic failures – INCOMPLETE OBTURATIONPrincipal cause of failure of endodontic treatmentSince Ingle’s classic study – Great emphasis given on developing materials and www.indiandentalacademy.com obturation techniques for
  • 6. Materials used for obturationCore + Sealer = ObturationAcc to Grossman:1. Plastics2. Solids3. Cements4. PastesRequirements of an ideal root canal filling material:1) Be easily introduced in canal2) Seal the canal laterally and apically3) Shouldn’t shrink after insertion4) Impervious to moisture5) Bacteriostatic6) Radiopaque www.indiandentalacademy.com
  • 7. 7) Shouldn’t stain the tooth8) Shouldn’t irritate periradicular tissue9) Should be sterile or easily/quickly sterilized10) Easy removal if necessarySealers :• Zinc oxide-Eugenol based• Calcium hydroxide based• Resin• Glass ionomer basedIdeal requisites of a root canal sealer (Grossman):1) Should be tacky – for good adhesion2) Hermetic seal www.indiandentalacademy.com
  • 8. 3) Radiopaque4) Fine particles - easy mixing with liquid5) Shouldn’t shrink6) Shouldn’t stain the tooth7) Bacteriostatic8) Set slowly9) Insoluble in tissue fluids10) Non irritating to periradicular tissues11) Soluble in common solvent – easy removal12) Should not provoke an immune response13) Neither mutagenic/carcinogenic www.indiandentalacademy.com
  • 9. Most common solid core root canal filling material – Gutta PerchaGold standard for endodontic obturation !!! resently – Gutta percha filling – Weak point in R.C.TTorabinejad et al – G.P fillings challenged by bacteria 50% specimen allowed penetration to entire lengthDrawbacks of Gutta Percha: . Inability to achieve a fluid impervious seal . Inability to reinforce tooth structure www.indiandentalacademy.com
  • 10. - Material that would effectively seal and reinforce the tooth www.indiandentalacademy.com
  • 11. www.indiandentalacademy.com
  • 12. Evolution of Adhesive endodontics Lack of adhesion of gutta percha and root dentin –Flared canalsCoronal microleakage with G.P fillings (Swanson and Madison, 1987) Coronal microleakage with temporary filling materials High incidence of vertical fractures Quest – a new material Resin sealers e.g. AH26, Epiphany etc with G.P RESILON – MONOBLOCK CONCEPT www.indiandentalacademy.com
  • 13. Bonding to root dentin Entry of adhesive endodontics – PromisingContributing factors in root dentin bonding:a) Anatomy of rootsb) Tooth positionc) Presence of residual tissuesd) Curing techniquese) Experience and skill of operatorf) Tubular density, microbranching and tubular arrangement www.indiandentalacademy.com
  • 14. Ferrari and Mjor (2000) – SEM insight of normal and etched root dentin NORMAL Coronal 3rd Middle 3rd Apical 3rd ETCHED www.indiandentalacademy.com
  • 15. mportant considerations:) The dentin tubule- structure, size and number- affect bonding (Patrick etal)) Effects of etching more pronounced in coronal than in apical 3rd – Limitation of penetration of etchant (Ferrari)) Carrying of adhesives to the apical 3 rd – A limiting factor) Ferrari et al – Resin dentin interdiffusion zone not uniform at the apical 3rd www.indiandentalacademy.com
  • 16. 5) Interaction of intracanal medicaments and irrigants with the adhesives: a) Calcium hydroxide – Neutralize the action of self etching primer, interfere with bonds in more coronal parts when present in excess b) NaOcl/ H2O2 – Decrease bond strengths (Erdemir)6) Difficulty in drying the canal - Self etch adhesives preferred www.indiandentalacademy.com
  • 17. Geometric factors affecting bonding in root canals Polymerization of resins Decrease in volume of monomer Shrinkage Shrinkage stresses Debonding MICROLEAKAGE FAILURE www.indiandentalacademy.com
  • 18. Stress relief α Cavity geometry and Resin film thicknessClass I cavity – Movement/flow of unbounded surface Stress reliefIn long narrow root canals – Small unbounded surface Insufficient stress relief Debonding of one/more surfaceConfiguration factor = Total bonded area Total unbonded areaC-factor α 1 (Franklin Tay et al) Sealer thickness www.indiandentalacademy.com
  • 19. i.e. Greater sealer = Lesser C-factorFranklin’s study – C-factor of 46-23461 with increasing sealer thickness (500 - 1µ) Lesser the sealer thickness Lesser the Shrinkage Lesser Polymerization stresses Lesser chance of DEBONDINGVery high C-factor in root canals – Major obstacle inproducing gap free adhesive fillings www.indiandentalacademy.com
  • 20. Shrinkage stresses - Higher in low filled, low viscosity resins Slow polymerizing resin Flow of resin Relief of shrinkage stresses due to prolonged gelation time (Autopolymerizes in 45 min) www.indiandentalacademy.com
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  • 23. DIAKET 1ST Resin sealer ( ESPE/Premier, Germany/USA) - 1951 Resin reinforced chelate formed between ZnOand polyvinyl resin dissolved in liquid DiketoneComposition:Powder – ZnO (90%), Bismuth Phosphate (3%)Liquid – Propylacetophenone (76%) Copolymers of vinyl acetate, vinyl chloride and vinyl isobutyl ether (23%) 2-2 dihydroxy, 5-5 dichlorophenylmethane (0.5%) Triethanolamine (0.2%) Very tacky, Contracts during setting but absorbs water Good sealing efficiency and biocompatible (Nencka, Regan et al) www.indiandentalacademy.com
  • 24. HYDRON Rapid setting hydrophillic plastic material Goldman et al - is polymer of HEMA and is biocompatible Sets in a dry canal in 10 min Requires special syringe and needle Significantly high leakage www.indiandentalacademy.com
  • 25. AH26 Schroder and Hermann Stich – Tried “Araldite” (Epoxy resin glue) Catalyst unsuitable for useTried Hexamethylene tetramine - disinfectant in urology SUCCESS – AH26 Story behind the name – A- Aethoxyline resin (Araldite) H- Hexamethylene tetramine 26- 26th Jackpot experiment www.indiandentalacademy.com
  • 26.  Manufactured by DeTrey/Dentsply, Germany, supplied as powder liquid systemComposition:Powder – Silver powder (10%) Hexamethylene tetramine (25%) Bismuth oxide (60%) Titanium Oxide (5%)Liquid - 100% bisphenol-A epoxyAdvantages: Not sensitive to moisture No Cracking/debonding – larger setting time and fluidity High Radiopacity, less shrinkage and low solubility www.indiandentalacademy.com
  • 27. isadvantages: Cytotoxixity – AH26 sets HMT decomposes in water/acid FORMALDEHYDE Film Thickness - 39µ - Thick – Limits the shrinkage stress relief (Wu et al, 1997) Michael Tagger (2003) - AH26 softened and increased the flow of of G.P. bisphenol – A epoxy – Partial solventGreyish Staining the tooth structureWeiner and schilder (1971) and DeGee et al (1994) – Initial expansion then shrinkage www.indiandentalacademy.com
  • 28. AH Plus  Another milestone in endodontics by Dentsply DeTrey  Advantages of AH26 retained and the disadvantages eliminated Composition: Supplied as paste-paste system and double barrel syringe Epoxide paste Amine pasteBisphenol-A and F epoxy resin DibenzyldiamineCalcium tungstate AminoadamantaneZirconium oxide Tricycodecane- diamineSilica Silica, Zirconium oxide and Ca tungstateIron oxide pigments Silicone oil www.indiandentalacademy.com
  • 29. Difference in composition of AH26 and AH Plus –Silicone oil as a vehicle as compared to formaldehydeSilicone oil – Hinders flowSetting reaction of AH Plus:Thermal polyaddition reaction – A step growth reactionMonomers, Amines & Diepoxides + Oligomers = Polymers Linear chain of repeating polymer unitsSetting time – 8 Hrs – long – Compensation for shrinkage stresses www.indiandentalacademy.com
  • 30. Properties of AH26, AHPlus and DiaketRadiopacity: AH Plus = 13.6/mm Al thickness AH 26 = 9.3 Diaket = 4.6 Epiphany = 6.1Solubility: Acc to ISO standards 6876, wt loss >3% not permitted AH Plus = Approx 1% AH 26 = Approx 3% Diaket = Approx 2%Polymerization shrinkage: AH Plus = 1.76% of total volume AH 26 = 1.46 Diaket = 1.18 Epiphany = 2.31Linear expansion: AH Plus = 0.129±0.08 Epiphany = 4.827±0.183 www.indiandentalacademy.com
  • 31. Film Thickness: Acc to ISO standards – 50 mm Ideal AH Plus = 26mm AH 26 = 26-36mmFlow Behaviour: Acc to ISO standards- > 25mm AH Plus = 36mm (Thixotropic )Shear bond strength: Ayce (2005) compared AH Plus, Diaket and EndoRez. Diaket and EndoRez = 1.2 Mpa approx AH Plus = 6 MpaSealing Properties: O Zemner (1997) Compared AH 26 and AH Plus AH Plus - More leakage owing to its faster set that can lead to shrinkage stress Min-Kai Wu- Ketac endo better than AH26 due towww.indiandentalacademy.com greater thickness of AH26
  • 32. Lasers and sealing ability:Lasers – µ-scopically rough substrate without demineralization open dentinal tubules without smear layer Dentin surface sterilizationEr – YAG laser – Better bond strengths than acid etchingDISADVANTAGE – Heat productionCox et al – Nd:YAG laser produces – Melted dentin Crazing Debris formation Alteration in tubule structureAriyaratnam et al – Similar findings www.indiandentalacademy.com
  • 33. Toxicological studies of AH Plus sealerTests done on both the individual pastes (uncured) andPolymerized in acc to ISO(10993)INDIVIDUAL PASTES:Mutagenicity: Non mutagenicSystemic toxicity: Non toxicCytotoxicity: non polymerized pastes – cytotoxic Bactericidal property Time limited – remains till 4 hrs Saleh et al – AH Plus kills E. Faecalis in tubulesAntimicrobial effects: Kaplan et al – AH Plus showed inhibtion of S.Mutans and A.IsraeliFormaldehyde release: Leonardo M R(1999), Cohen(1998): AH Plus (3.9 ppm) and AH26 (1347 ppm) www.indiandentalacademy.com
  • 34. Polymerized material:Mutagenicity: Non mutagenicCytotoxicity: Less than individual components Leonardo M R – No inflammation and Hard tissue formation Koulaouzidou E A – AH Plus far less toxic than AH26Hepatotoxicity: If material released in periradicular area and absorbed into body – act on liver AH26 and AH Plus - HepatotoxicSensitization: AH Plus – doesn’t release sensitizing substancesAntibacterial action: Pizzo et al – Ah plus antibacterial action till 24 hrs www.indiandentalacademy.com
  • 35. Heating of AH26 and AH Plus:Heat produced during warm vertical condensation – Alter theCytotoxic profilesTheodore – Heating of AH26 – Faster release of formaldehydeRemoval of AH26 and AH Plus from canals:Conventional techniques – Solvents and drillsSchafer et al – Epoxy resin sealers – high solubility in chlorofromHansen – AH26 soluble only in chloroform and not in xylene etc.Whitworth – AH Plus soluble in halothane www.indiandentalacademy.com
  • 36. ENDORESIN Studies Reported – excellent sealing ability of C&B Metabond, a MMA/TBB resin Drawbacks as root filling material – Too short working time Low radiopacity Difficult removal Yohji Imai&Takashi – Replaced Fluoropolymer and added radiopacifier Endoresin (ISO Standards) Endoresin2 (Decreased availability of fluoropolymer) www.indiandentalacademy.com
  • 37. Composition:Powder: PMMA (Polymethymethacrylate) – Polymer Barium Sulphate – RadiopacifierLiquid: MMA (Methylmethacrylate) – Monomer Tributylborane – CatalystProperties:Flow – 38 mmWorking time – 5.5 minSetting time – 35.5 minFilm Thickness – 5.6 µSolubility – 0.18%Radiopacity – 5.2 mm Al. www.indiandentalacademy.com
  • 38. www.indiandentalacademy.com
  • 39. RESILON Revolutionalized the adhesive endodonticsSequence of events: G.P + Sealer Poor sealing and lack of adhesion to dentin Epoxy Resin Sealers + G.P No Bonding/Monoblock Methacrylate resin sealers + G.P Methacrylate resin coated G.P RESILON www.indiandentalacademy.com
  • 40. Resilon Obturating System (Resilon research ltd, LLC) Core + Primer + SealerCore Material:Thermoplastic, synthetic polymer based( Polyester) Core Composition: Polycaprolactone – 50% Methacrylate co-polymers – 10% Glass fillers – 40% - Bioactive glass Others – Bismuth oxychloride Resilon points – Available in ISO sizes in 0.02, 0.04, 0.06 tapers www.indiandentalacademy.com
  • 41. roperties of Resilon: Thermoplasticity : Due to presence of polycaprolactone which has low glass transition temperature (-62ºC) Polymer – Cooled below glass transition temp – Brittle like glass Heated above - Soft and flexible like elastomer At room temp – Resilon is above glass transition temp – Rubbery At body temp - Below glass transition temp – Glassy Thermal properties – Marcus R Miner, 2006 Melting point – GP – 60.01ºC, Resilon – 60.57ºC Claimed by manufacturer – 70-80ºC Specific heat capacity – Heat that must be added to raise temp of 1 gm of material by 1ºC G.P – 0.94ºC, Resilon – 1.15ºC – More heat required to melt resilon www.indiandentalacademy.com
  • 42. ) Enthalpy change – Amt of heat absorbed or released when reaction takes place G.P – 10.88 J/gm, Resilon – 25.2 J/gmNFERENCE – Resilon requires more heat to equally plasticize as G.P) Cytotoxicity – Jennifer key, 2006 Same biocompatibility as G.P) Resilon for root reinforcement: A myth or realityChad williams et al (2006) –Modulus of elasticity of dentin – 16000 MpaMaterial to reinforce dentin Should have the same elasticityModulus of elasticity – G.P – 74.22 Mpa, Resilon – 129.16 www.indiandentalacademy.com
  • 43. Cohesive strength of dentin – 36-100 MpaCohesive strength – G.P- 6.3 Mpa, Resilon – 7.8 MpaResilon has glass transition temperature below bodytemperature:Acts as an elastomer - undergo flow or elongate understressIdeal material to reinforce roots:1. Cohesive strength and modulus of elasticity = Dentin2. Polymer with glass transition tmperature above body temperatureComposite resins – Satisfy the criteria to some extent , Modulus of elasticity = 12000 Mpa www.indiandentalacademy.com
  • 44. 5) Bondability of resilon with methacrylate sealers:Resilon – Introduced to bond with methacrylate selaers and produce a Monoblock with the toothFranklin Tay et al (2006):Weak chemical union between resilon and methacrylate sealerCause – Phase separation due to insufficient dimethacrylate inresilon and absence of free radicals within resilon for couplingAlternative – G.P coated with polybutadiene diisocyanate methacrylate resin www.indiandentalacademy.com
  • 45. 6) Removal for retreatment:Heat or solvents like chloroform etcDaniel pinto ( 2006) – Resilon and epiphany - easy and faster to remove than G.P and AH26 with rotary K3 files and chloroformElie Ezzie (2006) – similar findings with rotary (Profiles) and chloroformReason – Resilon has low melting poin than G.P. When heated it exhibits flowability – Quicker removal www.indiandentalacademy.com
  • 46. 7) Degradability: Polycaprolactone – Degradeable polymer Used as biodegradeable water or milk container, resorbable sutures Degrades slowly in water but the rate can be accelarated with enzymes e.g. esterases as it is a polyester Hydrolases e.g. lipases from bacteria, fungi and yeast – van also cleave the ester bonds Franklin and Pashley – Alkaline hydrolyses – Fissures seen on surface of resilon – susceptible to alkaline hydorlysis www.indiandentalacademy.com
  • 47.  Enzymatic hydrolysis – surface erosion Alkaline hydrolysis – bulk degradation Another study by Franklin – Cholestrol esterase – thinning of material and exposing of larger bioactive glass fillersFrom above data :Microbial attack Bacterial enzymes Resilon degradeAt present – Susceptibility of resilon to degradation to plethora of microrganisms in root canal space – UNKNOWNFurther studies and long term clinical datarequired www.indiandentalacademy.com
  • 48. Resilon sealer:A dual cured methacrylate resin based sealerComposition:BISGMA, Ethoxylated BISGMA, UDMA andHydrophillic, difunctional methacrylatesFillers (70%) – Ca hydroxide, barium sulfate, barium glass, bismuth oxychloride and silicaThinning resin – EBPADMA – To modify the viscosityResilon research limited (Madison, LLC) – Licensed the product toPentron (Epiphany), Sybron Endo (Realseal), Obtura Spartan( pellets for obtura system) and Light speed ( Simplifill) www.indiandentalacademy.com
  • 49. roperties of resilon sealer: ) Radiopacity – Epiphany – 6.1/ m of al AH PLUS – 13.6 ) Solubility – Acc to ADA specification 57 – not more than 3% Epiphany – 3.41% AH Plus – 0.21%Reason – erosion of filler particles due to degradation ) Flow test – Acc to ADA – Not less than 20 mm Epiphany – 35.74 mm AH Plus – 38.57 mm ) Setting time – Acc to ADA – should be within 10 % of that stated by manufacturer Acc to manufacturer – Epiphany – 25 min, AH Plus –480 min Acc to studies – Epiphany – 24.75 min, AH Plus – 500 min www.indiandentalacademy.com
  • 50. 5) Film thickness – Acc to ADA - not more than 50µ Epiphany – 20.1µ AH Plus – 10.66) Dimensional alterations – Acc to ADA – linear shrinkage of not more than 1% and expansion of 0.1% Expansion – Epiphany – 8.1%, AH Plus – 1.3%Reason – Water sorption due to:a) Hydrophillic difunctional methacrylates – Absorb waterb) Filler content – Ca hydroxide – Absorb water7) Sealing ability:Epiphany resistant to bacterial penetration – Shipper et al (2004), Teixeira et al(2004)Ryan Stratton et al - Epiphany and resilon leak less than G.P and AH PlusStephen G. Biggs – Comparable leakage to G.P and AH PlusTay et al - Similar results www.indiandentalacademy.com
  • 51. 8) Effect of intracanal medicaments and irrigants:Porkaew et al, Wuerch et al - Ca hydroxide did not adversely affect the apical sealKim et al – Ca hydroxide increased the apical leakageReason – EDTA used forms complexes with CaRyan Stratton et al – Irrigants like 5.25% Sod Hypo, 0.12% CHX, or 2% CHX – did not alter sealing ability9) Biocompatibility:Cassio et al(2006) – Intraosseous implantation –AH Plus = Severe inflammation, EndoRez = Severe inflammation with chronic inflammation,Epiphany = None to slightJennifer key – Epiphany more cytotoxic than Grossman, Sealapex and Thermaseal www.indiandentalacademy.com
  • 52. www.indiandentalacademy.com
  • 53. Epiphany (Pentron) Simplifill Realseal (Light speed) (SybronEndo)Inno Endo (Hereus Kulzer) Resinate (Obtura Spartan) www.indiandentalacademy.com
  • 54. Endo eze systemConsists of:• A Reciprocating handpiece• 7 Stainless steel files (3 shaping files used in hand piece and 4 hand files for apical 3 mm)3) Irrigants and Lubricants4) Delivery tips5) EndoRez Sealer and EndoRez points www.indiandentalacademy.com
  • 55. EndoRez Sealer: (Ultradent) Methacrlylate based resin sealer consists of 30% UDMA Biocompatible Hydrophilic – Excellent penetration in dentinal tubules Supplied as a TwoSpense 2 syringe (Double barrel): www.indiandentalacademy.com
  • 56.  Good radiopacity Equivalent to G.P and easy to remove Introduced directly in canal with a NavitipTM Can be used with conventional as well as hot G.P techniques Setting time – 15-20 min, final set -2 hrs.Disadvantages:Poor Sealing ability (Brian et al): After 7 days the sealer had not set, was seen bubbling out Oxygen in atmosphere could have prevented the setting SEM images- Sponge like appearance which allowed leakage www.indiandentalacademy.com
  • 57. EndoRez PointsTechniques: Resilon Points Resin coated G.P: Can be used with any sealer Franklin et al – Radiographically acceptable results Drawback – Resin coating and sealer interface weak link – Shrinkage and Delamination Cause -Absence of oxygen inhibited layer, removed to prevent sticking of G.P during storagelternative – Adhesive resin application on resin coated G.P before insertion (Noriko Hiraishi, 2006) www.indiandentalacademy.com
  • 58. Manipulation and dispensing of EndoRez Sealer www.indiandentalacademy.com
  • 59. FIBERFILL SYSTEM Methacrylate Sealer + Primer + Mater coneSealer – UDMA, PEGMDA, HDDMA and BISGMA, Treated bariumborosilicate glasses, Barium sulfate, Ca phosphate, Initiators, Stabilizers, Pigments, Benzoyl peroxidePrimer:Primer A – Acetone + Surface active monomer (NTG-GMA magnesium)Primer B - Acetone + PMGDMA + HEMA + Initiator + Stabilizer + water www.indiandentalacademy.com
  • 60. Single master cone – Glass fibers in resin matrix coronally – POST G.P apically – OBTURATIONSizes – 3 mm, 5 mm, 8 mm apical G.PTapers – 0.02, 0.04, 0.06Methacrylate sealer – sealer + post cementation www.indiandentalacademy.com
  • 61. Advantages: Obturation and post placement – same visit 80 % root strengthening Immediate coronal seal Highly radiopaque sealerChristos et al – Highest bond strength of fiberfill as compared to Endion, Topseal and CRCS.Saleh et al – Bond strength of fiberfill less than AH PlusNikolas Economides – Good sealing ability www.indiandentalacademy.com
  • 62. Introduction of resins into root canal has created arevolution in endodontics. But still known is a drop andunknown is an ocean.Further studies and long term clinical data is requiredbefore judging the credibility these adhesive root fillings. www.indiandentalacademy.com
  • 63. www.indiandentalacademy.com