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Introduction to Endodontics
Forth Year

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  2. 2. Requirements for an Ideal Root Canal-Filling Material According to Grossman, an ideal root canal-filling material should:  Easy manipulation with ample working time  Have dimensional stability  Be able to seal the canal laterally and apically  Not irritate periapical tissues  Be impervious to moisture and nonporous  Be unaffected by tissue fluids and insoluble in tissue fluids: not corrode or oxidize
  3. 3.  Bacteriostatic  Radiopaque  Not discolor the tooth structure  Be sterile or easily and quickly sterilizable  Be easily removed from the canal, if necessary.
  4. 4. Materials used for Obturation Sealers Core obturating materials Solid materials Semisolids [Pastes] i. ZnOE based ii. Resin based Gutta Percha iii. Glass ionomer based iv. Ca(OH)2 based Gutta percha [Regular/ β phase] Thermoplasticised [α phase] Resin-based core i. Injectable ii. Carrier based Silverpoints
  5. 5.  Gutta-percha polymer is a trans-1,4-polyisoprene, obtained from the coagulation of latex produced by trees of the Sapotaceae family  It exists in two crystalline forms (alpha and beta) with differing properties. Another unstable form (γ) exists, which is amorphous in nature.  In beta phase the material is a solid mass that is compactable, when heated the material changes to alpha phase that is pliable and tacky and can be made to flow under pressure Beta form 56-64oC Alpha form
  6. 6. Composition of commercial gutta-percha Materials Percentage Function Gutta-percha 18-22% Matrix Zinc oxide 59-76% Filler Waxes or resins 1-4% Plasticity Metal sulfates (barium or strontium) 1-18% Radiopacity
  7. 7. Advantages The advantages of gutta-percha as a filling material are 1. It is compactible and adapts excellently to the irregularities and contour of the canal by the lateral and vertical condensation method. 2. It can be softened and made plastic by heat or by organic solvents (eucalyptol, chloroform, xylol, turpentine). 3. It is inert. 4. It has dimensional stability; when unaltered by organic solvents, it will not shrink. 5. It is tissue tolerant (nonallergenic). 6. It will not discolor the tooth structure. 7. It is radiopaque. 8. It can be easily removed from the canal when necessary.
  8. 8. 9. Recent studies have demonstrated that, in vitro, gutta-percha has activity against several different bacterial species (Staphylococcus aureus, Streptococcus mutans, S. pyogenes). They have also hypothesized that the active antibacterial element of gutta-percha cones is probably zinc oxide. 9. It is also readily sterilizable, since immersion in 5.25% sodium hypochlorite for as little as 60 seconds suffices to eliminate even the most resistant spores
  9. 9. Disadvantages The disadvantages of gutta-percha as a filling material are as follows: 1. It lacks rigidity. The smallest, standardized gutta-percha cones are relatively more difficult to use unless canals are enlarged above size no. 25. 2. It lacks adhesive quality. Gutta-percha docs not adhere to the canal walls; consequently, sealer is required. The necessary use of a cementing agent introduces the risk of using tissue-irritating sealers.
  10. 10. 3. Gutta percha does not bond to any sealers 4. It can be easily displaced by pressure 5. Gutta percha is almost wholly dependent on a coronal seal to prevent the apical migration of bacteria if it's challenged by coronal leakage.
  11. 11. CURRENT FORMS OF GUTTA-PERCHA AVAILABLE  Solid core Gutta-percha points - Standardized - Non standardized  Thermo mechanical compactible Gutta-percha  Thermo plasticized Gutta-percha - Solid core system - Injectable form  Medicated Gutta-percha
  12. 12. Gutta percha is supplied as:  Sticks  used to check the vitality of teeth  used as a temporary filling  Points/ Cones  used for obturation  tracing of sinuses
  13. 13. Syringe material :  Obtura II Obtura II is a heated-gun system, whereby guttapercha sticks are placed within a chamber in the gun, and a plunger is used to express the heated, flowing gutta percha through replaceable injection tips. The flow of the gutta percha is controlled through the temperature of the unit - the higher the temperature, the easier the flow. By design, the system is considered a "high heat" system
  14. 14.  Ultrafil Ultrafil uses a pre-dosed cannula system. Cannulas containing various types of gutta percha are placed in a heating unit. When needed they are loaded into a gun (similar to a periodontal ligament injection unit), which expresses gutta percha from the cannula. The system is characterized as a "low-heat" unit, since the temperature needed to plasticize the gutta percha is much lower than the Obtura II system
  15. 15. Coating on metal or plastic cores :  Thermafil  It consists of a plastic core coated with alpha phase gutta-percha and a heating device that controls the temperature. The carrier is set to the predetermined length using the millimeter calibration markings on the carrier shaft. After heating it, the clinician has approximately 10 seconds to retrieve and insert it into the canal, without rotating or twisting it. The gutta-percha is allowed 2 to 4 minutes to cool before resecting the carrier.  An advantage to this technique is the movement of gutta-percha into lateral and accessory canals; however, extrusion of material beyond the apical extent of the preparation is a disadvantage.
  16. 16.  SimpliFill SimpliFill uses a flexible, stainless-steel shaft to hold a 5 mm long cone of gutta percha called the Apical GP Plug. Once the 5 mm Apical GP Plug is firmly condensed in the apical third of the canal with sealer, the SimpliFill handle is turned counter clockwise, allowing the carrier to be removed. Leaving only the Apical GP Plug (no carrier) allows for easy retreatment, should it become necessary
  17. 17. Thermomechanical Compaction of Gutta-percha: A totally new concept of heat softening and compacting gutta-percha was introduced by McSpadden in 1979. Initially called the McSpadden Compactor, the device resembled a reverse Hedstroem file, or a reverse screw design. It fit into a latch-type handpiece and was spun in the canal at speeds between 8,000 and 20,000 rpm. At these speeds, the heat generated by friction softened the gutta-percha and the design of the blades forced the material apically.
  18. 18. Microseal Condenser : is used in conjunction with heat-softened, alpha phase-like gutta-percha as well as regular gutta-percha points. To obturate a canal, the clinician is advised to place the primary gutta-percha point, followed by the appropriate size Condenser, which has been coated with the heat-softened gutta-percha. The Condenser is spun in the canal with a controlled speed handpiece at 1,000 to 4,000 rpm to form a firmer core. This “flings” the gutta-percha laterally and vertically
  19. 19. J.S. Quick-Fill  Titanium carriers coated with alpha-phase gutta-percha comes in four sizes and operates in regular slow-speed handpiece.  Friction plasticizes gutta-percha.  Titanium core may be severed and left or removed while still spinning
  20. 20. Gutta Percha Sealers: GP sealers are prepared by dissolving gutta-percha in solvents like chloroform, eucalyptol, xylol etc., as well as in rosin and balsam –  Chloropercha,  Eucapercha  Xylopercha  Kloropercha : contains balsam, rosin, and zinc oxide in addition to gutta-percha and chloroform
  21. 21. Medicated Gutta Percha: The iodoform, tetracycline and iodoform/tetracycline combination are bound within the gutta percha points. They act as a reservoir of antimicrobial that is capable of diffusing onto the surface of the gutta percha thereby inhibiting the colonization of bacteria on the gutta percha points and within the root canal system. Tetracycline is capable of coalescing within the dentinal tubules to inhibit long term microbial growth. These medicated gutta percha points are site specific, surface acting antimicrobial gutta percha points.
  22. 22.  Calcium hydroxide containing Gutta percha: Gutta percha with high content of Calcium hydroxide (40-60%)  Chlorohexidine Diacetate containing gutta percha : GP matrix embedded with 5% chlorohexidine diacetate Used primarily as Intracanal Medicaments.
  23. 23. Silver points : Introduced by Jasper In 1941, silver cones were the most widely used solid-core metallic filling material, although points of gold, iridioplatinum, and tantalum are also available Advantages:  Can be used in narrow and curved canals  Silver has more rigidity than gutta-percha and hence can be pushed into tightly fitting canals and around curves where it is difficult to force gutta-percha.
  24. 24. Disadvantages: • Silver points/cones have a circular cross section unlike the canals which may be oval hence a poor lateral seal • Show high levels of corrosion especially due to the dissolution of the sealers. • Retreivability is difficult
  25. 25. Paste-type filling materials Include zinc oxide-eugenol cements with various additives, epoxy resins (AH-26), acrylic, polyethylene, and polyvinyl resins (Diaket), calcium hydroxide Disadvantage: Microleakage
  26. 26. IDEAL REQUIREMENTS OF A ROOT CANAL SEALER 1. It should be tacky when mixed to provide good adhesion between it and the canal wall when set. 2. It should make a hermetic [sic] seal. 3. It should be radiopaque so that it can be visualized in the radiograph. 4. The particles of powder should be very fine so that they can mix easily with the liquid. 5. It should not shrink upon setting. 6. It should not stain tooth structure.
  27. 27. 7. It should be bacteriostatic or at least not encourage bacterial growth. 8. It should set slowly. 9. It should be insoluble in tissue fluids. 10. It should be tissue tolerant, that is, non-irritating to periradicular tissue. 11. It should be soluble in a common solvent if it is necessary to remove the root canal filling. 12. It should not provoke an immune response in periradicular tissue. 13. It should be neither mutagenic nor carcinogenic.
  28. 28. The root canal sealer acts as  a binding agent to cement the well-fitted primary cone into a canal [ much as zinc phosphate cement binds a well-fitted inlay into a cavity preparation]  a filler for the discrepancies between the cone and the canal walls, and  a lubricant to facilitate the seating of the primary cone into the canal.
  29. 29. Endodontic sealers can be broadly classified into : • Zinc oxide Eugenol based • Resin based • Calcium hydroxide based • Glass ionomer based
  30. 30. Zinc Oxide-Eugenol-Based Rickert's sealer Powder zinc oxide 41.2 parts precipitated silver 30 parts white resin 16 parts Thymol iodide 12.8 parts Liquid oil of clove 78 parts Canada balsam 22 parts It is germicidal, has excellent lubricating and adhesive qualities, and sets in about half an hour. Because of its silver content, Rickert's sealer may cause discoloration of tooth structure
  31. 31. Grossman's Formulation [Roth’s Sealer]: In 1958 Grossman recommended a nonstaining ZOE cement as a substitute for Rickert’s formula Powder Zinc oxide, reagent 42 parts Staybelite resin 27 parts Bismuth subcarbonate 15 parts Barium sulfate 15 parts Sodium borate, anhydrous 1 part Liquid Eugenol Considered standard by which other cements are measured because it reasonably meets most of Grossman’s requirements for cement
  32. 32.  All ZOE cements have an extended working time but set faster in the tooth than on the slab because of increased body temperature and humidity  Zinc oxide eugenol has the disadvantage, however, of being decomposed by water through a continuous loss of the eugenol. This makes ZOE a weak, unstable material and precludes its use in bulk, such as for retrofillings placed apically through a surgical approach
  33. 33. Other Zinc oxide Eugenol based sealers : Kerr Pulp sealer: The Rickerts sealer was reintroduced in 1951 as kerr pulp sealer. It has the same composition as Rickert’s Disadvantage : staining of the tooth Available as • Regular set • Pulp Canal Sealer EWT [Extended working time ]
  34. 34. Tubliseal: Base zinc oxide 57.4% Oleoresins 21.25% Bismuth trioxide 7.5% Thymol iodide 3.75% Oils and waxes 10% Catalyst Eugenol Polymerised resin Annidalin
  35. 35.  This sealer is packaged in two collapsible tubes containing a base and an accelerator, which when mixed together in equal amounts form a creamy mix  Advantages: Non-staining, quick and easy to mix, good radiopacity  Disadvantages: reduced working time in the presence of moisture, expands on setting
  36. 36. Zinc oxide Non-eugenol based sealer [NOGENOL] Developed to overcome the irritating quality of Eugenol Base Zinc oxide Barium sulphate Accelerator Hydrogenated rosin Methyl abietate Lauric acid Chlorothymol Salicylic acid
  37. 37. Formaldehyde containing sealers:  These sealers constantly release antimicrobial formalin.  Highly cytotoxic N2 : introduced by Sargenti in 1954 . Also called Sargenti’s Paste Powder : Zinc oxide, Bismuth subcarbonate Barium sulphate Hydrocortisone Prednisolone Paraformaldehyde Titanium dioxide Phenyl mercuric borate Lead tetraoxide Liquid: Eugenol Geraniol
  38. 38. • Advantages: Good antibacterial effect • Disadvantages: Irreversible damage to the nerve tissue Causes coagulation necrosis of the tissues
  39. 39. Other Formaldehyde containing sealers are: 1. RC2B [ American counterpart of N2 sealer] 2. Endomethasone 3. SPAD 4. Riebler’s paste
  40. 40. Resin based sealers: Diaket:  Introduced by Schmidt  A resin-reinforced chelate formed between zinc oxide and diketone, is known for its high resistance to absorption.  Advantages: good adhesion, sets quickly in the root canal, low solubility and good volume stability, superior tensile strength  Disadvantages: highly toxic, non resorbable and forms fibrous encapsulation if extruded
  41. 41. AH-26: Introduced by Schroeder 1957 It is an epoxy resin based sealer Powder Percentage Silver powder 10% Bismuth oxide 60% Hexamethylene tetramine 25% Titanium oxide 5% Liquid Bisphenol diglycidyl ether 100%
  42. 42.  As AH-26 sets, traces of formaldehyde are temporarily released, which initially makes it antibacterial.  AH-26 is not sensitive to moisture and will even set under water.  It will not set, however, if hydrogen peroxide is present.  It sets slowly, in 24 to 36 hours  Has strong adhesive properties  Disadvantages: slight contraction while setting, delayed setting, staining
  43. 43. AH- Plus Available as two paste system • Epoxide paste • Amine paste Advantages over AH-26 • less toxic • new amines added to maintain the natural color of the tooth • half the film thickness • better flow • shorter setting time of 8 hrs, • increased radiopacity
  44. 44. Epiphany Root canal Sealer Is a dual cure , hydrophilic resin sealer Used with Resilon core materials Dispensed from a double barrelled, automix syringe Originally it was used along with Epiphany Self-Etch Primer Now available as Epiphany Self-Etch Sealer [eliminates the priming step]
  45. 45. The system consists of three parts: 1. Resilon – a thermoplastic synthetic polymer-based (polyester) root canal filling material, as the major component; 2. Epiphany sealer – a resin-based composite that forms a bond to the dentin wall and the core material under chemical reactions and halogen curing light; and 3. Primer - which prepares the canal wall to get in contact with Resilon and the sealer
  46. 46. Calcium hydroxide based sealers: The two most important reasons for using calcium hydroxide as a root-filling material are • stimulation of the periapical tissues in order to maintain health or promotehealing and • for its antimicrobial effects
  47. 47. CRCS (Calciobiotic Root Canal Sealer)  Is essentially a ZOE/eucalyptol sealer to which calcium hydroxide hasbeen added for its called osteogenic effect.  CRCS takes 3 days to set fully in either dry or humid environments.  It also shows very little water sorption.  This means it is quite stable, which improves its sealant qualities, but brings into question its ability to actually stimulate cementum and/or bone formation. If the calcium hydroxide is not released from the cement, it cannot exert an osteogenic effect, and thus its intended role is negated
  48. 48. Seal apex: It is a zinc oxide based calcium hydroxide sealer containing polymeric resin Available as two paste system Base Catalyst Calcium hydroxide Barium sulphate Zinc oxide Titanium dioxide Butyl benzene Isobutyl salicylate Sulphonamide Aerosil Zinc stearate
  49. 49. Advantages: • Biocompatible • Extruded material resorbs in 4 months • Good therapeutic effect Disadvantages: • Long setting time • Absorbs water while setting and expands • Poor cohesive strength
  50. 50. Apexit: Available as a two paste system Better seal than that provided by sealapex Biocompatible
  51. 51. Glass ionomer based sealers: Ketac-Endo: Advantages: Biocompatible Chemical bonding with the root dentine, hence strengthens the root Less solubility Dimensionally stable Less technique sensitive Disadvantage: Extruded sealer is highly resistant to resorption [ delayed resorption] Retrievability is difficult
  52. 52. Heat sources during obturation with gutta percha: Touch N Heat Endotec II System B
  53. 53. Elements Obturation Unit The SybronEndo Elements Obturation Unit (EOU) is a thermoplastic gutta percha/RealSeal injector with backfill, down-pack, cautery and hot-pulp testing capability