INDIAN DENTAL ACADEMY Leader in Continuing Dental Educationwww.indiandentalacademy.com
CONTENTS1.   INTRODUCTION2.   IDEAL REQUIREMENTS OF A ROOT ENDFILLING MATERIAL3.   VARIOUS ROOT END FILLING MATERIALS4.   ...
INTRODUCTIONObjective of all endodonticproceduresApical         resection     orapicectomy followed by rootend      fillin...
IDEAL REQUIREMENTS OF ROOT END           FILLING MATERIALS    Biocompatible                        Readily available,   ...
VARIOUS ROOT END FILLING                MATERIALS   Amalgam                       Glass ionomer cement   Gallium Alloy ...
AMALGAM    Most extensively used    Farrar (1884)    Rhein (1897), Faulhaber           &     Newmann (1912), Hippels(19...
CONCERNS IN THE USE OF AMALGAM    AS A ROOT END FILLING      Type     of    Amalgam        (High   Cu   Vsconventional, Z...
Type of Amalgam (High Cu Vs Conventional,              Zinc Vs Non-zinc)         Alloy of silver, tin, copper & zinc with...
HIGH CU VS LOW CUFor Low Cu    Ag3Sn + Hg  Ag3Sn + Ag2Hg3 + Sn8Hg                           γ          γ1        γ2For H...
ZINC VS NON-ZINC     Effect of moisture on zinc alloys is wellestablished     ∴ from all the above high copper zinc freea...
LEAKAGE OF AMALGAM    Multiple techniques advocated to determinethe apical leakage.    Conclusion drawn from these studi...
TISSUE COMPATIBILITY   Fresh mixed conventional silver amalgam   Amalgam containing zinc   Various studies identified c...
MATERIAL PREPARATION & MANIPULATION     Preparation and manipulation is crucial     Key points to consider when alloys p...
d. Root end amalgams placing at the time ofsurgery       www.indiandentalacademy.com
ELECTRIC POTENTIALS    Root end amalgam in a tooth which has ametallic post or crown restoration.    a. Currents in exce...
TISSUE STAINING ARGYRIACauses    Amalgam scattered in surgical site    Fractured or loosened     amalgam root end fills...
PREVENTION    Control of placement    Efficient irrigation and aspiration     Appropriate bulk in the thickness andmech...
GUIDELINES FOR AMALGAM USAGE AS A ROOTEND FILLING    Control of moisture    High copper alloys    Varnish or Dentin bon...
GALLIUM ALLOYS    Toxic effect of mercury    Putt Kammer (1928)Properties    Wetting many materials    Mixed and conde...
COMPOSITION         Alloy                                        LiquidSilver           60%                            Gal...
DISADVANTAGES   Surface roughness and marginal discoloration   Manipulation difficult   Cost 16 times more           ww...
GOLD FOIL     Schuster (1913) and Lyons (1920)     Reports in 1960s and 1980s recommand itsuse   ----   perfect   margin...
     Although favourable material properties,does not appear practical ----- need to establishmoisture free environment, ...
SILVER CONES   Silver cones used to obturate the    root canals since early 1930’s   Several techniques recommended    r...
a. Summers (1946)            1. Reverse canal instrumentation            2. Specially recommended when post-core          ...
GUIDELINES CONCERNING SILVER CONES                  ROOT END FILLS     Silver cones cannot 3 Dimensionally obturate      ...
GUTTA PERCHA    As a true root end filling material     Orthograde root canal obturation with eithercold or hot burnishe...
Composition    Gutta percha               -      18.9 – 21.8%    Zinc Oxide                 -      56.1 – 75.3%    Heavy M...
Limitation    Porous in nature                        CAVIT   Zinc oxide based temporary filling             www.indiande...
Composition     Zinc   oxide,        calcium       sulfate,    zinc   sulfate,glycolacetate,    polyvinyl       acetate   ...
ZINC PHOSPHATE CEMENTS   Rhein (1897) – zinc phosphate cement with gutta    percha to seal root canal system   Herbert (...
Composition     Powder                                   LiquidZinc oxide -    90.2%               Phosphoric acid - 38.2%...
     Not indicated as root end filling material –solubility, leakage, irritating to tissues, inhibithealing          POLY...
    Powder – modified zinc oxide with fillers such as     magnesium oxide & stannous fluoride.     Liquid – aqueous solut...
DIAKET       Tetsch (1986) – as root canal filling material       Polyvinyl resin       As root end filling – thicker c...
      More radiopacity than MTA, GIC, Composite,cavit, super EBA, IRM and less compared to    amalgam& GP      Insoluble...
GLASS IONOMERS     Reaction of calcium aluminosilicate glassparticles with aqueous solution of polyacrylic acid     Bond...
      Biocompatibility – shown evidence of initialcytotoxicity     Good marginal adaptation and adhesion to tooth      s...
COMPOSITE RESIN   Combination with dentin bonding agent showed    good apical seal   Received minimal attention as root ...
    McDonald & Dumsha compared composite with     dentin bonding agent, composite alone, cavit,     amalgam, hot burnishe...
ZINC OXIDE EUGENOL     First described by Chisolm (1873)     Nicholls (1962) used zinc oxide cement asretrograde filling...
Composition     Powder                                  LiquidZinc oxide – 70%                        Eugenol – 100%Rosin ...
    ZOE cement modified in an attempt to resolve     these problems                          IRM       (Intermediate Rest...
    Developed to overcome the short comings of ZOE     cementComposition     Powder                                  Liqu...
    To further improve IRM as retrograde fillingmaterial, hydroxyapatite was added    For root end filling thick mix of ...
www.indiandentalacademy.com
     Has better physical properties than ZOE      High compressive strength, high tensile strength      neutral pH, no so...
    Tissue tolerance shows mild reaction    Provides better seal compared to amalgam GIC,     Gutta percha    Excellent...
MTA (Mineral Trioxide Aggregate)   Developed at Loma Linda University (1993)Composition    Tricalcium Silicate    Tricalc...
     MTA is a powder consists of fine hydrophilicpowder, sets in the presence of moisture.    pH after mixing – 10.2, ri...
Disadvantages   Difficult to manipulate   Long setting timeMixing MTA   Should be prepared just before its used    Pow...
   Mixture can be carried using a carrier or a plastic    instrument   Extra moisture can    be removed with a    dry pi...
     Initially MTA was available as grey powder,recently white powder also introduced by the exclusionof iron compounds  ...
MISCELLANEOUS MATERIALSTitanium   Most frequently used material for dental implants   Excellent corrosion resistance, hi...
Demerits   Metallic material no longer consider because they    share many of the problems of amalgam   Isthmus cannot b...
BONE CEMENT    It is a new material, potentially provide thenecessary properties for an ideal retrofill materialCompositi...
CONCLUSION     Root end filling material should provide ahermetic seal, should be non-toxic, non-carcinogenic,biocompatibl...
REFERENCES     Surgical Endodontics – James L. Gutmann     Colour atlas of micro surgery in endodontics – SyngcukKim   ...
Thank you for watchingwww.indiandentalacademy.com      www.indiandentalacademy.com
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Root canal end filling materials /certified fixed orthodontic courses by Indian dental academy

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Root canal end filling materials /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in Continuing Dental Educationwww.indiandentalacademy.com
  2. 2. CONTENTS1. INTRODUCTION2. IDEAL REQUIREMENTS OF A ROOT ENDFILLING MATERIAL3. VARIOUS ROOT END FILLING MATERIALS4. MISCELLANEOUS MATERIALS5. CONCLUSION6. REFERENCES www.indiandentalacademy.com
  3. 3. INTRODUCTIONObjective of all endodonticproceduresApical resection orapicectomy followed by rootend filling (RetrogradeFilling)A wide variety of root endfilling materials www.indiandentalacademy.com
  4. 4. IDEAL REQUIREMENTS OF ROOT END FILLING MATERIALS Biocompatible  Readily available, easy to handle Insoluble  Non-corossive Adhesive  Radiopaque Bacteriocidal or  Electrochemically inactive Bacteriostatic  Promote Dimensionally stable Cementogenesis www.indiandentalacademy.com
  5. 5. VARIOUS ROOT END FILLING MATERIALS Amalgam  Glass ionomer cement Gallium Alloy  Composite Resins Gold Foil  Zinc oxide eugenol Silver Cones Gutta Percha  IRM Cavit  Super EBA Zinc Phosphate  MTA Diaket  Miscellaneous Polycarboxylate MaterialsCement www.indiandentalacademy.com
  6. 6. AMALGAM Most extensively used Farrar (1884) Rhein (1897), Faulhaber & Newmann (1912), Hippels(1914) & Garvin (1919) www.indiandentalacademy.com
  7. 7. CONCERNS IN THE USE OF AMALGAM AS A ROOT END FILLING Type of Amalgam (High Cu Vsconventional, Zinc Vs Non- zinc) Leakage Tissue compatibility Preparation and manipulation Electric potential Pigmentation or argyria www.indiandentalacademy.com
  8. 8. Type of Amalgam (High Cu Vs Conventional, Zinc Vs Non-zinc)  Alloy of silver, tin, copper & zinc with small amounts of Indium and palladium.  % of components in low Cu and high Cu Ag% Sn% Cu% Zn% In% Pd%Low Cu 63-70 26-28 2-7 0-2 - -High Cu 40-60 22-30 13-30 0 0-5 0-1 www.indiandentalacademy.com
  9. 9. HIGH CU VS LOW CUFor Low Cu Ag3Sn + Hg  Ag3Sn + Ag2Hg3 + Sn8Hg γ γ1 γ2For High Cu Ag3Sn + Cu + Hg  Ag3Sn + Ag2Hg3 + Cu6Sn5 γ γ1 η www.indiandentalacademy.com
  10. 10. ZINC VS NON-ZINC Effect of moisture on zinc alloys is wellestablished ∴ from all the above high copper zinc freeamalgam is preferred as root end filling material. www.indiandentalacademy.com
  11. 11. LEAKAGE OF AMALGAM Multiple techniques advocated to determinethe apical leakage. Conclusion drawn from these studies Use of amalgam bond, 4-META bonding agent www.indiandentalacademy.com
  12. 12. TISSUE COMPATIBILITY Fresh mixed conventional silver amalgam Amalgam containing zinc Various studies identified cytotoxicity of both low and high copper content alloys. www.indiandentalacademy.com
  13. 13. MATERIAL PREPARATION & MANIPULATION Preparation and manipulation is crucial Key points to consider when alloys placedintra orally a. Amalgam squeezed of excess mercury b. Instruction by the manufacturer fortrituration c. Amalgam closely adapted to the confinesof the cavity www.indiandentalacademy.com
  14. 14. d. Root end amalgams placing at the time ofsurgery www.indiandentalacademy.com
  15. 15. ELECTRIC POTENTIALS Root end amalgam in a tooth which has ametallic post or crown restoration. a. Currents in excess of 50µA b. Increase production galvenic currents leads to electrochemical corosion www.indiandentalacademy.com
  16. 16. TISSUE STAINING ARGYRIACauses Amalgam scattered in surgical site Fractured or loosened amalgam root end fills Galvanism and electrochemical corrosion www.indiandentalacademy.com
  17. 17. PREVENTION Control of placement Efficient irrigation and aspiration Appropriate bulk in the thickness andmechanical retention. www.indiandentalacademy.com
  18. 18. GUIDELINES FOR AMALGAM USAGE AS A ROOTEND FILLING Control of moisture High copper alloys Varnish or Dentin bonding agent Creates smooth surface Prevent dispersion of alloy particles Keep Alloy as small in diameter with enoughthickness www.indiandentalacademy.com
  19. 19. GALLIUM ALLOYS Toxic effect of mercury Putt Kammer (1928)Properties Wetting many materials Mixed and condensed as silver amalgam Compressive and tensile strength increaseswith time Expand after mixing Stability and corrosion resistance www.indiandentalacademy.com
  20. 20. COMPOSITION Alloy LiquidSilver 60% Gallium 62%Tin 25% Iridium 25%Copper 13% Tin 25%Palladium 20%Reaction AgSn + Ga  AgGa + Sn www.indiandentalacademy.com
  21. 21. DISADVANTAGES Surface roughness and marginal discoloration Manipulation difficult Cost 16 times more www.indiandentalacademy.com
  22. 22. GOLD FOIL Schuster (1913) and Lyons (1920) Reports in 1960s and 1980s recommand itsuse ---- perfect marginal adaptation, surfacesmoothness and tiss biocompatibility. Least toxic compared to IRM, composite,amalgam and GIC www.indiandentalacademy.com
  23. 23.  Although favourable material properties,does not appear practical ----- need to establishmoisture free environment, careful placementand finishing. www.indiandentalacademy.com
  24. 24. SILVER CONES Silver cones used to obturate the root canals since early 1930’s Several techniques recommended root end fill with silver cone www.indiandentalacademy.com
  25. 25. a. Summers (1946) 1. Reverse canal instrumentation 2. Specially recommended when post-core crown present b. TRICE recommended a Fissure bur to cutthe previously placed silver cones. www.indiandentalacademy.com
  26. 26. GUIDELINES CONCERNING SILVER CONES ROOT END FILLS Silver cones cannot 3 Dimensionally obturate the root canal space Open voids between the cones and dentin wall Dissection of silver cone increases corrosivepotential Cannot be burnished to perfect apical seal Ideally teeth containing silver cones requiring surgery should retreated A root end fill is indicated in all cases www.indiandentalacademy.com
  27. 27. GUTTA PERCHA As a true root end filling material Orthograde root canal obturation with eithercold or hot burnisher. ABDAL & RETIEF compared heat sealed gutta percha, amalgam, IRM and super EBA. www.indiandentalacademy.com
  28. 28. Composition Gutta percha - 18.9 – 21.8% Zinc Oxide - 56.1 – 75.3% Heavy Metal Sulfates - 1.5 – 17.3% Waxes & Resins - 1 – 4%Adaptation to the root canal system & apicalseal of gutta percha depends on following : Thoroughness of condensation Use of solvents Type of instrument used for adaptation Temperature Nature & Amount of the root canal sealer used Skill of the operator www.indiandentalacademy.com
  29. 29. Limitation Porous in nature CAVIT Zinc oxide based temporary filling www.indiandentalacademy.com
  30. 30. Composition Zinc oxide, calcium sulfate, zinc sulfate,glycolacetate, polyvinyl acetate polyvinyl chlorideacetate, Tri ethanolamine, red pigment. Cavit G & Cavit W available Hygroscopic set after permeation with water Greater leakage than IRM or ZOE Biocompatibility studies are in conflict – toxic and non toxic www.indiandentalacademy.com
  31. 31. ZINC PHOSPHATE CEMENTS Rhein (1897) – zinc phosphate cement with gutta percha to seal root canal system Herbert (1941) zinc phosphate with thymol as root end filling material www.indiandentalacademy.com
  32. 32. Composition Powder LiquidZinc oxide - 90.2% Phosphoric acid - 38.2%Magnesium oxide - 8.2% Aluminum - 2.5%Silica dioxide - 1.4% Zinc - 7.1%Bismuth trioxide – 0.1% Water – 36.0%Barium oxideBarium sulphate TracesCalcium Oxide www.indiandentalacademy.com
  33. 33.  Not indicated as root end filling material –solubility, leakage, irritating to tissues, inhibithealing POLYCARBOXYLATE CEMENTS Smith in 1968 www.indiandentalacademy.com
  34. 34.  Powder – modified zinc oxide with fillers such as magnesium oxide & stannous fluoride. Liquid – aqueous solution of polyacrylic acid Reaction occurs between zinc ions and thecarboxyl groups of the polyacrylic acid pH – 1.7, working time 3-5 minutesLimitations Inflammation of periradicular tissue Leak significantly greater than amalgam or G-P Poor sealing ability, uncertain periradicular tissue response www.indiandentalacademy.com
  35. 35. DIAKET Tetsch (1986) – as root canal filling material Polyvinyl resin As root end filling – thicker consistency Better apical seal than IRM or super EBA Comparative study of Diaket an MTA  Both are biocompatible, promote periradicular tissue regeneration.  Diaket is easy to place than MTA  Sets in a short time www.indiandentalacademy.com
  36. 36.  More radiopacity than MTA, GIC, Composite,cavit, super EBA, IRM and less compared to amalgam& GP Insoluble in tissue fluid www.indiandentalacademy.com
  37. 37. GLASS IONOMERS Reaction of calcium aluminosilicate glassparticles with aqueous solution of polyacrylic acid Bond physico-chemically to dentine and enamel, anticariogenic activity Setting reaction is in two phase www.indiandentalacademy.com
  38. 38.  Biocompatibility – shown evidence of initialcytotoxicity Good marginal adaptation and adhesion to tooth structure Sealing ability adversely affected whencontaminated with moisture Newer GIC’s containing glass metal powder (Fugi II, Ketac Silver) Chong et al used light cured GIC as retrograde filling  Compared thinly (1mm) applied and thick light cured GIC’s www.indiandentalacademy.com
  39. 39. COMPOSITE RESIN Combination with dentin bonding agent showed good apical seal Received minimal attention as root end filling because of cytotoxic effects www.indiandentalacademy.com
  40. 40.  McDonald & Dumsha compared composite with dentin bonding agent, composite alone, cavit, amalgam, hot burnished G-P and cold burnished G-P Recently Wennerberg reported composite resins bonded tightly to apicoectomized root withbonding agent. All polymerizing resins leave and uncured oxygen inhibiting surface layer Physical and chemical properties of composite resin vary widely www.indiandentalacademy.com
  41. 41. ZINC OXIDE EUGENOL First described by Chisolm (1873) Nicholls (1962) used zinc oxide cement asretrograde filling material www.indiandentalacademy.com
  42. 42. Composition Powder LiquidZinc oxide – 70% Eugenol – 100%Rosin – 30%Zinc acetate traces ZOE cement in contact with water or tissue fluids, hydrolyzed into zinc hydroxide and eugenol Eugenol can inhibit prostoglandin synthetase, sensory nerve activity, mitochondrial respiration, eliminates a range of native oral microorganism and can be an allergen. www.indiandentalacademy.com
  43. 43.  ZOE cement modified in an attempt to resolve these problems IRM (Intermediate Restorative Material) Is a ZOE cement reinforced by the addition of 20%polymethylmethacrylate to the powder. www.indiandentalacademy.com
  44. 44.  Developed to overcome the short comings of ZOE cementComposition Powder LiquidZinc Oxide – 80% Eugenol – 99%Polymethylmethacrylate-20% Acetic Acid – 1% With reinforcement, problem of absorbability of ZOE eliminated IRM elicited a mild to zero inflammatory effect after 80 days and relatively biocompatible. www.indiandentalacademy.com
  45. 45.  To further improve IRM as retrograde fillingmaterial, hydroxyapatite was added For root end filling thick mix of IRM improves placement, IRM does not adhere well to itself. SUPER EBA (Super ethoxy benzoic acid) ZOE cement modified with ethoxy benzoic acid www.indiandentalacademy.com
  46. 46. www.indiandentalacademy.com
  47. 47.  Has better physical properties than ZOE High compressive strength, high tensile strength neutral pH, no solubility, adhere to toothstructure, adheres well to itselfComposition Powder LiquidZinc Oxide – 60% Ethoxy Benzoic Acid -62.5%Aluminium oxide – 34% Eugenol – 37.5%Natural resin-6% www.indiandentalacademy.com
  48. 48.  Tissue tolerance shows mild reaction Provides better seal compared to amalgam GIC, Gutta percha Excellent material adaptation and collagen fibres growing over the materialDisadvantages Difficult to manipulate – slow setting time,material adhere to all surfaces, sensitive totemperature and humidity. Only moderately radiopaque www.indiandentalacademy.com
  49. 49. MTA (Mineral Trioxide Aggregate) Developed at Loma Linda University (1993)Composition Tricalcium Silicate Tricalcium Aluminate Tricalcium Oxide Silicate Oxide Mineral Oxides in tracers bismuth oxides www.indiandentalacademy.com
  50. 50.  MTA is a powder consists of fine hydrophilicpowder, sets in the presence of moisture. pH after mixing – 10.2, rising to 12.5 after 3 hrs Setting time – 4 hrs Compressive strength comparable that of IRM and Super EBA, significantly less than amalgam Compared with amalgam, IRM & Super EBA MTA provides better sealAdvantages Least toxic Excellent biocompatibility Hydrophilic Reasonable radiopaque www.indiandentalacademy.com
  51. 51. Disadvantages Difficult to manipulate Long setting timeMixing MTA Should be prepared just before its used Powder should mixed with water (3:1) to putty consistency www.indiandentalacademy.com
  52. 52.  Mixture can be carried using a carrier or a plastic instrument Extra moisture can be removed with a dry piece of gauze www.indiandentalacademy.com
  53. 53.  Initially MTA was available as grey powder,recently white powder also introduced by the exclusionof iron compounds Failed apicectomy with One year following second amalgam root end filling. apicectomy with MTA root www.indiandentalacademy.comfilling end
  54. 54. MISCELLANEOUS MATERIALSTitanium Most frequently used material for dental implants Excellent corrosion resistance, high mechanical strength, good biocompatibility, can be easily formed into any shape Yasunari et al developed titanium inlay as a root end filling, showed no clinical or radiographic problems www.indiandentalacademy.com
  55. 55. Demerits Metallic material no longer consider because they share many of the problems of amalgam Isthmus cannot be filled with titanium inlay ALUMINIUM OXIDE PINS Excellent biocompatibility with tight sealing of the root canal Keller et al reported success rate of 95% Contra indicated in large oval cross sections www.indiandentalacademy.com
  56. 56. BONE CEMENT It is a new material, potentially provide thenecessary properties for an ideal retrofill materialComposition Powder LiquidPolymethylmethacrylate MethylmethacrylateMethylmethacrylateBarium Sulfate Low toxicity, excellent biocompatibility, inhibits bacterial growth, tolerates moist environment www.indiandentalacademy.com
  57. 57. CONCLUSION Root end filling material should provide ahermetic seal, should be non-toxic, non-carcinogenic,biocompatible and dimensionally stable. Based on studies and clinical performance it isclear that IRM, super – EBA, and MTA are therecommended materials available for root end filling.The sealing ability of MTA is superior to that of IRMand super-EBA. The regeneration of new cementumover MTA is a unique phenomenon that has not beenreported with other root end filling materials thusmaking MTA the retrofilling material of choice. www.indiandentalacademy.com
  58. 58. REFERENCES Surgical Endodontics – James L. Gutmann Colour atlas of micro surgery in endodontics – SyngcukKim Vasudev S.K et al, Root end filling materials – A review – JOE, 2003, 15, 11 – 18. J. Camilleri et al, The constitution of mineral trioxideaggregate, 2005, 21, 297 – 303. Niederman et al, A systematic review of invivo retrogradeobturating material, IEJ, 2003, 36, 577 – 585. Tagger et al, A standard for radiopacity of root end fillingmaterials is urgently needed, IEJ, 2004, 37, 260 – 264. Sousa et al, A comparative evaluation of thebiocompatibility of materials used in apical surgery, 2004, www.indiandentalacademy.com37, 738 – 748.
  59. 59. Thank you for watchingwww.indiandentalacademy.com www.indiandentalacademy.com

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