A description of the monobloc concept/ principle in endodontics including a detailed introduction and meaning of concept, classification of monoblocs in endodontics, various examples in monoblocs and a review of various studies undertaken using different monobloc systems and root canal filling materials
dental Monoblock obturation technique or concept in endodonticsAhmed Ali
dental Monoblock obturation technique or concept in endodontics which are classified into primary ,secondary & tertiary based upon resin , now the bioceramics
A simple presentation to guide a dentist to choose best irrigant for the case. types of irrigants, their properties, advantages and disadvantages and tips has been discussed through this presentation.
dental Monoblock obturation technique or concept in endodonticsAhmed Ali
dental Monoblock obturation technique or concept in endodontics which are classified into primary ,secondary & tertiary based upon resin , now the bioceramics
A simple presentation to guide a dentist to choose best irrigant for the case. types of irrigants, their properties, advantages and disadvantages and tips has been discussed through this presentation.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Bioceramics are materials which include Alumina, Zirconia, Bioactive glass, Glass ceramics, Hydroxyapatite, resorbable Calcium phosphates.
Used in dentistry for
Filling up bony defects
Root repair materials
Apical fill materials
Aids in regeneration etc.
Bioinert: non-interactive with biological systems (Alumina, zirconia)
Bioactive: durable tissues that can undergo interfacial interactions with surrounding tissue (bioactive glasses, bioactive glass ceramics, hydroxyapatite, calcium silicates)
Biodegradable: soluble or resorbable, eventually replaced or incorporated into tissue (Tricalcium phosphate, Bioactive glasses).
Endodontic emergencies include Pre-treatment emergency of which hot tooth is a commonly encountered situation.
This ppt is contains concise pickup notes on Hot tooth.
major advantages and unique features as well as its ability to overcome the disadvantages of other materials, biodentine has great potential to revolutionize the different aspects of managing both primary and permanent in endodontics as well as operative dentistry.
Single-Step Apexification with Mineral Trioxide Aggregate (MTA) –Case ReportsAbu-Hussein Muhamad
The completion of root development and closure of the apex occurs up to 3 years after the eruption of
the tooth. The treatment of pulpal injury during this period provides a significant challenge for the clinician.
The most commonly advocated medicament is calcium hydroxide, although recently considerable interest has
been expressed in the use of mineral trioxide aggregate (MTA). We report a case with MTA were used
successfully for one step apexification in teeth with open apex
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Bioceramics are materials which include Alumina, Zirconia, Bioactive glass, Glass ceramics, Hydroxyapatite, resorbable Calcium phosphates.
Used in dentistry for
Filling up bony defects
Root repair materials
Apical fill materials
Aids in regeneration etc.
Bioinert: non-interactive with biological systems (Alumina, zirconia)
Bioactive: durable tissues that can undergo interfacial interactions with surrounding tissue (bioactive glasses, bioactive glass ceramics, hydroxyapatite, calcium silicates)
Biodegradable: soluble or resorbable, eventually replaced or incorporated into tissue (Tricalcium phosphate, Bioactive glasses).
Endodontic emergencies include Pre-treatment emergency of which hot tooth is a commonly encountered situation.
This ppt is contains concise pickup notes on Hot tooth.
major advantages and unique features as well as its ability to overcome the disadvantages of other materials, biodentine has great potential to revolutionize the different aspects of managing both primary and permanent in endodontics as well as operative dentistry.
Single-Step Apexification with Mineral Trioxide Aggregate (MTA) –Case ReportsAbu-Hussein Muhamad
The completion of root development and closure of the apex occurs up to 3 years after the eruption of
the tooth. The treatment of pulpal injury during this period provides a significant challenge for the clinician.
The most commonly advocated medicament is calcium hydroxide, although recently considerable interest has
been expressed in the use of mineral trioxide aggregate (MTA). We report a case with MTA were used
successfully for one step apexification in teeth with open apex
Single step apexification with mineral trioxide aggregateAbu-Hussein Muhamad
Abstract: The completion of root development and closure of the apex occurs up to 3 years after the eruption of the tooth. The treatment of pulpal injury during this period provides a significant challenge for the clinician. The most commonly advocated medicament is calcium hydroxide, although recently considerable interest has been expressed in the use of mineral trioxide aggregate (MTA). We report a case with MTA were used successfully for one step apexification in teeth with open apex. Key words: Immature teeth, one visit apexification, Mineral Trioxide Aggregate, monoblock, artificial barrier
The final restoration over an endodontically treated tooth is as important or probably even more important than the actual root canal therapy itself.
The main aim of endodontics and restorative dentistry is to retain the natural teeth with maximal function and pleasing esthetics.The permanency of endodontically involved teeth has been greatly enhanced by continuing developments made in endodontic therapy and restorative procedures including the use of intraradicular devices.
These devices vary from a conventional custom cast post and core to one visit techniques, using commercially available prefabricated post systems.
These systems are being discussed in this E-content.
Critical review on glass ionomer seal under composite resin of obturated root...Ziad Abdul Majid
Introduction: The root canal treated teeth need an adhesive seal for coronal leakage prevention. Glass ionomer sealant is the usual interface used between the coronal restoration and dental hard tissue however when composite resin material is used as a coronal restoration, some dental clinician prefer not to use it. The aim of this review is to determine the need to seal the orifice of an obturated root canal with glass ionomer under composite resin to prevent microleakage. Material and methods: Electronic searches were performed in the Pubmed and Scopus databases using relevant keywords. Textbook searching was also applied. Following selection, articles were fully reviewed to ensure that they met inclusion/ exclusion criteria. Results: The intracoronal sealing abilities of a wide variety of restorative materials have been investigated, assessed and compared within the dental literature. Conclusion: No definitive guidelines were found regarding the use of orifice sealing materials following endodontic treatment. This review was not able to answer the research question, and further investigation is required to achieve this goal.
A description of a new concept in dentin and enamel bonding - called the acid base resistant zone. points on features of the acid base resistant zone and summary of various studies
Nervous system and mechanism of pain sensationDeepa jinan
summary of nervous system, including peripheral nervous system and central nervous system, a brief on nerve anatomy and functioning,gate control theory, mechanism of dental pain
The role of fluoride and chlorhexidine in the prevention of dental cariesDeepa jinan
a detailed description of the role of fluoride and chlorhexidine in the prevention of dental caries, including mehanism of action, modes/ routes of administration, dose recommendations, comparisons.
Description of restorative dentistry and its importance in forensic applications. This includes an introduction into forensic dentistry and its applications, historical aspects of forensic dentistry, specific applications of restorative dentistry and real accident case examples.
A detailed description about endo perio interrelationship, including introduction, development and etiology, historical aspects, definition, classification, diagnosis, differential diagnosis, management, special consideration in management,controversies prognosis, conclusion.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
5. INTRODUCTION
‘Monobloc’
‘Single unit’
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398.
DEFINITION
A forging or casting made in a single piece, rather than being
fabricated from components
In orthodontics, introduced in 1902 by Dr. Pierre Robin -
united upper and lower acrylic removable appliances
To treat Class II division 1malocclusion & forms forerunner of
functional appliances by uniting two functional matrices (i.e.,
maxilla & mandible) into single unit
1
6. ROLE IN ENDODONTICS
‘Monobloc’Recent interest in the application of dentin adhesive technology to
endodontics
Improve the quality of seal in
root fillings
Strengthen roots
1 2
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398.
Scenario - canal space perfectly filled with a gap-free, solid mass that
consist of different materials & interfaces
Post systemsRoot canal filling materials
Generated controversial discussionsPotential of adhesive sealers & adhesive post systems to create
‘MONOBLOCS
‘Single units – reinforce tooth structure’
2
7. CLASSIFICATION
Replacement monoblocks created in root canal spaces classified as
Primary Monobloc
Secondary monobloc
1
2
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398.
Tertiary monobloc
3
interfaces present
between
the bonding substrate
and the bulk material
core
Root canal filling
material
Post & core systems
May be applied to
3
8. CLINICAL SIGNIFICANCE
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398.
Diseased pulps to be replaced by sealing
restorative materials – prevent reinfection
Rigidity of the root weakened by
endodontic & restorative instrumentation
Sealing quality & tooth strengthening
potential of monoblocks -important
Long term prognosis of endodontic treatment
4
9. CHARACHTERISTICS OF MONOBLOC
Ona M1, Wakabayashi N, Yamazaki T, Takaichi A, Igarashi Y. The influence of elastic modulus mismatch between tooth and post and core
restorationson root fracture. Int Endod J. 2013 Jan;46(1):47-52.
Sealing quality
Improoving degree of
bonding/adhesion of root filling
material
Strengthening
Similarity of Elastic modulus of
root filling materials to dentin
1 2
5
10. SEALABILITY
Schwartz RS. Adhesive dentistry and endodontics. Part 2: bonding in the root canal system-the promise and the problems: a review. J Endod. 2006 Dec;32(12):1125-34.
Reason for microgaps
Poor adhesion &
wetting
1
Successful RCT - achieve & maintain tight seal, chemically / mechanically, along
canal system
Prevent microleakage - passage of bacteria, fluids, molecules or ions
between a cavity wall and the restorative material
Polymerization
shrinkage
Thermal stresses, occlusal
loading /water sorption
2 3
6
11. SEALABILITY
Belli S, Eraslan O, Eskitascioglu G, Karbhari V. Monoblocks in root canals: a finite elemental stress analysis study. Int Endod J. 2011 Sep;44(9):817-26.
4 generations of methacrylate resin–based sealers have been introduced
HYDRON use
of poly[2-
hydroxyethyl
methacrylate] as
major ingredient
1 Recent trends in endodontics - development of bonded
obturating materials, - attempt provide more effective seal
coronally & apically
Low viscosity methacrylate resin–based root canal sealers
New root filling material that claims to adhere to methacrylate resins
Non etching
& hydrophilic, no
adjunctive use of
a dentin adhesive
ENDOREZ
Self-etching
primer & dual-
cured resin
composite canal
Sealer
RESILON/EPIPH
ANY
2
3
Combination
etchant, primer,
& sealer into an
all-in-one self
etching,
self-adhesive
sealer
METASEAL
4
7
Since fibre posts are passively retained into the root canal, an adhesive
cement important for good seal
Due to their ability to bond to tooth structure, resin cements have potential to
exhibit less microleakage than other cementsTotal-Etch Resin
Cements
Self-Etch Resin
Cements
Self-Adhesive Resin
Cements
To achieve a monoblock, high bond strengths necessary between dentin &
sealer, as well as between the sealer and obturating material
12. STRENGTHENING ROOTS
Belli S, Eraslan O, Eskitascioglu G, Karbhari V. Monoblocks in root canals: a finite elemental stress analysis study. Int Endod J. 2011 Sep;44(9):817-26.
Root filled teeth more prone to biomechanical failure
Loss of tooth structure
Clinical failure attributed to physiologic masticatory forces / parafunctional forces
repeated over long periods
Fatigue stress
8
13. STRENGTHENING ROOTS
Belli S, Eraslan O, Eskitascioglu G, Karbhari V. Monoblocks in root canals: a finite elemental stress analysis study. Int Endod J. 2011 Sep;44(9):817-26.
In biomechanical aspect -restoration of root filled teeth with materials
having similar MOE to dentin can save remaining tooth structure
Allowing some slight
flex
Favorable dissipation
of stress
Reducing the
likelihood of damage
to the root
Popularity of fibre posts with Resin
cements
9
Adhesive composite cements whose elastic modulus is in the same range of
that of both the
post and dentin have the potential to reinforce the root
14. PRIMARY MONOBLOC
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398
Cementum
Dentin
Root filling
material
One interface that extends circumferentially between the material and the root
canal wall
Hydron
MTA
1
2
Polyethylene fibre post-
core sys Ribbond
3
10
15. PRIMARY MONOBLOC
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398.
In the late 1970s, Poly HEMA containing root filling material (Hydron; Hydron
Technologies) marketed
HYDRON
Interest as a potential successor for sealer-dependent lateral and vertical gutta-
percha obturation
En masse filling of roots
Easy to use
Nonirritating
Adaptable to walls
Nonsupport bacteria
Calcify - extrusion
11
16. Became obsolete in the 1980s because discrepancies between manufacturer’s
claims and laboratory/clinical findings
HYDRON
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398.
SEALABILITY ?
Residual moisture within root
canals – Polymerisation hampered
Polymerisation in situ ??
Presence of water form soft
hydrogels - permeable &
leachable
Studies demonstrated - Hydron-
filled root canals exhibited
extensive leakages
Injectible
12
17. Manufacturer of Hydron did not infer that filling root canals with Hydron helps to
strengthen roots and prevent root fractures
HYDRON
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398.
STRENGTH ?
Modulus of elasticity of porous poly (HEMA) hydrogels
such as Hydron ranges from 180 to 250 MPa
To reinforce roots, the modulus of elasticity of a root filling
material would need to approximate that of dentin (i.e., 14,000
MPa)
13
18. PRIMARY MONOBLOC
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398.
Calcium silicate based material , distributed as ProRoot MTA, Dentsply from
1998
MTA
Orthograde obturation with mineral trioxide aggregate - as an apexification
material represents a primary monoblock
Apexification material
Biocompatible
Antimicrobial
Retreatment not possible
14
19. These alkaline biomaterials have gained wide acceptance in endodontic
community - good physico-chemical & biological properties
MTA
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398.
SEALABILITY & BOND STRENGTH
Hydrophilic , sets in the presence
of moisture
Setting in situ ??
Adhere to root dentine by forming a
crystalline bond by
biomineralization
Formation of gap-filling apatite
deposits
accounts for the seal
Syringed - carrier
Plugged columns
Lee MTA block &
plugger
15
21. MTA
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398
STRENGTH ?
The compressive EM of Portland cement
increases
after 14 days to 15,000 Mpa with a w/P ratio of
0.6
MTA theoretically able to strengthen roots EM 14,000 –18,600 MPa
Recent study - examined fracture resistance of MTA applied to
immature sheep roots - no difference filled with saline versus those
filled with MTA
17
22. MTA
Andreasen JO1, Munksgaard EC, Bakland LKComparison of fracture resistance in root canals of immature sheep teeth after filling with calcium hydroxide
or MTA.. Dent Traumatol. 2006 Jun;22(3):154-6.
STRENGTH ?
18
Saline Calcium
hydroxide
MTA
23. PRIMARY MONOBLOC
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398
Ultra-high molecular weight polyethylene fibres coated with a dentine bonding
agent are used to build-up endodontic posts and cores.
POLYETHYLENE FIBRE POST-CORE
19
Woven fibres have a modulus of
elasticity similar to that of dentine
Fibres adapt to root canal, canal
enlargement is not required
Polyethylene fibers conditioned with bonding
agent, placed in the slot of the root canal,
Braided polyethylene
fibers
24. POLYETHYLENE FIBRE POST-CORE
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398
STRENGTH
In clinical conditions MOE of polyethylene fibre
reinforced material with an adhesive material like
flowable composite has a MOE of 23GPa
High MOE and low flexural modulus of polyethylene fibre have a
modifying effect on interfacial stresses developed along resin dentin
boundary
20
28. PRIMARY MONOBLOC
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398.
Commercial product was containing bioactive glass of the 45S5 type
incorporated into polyisoprene, the matrix polymer of gutta-percha
BIOGUTTA
Formation of CaP crystals on the material’s surface in a wet environment
Self adhesive
Good sealing
Preliminary studies –
push out bond strength
24
29. SECONDARY MONOBLOC
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398.
Cementum
Dentin
Root filling
material
Resin cement/
root canal sealer
Resilon based systems
Fibre re-inforced posts
1
2
2 circumferential interfaces, one between cement & dentin & other between the cement
& core material.
25
30. SECONDARY MONOBLOC
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398.
By definition, conventional root canal obturations may be regarded as secondary
monoblock systems
Sealer does not bond to dentin or gutta percha
MOE 175–230 times lower than dentin
26
31. SECONDARYMONOBLOC
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398.
Monoblock concept rekindled in 2004 -Advent of bondable root filling materials
RESILON
Material looks and handles like conventional gutta percha. Unlike gutta percha ,
Resilon obturators bond to its associated sealer – Epiphany Sealer.
Primer & a dual cure sealer
(Epiphany)
Resilon - polycaprolactone-based,
dimethacrylate resin– contains Bioactive
glass
27
32. Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398.
SEALABILITY ?
Fill the root canal space with Resilon Points &
light cure – 40 secs
Apply self etch primer to the level of the apex with a
well fitting paper point
Express a small amount of the dual cure sealer –
place in
canal
RESILON
Only bondable root filling material works effectively with vertical condensation
and lateral
condensation techniques and includes pellets for the Obtura* gun system
Resilon material only shrinks 0.5%, unlike Gutta
Percha, it is physically bonded to the sealer by
polymerization - no gaps are present due to
shrinkage.
Coronal 2 mm of canal filling polymerized with a
curing light, - enhancing coronal seal
28
33. Bodrumlu E1, Tunga U. The apical sealing ability of a new root canal filling material. Am J Dent. 2007 Oct;20(5):295-8.
SEALABILITY ?RESILON
29
34. Bodrumlu E1, Tunga U. The apical sealing ability of a new root canal filling material. Am J Dent. 2007 Oct;20(5):295-8.
ROOT REINFORCEMENT?RESILON
30
35. SECONDARYMONOBLOC
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398.
First implied existence of a mechanically homogeneous monoblock in
reported in 1996 with the bonding of epoxy resin– based, carbon fiber–
reinforced posts to root dentin
FIBRE POSTS
Authors claim -carbon fiber posts, having MOE similar to that of dentin, could
achieve a
tooth–post– core monoblock
C fibers made to bond to
epoxy resins oxidative
process
Strongest carbon fibers
have a tensile modulus 500
–1000 GPa
Fibres no longer surface active once post exposed by
roughening /with bur
Stiffness of carbon fiber lowered by presence of epoxy
resin
Epoxy resin not bondable to methacrylates under
physiological temperatures
Beneficial claims of carbon fiber post–root dentin monoblock could not be validated in
independent
in vitro and retrospective in vivo studies
31
36. SECONDARYMONOBLOC
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398
Over the years, carbon fibers in this type of first-generation fiber post replaced
glass
FIBRE POSTS
The epoxy resin embedding matrix replaced with highly cross-linked,
methacrylate resin matrices have the potential to bond to methacrylate-based
resin cements
Different modalities of surface treatments of posts
are also available
More conducive to bonding to methacrylate-based
resins
Similarity in the modulus of
Elasticity between fiber posts and root dentin
32
37. Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–39Schwartz RS. Adhesive dentistry and
endodontics. Part 2: bonding in the root canal system-the promise and the problems: a review. J Endod. 2006 Dec;32(12):1125-34.
SEALABILITY & BOND ?
Remove obturation with drill
FIBRE POST + RESIN
Problems with bonding in root canals
33
Etch & rinse
Prepare dual cure/self cure primer, coat canal
Apply self/dual cure resin cement in canal
Place post, remove excess and cure
38. TERTIARY MONOBLOC
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398
Cementum
Dentin
Bondable coating on
fiber post/root filling
material
Resin cement/
Root canal sealr
Endorez
Fibre posts + external
silane
Third circumferential interface is introduced between the bonding substrate and the
abutment
material
34
39. TERTIARY MONOBLOC
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398.
EndoREZ (Ultradent Products Inc, is a dualcured radiopaque methacrylate
sealer
ENDOREZ
Hydrophilic and self-priming resin sealer, does not require the adjunctive use of
a dentin adhesive
EndoREZ points
resin-coated gutta-percha
Used - wet environment of canal
Effective penetration of dentinal
tubules & adapting walls
GP resin coating bondable
resin sealer
35
40. ENDOREZ
Tay FR1, Loushine RJ, Monticelli F, Weller RN, Breschi L, Ferrari M, Pashley D. Effectiveness of resin-coated gutta-percha cones and a dual-cured, hydrophilic
methacrylate resin-based sealer in obturating root canals. J Endod. 2005 Sep;31(9):659-64.
SEALABILITY ?
Mixed material deposited
into canal by passive
injection
Use of resin
coated GP cones
passively
Syringed – Navi tip
Leakage & morphologic studies showed - seal of the EndoRez system is mediocre
SEALER
RESIN TAGS
DENTIN
Long resin tags could be identified within dentinal tubules
May be attributed to
Polymerization shrinkage of sealer
Weak bond of sealer to prepolymerized coating
Inconsistency of resin coating
Uneven circumferential thickness or
partial detachment
Lack of FR for bonding - removal of
OI layer - Packing
1
2
3
Tensile B.S Apical seal
Improoved
Dual-cured self-etching
primer/adhesive
Problem - rapid
polymerization of adhesive in
environ with reduced oxygen
36
41. TERTIARY MONOBLOC
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398.
In ActiV GP (Brasseler USA), the root filling system is marketed as a
monoblock system
ACTIV GP
Stiffer GP cone - function as both the tapered filling cone and as its own carrier
core
Silanated glass ionomer particles at % - not affect the properties of GP
Capability of wet bonding
Creates an ionic bond to the dentinGP cones-surface coated with GI
fillers
37
42. As this system is new, limited information is available
ACTIV GP
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398
SEALABILITY ?
Apical seals to fluid filtration -
comparable to GP & AH Plus
Being single-cone technique, coronal
leakage to fluid filtration was worse than GP &AH
Plus
Hand file coated with Activ GP sealer & taken to
WL
Activ GP cone is coated with sealer & slowly
inserted into the canal to its working length
38
43. ENDOREZ & ACTIV GP
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398.
STRENGTH ?
Bulk of the material inside still consists of
thermoplastic GP
Unrealistic to expect establishment of a mechanically homogenous unit
within root canal with the EndoRez system & Activ GP
Elastomeric polymer - flows when stressed
39
44. TERTIARY MONOBLOC
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398
Conditioning of post is commonly done chairside, which makes the treatment
longer and increases the risk of failure
FIBRE POSTS + EXTERNAL SILANE
DT Light®SL
Coating made of silane and silicate is applied to the
post
In order to protect its activation before its use in dental
practice, an additional protective layer made of MMA is
applied
Fibre post conditioned with the latest coating technologies in an industrial process, The
practitioner no longer needs to condition post as the post is pre-conditioned
40
45. FIBRE POSTS + EXTERNAL SILANE
Goracci C1, Raffaelli O, Monticelli F, Balleri B, Bertelli E, Ferrari M. The adhesion between prefabricated FRC posts and composite resin cores: microtensile bond strength
with and without post-silanization. Dent Mater. 2005 May;21(5):437-44.
BONDING ?
41
46. TERTIARY MONOBLOC
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398.
Further improvement in post adaptation and retention attempted with
‘ANATOMIC POST’
ANATOMIC POSTS
Translucent fibre post – covered by a layer of light curing resin, which allows for
individual anatomic shaping of post
Individualized posts – appearance
after light curing outside of patients
oral cavity
Better fit than prefabricated posts
Precise fit – thin uniform layer of cement ideal for post
retention
42
47. TERTIARY MONOBLOC
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398.
Post adapted to lubricated post space & photoactivated to partially polymerize
composite
ANATOMIC POSTS
Efficacy of system not throughly investigated
43
Relined assembly,
removed & optimally
polymerized
Resin cement layer significantly reduced
Reduction in resin cement layer – reduction in volumetric
shrinkage
Reduction of polymerisation shrinkage in low compliance
environment ??
Gaps b/t post & relining composite – act as stress raisers
result in adhesive failure
48. TERTIARY MONOBLOC
Belli S, Eraslan O, Eskitascioglu G, Karbhari V. Monoblocks in root canals: a finite elemental stress analysis study. Int Endod J. 2011 Sep;44(9):817-26.
ROOT REINFORCEMENT?
44
Secondary
monobloc
Tertiary
monobloc
Primary
monobloc
49. CONTROVERSIES
Belli S, Eraslan O, Eskitascioglu G, Karbhari V. Monoblocks in root canals: a finite elemental stress analysis study. Int Endod J. 2011 Sep;44(9):817-26.
Root canal filling available today have MOE far less
compared to
dentin
Monoblocks aim at achieving a single unit – most root filling
materials require additional interfaces
46
Good bond strength of adhesive materials may not
imply good sealing
50. CONTROVERSIES
MBRS + RESIN POINT APICAL
FILLING
DENTI
N
FIBRE
POST
COMPOSITE
CORE
CERAMIC
CROWN
RESIN
CEMENT
Concept of single unit Monobloc
hypothetical ??
47
51. “The future of endodontics is bonded”
“The goal of being able to bond a canal from the minor constriction to the
canal orifice to the occlusal surface is a desirable one.’’
CONCLUSION
Review of the available data Contradicting ex vivo and in
vivo tests
Resin based materials are
here to stay
Replace conventional
materials
In parallel - alternative choice
48
52. REFERENCES
Goracci C1, Raffaelli O, Monticelli F, Balleri B, Bertelli E, Ferrari M. The adhesion
between prefabricated FRC posts and composite resin cores: microtensile bond
strength with and without post-silanization. Dent Mater. 2005 May;21(5):437-44.
Pitout E, Oberholzer TG, Blignaut E, Molepo J. Coronal leakage of teeth root-filled
with gutta-percha or Resilon root canal filling material. J Endod 2006; 32: 879–81.
Pameijer CH, Zmener O. Resin materials for root canal obturation. Dental Clinic N
America 2010; 325-44.
Radovic I, Monticelli F, Goracci C, Vulicevic ZR, Ferrari M. Self- adhesive resin
cements: A literature review. J Adhes Dent 2008; 10: 251–8.
Marending M1, Bubenhofer SB, Sener B, De-Deus G. Primary assessment of a self-
adhesive gutta-percha material. Int Endod J. 2013 Apr;46(4):317-22.
Schwartz RS. Adhesive dentistry and endodontics. Part 2: bonding in the root canal
system-the promise and the problems: a review. J Endod. 2006 Dec;32(12):1125-34.
53. REFERENCES
Franklin R. Tay and David H. Pashley. Monoblocks in root canals - a hypothetical or
a tangible goal. J Endod. Apr 2007; 33(4): 391–398
Kim YK, Grandini S, Ames JM, Gu LS, Kim SK, Pashley DH, Gutmann JL, Tay FR.
Critical review on methacrylate resin-based root canal sealers. J Endod. 2010
Mar;36(3):383-99.
Belli S, Eraslan O, Eskitascioglu G, Karbhari V. Monoblocks in root canals: a finite
elemental stress analysis study. Int Endod J. 2011 Sep;44(9):817-26.
Tay FR1, Loushine RJ, Monticelli F, Weller RN, Breschi L, Ferrari M, Pashley D.
Effectiveness of resin-coated gutta-percha cones and a dual-cured, hydrophilic
methacrylate resin-based sealer in obturating root canals. J Endod. 2005
Sep;31(9):659-64.
Ona M1, Wakabayashi N, Yamazaki T, Takaichi A, Igarashi Y. The influence of
elastic modulus mismatch between tooth and post and core
restorationson root fracture. Int Endod J. 2013 Jan;46(1):47-52
54. REFERENCES
Andreasen JO1, Munksgaard EC, Bakland LKComparison of fracture resistance in
root canals of immature sheep teeth after filling with calcium hydroxide
or MTA.. Dent Traumatol. 2006 Jun;22(3):154-6.
Pitout E, Oberholzer TG, Blignaut E, Molepo J. Coronal leakage of teeth root-filled
with gutta-percha or Resilon root canal filling material. J Endod 2006; 32: 879–81.
Pameijer CH, Zmener O. Resin materials for root canal obturation. Dental Clinic N
America 2010; 325-44.
Radovic I, Monticelli F, Goracci C, Vulicevic ZR, Ferrari M. Self- adhesive resin
cements: A literature review. J Adhes Dent 2008; 10: 251–8.
Marending M1, Bubenhofer SB, Sener B, De-Deus G. Primary assessment of a self-
adhesive gutta-percha material. Int Endod J. 2013 Apr;46(4):317-22.
Schwartz RS. Adhesive dentistry and endodontics. Part 2: bonding in the root canal
system-the promise and the problems: a review. J Endod. 2006 Dec;32(12):1125-34.
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tight seal should prevent the ingress of
bacteria and their by-products into periradicular
tissues or entomb the remaining microorganisms and
hence prevent or heal apical periodontitis
tight seal should prevent the ingress of
bacteria and their by-products into periradicular
tissues or entomb the remaining microorganisms and
hence prevent or heal apical periodontitis
tight seal should prevent the ingress of
bacteria and their by-products into periradicular
tissues or entomb the remaining microorganisms and
hence prevent or heal apical periodontitis
tight seal should prevent the ingress of
bacteria and their by-products into periradicular
tissues or entomb the remaining microorganisms and
hence prevent or heal apical periodontitis
tight seal should prevent the ingress of
bacteria and their by-products into periradicular
tissues or entomb the remaining microorganisms and
hence prevent or heal apical periodontitis
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Strengthening of immature root canals with open apices and reduced circumferential
dentin thickness are also issues of concern
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Recent study - examined fracture resistance of MTA applied to immature sheep roots - no difference filled with saline versus those filled with MTA
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Resilon is an FDA approved thermoplastic synthetic polymer material, based on Polyester. It also contains Bioactive Glass, Bismuth Oxychloride and Barium Sulphate. (65% filler by weight) It is a fully polymerized resin, slightly stiffer than Gutta Percha but it can go around curves as well due to the filler components that make it flexible. It is slightly MORE radio-opaque that Gutta Percha. It is available in Standard and Non Standard cones as well as Obtura pellet form. These look exactly like Gutta Percha except for the white color. The Resilon Material is sold with a Dentin Primer and a dual cure sealer (Epiphany).
After completion of a constant taper preparation and verification by radiograph of the fit of the Activ GP cone, a hand file is chosen that matches the final size of the preparation. The file is coated with the Activ GP sealer and taken to working length. It is recommended that this process is repeated a second time. - See more at: http://www.dentalaegis.com/id/2006/02/activ-gp-a-single-cone-obturation-technique#sthash.5Dqv3THh.dpuf
After completion of a constant taper preparation and verification by radiograph of the fit of the Activ GP cone, a hand file is chosen that matches the final size of the preparation. The file is coated with the Activ GP sealer and taken to working length. It is recommended that this process is repeated a second time. - See more at: http://www.dentalaegis.com/id/2006/02/activ-gp-a-single-cone-obturation-technique#sthash.5Dqv3THh.dpuf
Teixeira et al (6). They showed that roots filled with Resilon/Epiphany
exhibited significantly higher fracture load values than those filled with
gutta-percha/AH 26 when the specimens were subjected to vertical
loading forces
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In addition, the extremely unfavorable cavity geometry
(ie, C-factor) of root canals causes gaps along the dentin/sealer
interface during polymerization of the methacrylate resin–based
sealerspreponderance of sclerotic dentin along the apical part of the
root canal (62), differences in regional bond strengths (63), debris on
the canal wall (64–66), and high cavity configuration factor (C-factor)
(3, 63, 67, 68) inside long narrow canals. Under these circumstances,
the sealing performance of thin films of low viscosity resin sealers might
be severely jeopardized
After completion of a constant taper preparation and verification by radiograph of the fit of the Activ GP cone, a hand file is chosen that matches the final size of the preparation. The file is coated with the Activ GP sealer and taken to working length. It is recommended that this process is repeated a second time. - See more at: http://www.dentalaegis.com/id/2006/02/activ-gp-a-single-cone-obturation-technique#sthash.5Dqv3THh.dpuf
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After completion of a constant taper preparation and verification by radiograph of the fit of the Activ GP cone, a hand file is chosen that matches the final size of the preparation. The file is coated with the Activ GP sealer and taken to working length. It is recommended that this process is repeated a second time. - See more at: http://www.dentalaegis.com/id/2006/02/activ-gp-a-single-cone-obturation-technique#sthash.5Dqv3THh.dpuf
available
root filling materials when compared with dentin, with the former
behaving as elastomers that dissipate instead of transmitting stresses
Placing a fibre post means conditioning not only the root canal, but also the post's surface
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The anatomic post was then removed and a luting procedure was performed, as for any other translucent post. The clinical procedure was simple, and a superior fit to the root canal walls was achieved, thus reducing the amount of cement needed. The luting procedure described can be proposed as a clinical technique for routine use when the prepared root canal is too wide or not perfectly round.
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More long-term data needed to
determine whether they will eventually or will be used when filling root canals.
More long-term data needed to
determine whether they will eventually or will be used when filling root canals.
