This document discusses various materials that have been used for retrograde root canal fillings. It begins by outlining the ideal properties of retrograde filling materials, including good adhesion, biocompatibility, and preventing microorganism leakage. The document then examines the properties and limitations of numerous materials that have been used, including amalgam, zinc oxide-eugenol cements, glass ionomer cement, MTA cement, and various other alternatives. It provides details on the composition, sealing ability, biocompatibility and other characteristics of each material. In conclusion, the document states that MTA cement is currently considered the best material due to its biocompatibility, sealing ability and dimensional stability.
An inlay may cap none, or may cap all but one cusp.
Sturdevant’s 4th ed. page579
Inlays may be used as single-tooth restorations for proximo-occlusal or gingival lesions with minimal to moderate extensions
Shillingburg page 1
An inlay may be defined as a restoration which has been constructed out of mouth from gold, porcelain, or other material & then cemented into the prepared cavity of a tooth.
William McGehee pg410
An inlay may cap none, or may cap all but one cusp.
Sturdevant’s 4th ed. page579
Inlays may be used as single-tooth restorations for proximo-occlusal or gingival lesions with minimal to moderate extensions
Shillingburg page 1
An inlay may be defined as a restoration which has been constructed out of mouth from gold, porcelain, or other material & then cemented into the prepared cavity of a tooth.
William McGehee pg410
Success of any dental procedure is determined by a good isolation. Here is a seminar on how to isolate the oral cavity from fluids and maintain a good dry field while working on a patient
Smear layer is a controversial topic in the field of operative dentistry and endodontics. This presentation includes composition, concepts, structure, advantages, disadvantages, and removal methods of smear layer.
Remineralization is defined as the process whereby calcium and phosphate ions are supplied from an external source to the tooth thereby, causing ion deposition into crystal voids in demineralized enamel, thus producing net mineral gain.
Remineralization Agents - Biomimetic approaches to stabilization of bioavailable calcium, phosphate, and fluoride ions and the localization of these ions to non-cavitated caries lesions for controlled remineralization.
Fermentable carbohydrates provide plaque bacteria with substrate for acid production.
This causes a rapid drop in plaque pH and when pH becomes less than 5.5, hydroxyapatite in enamel breaks down and calcium and phosphate ions diffuse out from the enamel.
5.5 is the “critical pH”, the point where equilibrium exists. There is no mineral dissolution and no mineral precipitation.
The plaque remains acidic for about 30-60 minutes after which normal pH is restored gradually.
The calcium and phosphate ions re-enter enamel when normal pH is restored and thus remineralization occurs.
Introduction
History
Bleaching agent
Classification of Bleaching technique.
Vital bleaching technique
Effect of vital bleaching on tooth structure
Effect of vital bleaching on tetracycline stain
Effect of vital bleaching on Fluorosis stain
Effect of vital bleaching on restorative material
Conclusion
References
INTRODUCTION
DEFINITION
TYPES OF TRAUMA FROM OCCLUSION
GLICKMAN CONCEPT
WAERHAUG CONCEPT
STAGES OF TISSUE RESPONSE TO INJURY
CLINICAL AND RADIOGRAPHIC FEATURES OF TFO
CLINICAL DIAGNOSIS OF TFO
TFO AND IMPLANTS
TREATMENT OF TFO
CONCLUSION
REFRENCES
GIC is the Direct Aesthetic restorative material hsving a variety of Applications in Dentistry. Most important properties are F release and chemical bonding with tooth structure. In this presentation Dr Rashid covers all the aspects of GIC.
Success of any dental procedure is determined by a good isolation. Here is a seminar on how to isolate the oral cavity from fluids and maintain a good dry field while working on a patient
Smear layer is a controversial topic in the field of operative dentistry and endodontics. This presentation includes composition, concepts, structure, advantages, disadvantages, and removal methods of smear layer.
Remineralization is defined as the process whereby calcium and phosphate ions are supplied from an external source to the tooth thereby, causing ion deposition into crystal voids in demineralized enamel, thus producing net mineral gain.
Remineralization Agents - Biomimetic approaches to stabilization of bioavailable calcium, phosphate, and fluoride ions and the localization of these ions to non-cavitated caries lesions for controlled remineralization.
Fermentable carbohydrates provide plaque bacteria with substrate for acid production.
This causes a rapid drop in plaque pH and when pH becomes less than 5.5, hydroxyapatite in enamel breaks down and calcium and phosphate ions diffuse out from the enamel.
5.5 is the “critical pH”, the point where equilibrium exists. There is no mineral dissolution and no mineral precipitation.
The plaque remains acidic for about 30-60 minutes after which normal pH is restored gradually.
The calcium and phosphate ions re-enter enamel when normal pH is restored and thus remineralization occurs.
Introduction
History
Bleaching agent
Classification of Bleaching technique.
Vital bleaching technique
Effect of vital bleaching on tooth structure
Effect of vital bleaching on tetracycline stain
Effect of vital bleaching on Fluorosis stain
Effect of vital bleaching on restorative material
Conclusion
References
INTRODUCTION
DEFINITION
TYPES OF TRAUMA FROM OCCLUSION
GLICKMAN CONCEPT
WAERHAUG CONCEPT
STAGES OF TISSUE RESPONSE TO INJURY
CLINICAL AND RADIOGRAPHIC FEATURES OF TFO
CLINICAL DIAGNOSIS OF TFO
TFO AND IMPLANTS
TREATMENT OF TFO
CONCLUSION
REFRENCES
GIC is the Direct Aesthetic restorative material hsving a variety of Applications in Dentistry. Most important properties are F release and chemical bonding with tooth structure. In this presentation Dr Rashid covers all the aspects of GIC.
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.
Root repair materials in Dentistry is evolving like never before with the advent of bioactive materials.lets have quick look at the products that have become history to the recent advances .
Luting agents for fixed prosthodontics/ orthodontic course by indian dental a...Indian dental academy
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.
Mineral Trioxide Aggregate (MTA) is identical to Portland cement. It is a new remarkable biocompatible material with exciting clinical applications pioneered by Dr. Mahmoud Torabinejad, Loma Linda University, in 1993
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
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.
His eva of caoh&bond agnt in direct pulp capping/ rotary endodontic courses b...Indian dental academy
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.
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.
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.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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
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.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
4. Introduction
Resection of the root end during periradicular surgery results in
an exposed apical dentine surface bounded by cementum with a
root canal at its centre. Following the apical preparation, a
retrograde filling material is usually used to seal the root-end
cavity.
Apicoectomy followed by retrograde filling is a well-
established procedure to treat teeth with persistent periapical
infections and teeth in which conventional root canal therapy
has failed. 4
5. The main purpose of placement of a root end filling material is
to provide an adequate apical seal.
The most important objective of filling the root end
preparation is to hermetically seal it from bacteria or
byproducts.
5
6. Ideal Properties
Sticks and adapts to the walls of the preparation.
Easy to use.
Dimensionally stable.
Moisture-resistant.
Insoluble in tissue fluids.
Nonstaining.
6
7. Prevents leakage of micro-organisms and their products to the
peri radicular tissues.
Bactericidal or bacteriostatic.
Biocompatible and cementogenesis promotor.
Radiopaque.
7
10. Amalgam
Amalgam has been used for a long time, but it has several
problems.
There tends to be marginal adaptation and filtration. There is
also a problem with biocompatibility.
Amalgams with a higher content of copper or zinc were also
cytotoxic due to ion release.
In addition, a galvanic current is produced due to contact with
metal posts and crowns.
10
11. Finally, tattoos arise due to corrosion of amalgam/silver cones or
leaving amalgam outside the cavity or removal of previous
apicoectomies with amalgam/old silver cones.
Amalgam studies show that success rates were as low as 44%,
especially in studies longer than 5 years.
11
12. ZincOxide-eugenol(ZOE)Cements
Zinc oxide-eugenol cements have been used in the past decade
to replace amalgams; but they contain eugenol which, in contact
with tissue fluids, is hydrolyzed and released.
When ZOE comes in contact with water, it undergoes surface
hydrolysis, producing zinc hydroxide and eugenol. This reaction
continues until all the ZOE in contact with the free water is
converted to zinc hydroxide.
12
13. Free eugenol has several dangerous effects depending on its
concentration and length of exposure.
It depresses vasoconstrictor response, and suppresses or
enhances effects on the immune response. It can be an allergen
and eliminates native oral microorganisms.
It depresses vasoconstrictor response, and suppresses or
enhances effects on the immune response. It can be an allergen
and eliminates native oral microorganisms.
13
14. Other materials have been added to the basic ZOE mixture in an
effort to increase the strength and radiopacity and reduce the
solubility of the final material.
Commercially available ZOE materials include intermediate
restorative material (IRM; Dentsply Caulk, Milford, DE) and
Super-EBA (Bosworth Company, Skokie, IL).
14
15. Intermediate Restorative Material (IRM)
Intermediate Restorative Material is a modified ZOE cement that
has been reinforced by the addition of polymethacrylate in the
powder, eliminating the absorbability problem and eliciting a
milder reaction.
IRM consists of a powder containing greater than 75% zinc oxide
and approximately 20% polymethacrylate mixed in equal parts
with a liquid that contains greater than 99% eugenol and less than
1% acetic acid.
15
16. Studies show a better biocompatibility and higher clinical
success rate than amalgam.
IRM appears to be tolerated in the periradicular tissue, but it has
no dental hard-tissue regenerative capacity.
In a tissue tolerance study, it was found that IRM elicited little
to no inflammatory effects after 90 days, which led to the
conclusion that the oral tissue was just as tolerant of IRM as it
was of any other retrograde filling material.
16
17. SuperEBA
Super ethoxybenzoic acid cement is an improved IRM.
Super-EBA consists of a powder containing 60% zinc oxide,
34% aluminum oxide, and 6% natural resins. It is mixed in equal
parts with a liquid that contains 37.5% eugenol and 62.5% ortho-
ethoxybenzoic acid.
Ethoxybenzoic acid was developed in an attempt to alter the
setting time and increase the strength of basic ZOE cements.
Super EBA is pH neutral, has low solubility, and has less
leakage than amalgam. 17
18. It produces minimal chronic inflammation in the apex.
SuperEBA adapts very well to canal walls compared with
amalgam, which appears to be well condensed but has poor
adaptation.
However, it is a difficult cement to manage when a large cavity
has to be sealed, because of its short setting time, and it is also
greatly affected by moisture and disintegrates in acidic pH.
18
19. In summary, superEBA cement is well tolerated by tissues, is
fast setting, polishable and dimensionally stable, and provides a
good apical seal.
Disadvantages are that is difficult to manage, sensitive to
temperature, moisture and acidic pH, and is only moderately
radiopaque.
It has no capacity to regenerate cementum.
19
20. For application, the liquid and powder are mixed in a 1:4 ratio.
The powder is mixed into the liquid slowly in small increments.
Once the rolled SuperEBA mixture loses its shine and the tip
does not droop when picked up by a carrier, the mixture has the
right consistency.
20
21. Glass lonomerCement (GIC)
Glass ionomer cement consists of aqueous polymeric acid, such
as polyacrylic acid, plus basic glass powders, such as calcium
aluminosilicate.
The cement can be either light or chemically cured.
GIC is very technique-sensitive however, there are the benefits of
biocompatibility and GIC is adhesive to dentine.
21
22. As with IRM, it is greatly affected by moisture and blood during
the initial setting time, resulting in increased solubility and
decreased bond strength; this significantly occurred in
unsuccesful cases.
The cytotoxicity and tissue response is similar to ZOE-based
cements
The tissue response to GIC is considerably more favorable than
to amalgam and similar to that with ZOE-based materials
22
23. Diaket
Diaket (ESPE GmbH, Seefeld, Germany) a polyvinyl resin
initially intended for use as a root canal sealer, has been
advocated for use as a root-end filling material.
It is a powder consisting of approximately 98% zinc oxide and
2% bismuth phosphate mixed with a liquid consisting of 2.2-
dihydroxy-5.5 dichlorodiphenylmethane,
propionylacetophenone, triethanolamine, caproic acid
copolymers of vinyl acetate, and vinyl chloride vinyl
isobutylether.
23
24. Leakage studies comparing Diaket to other commonly used root-
end filling materials have shown it to have a superior sealing
ability.
When Diaket was used as a root canal sealer, biocompatibility
studies showed that it was cytotoxic in cell culture276 and
generated long-term chronic inflammation in osseous502 and
subcutaneous tissues.
However, when mixed at the thicker consistency advocated for
use as a root-end filling material, Diaket has shown good
biocompatibility with osseous tissues.
24
25. Gold Foil
The use of gold foil as a root-end filling material was first
reported in 1913 and 1920.
It exhibits perfect marginal adaptability, surface smoothness and
tissue biocompatibility.
Implants of gold foil produce only mild tissue reaction.
Gold Foil was found to be the best apical sealing material as far
as the improvement in biting force is concerned.
25
26. When compared to IRM, composite resin, amalgam and glass
ionomer, goldfoil was least toxic.
The routine use of gold foil as a root-end filling material does not
appear practical because it requires a moisture free environment,
careful placement and finishing.
26
27. Gutta-percha
Gutta-percha cones or pellets contain approximately 19–22%
gutta-percha, 59–75% zinc oxide, and a series of other additives
including waxes, colouring agents, antioxidants and metallic
salts.
Most of the earlier treatment failures with this material were
related to poor adaptation of gutta-percha to the canal walls.
Leakage can be seen in many surgical cases without using
methylene blue.
27
28. Gutta-percha cones have shown evidence of toxicity in very
sensitive tests in vitro. This is thought to be due to the high zinc
oxide content.
Therefore, the surgeon cannot rely on cold- or heat-burnished
gutta-percha and finish microsurgery after apicoectomy without
preparing a 3 mm deep apical microcavity and obturating it with
a well-sealing and dimensionally stable biocompatible cement.
28
29. MTACement
MTA consists of tricalcium silicate, tricalcium aluminate,
tricalcium oxide, and silicate oxide. It also has bismuth oxide
powder for radiopacity.
The crystals are composed of calcium oxide and the amorphous
matrix is composed of 33% calcium, 49% phosphate, 2% carbon,
3% chloride, and 6% silica.
Calcium and phosphorous are the main ions. Iron is absent in the
white MTA.
29
30. Hydration of the powder, which has a mean particle diameter of
10 nanometers, produces a colloidal gel that solidifies into a hard
structure consisting of discrete crystals in an amorphous matrix.
The compressive strength is quite low at 24 hours (40 MPa) but
it increases to 67 MPa at 21 days after mixing.
The solubility of MTA is similar to amalgam and superEBA.
Importantly, it is hydrophilic, so moisture and blood do not
affect its setting.
30
31. Initially the pH is 10.2, but this increases to 12.5 at 3 hours after
mixing. Its radiopacity (7.17) is reasonable, being higher than
superEBA and IRM.
It is currently the only available filling material that produces a
cementum deposition layer over it, and only a minimal degree of
inflammatory cell response, periodontal ligament regeneration
thickness and osseous healing.
31
32. MTA is the best filling material available today in terms of
biocompatibility, sealing ability, dimensional stability.
Disadvantages are that, although moisture is required for its
setting, during packing, isolation is critical because just one drop
of liquid can remove it from the retrocavity.
Also, its setting time is very long, radiopacity is not high, and
clinically is the least scientifically tested cement, so far.
32
33. Composite Resin
It should be used in cases when apicoectomy or retrocavity or
both cannot be made due to:
1. Cast posts that fill the canal all the way down.
2. Previous apicoectomy that has resected the root up to the level
of the post.
3. Weak dentin walls remaining after apicoectomy that cannot
support ultrasonic vibration, or short roots where apicoectomy
will make the roots even shorter
33
34. 4. Composite leaks less than superEBA, IRM and GIC.
However, it is a material that is more sensitive to technique
because moisture and blood contamination during the
bonding/setting process reduces bond strength and increases
leakage.
34
35. Compomers
Geristore (Dent-Mat, Santa Maria, CA, USA) is a resin-
reinforced glass ionomer hybrid in a dual-curing paste/paste
formulation of a hydrophilic bisphenol-A-glycidyl methacrylate
(bis-GMA) with long-term fluoride release.
It is less sensitive to moisture than conventional glass-ionomer
cement, but a dry environment produces stronger bonds.
35
36. These materials have been shown to be equal or superior to IRM
and equivalent to superEBA in their ability to reduce apical
leakage.
In Europe a composite resin-type material named Retroplast
(Retroplast Trading, Dybersovej, Denmark) was introduced in
endodontic surgery with favorable long-term results.
The root end management with these materials (Geristore and
Retroplast) is different from that in endodontic microsurgery
36
37. The major disadvantage of these resin-type materials is
difficulty in avoiding blood/moisture contamination.
37
39. Bioceramics
Bioceramics are a relatively new and potentially promising
addition to the group of materials available for root-end filling.
In vitro testing of EndoSequence Root Repair Material (ERRM;
Brasseler, Savannah, GA) demonstrates biocompatibility and
antimicrobial activity that is similar to MTA.
ERRM is composed of calcium silicates, monobasic calcium
phosphate, and zirconium oxide.
39
40. The material is hydrophilic, radiopaque, and has high pH.
ERRM is available as a putty and a syringable paste.
An advantage of RRM, based on clinical experience, is its
handling properties, similar to that of Cavit (3M, St. Paul, MN
USA).
RRM is biocompatible, hydrophilic, insoluble, dimensionally
stable, a high PH, has 30 minutes of working time, and as short
as 2 hours setting time.
40
41. Bioaggregate
Bioaggregate is a modification of MTA.
It is a new bioceramic root repair and root-end filling material
composed of a powder component consisting of tricalcium
silicate, dicalcium silicate, tantalum pentoxide, calcium
phosphate monobasic and amorphous silicon oxide and a liquid
component of deionized water.
41
42. In a study investigating the cytotoxicity of Bioaggregate,
Bioaggregate showed a significantly better inflammatory
reaction and foreign body reaction than the MTA.
An in vitro comparative study of the sealing ability of Diadent
Bioaggregate and other root-end filling materials was done using
methylene blue dye penetration technique; the results showed
that microleakage was significantly less in Bioaggregate.
42
43. Biodentine
It is a calcium silicate based material introduced in 2010 and is
used as a material for crown and root dentin repair treatment,
repair of perforations, apexifications, resorption repair and root-
end fillings.
The main component is a highly purified tricalcium silicate
powder that contains small amounts of dicalcium silicate,
calcium carbonate, and a radioopaquer.
The flowable consistency of Biodentine penetrates dentinal
tubules and helps in the mechanical properties of the interface.
43
44. Investigation of the bioactivity of Biodentine, MTA and a new
Tricalcium silicate cement revealed that all three cements
allowed the deposition of hydroxyapatite on the surface. This
shows that all three materials are bioactive.
An in vitro study to compare the sealing ability of MTA and
Biodentine; MTA showed the highest seal and the least dye
absorbance. Biodentine showed a seal slightly less than MTA.
44
45. Ceramicrete
This material has hydroxyapatite powder and cerium oxide
radioopaque fillers.
It is a self-setting phosphate ceramic that sets using an acid-base
reaction to form a potassium magnesium phosphate hexahydrate
ceramic matrix phase.
A comparison of the root-end seal achieved using ceramicrete,
bioaggregate and White MTA was done to study the prevention of
glucose penetration; Both bioaggregate and ceramicrete showed similar
sealing ability to MTA, with ceramicrete showing significantly better
results than bioaggregate. 45
46. iRoot BPplus
iRoot BP Plus (Innovative BioCeramix Inc., Canada) is a
synthetic water-based bioceramic cement. It is available in
ready to use premixed form and has a biocompatibility similar
to MTA.
46
47. GenerexA
Generex A (Dentsply Tulsa dental, USA) is a calcium silicate
based cement and is similar to MTA but the handling properties
are different.
Instead of water the cement is mixed with a special gel.
The final consistency is similar to IRM like dough and easy to
manipulate.
47
48. Endobinder
EndoBinder (Binderware, Brazil) is a new calcium aluminate
cement.
During production, free magnesium oxide and calcium oxide are
eliminated to avoid expansion of the material and ferric oxide
which can cause tooth discolouration is also eliminated.
48
49. Conclusion
Many different materials have been advocated for use as root
end filling materials, and each has specific advantages and
disadvantages.
However, from the biologic perspective of regeneration of the
periradicular tissues, MTA, followed by Retroplast, appears to
have a clear advantage over the other available materials.
49
50. Bioceramic materials may join this group, but require more
clinical testing.
Retroplast and other composite resin–based filling materials
require meticulous hemostasis and a dry surgical field for
optimum results.
The most commonly cited disadvantage of MTA is its handling
properties.
Even when properly prepared, MTA is more difficult to place in
the root-end cavity than most other materials.
50
51. No ideal retrofilling cement exists. IRM has been substituted by
superEBA, but it continues to be the cement of choice in large
cavities like strip perforations.
SuperEBA is a reinforced IRM cement that provides a good
apical seal. MTA is today's gold standard, and it is even easier
and faster to work with than superEBA.
Amalgam is no longer used.
51
52. References
Cohen’s Pathways of the Pulp: 11th Edition.
Endodontic Microsurgery: Merino.
Ingles Endodontics: 6th Edition.
Microsurgery in Endodontics: Syngcuk Kim.
Kanchan Bhagat., et al; “Root End Filling Materials and Recent Advances: A
Review”; EC Dental Science 12.2 (2017): 46-57.
J. Aqrabawi; Sealing ability of amalgam, super EBA cement, and MTA when
used as retrograde filling materials; BRITISH DENTAL JOURNAL, 188(5).
Emre Bodrumlu; Biocompatibility of retrograde root filling materials: A
review; Aust Endod J 2008; 34: 30–35.
52
Editor's Notes
Freshly mixed silver amalgams were very cytotoxic due to unreacted mercury, with cytotoxicity decreasing rapidly as the materials hardened.
Migration of metallic particles into the tissues. These amalgam particles have been associated with inflammation.
Macrophage and fibroblast cytotoxicity.
Cell respiration depression.