The document discusses various materials used for obturation in root canals of primary teeth. The goals of obturation include maintaining arch length, preserving function, and removing infection. Commonly used materials include zinc oxide eugenol (ZOE), calcium hydroxide, and iodoform-based pastes. ZOE has advantages of antibacterial effects and radiopacity but low resorption. Iodoform provides antibacterial properties and resorbs excess material. Calcium hydroxide is biocompatible with no toxic effects. No single material meets all criteria. Combination materials and addition of substances aim to improve properties. Selection depends on factors like resorption rate and biocompatibility.

1. Root canal Obturating Materials
in Primary teeth
Dr. Aravindhan A
JR-3
Dept of Paediatric and Preventive Dentistry

2. The goal of an any procedure performed in a
primary tooth are to
• Maintain arch length
• Preserve masticatory function
• Remove acute and chronic infection from
tooth or oral cavity.

3. Challenges
• Tortuous and ribbon shaped anatomy of the
primary teeth canals
• Physiological resorption of roots
• Primary molar roots are usually curved
• Accessory canals.
- more common in mandibular molars
than maxillary molars. Especially in furcation
areas

4. Goal of obturation
• The ultimate goal of endodontic obturation
has remained the same for the past 50 years:
“to create a fluid-tight seal along the length of
the root canal system, from the coronal
opening to the apical termination.”

5. RIFKIN criteria of obturating materials
• Resorbability
• Antiseptic property
• Non-inflammatory and non irritating to the
underlying permanent tooth germ
• Radio-opacity for visualization on radiographs
• Ease of insertion and
• Ease of removal
-However, none of the currently available
obturating materials meet all of these criteria.
Rifkin A . The root canal treatment of abscessed primary teeth: A three to four year follow-
up. J Dent Child 1982; 49: 428-431.

6. • Most commonly used materials for primary
root canal fillings are
1. ZnOE based
2. CaOH based
3. Iodoform based

7. ZOE
• Bonastre (1837) discovered zinc oxide Eugenol
and it was subsequently used in dentistry by
Chisholm (1876).
• Zinc oxide Eugenol paste was the first root
canal filling material to be recommended for
primary teeth, as described by Sweet in 1930.
• It was the only material explicitly
recommended in the clinical guidelines
developed by the AAPD untill 2008.

8. Advantages of ZOE
• Excellent antibacterial & analgesic effects (in
lower concentrations)
• Radiopaque for good radiographic visibility
• Easy to manipulate & fill in the canals
• Insoluble in tissue fluids
• Easily available
• Cost effective
• No tooth discolouration

9. Disadvantages of ZOE
• LOW resorption rate (Erausquin,1967)
• Deflection of tooth bud (Coll & Sadrian, 1996)
• Irritation to periapical tissue(Spedding, 1985)
• Necrosis to bone and cementum ( Hendry,
Jeansonne, Dummet and Burrel, 1982)

10. Combination Author observation
Zno +
propolis
Al-Ostwani et al., ZOP paste was synthesized by mixing 50% zinc oxide
powder with 50% hydrolytic
propolis. There was acceptable clinical and radiographic
success rate with faster
resorption seen in some cases.
ZnO+
Ca (OH)2 +
NaF
Chawla et al., Ca(OH)2 - demerit of resorbing at a faster rate than the
physiologic root resorption. To
overcome this filling material incorporated with fluoride
was utilized. The addition of
fluoride was seen to give this material a resorption rate
that matched the resorption rate of primary teeth.
Iodoformised
ZOE
Garcia godoy It was found to be effective for both aerobic and
anaerobic bacteria with a maximum
sustaining period of 10 days.
ZnO + Ca(OH)2 Praveen et al., Obturated material remained up to the apex of root
canals till the beginning of physiologic
root resorption and was found to resorb at the same
rate as that of primary teeth

11. Iodoform based
• KRI PASTE
• MAISTO PASTE
• VITAPEX/METAPEX
• ENDOFLAS
• GUEDES-PINTO PASTE

12. Why iodoform?
• Antibacterial properties (bacteriostatic)
( Esterala et al.,2006)
• Healing potential ( Nurko & ranly, 2000)
• Ability to be resorbed when in excess (Garcia
Godoy, 2000)
• Radio opacity
- after 2008, AAPD started recommending
iodoform based pastes for obturating primary
tooth.

13. • WALKHOFF PASTE (1928)
Parachlorophenol 4-8%
Camphor and Menthol crystals 1.40-2.90%
Eugenol 22-24%
Zinc oxide 48-58%
Thymol 12-18%
Silver powder 0.70-1.45%
-Total resorption, which occurs both in the
periapical area and in the canal area of the tooth

14. KRI paste
• Iodoform (60 parts)
Solution (40 parts)
• Camphor
• Menthol
• Parachlorophenol

15. • KRI-3: This liquid differs from commonly used
Kri 1 paste in that, its para-chlorophenol,
camphor and menthol concentration are
twelve times superior and hence possess
greater antimicrobial efficacy.

16. Advantages
•KRI paste resorbs rapidly & has no undesirable
effects on succedaneous teeth.
•Also used as a root canal medicament in
abscessed primary teeth with no harmful effects
•Rate of resorption of the extruded material is
faster than the tooth root,sometimes the
material also resorbed inside the canal
•Has long lasting bactericidal potential
•Does not set into hard mass & can be removed if
retreament is required

17. Maisto paste
• Iodoform (42 g)
• Camphor (3 cc)
• Menthol
• Parachlorophenol
• Zinc oxide (14g)
• Lanolin (0.5g)
• Thymol (2 g)
- This paste is known for its comparatively slow
rate of resorption when used as an obturating
material for primary teeth.

18. Vitapex/ metapex
• Vitapex have been published by Fuchino and
Nishino (1980).
• Vitapex that contains Calcium hydroxide and
iodoform along with silicone oily base (additive)
- Iodoform 40.4%,
- Calcium hydroxide 30.3%, and
- Silicone 22.4%.
• A lot of researchers considered this mixture as
nearly an ideal root canal filling material for
primary tooth, owing to its excellent properties.

19. • The iodoform is a known bactericide that is
released from the sealer and suppresses any
residual bacteria in the canal or periapical region.
• calcium hydroxide has a biocompatible
antibacterial activity, induction of mineralized
tissue formation, activation of alkaline
phosphatase and collagen synthesis and ability to
produce hydrolysis of bacterial endotoxin.

20. ADVANTAGES
• Has no toxic effects on the permanent successor
tooth
• Good antiseptic action
• Adheres well to the canal walls
• It does not set to a hard mass
• Resorption occurs at a slightly faster rate then the
roots, complete resorption of the excess paste is
expected within 2-8 weeks.
• Ease of applicability of the material
• Is radiopaque, so better radiographic visibility

21. DISADVANTAGES
• Resorbs if pushed beyond the apex however
the rate of resorption is faster than the roots.
• Causes discoloration of the teeth.
• The rapid elimination of iodoform leaves
behind empty spaces inside the root canal,
which may undermine the success of the
endodontic therapy.

22. Endoflas
• Endoflas is a resorbable paste Obtained by mixing
a powder containing
1.Iodoform,
2.Zinc Oxide (56.5%),
3.Calcium Hydroxide (1.07%),
4.Tri-iodomethane Dibutyl orthocresol (40.6%),
5.Barium Sulphate (1.63%) And
6.Liquid Consisting Of Eugenol And
Paramonochlorophenol.

23. • The material is hydrophilic and can be used in
mildly humid canals. It firmly adheres to the
surface of the root canals to provide a good seal.
• Due to its broad spectrum of antibacterial
activity, Endoflas has the ability to disinfect
dentinal tubules and difficult to reach accessory
canals that cannot be disinfected or cleansed
mechanically.
• Unlike other pastes, Endoflas only resorbs when
extruded extraradicularly, but does not wash out
intra-radicularly (Fuks et al 2002).

24. • Eugenol content can cause periapical irritation. It also
has a drawback of causing tooth discoloration.
Endoflas-chlorophenol-free (CF):
• Radiolucent lesions following endodontic treatment of
primary teeth were, may be due to the filling material
that contain phenol.
• Due to this endoflas cf was developed which is free of
chlorophenol. Chlorophenol was eliminated from
endoflas composition because it has fixation effect
which may affect the osteoblast cells

25. Why endoflas is resorbed only
periapically?

26. • Navit S et al., (2016) evaluated the
antimicrobial efficacy of obturating materials
against E. faecalis, amongst all the groups
Endoflas had significantly higher zone of
inhibition.
• Antimicrobial efficacy of various materials
according to this study can be summarized as
follows:
Endoflas > ZOE >Calcium hydroxide +
Chlorhexidine > Calcium hydroxide + Iodoform
+Distilled water ~ Metapex > Saline.

27. Guedes pinto paste (1981)
• Rifocort –
Prednisolone Acetate Corticosteroid 5mg (Anti inflammatory )
Rifamycin Sodium Salt (Antibiotic)
Propylene glycol (Vehicle)
Macrogol (Polyethylene-glycol) - Vehicle
• Champhorated paracholorophenol (Proportion 3:7)
30% Parachlorophenol 70% Camphor (Antimicrobial+analgesic)
• Iodoform – Iodine (Antimicrobial)

28. CaOH
• Calcium hydroxide is a white odourless
crystalline powder.
• It has low solubility in water (a good clinical
characteristic because a long period is
necessary before it becomes soluble in tissue
fluids when in direct contact with vital
tissues.)
• It has high pH about 12.5

29. • Leonardo et al in 1982, recommended the
addition of other substances to the paste.
1. To maintain the paste consistency of the
material which does not harden on set.
2. To improve flow
3. To maintain the high pH of calcium hydroxide
4. To improve radiopacity
5. To make clinical use easier

30. • This material was found to be easy to apply.
• Resorbs at a slightly faster rate than that of
the root.
• It has no toxic effects on permanent successor.
• Radiopaque.

31. Hollow tube effect ( Goldman and
Pearson,1965)
Rajsheker S, Mallineni SK, Nuvvula S (2018) Materials Used for Pulpectomy in Primary
Teeth- A Mini Review. J Dent Craniofac Res Vol.3 No.1: 3.

32. • Mortazavi and Mesbahi, who treated children
in two visits, performed formocresol
pulpotomy on the first visit and then
preparation and obturation of the canals in
the second visit.
• It is possible that foreign body giant cells may
have been chemically fixed, thus losing their
ability to resorb the vitapex paste in the root
canals.
Mortazavi M, Mesbahi M (2004) Comparison of zinc oxide and
eugenol, and Vitapex for root canal treatment of necrotic
primary teeth. Int J Paediatr Dent 14: 417-424.

33. Calen paste
• A calcium hydroxide-based paste
• Calen paste exhibited biocompatibility , high
antimicrobial activity and satisfactory clinical,
radiographic outcomes & intermediate setting
time values.
• The mean initial pH was 6.1, and it exhibited a
progressive increase until reaching a peak at the
five-hour time point with mean pH value of 8.4.
• high radiopacity

34. CTZ
• CTZ is an antibiotic paste
• Combination of
- chloramphenicol 500mg+
- tetracycline 500mg+
- zinc oxide 1000mg+
- eugenol 1 drop

35. • Chloramphenicol is an antimicrobial agent that acts
against a large number of aerobic, facultative anaerobe
and spirochetes as well as gram +ve and gram –ve
microorganisms.
• Tetracycline is a broad spectrum antibiotic, which can
be bactericidal at high conc. Offer excellent
effectiveness against gram –ve bacteria and all
anaerobes.
• ZOE provides analgesic properties and potent
antibacterial action against staphylococcus, micrococci,
bacillus and enterobacteria for more than 30 days.

36. Frank paste
• Combination of calcium hydroxide +
champhorated parachlorophenol
• It is well tolerated by adjacent periapical
tissue without any inflammation & with
deposition of osteodentin.

37. Aloe vera
• Aloe vera can be used for various therapeutic
as well as preventive purposes owing to its
anti-inflammatory, antibacterial, antifungal,
antiviral, moisturizing, and pain-relieving
properties.
• Because of these properties that are useful in
dentistry, aloe vera gel can be also used in any
obturating medium for therapeutic purposes.

38. • zinc oxide powder, if mixed with aloe vera gel,
provides the following advantages:
- it does not set, its ease of placement,
- easily retrievable nature.
• Khairwa A et al in 2014 in their study they
have used zinc oxide powder with aloe vera
gel to check the efficacy of this combination as
an obturating material for primary teeth.

39. Tulsi
• Jaidka S et al (2014) conducted a study on tulsi
with obturating material in primary tooth.
• The antimicrobial efficacy of obturating
materials used in primary teeth was evaluated
against E. Faecalis
• Materials zinc oxide eugenol, zinc oxide with
tulsi extract and zinc oxide with aloe vera as
obturating materials.

40. • Intergroup comparison revealed significant
difference amongst all the groups except
between zinc oxide eugenol and zinc oxide with
tulsi extract.
• Zinc oxide eugenol had significantly higher zone
of inhibition among all the groups.
• According to results obtained from the study can
be summarized as follows:
Zinc oxide eugenol > Zinc oxide with tulsi
extract > Zinc oxide with aloe vera

41. Ozonated oil
• Ozone is gaseous, energized form of oxygen, it is
unstable and dissociates readily back into oxygen,
thus liberating so called singlet oxygen, which is a
strong oxidizing agent.
• They are responsible for remarkable bactericidal
and fungicidal effects.
• Chandra et al., observed good clinical success
rate at 12 months follow up, antibacterial and
excellent healing properties of ozone peroxides,
progressive bone regeneration when ozonated oil
mixed with ZnO.
Chandra SP, Chandrasekhar R, Uloopi KS, Vinay C, Kumar NM (2014) Success of root
fillings with zinc oxide-ozonated oil in primary molars: preliminary results. Eur Arch
Paediatr Dent 15: 191-195.

42. Colla cote
• Not an obturation material per se.
• Acts as apical barrier
• It prevents the apical extrusion of obturation
material
• Made up of bovine collagen
• Resorbable.

43. Deciduous tooth with no successors
• Retained deciduous tooth requiring different
obturating material that would not undergo
resorption & biocompatible to the retained
primary roots.
• So, materials used for situation like this are
• Guttapercha
• Mineral Trioxide Aggregate (MTA) and
• Calcium Enriched Mixture (CEM)

44. LSTR
• Lesion sterilisation and tissue repair
• Non instrumentation endodontic treatment
• The theory behind LSTR is that the repair of
damaged tissue might occur if lesions are
disinfected.
• Abscessed teeth with poor prognosis (nanda et
al.,)
• a mixture of 3 antibiotics. ( 1:3:3 in MP)
1. ciprofloxacin
2. Metronidazole
3. minocycline.

45. Root canal filing methods
• Endodontic pressure syringe
• Lentulo spiral
• Mechanical syringe
• Incremental filling technique
• Tuberculin syringe
• Disposable injection technique
• Reamer technique
• Insulin syringe technique
• Navitip
• Bi-directional spiral
• Pastinject Jiffy tube

46. Other techniques:
• 1. Amalgam plugger by Nosonwitz (1960) and
King (1984)
• 2. Paper points by Spedding (1973)
• 3. Plugging action with wet cotton pellet by
Donnenberg (1974)