Endodontic materials
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Endodontic Materials. The main objectives of root canal therapy are: Removal of the pathologic pulp. Cleaning and shaping of the root canal system. Three dimensional obturation to prevent reinfection. Functions of irrigants.

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Endodontic materials

Endodontic Materials


Endodontic materials

  • The main objectives of root canal therapy are:

  • Removal of the pathologic pulp.

  • Cleaning and shaping of the root canal system.

  • Three dimensional obturation to prevent reinfection.


Functions of irrigants

Functions of irrigants

Irrigants are used to clean the root canal and are used in association with the shaping instruments.

Functions of irrigants include:

Lubrication of instruments used to shape the canal.

Flushing out of gross debris.

Dissolution of organic and inorganic tissue.

Antimicrobial effect.


Irrigants

Irrigants

Ideal properties:

Lubricant

Antimicrobial

Dissolve organic debris

Flushing

Biocompatible

Cheap


Classification of irrigants

Classification of irrigants

Chemically inactive irrigants

Water

Saline

Local anaesthetic solution

Chemically active irrigants

Sodium hypochlorite (NaOCl).

Oxidizing agents as Hydrogen peroxide (H2O2)

Chelating agents as EDTA.


Irrigants1

Irrigants

Use

Adequate volume required

Stays within the confines of root canal

Never deliver with excessive force

Apical extrusion results in pain and possible swelling.

Use luer-lok 27 gauge endodontic needle

Efficiency enhanced with ultrasonic, sonic and mechanical instruments


Sodium hypochlorite

Sodium hypochlorite

0.5-5.25 %

Antibacterial

Dissolve organic matter

Corrosive/caustic

Low toxicity

Apical reaction

Rubber dam


Hydrogen peroxide

Hydrogen peroxide

3% +/- NaOCl

Production of O2 eliminate anaerobes

Bubbles may prevent adequate contact of irrigant with debris

Limited shelf life


Chlorhexidine

Chlorhexidine

Hibisrcub(HIBISCRUB is an antimicrobial preparation for pre-operative surgical hand disinfection, antiseptic handwashing

Usually used in 0.2% concentration

Antibacterial, Substantivity.

Flushing

Lubricant

Does not dissolve organic debris


Chelating agent

Chelating agent

Ethylene DiamineTetracetic Acid “EDTA” (File-eze, RC Prep)

Remove smear layer allowing

cleaning of tubules

Soften dentine

Not antibacterial

File-eze is water soluble unlike RC Prep which contains carbowax and is difficult to remove


Irrigants2

Irrigants

Sterile water

Local anaesthetic

Saline (0.9%)

They only provide lubrication and gross debris removal functions.


Intracanal medicamanets

Intracanalmedicamanets

If root canal treatment can’t be finished in a single visit, root canals are dressed with medicaments.

Functions of intracanal medicaments:

Primary function: antimicrobial activity

Antisepsis(is the destruction or inhibition of (slowing the growth of) microorganisms )

Disinfection(Cleaning an article of some or all of the pathogenic organisms which may cause infection )

Secondary functions

Hard-tissue formation

Pain control

Exudation control

Resorption control


Intracanal medicament

Intracanal medicament

Ideal properties

Antibacterial

Penetrates dentinal tubules

Control exudation or bleeding

Biocompatibile.

Eliminates pain

Induce calcific barrier

No effect on temporary

Radio-opaque

Does not stain tooth


Calcium hydroxide

Calcium hydroxide

Hypocal(contains calcium hydroxide and barium sulfate)

Ca(OH)2, 34-50% Ba SO4,5-15% Methylcellulose.

Antibacterial (pH>12)

Denatures protein

Synergestic with NaOCL

Cytotoxic-local necrosis, calcific barrier

Cheap

Dries weeping canals


Antibiotics

Antibiotics

Combination of drugs required to be effective

Resistant strains becoming more difficult to treat

Allergies


Steroids

Steroids

Triamicinolone, prednisolone

Pain relief but no evidence of more effective than Ca(OH)2

?use in root resorption by inhibiting odontoclasts

?depresses the host inflammatory response

Not antibacterial but can be mixed with Ca(OH)2

Ledermix= triamicinolone+ tetracycline


Phenol based agents aldehydes and halidyes

Phenol based agents, Aldehydes and Halidyes

Phenol, parachlorophenol(PCP), camphorated mono PCP, cresol, creosote, formacresol and chlorine.

Antibacterial agents.

Highly toxic agents.

Possible mutagenic and carcinogenic effect.


Obturating materials

Obturating materials

Ideal properties of root canal filling materials:

Antimicrobial

Biocompatible.

Good flow

Adhesive in nature

Dimensionally stable

Not affected by moisture

Radio-opaque

Good handling

Easily removed, post prep or retreat

Does not stain dentine

Cheap


Gutta percha

GuttaPercha

Guttapercha “ Isoprene” (C5H8) is one of the oldest and most common root filling material in use today.

A natural latex produced from a genus of tropical trees

Polymers of isoprene:

Cis-natural rubber

Trans-guttapercha.


Endodontic materials

Guttapercha points used in clinic consists of:

Guttapercha 20%

Zinc oxide 60-75%

Metal sulphides, waxes, resin, opacifiers

Guttapercha is available in 2 phases; Alpha and Beta.


Endodontic materials

Guttapercha taken from trees is in Alpha phase.

Guttapercha in points used in the clinic is in Beta phase.

Both phases differ in Melting temperature, volumetric changes and flow characteristics when molten.


Gutta percha1

Guttapercha

Advantages of guttapercha:

Biocompatible

Dimensionally stable

Compactable

Easily removed

Cheap

Disadvantages of guttapercha:

Does not adhere to dentine

Lacks rigidity


Metal points

Metal points

  • Silver (gold, tin, lead and titanium have been used)

  • Introduced in 1930’s

  • Silver preferred due to antibacterial effect

  • Rigid, unyielding

  • Impossible to adapt to canals

  • Poor seal as canal not commonly circular in shape

  • Corrosion

  • Difficult to remove for post

  • Titanium- biocompatible and avoids corrosion


Silver point failure

Silver Point Failure


Sealers

Sealers

Sealers are used in association with Guttapercha.

Functions of sealer

Cementing (luting, binding) the core material (guttapercha) into the canal.

Filling the discrepancies between the canal walls and core material

Acting as a lubricant to enhance the positioning of the core filling material

Acting as a bactericidal agent


Root canal sealers

Root canal sealers

Most sealers are toxic when freshly mixed

Toxicity substantially reduced when set

Most sealers are absorbable to some extent when exposed to tissue fluid

Ideally sealer should flow backwards out of the canal

However, no evidence that apical extrusion reduces success rate providing preparation and obturation are meticulous


Zinc oxide eugenol

Zinc-oxide eugenol

Grossmans, Tubliseal

Antibacterial

Radio-opaque

Slightly toxic when freshly mixed.

Good flow and working time

Does not adhere

soluble


Calcium hydroxide based sealers

Calcium hydroxide based sealers

Sealapex, Apexit

Radio-opaque

Soluble

Biocompatible

Preserve vitality of pulp stump and promote healing

Does not adhere


Resin based sealers

Resin based sealers

AH26, AH Plus, Endorez, Epiphany, RealSeal.

Adhesive

Antibacterial

Toxic when freshly mixed

Show setting shrinkage when set


Glass ionomer based sealers

Glass-ionomer based sealers

Ketac Endo and ActiV GP.

Mildly antibacterial

Adheres to dentine

Slightly soluble

Unset GIC is cytotoxic but when set this reduces with time

Very difficult to be removed


Silicone based sealers

Silicone based sealers

Roekoseal sealer.

Slightly expands when set.

Addition type silicone.

GuttaFlow is Roekoseal sealer with added guttapercha particles.

Does not adhere to root canal.


New root canal filling materials

New root canal filling materials

Resilon: resin-based cones. Similar in appearance and handling to guttapercha cones. Used with any resin-based sealer.

Endorez cones: resin-coated guttapercha. Used with endorez sealer or any other resin-based sealer.

ActiV GP: glass ionomer coated guttapercha. Used with glass ionomer based sealers.


Retrograde root filling materials

Retrograde root filling materials

Ideal properties

Seals apex

Biocompatible

Ease of handling

Moisture and blood tolerant

Low solubility

Radio-opaque

Good tissue response

Bonds to dentine


Amalgam

Amalgam

Corrosion

Apical inflammation

Poor sealing ability

Mercury toxicity


Endodontic materials

IRM

Modified zinc oxide-eugenol

Seals better than amalgam

Need high powder to liquid ratio to decrease toxicity and solubility

Short working time


Super eba

Super EBA

Modified zinc oxide-eugenol

High compressive and tensile strength

Neutral pH

Low solubilty

Not affected by blood

Good tissue response


Composite

Composite

Problems with moisture control

Some good results in sealing ability but further work required


Glass ionomer cements

Glass Ionomer Cements

Bonds to tooth substance

Biocompatibilty (Toxicity reduces when set)

Some antibacterial properties

Seal superior to amalgam


New materials

New materials

Diaket (Tricalcium phosphate paste)

Polyvinyl resin

Good tissue response

?cementum forming

Mineral Trioxide aggregates (MTA)

Seals better than amalgam or super EPA

Not adversly affected by blood

Marginal adaptation better than amalgam, IRM or super EBA

?cytotoxicity

Laser

Hydroxyapatite


Endodontic materials

MTA

Mineral trioxide aggregate:

Pulp capping

Nonsurgical apical closure

Perforation repair

Surgical root end filling


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