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A Critique of the Proposed National Education Policy Reform
Root canal end filling materials /certified fixed orthodontic courses by Indian dental academy
1. INDIAN DENTAL ACADEMY
Leader in Continuing Dental Education
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2. CONTENTS
1. INTRODUCTION
2. IDEAL REQUIREMENTS OF A ROOT END
FILLING MATERIAL
3. VARIOUS ROOT END FILLING MATERIALS
4. MISCELLANEOUS MATERIALS
5. CONCLUSION
6. REFERENCES
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3. INTRODUCTION
Objective of all endodontic
procedures
Apical resection or
apicectomy followed by root
end filling (Retrograde
Filling)
A wide variety of root end
filling materials
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4. IDEAL REQUIREMENTS OF ROOT END
FILLING MATERIALS
Biocompatible Readily available,
easy to handle
Insoluble
Non-corossive
Adhesive Radiopaque
Bacteriocidal or Electrochemically
inactive
Bacteriostatic
Promote
Dimensionally stable Cementogenesis
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7. CONCERNS IN THE USE OF AMALGAM
AS A ROOT END FILLING
Type of Amalgam (High Cu Vs
conventional, Zinc Vs Non- zinc)
Leakage
Tissue compatibility
Preparation and manipulation
Electric potential
Pigmentation or argyria
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8. Type of Amalgam (High Cu Vs Conventional,
Zinc Vs Non-zinc)
Alloy of silver, tin, copper & zinc with small
amounts of Indium and palladium.
% of components in low Cu and high Cu
Ag% Sn% Cu% Zn% In% Pd%
Low Cu 63-70 26-28 2-7 0-2 - -
High Cu 40-60 22-30 13-30 0 0-5 0-1
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9. HIGH CU VS LOW CU
For Low Cu
Ag3Sn + Hg Ag3Sn + Ag2Hg3 + Sn8Hg
γ γ1 γ2
For High Cu
Ag3Sn + Cu + Hg Ag3Sn + Ag2Hg3 + Cu6Sn5
γ γ1 η
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10. ZINC VS NON-ZINC
Effect of moisture on zinc alloys is well
established
∴ from all the above high copper zinc free
amalgam is preferred as root end filling material.
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11. LEAKAGE OF AMALGAM
Multiple techniques advocated to determine
the apical leakage.
Conclusion drawn from these studies
Use of amalgam bond, 4-META bonding agent
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12. TISSUE COMPATIBILITY
Fresh mixed conventional silver amalgam
Amalgam containing zinc
Various studies identified cytotoxicity of both
low and high copper content alloys.
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13. MATERIAL PREPARATION & MANIPULATION
Preparation and manipulation is crucial
Key points to consider when alloys placed
intra orally
a. Amalgam squeezed of excess mercury
b. Instruction by the manufacturer for
trituration
c. Amalgam closely adapted to the confines
of the cavity
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14. d. Root end amalgams placing at the time of
surgery
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15. ELECTRIC POTENTIALS
Root end amalgam in a tooth which has a
metallic post or crown restoration.
a. Currents in excess of 50µA
b. Increase production galvenic currents leads
to electrochemical corosion
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16. TISSUE STAINING ARGYRIA
Causes
Amalgam scattered in surgical site
Fractured or loosened
amalgam root end fills
Galvanism and electrochemical corrosion
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17. PREVENTION
Control of placement
Efficient irrigation and aspiration
Appropriate bulk in the thickness and
mechanical retention.
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18. GUIDELINES FOR AMALGAM USAGE AS A ROOT
END FILLING
Control of moisture
High copper alloys
Varnish or Dentin bonding agent
Creates smooth surface
Prevent dispersion of alloy particles
Keep Alloy as small in diameter with enough
thickness
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19. GALLIUM ALLOYS
Toxic effect of mercury
Putt Kammer (1928)
Properties
Wetting many materials
Mixed and condensed as silver amalgam
Compressive and tensile strength increases
with time
Expand after mixing
Stability and corrosion resistance
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20. COMPOSITION
Alloy Liquid
Silver 60% Gallium 62%
Tin 25% Iridium 25%
Copper 13% Tin 25%
Palladium 20%
Reaction
AgSn + Ga AgGa + Sn
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21. DISADVANTAGES
Surface roughness and marginal discoloration
Manipulation difficult
Cost 16 times more
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22. GOLD FOIL
Schuster (1913) and Lyons (1920)
Reports in 1960s and 1980s recommand its
use ---- perfect marginal adaptation, surface
smoothness and tiss biocompatibility.
Least toxic compared to IRM, composite,
amalgam and GIC
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23. Although favourable material properties,
does not appear practical ----- need to establish
moisture free environment, careful placement
and finishing.
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24. SILVER CONES
Silver cones used to obturate the
root canals since early 1930’s
Several techniques recommended
root end fill with silver cone
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25. a. Summers (1946)
1. Reverse canal instrumentation
2. Specially recommended when post-core
crown present
b. TRICE recommended a Fissure bur to cut
the previously placed silver cones.
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26. GUIDELINES CONCERNING SILVER CONES
ROOT END FILLS
Silver cones cannot 3 Dimensionally obturate
the root canal space
Open voids between the cones and dentin wall
Dissection of silver cone increases corrosive
potential
Cannot be burnished to perfect apical seal
Ideally teeth containing silver cones requiring
surgery should retreated
A root end fill is indicated in all cases
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27. GUTTA PERCHA
As a true root end filling material
Orthograde root canal obturation with either
cold or hot burnisher.
ABDAL & RETIEF compared heat sealed gutta
percha, amalgam, IRM and super EBA.
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28. Composition
Gutta percha - 18.9 – 21.8%
Zinc Oxide - 56.1 – 75.3%
Heavy Metal Sulfates - 1.5 – 17.3%
Waxes & Resins - 1 – 4%
Adaptation to the root canal system & apical
seal of gutta percha depends on following :
Thoroughness of condensation
Use of solvents
Type of instrument used for adaptation
Temperature
Nature & Amount of the root canal sealer used
Skill of the operator
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29. Limitation
Porous in nature
CAVIT
Zinc oxide based temporary filling
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30. Composition
Zinc oxide, calcium sulfate, zinc sulfate,
glycolacetate, polyvinyl acetate polyvinyl chloride
acetate, Tri ethanolamine, red pigment.
Cavit G & Cavit W available
Hygroscopic set after permeation with water
Greater leakage than IRM or ZOE
Biocompatibility studies are in conflict – toxic
and non toxic
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31. ZINC PHOSPHATE CEMENTS
Rhein (1897) – zinc phosphate cement with gutta
percha to seal root canal system
Herbert (1941) zinc phosphate with thymol as
root end filling material
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33. Not indicated as root end filling material –
solubility, leakage, irritating to tissues, inhibit
healing
POLYCARBOXYLATE CEMENTS
Smith in 1968
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34. Powder – modified zinc oxide with fillers such as
magnesium oxide & stannous fluoride.
Liquid – aqueous solution of polyacrylic acid
Reaction occurs between zinc ions and the
carboxyl groups of the polyacrylic acid
pH – 1.7, working time 3-5 minutes
Limitations
Inflammation of periradicular tissue
Leak significantly greater than amalgam or G-P
Poor sealing ability, uncertain periradicular tissue
response
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35. DIAKET
Tetsch (1986) – as root canal filling material
Polyvinyl resin
As root end filling – thicker consistency
Better apical seal than IRM or super EBA
Comparative study of Diaket an MTA
Both are biocompatible, promote periradicular
tissue regeneration.
Diaket is easy to place than MTA
Sets in a short time
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36. More radiopacity than MTA, GIC, Composite,
cavit, super EBA, IRM and less compared to amalgam
& GP
Insoluble in tissue fluid
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37. GLASS IONOMERS
Reaction of calcium aluminosilicate glass
particles with aqueous solution of polyacrylic acid
Bond physico-chemically to dentine and enamel,
anticariogenic activity
Setting reaction is in two phase
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38. Biocompatibility – shown evidence of initial
cytotoxicity
Good marginal adaptation and adhesion to tooth
structure
Sealing ability adversely affected when
contaminated with moisture
Newer GIC’s containing glass metal powder
(Fugi II, Ketac Silver)
Chong et al used light cured GIC as retrograde
filling
Compared thinly (1mm) applied and thick light
cured GIC’s
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39. COMPOSITE RESIN
Combination with dentin bonding agent showed
good apical seal
Received minimal attention as root end filling
because of cytotoxic effects
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40. McDonald & Dumsha compared composite with
dentin bonding agent, composite alone, cavit,
amalgam, hot burnished G-P and cold burnished
G-P
Recently Wennerberg reported composite resins
bonded tightly to apicoectomized root with
bonding agent.
All polymerizing resins leave and uncured oxygen
inhibiting surface layer
Physical and chemical properties of composite
resin vary widely
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41. ZINC OXIDE EUGENOL
First described by Chisolm (1873)
Nicholls (1962) used zinc oxide cement as
retrograde filling material
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42. Composition
Powder Liquid
Zinc oxide – 70% Eugenol – 100%
Rosin – 30%
Zinc acetate traces
ZOE cement in contact with water or tissue fluids,
hydrolyzed into zinc hydroxide and eugenol
Eugenol can inhibit prostoglandin synthetase,
sensory nerve activity, mitochondrial respiration,
eliminates a range of native oral microorganism
and can be an allergen.
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43. ZOE cement modified in an attempt to resolve
these problems
IRM
(Intermediate Restorative Material)
Is a ZOE cement reinforced
by the addition of 20%
polymethylmethacrylate to
the powder.
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44. Developed to overcome the short comings of ZOE
cement
Composition
Powder Liquid
Zinc Oxide – 80% Eugenol – 99%
Polymethylmethacrylate-20% Acetic Acid – 1%
With reinforcement, problem of absorbability of
ZOE eliminated
IRM elicited a mild to zero inflammatory effect
after 80 days and relatively biocompatible.
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45. To further improve IRM as retrograde filling
material, hydroxyapatite was added
For root end filling thick mix of IRM improves
placement, IRM does not adhere well to itself.
SUPER EBA
(Super ethoxy benzoic acid)
ZOE cement modified with
ethoxy benzoic acid
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47. Has better physical properties than ZOE
High compressive strength, high tensile strength
neutral pH, no solubility, adhere to tooth
structure, adheres well to itself
Composition
Powder Liquid
Zinc Oxide – 60% Ethoxy Benzoic Acid -62.5%
Aluminium oxide – 34% Eugenol – 37.5%
Natural resin-6%
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48. Tissue tolerance shows mild reaction
Provides better seal compared to amalgam GIC,
Gutta percha
Excellent material adaptation and collagen fibres
growing over the material
Disadvantages
Difficult to manipulate – slow setting time,
material adhere to all surfaces, sensitive to
temperature and humidity.
Only moderately radiopaque
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49. MTA (Mineral Trioxide Aggregate)
Developed at Loma Linda University (1993)
Composition
Tricalcium Silicate
Tricalcium Aluminate
Tricalcium Oxide
Silicate Oxide
Mineral Oxides in tracers bismuth oxides
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50. MTA is a powder consists of fine hydrophilic
powder, sets in the presence of moisture.
pH after mixing – 10.2, rising to 12.5 after 3 hrs
Setting time – 4 hrs
Compressive strength comparable that of IRM and
Super EBA, significantly less than amalgam
Compared with amalgam, IRM & Super EBA MTA
provides better seal
Advantages
Least toxic
Excellent biocompatibility
Hydrophilic
Reasonable radiopaque
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51. Disadvantages
Difficult to manipulate
Long setting time
Mixing MTA
Should be prepared just before its used
Powder should mixed with water (3:1) to putty
consistency
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52. Mixture can be carried using a carrier or a plastic
instrument
Extra moisture can
be removed with a
dry piece of gauze
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53. Initially MTA was available as grey powder,
recently white powder also introduced by the exclusion
of iron compounds
Failed apicectomy with One year following second
amalgam root end filling. apicectomy with MTA root
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end
54. MISCELLANEOUS MATERIALS
Titanium
Most frequently used material for dental implants
Excellent corrosion resistance, high mechanical
strength, good biocompatibility, can be easily
formed into any shape
Yasunari et al developed titanium inlay as a root
end filling, showed no clinical or radiographic
problems
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55. Demerits
Metallic material no longer consider because they
share many of the problems of amalgam
Isthmus cannot be filled with titanium inlay
ALUMINIUM OXIDE PINS
Excellent biocompatibility with tight sealing of
the root canal
Keller et al reported success rate of 95%
Contra indicated in large oval cross sections
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56. BONE CEMENT
It is a new material, potentially provide the
necessary properties for an ideal retrofill material
Composition
Powder Liquid
Polymethylmethacrylate Methylmethacrylate
Methylmethacrylate
Barium Sulfate
Low toxicity, excellent biocompatibility, inhibits
bacterial growth, tolerates moist environment
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57. CONCLUSION
Root end filling material should provide a
hermetic seal, should be non-toxic, non-carcinogenic,
biocompatible and dimensionally stable.
Based on studies and clinical performance it is
clear that IRM, super – EBA, and MTA are the
recommended materials available for root end filling.
The sealing ability of MTA is superior to that of IRM
and super-EBA. The regeneration of new cementum
over MTA is a unique phenomenon that has not been
reported with other root end filling materials thus
making MTA the retrofilling material of choice.
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58. REFERENCES
Surgical Endodontics – James L. Gutmann
Colour atlas of micro surgery in endodontics – Syngcuk
Kim
Vasudev S.K et al, Root end filling materials – A review –
JOE, 2003, 15, 11 – 18.
J. Camilleri et al, The constitution of mineral trioxide
aggregate, 2005, 21, 297 – 303.
Niederman et al, A systematic review of invivo retrograde
obturating material, IEJ, 2003, 36, 577 – 585.
Tagger et al, A standard for radiopacity of root end filling
materials is urgently needed, IEJ, 2004, 37, 260 – 264.
Sousa et al, A comparative evaluation of the
biocompatibility of materials used in apical surgery, 2004,
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37, 738 – 748.
59. Thank you for watching
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