Root canal end filling materials /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
Leader in Continuing Dental Education

www.indiandentalacademy.com

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

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

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

VARIOUS ROOT END FILLING
MATERIALS
 Amalgam  Glass ionomer cement
 Gallium Alloy
 Composite Resins
 Gold Foil
 Zinc oxide eugenol
 Silver Cones
 Gutta Percha  IRM
 Cavit  Super EBA
 Zinc Phosphate  MTA
 Diaket  Miscellaneous
 Polycarboxylate
Materials
Cement www.indiandentalacademy.com

AMALGAM

 Most extensively used

 Farrar (1884)

 Rhein (1897), Faulhaber &
Newmann (1912), Hippels
(1914) & Garvin (1919)


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

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

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


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.


LEAKAGE OF AMALGAM

 Multiple techniques advocated to determine
the apical leakage.
 Conclusion drawn from these studies
 Use of amalgam bond, 4-META bonding agent


TISSUE COMPATIBILITY

 Fresh mixed conventional silver amalgam

 Amalgam containing zinc

 Various studies identified cytotoxicity of both

low and high copper content alloys.


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

d. Root end amalgams placing at the time of
surgery


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

TISSUE STAINING ARGYRIA

Causes
 Amalgam scattered in surgical site
 Fractured or loosened
amalgam root end fills

 Galvanism and electrochemical corrosion

PREVENTION

 Control of placement

 Efficient irrigation and aspiration

 Appropriate bulk in the thickness and

mechanical retention.


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

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

COMPOSITION

Alloy Liquid

Silver 60% Gallium 62%

Tin 25% Iridium 25%

Copper 13% Tin 25%

Palladium 20%

Reaction

AgSn + Ga  AgGa + Sn

DISADVANTAGES

 Surface roughness and marginal discoloration

 Manipulation difficult

 Cost 16 times more


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


 Although favourable material properties,

does not appear practical ----- need to establish

moisture free environment, careful placement

and finishing.


SILVER CONES

 Silver cones used to obturate the

root canals since early 1930’s

 Several techniques recommended

root end fill with silver cone


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.


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

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.

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

Limitation
Porous in nature

CAVIT
 Zinc oxide based temporary filling


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

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

Composition
Powder Liquid

Zinc oxide - 90.2% Phosphoric acid - 38.2%

Magnesium oxide - 8.2% Aluminum - 2.5%

Silica dioxide - 1.4% Zinc - 7.1%

Bismuth trioxide – 0.1% Water – 36.0%

Barium oxide

Barium sulphate Traces

Calcium Oxide

 Not indicated as root end filling material –

solubility, leakage, irritating to tissues, inhibit

healing

POLYCARBOXYLATE CEMENTS
 Smith in 1968


 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

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

 More radiopacity than MTA, GIC, Composite,

cavit, super EBA, IRM and less compared to amalgam

& GP

 Insoluble in tissue fluid


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

 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

COMPOSITE RESIN

 Combination with dentin bonding agent showed
good apical seal
 Received minimal attention as root end filling
because of cytotoxic effects

 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

ZINC OXIDE EUGENOL

 First described by Chisolm (1873)
 Nicholls (1962) used zinc oxide cement as
retrograde filling material

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.

 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.


 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.

 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


 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%

 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

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

 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

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


 Mixture can be carried using a carrier or a plastic
instrument
 Extra moisture can
be removed with a
dry piece of gauze


 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
www.indiandentalacademy.comfilling
end

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

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

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

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.

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,
37, 738 – 748.

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