Endodontic Materials

Functions of irrigants Irrigants are used to clean the root canal and are used in association with the shaping instruments. Irrigants are used to clean the root canal and are used in association with the shaping instruments. Functions of irrigants include: 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 Ideal properties: Ideal properties: – Lubricant – Antimicrobial – Dissolve organic debris – Flushing – Biocompatible – Cheap

Classification of irrigants Chemically inactive irrigants Chemically inactive irrigants – Water – Saline – Local anaesthetic solution Chemically active irrigants Chemically active irrigants – Sodium hypochlorite (NaOCl). – Oxidizing agents as Hydrogen peroxide (H 2 O 2 ) – Chelating agents as EDTA.

Irrigants Use Use – Adequate volume required – Stays within the confines of root canal – Never deliver with excessive force Apical extrusion results in pain and possible swelling. 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 % % Antibacterial Antibacterial Dissolve organic matter Dissolve organic matter Corrosive/caustic Corrosive/caustic Low toxicity Low toxicity Apical reaction Apical reaction Rubber dam Rubber dam

Hydrogen peroxide 3% +/- NaOCl 3% +/- NaOCl Production of O2 eliminate anaerobes Production of O2 eliminate anaerobes Bubbles may prevent adequate contact of irrigant with debris Bubbles may prevent adequate contact of irrigant with debris Limited shelf life Limited shelf life

Chlorhexidine Hibisrcub( Hibisrcub( HIBISCRUB is an antimicrobial preparation for pre-operative surgical hand disinfection, antiseptic handwashing Usually used in 0.2% concentration Usually used in 0.2% concentration Antibacterial, Substantivity. Antibacterial, Substantivity. Flushing Flushing Lubricant Lubricant Does not dissolve organic debris Does not dissolve organic debris

Chelating agent Ethylene Diamine Tetracetic Acid “EDTA” (File-eze, RC Prep) Ethylene Diamine Tetracetic Acid “EDTA” (File-eze, RC Prep) Remove smear layer allowing Remove smear layer allowing cleaning of tubules Soften dentine Soften dentine Not antibacterial Not antibacterial File-eze is water soluble unlike RC Prep which contains carbowax and is difficult to remove File-eze is water soluble unlike RC Prep which contains carbowax and is difficult to remove

Irrigants Sterile water Sterile water Local anaesthetic Local anaesthetic Saline (0.9%) Saline (0.9%) They only provide lubrication and gross debris removal functions.

Intracanal medicamanets If root canal treatment can’t be finished in a single visit, root canals are dressed with medicaments. If root canal treatment can’t be finished in a single visit, root canals are dressed with medicaments. Functions of intracanal medicaments : Functions of intracanal medicaments : – Primary function: antimicrobial activity Antisepsis ( Antisepsis (is the destruction or inhibition of (slowing the growth of) microorganisms ) Disinfection ( Disinfection (Cleaning an article of some or all of the pathogenic organisms which may cause infection ) – Secondary functions Hard-tissue formation Hard-tissue formation Pain control Pain control Exudation control Exudation control Resorption control Resorption control

Intracanal medicament Ideal properties 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 Hypocal ( Hypocal (contains calcium hydroxide and barium sulfate) Ca(OH)2, 34-50% Ba SO4,5-15% Methylcellulose. Ca(OH)2, 34-50% Ba SO4,5-15% Methylcellulose. Antibacterial (pH>12) Antibacterial (pH>12) Denatures protein Denatures protein Synergestic with NaOCL Synergestic with NaOCL Cytotoxic-local necrosis, calcific barrier Cytotoxic-local necrosis, calcific barrier Cheap Cheap Dries weeping canals Dries weeping canals

Antibiotics Combination of drugs required to be effective Combination of drugs required to be effective Resistant strains becoming more difficult to treat Resistant strains becoming more difficult to treat Allergies Allergies

Steroids Triamicinolone, prednisolone Triamicinolone, prednisolone Pain relief but no evidence of more effective than Ca(OH)2 Pain relief but no evidence of more effective than Ca(OH)2 ?use in root resorption by inhibiting odontoclasts ?use in root resorption by inhibiting odontoclasts ?depresses the host inflammatory response ?depresses the host inflammatory response Not antibacterial but can be mixed with Ca(OH)2 Not antibacterial but can be mixed with Ca(OH)2 Ledermix= triamicinolone+ tetracycline Ledermix= triamicinolone+ tetracycline

Phenol based agents, Aldehydes and Halidyes Phenol, parachlorophenol(PCP), camphorated mono PCP, cresol, creosote, formacresol and chlorine. Phenol, parachlorophenol(PCP), camphorated mono PCP, cresol, creosote, formacresol and chlorine. Antibacterial agents. Antibacterial agents. Highly toxic agents. Highly toxic agents. Possible mutagenic and carcinogenic effect. Possible mutagenic and carcinogenic effect.

Obturating materials Ideal properties of root canal filling 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 Gutta percha “ Isoprene” (C 5 H 8 ) 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: Polymers of isoprene: – Cis-natural rubber – Trans-gutta percha.

Gutta percha points used in clinic consists of: Gutta percha 20% Gutta percha 20% Zinc oxide 60-75% Zinc oxide 60-75% Metal sulphides, waxes, resin, opacifiers Metal sulphides, waxes, resin, opacifiers Gutta percha is available in 2 phases; Alpha and Beta.

Gutta percha taken from trees is in Alpha phase. Gutta percha taken from trees is in Alpha phase. Gutta percha in points used in the clinic is in Beta phase. Gutta percha in points used in the clinic is in Beta phase. Both phases differ in Melting temperature, volumetric changes and flow characteristics when molten. Both phases differ in Melting temperature, volumetric changes and flow characteristics when molten.

Gutta percha Advantages of gutta percha: Biocompatible Biocompatible Dimensionally stable Dimensionally stable Compactable Compactable Easily removed Easily removed Cheap Cheap Disadvantages of gutta percha: Does not adhere to dentine Does not adhere to dentine Lacks rigidity Lacks rigidity

Metal points

Silver Point Failure

Sealers Sealers are used in association with Gutta percha. Sealers are used in association with Gutta percha. Functions of sealer Functions of sealer – Cementing (luting, binding) the core material (gutta percha) 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 Most sealers are toxic when freshly mixed Most sealers are toxic when freshly mixed Toxicity substantially reduced when set Toxicity substantially reduced when set Most sealers are absorbable to some extent when exposed to tissue fluid Most sealers are absorbable to some extent when exposed to tissue fluid Ideally sealer should flow backwards out of the canal 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 Grossmans, Tubliseal Grossmans, Tubliseal Antibacterial Antibacterial Radio-opaque Radio-opaque Slightly toxic when freshly mixed. Slightly toxic when freshly mixed. Good flow and working time Good flow and working time Does not adhere Does not adhere soluble soluble

Calcium hydroxide based sealers Sealapex, Apexit Sealapex, Apexit Radio-opaque Radio-opaque Soluble Soluble Biocompatible Biocompatible Preserve vitality of pulp stump and promote healing Preserve vitality of pulp stump and promote healing Does not adhere Does not adhere

Resin based sealers AH26, AH Plus, Endorez, Epiphany, RealSeal. AH26, AH Plus, Endorez, Epiphany, RealSeal. Adhesive Adhesive Antibacterial Antibacterial Toxic when freshly mixed Toxic when freshly mixed Show setting shrinkage when set Show setting shrinkage when set

Glass-ionomer based sealers Ketac Endo and ActiV GP. Ketac Endo and ActiV GP. Mildly antibacterial Mildly antibacterial Adheres to dentine Adheres to dentine Slightly soluble Slightly soluble Unset GIC is cytotoxic but when set this reduces with time Unset GIC is cytotoxic but when set this reduces with time Very difficult to be removed Very difficult to be removed

Silicone based sealers Roekoseal sealer. Roekoseal sealer. Slightly expands when set. Slightly expands when set. Addition type silicone. Addition type silicone. GuttaFlow is Roekoseal sealer with added gutta percha particles. GuttaFlow is Roekoseal sealer with added gutta percha particles. Does not adhere to root canal. Does not adhere to root canal.

New root canal filling materials Resilon: resin-based cones. Similar in appearance and handling to gutta percha cones. Used with any resin-based sealer. Resilon: resin-based cones. Similar in appearance and handling to gutta percha cones. Used with any resin-based sealer. Endorez cones: resin-coated gutta percha. Used with endorez sealer or any other resin-based sealer. Endorez cones: resin-coated gutta percha. Used with endorez sealer or any other resin-based sealer. ActiV GP: glass ionomer coated gutta percha. Used with glass ionomer based sealers. ActiV GP: glass ionomer coated gutta percha. Used with glass ionomer based sealers.

Retrograde root filling materials Ideal properties Ideal properties – Seals apex – Biocompatible – Ease of handling – Moisture and blood tolerant – Low solubility – Radio-opaque – Good tissue response – Bonds to dentine

Amalgam Corrosion Corrosion Apical inflammation Apical inflammation Poor sealing ability Poor sealing ability Mercury toxicity Mercury toxicity

IRM Modified zinc oxide-eugenol Modified zinc oxide-eugenol Seals better than amalgam Seals better than amalgam Need high powder to liquid ratio to decrease toxicity and solubility Need high powder to liquid ratio to decrease toxicity and solubility Short working time Short working time

Super EBA Modified zinc oxide-eugenol Modified zinc oxide-eugenol High compressive and tensile strength High compressive and tensile strength Neutral pH Neutral pH Low solubilty Low solubilty Not affected by blood Not affected by blood Good tissue response Good tissue response

Composite Problems with moisture control Problems with moisture control Some good results in sealing ability but further work required Some good results in sealing ability but further work required

Glass Ionomer Cements Bonds to tooth substance Bonds to tooth substance Biocompatibilty (Toxicity reduces when set) Biocompatibilty (Toxicity reduces when set) Some antibacterial properties Some antibacterial properties Seal superior to amalgam Seal superior to amalgam

New materials Diaket (Tricalcium phosphate paste) Diaket (Tricalcium phosphate paste) – Polyvinyl resin – Good tissue response – ?cementum forming Mineral Trioxide aggregates (MTA) 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 Laser Hydroxyapatite Hydroxyapatite

MTA Mineral trioxide aggregate: Mineral trioxide aggregate: Pulp capping Pulp capping Nonsurgical apical closure Nonsurgical apical closure Perforation repair Perforation repair Surgical root end filling Surgical root end filling