root canal filing materials

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Root canal Filling Materials Dr. Deepthi P.R. 3 rd Year MDS Dept. of Conservative Dentistry & Endodontics

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Page 1: Root Canal Filing Materials

Root canal Filling Materials

Dr. Deepthi P.R.3rd Year MDSDept. of Conservative Dentistry & Endodontics

Page 2: Root Canal Filing Materials

History

Amalgam Asbestos Balsam Bamboo Cement Cu, Fe, ZnOCl, Au or Sn foil, Ag points Pastes PoP Resin Rubber

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Ideal reqmts: Grossman modified Brownlee’s criteria

Obturation of Root canal systems- Endodontics : Colleagues of Excellence, Fall 2009

Page 4: Root Canal Filing Materials

2 basic groups Core filling materials Sealers

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Core materials

Solid core : Ag pointsSemisolid core: Gutta perchaPaste : ZnO containing pastes

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Solid core filling materials-Ag Points Jasper- 1933 1930s- 1960s Advantages DrawbacksSeltzer et al.Brady & Del RioGoldbergGuttirezKehoe

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Newer solid core filling material: Resilon/ Real Seal Polycaprolactone core material

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Resilon/ Real Seal

Bioactive glass Bi, Ba salts: fillers Pigments Resin sealer

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Resilon/ Real Seal

“Monoblock”

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Resilon/ Real Seal

Primer Sealer Synthetic polymer points/ pellets Lower temperatures than GPMiner et al.Nielsen & BaumgartnerShipper et al.

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Resilon/ Real Seal

Susceptibility to degradation- Tay et al.

Interfacial strength analysis: Gesi et al.

Stratton et al, Von Fraunhofer et al.

Wang et al.Epley et al.Williams et al.Karr et al.J Endod 2007; 33: 749-752

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Semisolid core filling materials Gutta percha C- points

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Gutta percha- Discovery & Historical uses “GETAH”: gum “PERTJA”: name of the tree in Malay

language John Tradescant: 1656- ‘ Mazer

Wood’Dr. William Montgomerie: Gold

medal in 1843Ernst Werner von Siemans: 1848

Prakash et al. Gutta- percha: An untold story- ENDODONTOLOGY

Page 14: Root Canal Filing Materials

Gutta percha- Discovery & Historical usesAlexander Cabriol & Duclos: first

GP patentHamock & Bewley: 1845 James Paterson: 1845- hand

moulded golf balls ‘Gutties’Field of Medicine

Prakash et al. Gutta- percha: An untold story- ENDODONTOLOGY

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GP: Evolution into dentistryEdwin Truman: Temporary filling

materialHill’s stopping: 1847Bowman: 1867- root canal filling

materialPerry: 1883S.S. White company: 1887Rollins: 1893Prakash et al. Gutta- percha: An untold story- ENDODONTOLOGY

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GP: Evolution into dentistryCallahan: 1914 Ingle & Levine: 1959Standardized GP: 2nd International

Conference at Philadelphia – 1959 ISO: 1976ADA # 78

Prakash et al. Gutta- percha: An untold story- ENDODONTOLOGY

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Gutta percha- Sources

Rubber trees :Malaysia, Borneo, Indonesia, Brazil

Mimusops globsa, Manilkara bidentata, Blanco genus

Palaqium gutta, Isonanadra gutta, Dichopis gutta

Prakash et al. Gutta- percha: An untold story- ENDODONTOLOGY

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Gutta percha- Indigenous Sources Palaquium obavatum Palaquium polyanthum Palaquium ellipticum Palaquium gutta

Prakash et al. Gutta- percha: An untold story- ENDODONTOLOGY

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Other substitutes

Surinam Gutta-percha Butyrospermum park Dyera costulata Maytenus phyllanthoides Calatropis giganlea Manilkara species Synthetic trans- poly isoprene

Prakash et al. Gutta- percha: An untold story- ENDODONTOLOGY

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Gutta percha- Chemistry

BUNN: 1942

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Gutta percha- Compositions

Crude formGutta : 75- 82 %Alban: 14- 16%Fluavil: 4-6 %Tannin, salts, saccharine

substances

Prakash et al. Gutta- percha: An untold story- ENDODONTOLOGY

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Gutta percha- Compositions 19% to 22% Balata 59% to 75% zinc oxide Waxes Coloring agents Antioxidants Metallic salts

J.L. Gutmann. Root Canal Obturation: An Update. www.ineedce.com

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Gutta percha- CompositionsDental GP- not mostly GP ZnO: 50-79% Heavy metal salts: 1- 17 % Wax or resin: 1- 14% Actual GP: 19- 22%

Obturation of Root Canal Systems- Endodontics: Colleagues for Excellence- Fall 2009

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Gutta percha- Compositions

Ingle’s Endodontics: 6th Edition

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Gutta percha- Compositions ZnO: filler, mild antibacterial Waxes & resins: Plasticizers Metal sulfates:BaSO4-radiopacifier

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Medicated GP

Iodoform Free iodine Protection No difference: regular GP points &

MGP- ability to delay microleakage of E. faecalis Martin et al. 1999

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Medicated GP

Ca(OH)2: (40–60%) (Roeko/Coltene/Whaledent, Langenau, Germany)

Ca(OH)2 containing GP point: improvement in the apical sealing quality Holland et al.

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Medicated GP

Activ Point (Roeko/Coltene/Whaledent): CHX

Better antibacterial than Ca(OH)2 containing GP: Lin et al.

Podbielski et al. GP + tetracycline

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GP: Crystalline phases

Alpha Beta

Prakash et al. Gutta- percha: An untold story- ENDODONTOLOGY

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GP: Commercial manufacture Coagulation Obach’s technique Aging: rejuvenation

Prakash et al. Gutta- percha: An untold story- ENDODONTOLOGY

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Size availability

ISO sizes 0.04 & 0.06 taper Traditional sizes Pellets

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GP: Storage , Sterilization Low humidity Effects of high

humidity

Senia et al.- 5.25% NaOCl – 1 minute

Short et al. Valois et al. Gomes et al.

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GP: Current forms

Solid core Gutta-percha points- Standardized- Non standardized Thermo mechanical compactible GP Thermo plasticized GP- Solid core system- Injectable form Medicated Gutta-percha

Prakash et al. Gutta- percha: An untold story- ENDODONTOLOGY

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GP: Properties

ToxicitySjogren et al.Serene et al. Cross reactivityCosta et al. , Hamann et al.

Solubility

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GP: Thermomechanical properties Plasticity at relatively low

temperatures Heat cycling Shrinkage: 1-2 % Relative inability to transmit heat for

softening and 3D molding

Simons W. Revolutionary Advances, Part 3: Pursuit of the 3-D cork. Dentistry Today. 2015Obturation of Root Canal Systems- Endodontics: Colleagues for

Excellence- Fall 2009

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GP: Advantages

Natural Inert High biocompatibility Dimensionally stable Thermoplastic Compactable Radiopaque Dissolvable Antibacterial activity

Simons W. Revolutionary Advances, Part 3: Pursuit of the 3-D cork. Dentistry Today. 2015

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GP: Disadvantages

Distorted by pressure Forced through the apical foramen if

too much pressure is used Not rigid A sealer is necessary

Carrotte P. Endodontics: Part 8. Filling the Root Canal System. British Dental Journal 197, 667- 672 (2004)

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Smart Seal Obturation SystemSmart materials-Designed materials that have one or more properties that can be significantly changedin a controlled fashion by external stimuli, such as stress, temperature, moisture, pH, and electric or magnetic fields

Badamill & Ahuja. Biosmart Materials: Braeaking New Ground in Dentistry. Hindawi Publications. Vol. 2014

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Smart Seal Obturation System

EndoTechnologies, LLC

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Smart Seal Obturation System Lateral expansion Non isotropicSmart Paste Bio Sealer Bioceramics Ca (OH)2 & HAP Setting time

Badamill & Ahuja. Biosmart Materials: Braeaking New Ground in Dentistry. Hindawi Publications. Vol. 2014

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Smart Seal Obturation SystemEconomides et al.Eid et al.Didato et al. 25 to 45 sizes: 0.04 % & 0.06% taper

Badamill & Ahuja. Biosmart Materials: Braeaking New Ground in Dentistry. Hindawi Publications. Vol. 2014

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Smart Seal Obturation System Self sealing; dentin derived moisture Less dentin removal Avoids compaction forces

EndoTechnologies, LLC

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Paste filling Materials

ZnO Russian Red Trailement SPAD MTA Paraformaldehyde

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Russian Red Eastern Europe, Asian & Pacific rim nations

Orstavik

http://www.dentstal.com

Powder:Dexamethazone 20mgResorcin 11gZinc oxide 50 gBaSO4 29g

Liquid:Formaldehyde solution 10 ml Catalyst:Resorcin 20gHCl 2 mlAqua destillata about 1000m

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MTA

Conventional core filling materials cannot be used

Drawbacks: Somewhat difficult handling characteristics

Extended setting time of at least 3 hours or more

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MTA

Sealing ability Marginal adaptation Leakage Cytotoxicity Repair & Regeneration Use of moist cotton Solubility

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MTA

Whitworth J. Methods of Filling Root canls: Principles & Practices. Endo Topics. 2005, 12, 2- 24

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Paraformaldehyde pastes Angelo Sargenti- Early 1950s Sargenti Paste N2 N2 Normal N2 Medical N2 Universal N2 Apical RC-2B RC-2W TCM White One-Step Endodontic Formula EndodilatoBarrett S. Be Wary of Sargenti Paste. Dental Watch. 09. 01.

2014

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Paraformaldehyde pastes Easier and faster to place Release HCHO Serious injuries to surrounding

tissues

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Paraformaldehyde pastesBrewer D.L.Schwartze T. Position statement by AAE in 1991 No FDA approval Proponents: 1969- American

Endodontic SocietySargenti Opposition Society:

2008

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Paraformaldehyde pastesEndomethasone: Powder: dexamethasone,

hydrocortisone acetate, thymol iodide, paraformaldehyde, & a radiopaque excipient

Liquid: eugenol, peppermint oil & Anise oil

Riebler’s pasteTrailement SPAD

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SEALERS

‘A radiopaque dental cement used, usually in combination with a solid or semi-solid core material, to fill voids and to seal root canals during obturation’ - Glossary of Endodontic Terms

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SEALERS

Impervious seal Filler Antimicrobial Lubricant Adhesive properties

J.L. Gutmann. Root Canal Obturation: An Update. www.ineedce.com

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Requirements of Ideal Sealer1. It should be tacky when mixed to provide good adhesion between it and the canal wall when set.2. It should make a hermetic seal.3. It should be radiopaque so it can be visualized in the radiograph.4. The particles of powder should be very fine so they can mix easily with the liquid.5. It should not shrink upon setting.6. It should not stain tooth structure.

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Requirements of Ideal Sealer7. It should be bacteriostatic or at least not encourage bacterial growth.8. It should set slowly.9. It should be insoluble in tissue fluids.10. It should be tissue tolerant, that is, nonirritating to periradicular tissues.11. It should be soluble in a common solvent, if it is necessary to remove the root canal filling

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Additional requirements

12. It should not provoke an immune response in periradicular tissues. ( Block et al.)13. It should be neither mutagenic nor carcinogenic. ( Harnden & Lewis)

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Criteria of an Ideal Sealer

The sealer should adhere to the obturating material, usually gutta

percha, when placed in the canal, and should adhere to the canal wall with its irregularities to completely fill the

canal space.Gatewood R.S. Endodontic Materials. Dent Clin N Am 51 (2007) 695–712

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Criteria of an Ideal Sealer

The core material itself does not provide an

adhesive seal to the canal wall. To create

and maintain a fluid-tight seal of thecanal is a prime requirement of a

sealerGatewood R.S. Endodontic Materials. Dent Clin N Am 51 (2007) 695–712

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Criteria of an Ideal Sealer

The sealer should contribute to theradiopacity of the root filling forvisualization on radiographs andevaluation of obturation of lateral

canalsand apical ramifications.

Gatewood R.S. Endodontic Materials. Dent Clin N Am 51 (2007) 695–712

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Criteria of an Ideal Sealer

Any shrinkage of the sealer would tend to

create gaps at the dentin interface orwithin the core material,

compromisingthe seal.

Components of sealer should not leach into

dentin leading to coronal or cervicaldiscoloration of the crown

Gatewood R.S. Endodontic Materials. Dent Clin N Am 51 (2007) 695–712

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Criteria of an Ideal Sealer

This property is desirable, but increasing

the antibacterial qualities of a sealer also

increases its toxicity to host tissues.

Should set slowly. A sealer must have ample working time to

allow for placement during obturationand adjustment in the case of

immediatepost-space preparation.

Gatewood R.S. Endodontic Materials. Dent Clin N Am 51 (2007) 695–712

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Criteria of an Ideal SealerStability of sealer when set is a prime factor

in maintaining a hermetic seal over time.This is compromised if fluid contact

causes dissolution of the sealer.

Biocompatibility of the sealer promotesperiradicular repair. Most sealers tend tobe more tissue-toxic in the unset stateand considerably less toxic when fully

set.Gatewood R.S. Endodontic Materials. Dent Clin N Am 51 (2007) 695–712

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Criteria of an Ideal SealerTo allow for retreatment or post-spacepreparation, the sealer and the corematerial should be removable. This

canbe facilitated by using a solvent.

Gatewood R.S. Endodontic Materials. Dent Clin N Am 51 (2007) 695–712

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Based on constituents

Zinc oxide-eugenol Polyketone Epoxy Ca(OH)2 Silicone Resin Glass ionomer Resin-modified glass ionomer

J.L. Gutmann. Root Canal Obturation: An Update. www.ineedce.com

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Eugenol - Rickert’s formula - Grossman’s formula

Carrotte P. Endodntics- Part 5. British Dental Journnal 2004; 197: 455- 464

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Non- eugenol Medicated : Corticosteroid +

paraformaldehyde

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ZnO containing sealers

Paraformaldehyde, Rosin, Canada balsam

Procosol sealer

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ZnO containing sealers

Roth’s 801 Sealer Bismuth subnitrate

Rickert’s formula Kerr’s Pulp Canal Sealer

Pulp Canal Sealer EWT- 6 hours

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ZnO containing sealers

Tubli-SealZnO base paste: BaSO4 Mineral oil Cornstarch Lecithin

Catalyst tube: Polypale resin Eugenol Thymol iodide

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ZnO containing sealers

Wach’s PastePowder: ZnO Bi subnitrate Bi subiodide MgO, Ca3(PO4)2

Liquid: Oil of cloves Eucalyptol Canada balsam Beechwood creosote

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ZnO containing sealers

NogenolBase: ZnO BaSO4 Bi oxychloride Vegetable oil Catalyst Hydrogenated rosin Methyl abietate Lauric acid Chlorothymol Salicylic acid

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ZnO containing sealers

Medicated Canal Sealer Martin Iodoform MGP GP- 10% CHI3

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Ca(OH)2 Containing SealersSealapexBase: ZnO Ca(OH)2 Butyl benzene Sulfonamide Zn stearateCatalyst: BaSO4 TiO2 Proprietary resin Isobutyl salicylate Aerocil

Holland & De Souza

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Ca(OH)2 Containing SealersApexit

www.ivoclarvivadent.in

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Ca(OH)2 Containing SealersCalcibiotic Root Canal SealerSlow setting- 3 daysStable

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Ca(OH)2 Containing SealersVitapex 40% iodoform Silicone oil

Beltes et al.Siquiera et al.

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RESIN SEALERS AH 26 HCHO Advantages Disadvantages

AH Plus & Thermaseal Plus Advantages of AH 26 Epoxy- bisphenol resin:

adamantine WT & ST Other improvements

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EPIPHANY/ REAL SEAL

UDMA, PEGDMA, EPGADMA, Bis- GMA Silane-treated Ba borosilicate Glass, BaSO4, Silica, Ca(OH)2 Bi oxychloride with amines, peroxide Photo inhibitor, pigments Self- etch primer NaOCl & peroxide lubricants EDTA & sterile water

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EPIPHANY/ REAL SEAL Sousa et al. Versiani et al. Solubility Dimensional stability ANSI/ ADA standards Ungor et al.

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DIAKET Polyketone compound Vinyl polymers + ZnO & Bi3(PO4)2 PVC B- diketone Biocompatibility

Eldeniz et al. Shear bond strength

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SILICONE BASED SEALERS Lee Endo-Fill, RoekoSeal Wu et al. Gutta Flow: - Silicone oil - Paraffin oil - Platin catalyst - ZrO2

-Nano-Ag: preservative, coloring agent

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URETHANE METHACRYLATE SEALERS EndoREZ 2- part: chemical set Sealer, Resin- coated Gutta Percha,

Accelerators Hydrophilic characteristics Tay et al. Hirashi et al. Zmener et al.

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ahrendental.com

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Urethane methacrylate sealersEZ Fill Single GP; Bidirectional spiral

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Urethane methacrylate sealersMetaSEAL Thinner version of 4- METABelli et al. Self- etching

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Glass Ionomer Based Sealers Ketac- Endo Good biocompatibility Seal Solubility

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Solvent- based sealers

Johnston & Callahan GP particles + CHCl3 Shrinkage & voids Chlorosin Chloropercha Kloropercha N-

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Evaluation & ComparisonOrstavik ANSI/ ADA & ISO Flow, WT, ST Radiopacity Solubility & disintegration Dimensional change following setting Biologic tests, Usage tests ,

Antibacterial testing Clinical test

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Leakage

Juhasz et al.-Sealapex allowed more leakage than Pulp Canal Sealer

Cobankara et al.- SealapexOrucoglu et al. Diaket + cold

lateral compactionSaleh et al.Pommel et al.Lee et al.Tagger et al.

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Tissue tolerance

Miletic et al.Spangberg & PasconEconomides et al.Huumonen et al.

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Flow

Orstavik Lacey et al.McMichen et alTagger et al.

Orstavik. Endodontic Topics 2005, 12, 25–38

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Setting time & Working time Nielsen et al. Anaerobic: Ketac-

Endo & Resilon Aerobic: Kerr Tubli

Seal & Ketac Endo Roth’s 801 & 811-

slowest Kazemi et al:- ZOE: 4 hours- Endomethasone: 9 hrs- Endo-Fill: 2.5 hrs- AH-26: 12 hrs

Orstavik et al. Flow as a function

of time ZOE sealers

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Solubility & Dimensional change ZOE & Ca(OH)2 Schafer &

Zandbiglari AH plus

Kazemi et al. ZOE sealers Endo- Fill : least Endo- Fill & AH-

26- lower rates

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Radiopacity

Minimum: 3mm Al Std. GP points: 6mm Al

Orstavik. Endodontic Topics 2005, 12, 25–38

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Biological testing

Concern for untoward reaction Extreme situations Delay / prevent resolution

Orstavik. Endodontic Topics 2005, 12, 25–38

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Usage testing

Expt. Animals Uninfected teethKatebzadeh et al. Induced apical

periodontitis

Orstavik. Endodontic Topics 2005, 12, 25–38

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Antibacterial activity

Sipert et al.Pizzo et al.Williamson et al.Siqueira and GoncalvesLeonardo et al.Kayaoglu et al.Aravind et al.

JCD. Iss. 9(1): 2006

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Intraorifice barriers

Composite resins Glass ionomers Cavit IRM Super EBA Dentin bonding agent

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Temporary Filling MaterialsCavit: ZnO CaSO4 ZnSO4 Glycoacetate Polyvinylacetate resin PVC acetate Triethanolamine Red pigment

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Temporary Filling MaterialsIRM:Polymer-resin-reinforced ZOE

TERM: UDMA polymers Inorganic radiopaque filler Pigments Initiators

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Summary

Grossman’s requirements Long term RCTs Tissue regeneration