Transcript Endodontic materials

Endodontic
Materials
The main objectives of root canal therapy are:
1. Removal of the pathologic pulp.
2. Cleaning and shaping of the root canal
system.
3. Three dimensional obturation to prevent
reinfection.
Functions of irrigants
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2.
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4.
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
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Ideal properties:
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Lubricant
Antimicrobial
Dissolve organic debris
Flushing
Biocompatible
Cheap
Classification of irrigants
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Chemically inactive irrigants
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Water
Saline
Local anaesthetic solution
Chemically active irrigants
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Sodium hypochlorite (NaOCl).
Oxidizing agents as Hydrogen peroxide
(H2O2)
Chelating agents as EDTA.
Irrigants
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Use
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Adequate volume required
Stays within the confines of root canal
Never deliver with excessive force
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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
0.5-5.25 %
 Antibacterial
 Dissolve organic matter
 Corrosive/caustic
 Low toxicity
 Apical reaction
 Rubber dam
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Hydrogen peroxide
 3%
+/- NaOCl
 Production of O2 eliminate anaerobes
 Bubbles may prevent adequate
contact of irrigant with debris
 Limited shelf life
Chlorhexidine
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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
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Chelating agent
Ethylene Diamine Tetracetic 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
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Irrigants
Sterile water
 Local anaesthetic
 Saline (0.9%)
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They only provide lubrication and
gross debris removal functions.
Intracanal medicamanets
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If root canal treatment can’t be finished in a single visit, root
canals are dressed with medicaments.
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Functions of intracanal medicaments:
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Primary function: antimicrobial activity
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Antisepsis(is the destruction or inhibition of (slowing the growth
of) microorganisms )
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Disinfection(Cleaning an article of some or all of the pathogenic
organisms which may cause infection )
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Secondary functions
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Hard-tissue formation
Pain control
Exudation control
Resorption control
Intracanal medicament
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Ideal properties
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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
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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
Combination of drugs required to be
effective
 Resistant strains becoming more
difficult to treat
 Allergies
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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,
parachlorophenol(PCP),
camphorated mono PCP, cresol,
creosote, formacresol and chlorine.
 Antibacterial agents.
 Highly toxic agents.
 Possible
mutagenic
and
carcinogenic effect.
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Obturating materials
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Ideal properties of root canal filling materials:
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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” (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
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Polymers of isoprene:
– Cis-natural rubber
– Trans-gutta percha.
Gutta percha points used in
clinic consists of:
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Gutta percha 20%
Zinc oxide 60-75%
Metal sulphides, waxes, resin, opacifiers
Gutta percha is available in 2 phases; Alpha and
Beta.
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Gutta percha taken from trees is in Alpha
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.
Gutta percha
Advantages of gutta percha:
 Biocompatible
 Dimensionally stable
 Compactable
 Easily removed
 Cheap
Disadvantages of gutta percha:
 Does not adhere to dentine
 Lacks rigidity
Metal points
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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
Sealers
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Sealers are used in association with Gutta percha.
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Functions of sealer
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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
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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
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However, no evidence that apical extrusion
reduces success rate providing preparation
and obturation are meticulous
Zinc-oxide eugenol
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Grossmans, Tubliseal
Antibacterial
Radio-opaque
Slightly toxic when
freshly mixed.
Good flow and working
time
Does not adhere
soluble
Calcium hydroxide based
sealers
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Sealapex, Apexit
Radio-opaque
Soluble
Biocompatible
Preserve vitality of pulp stump and
promote healing
Does not adhere
Resin based sealers
AH26, AH Plus, Endorez, Epiphany,
RealSeal.
 Adhesive
 Antibacterial
 Toxic when freshly mixed
 Show setting shrinkage when set
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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
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Silicone based sealers
Roekoseal sealer.
 Slightly expands when set.
 Addition type silicone.
 GuttaFlow is Roekoseal sealer with
added gutta percha particles.
 Does not adhere to root canal.
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New root canal filling materials
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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.
ActiV GP: glass ionomer coated gutta
percha. Used with glass ionomer based
sealers.
Retrograde root filling
materials
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Ideal properties
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Seals apex
Biocompatible
Ease of handling
Moisture and blood tolerant
Low solubility
Radio-opaque
Good tissue response
Bonds to dentine
Amalgam
 Corrosion
 Apical
inflammation
 Poor sealing ability
 Mercury toxicity
IRM
Modified zinc oxide-eugenol
 Seals better than amalgam
 Need high powder to liquid ratio to
decrease toxicity and solubility
 Short working time
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Super EBA
Modified zinc oxide-eugenol
 High compressive and tensile
strength
 Neutral pH
 Low solubilty
 Not affected by blood
 Good tissue response
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Composite
 Problems
with moisture control
 Some good results in sealing
ability but further work required
Glass Ionomer Cements
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Bonds to tooth substance
Biocompatibilty (Toxicity reduces when set)
Some antibacterial properties
Seal superior to amalgam
New materials
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Diaket (Tricalcium phosphate paste)
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Mineral Trioxide aggregates (MTA)
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Polyvinyl resin
Good tissue response
?cementum forming
Seals better than amalgam or super EPA
Not adversly affected by blood
Marginal adaptation better than amalgam, IRM or super
EBA
?cytotoxicity
Laser
Hydroxyapatite
MTA
 Mineral
trioxide aggregate:
 Pulp capping
 Nonsurgical apical closure
 Perforation repair
 Surgical root end filling