Root End FillingAbdurrahman Mosaad Mohamed

Under supevision of

Prof.Dr Ali Saafan

Dr Latifa AbdelGawad

National Institute of Laser Enhanced Science

Cairo University

What Is it ?!

• a filling placed in the apical part of a tooth root to seal that affected

part of the root after surgical intervention .

Also called

• Endodontic retro-grade filling

Why we do it ?!

• Objective of retrograde filling is to achieve Tight obturation of the apical canal which is needed to keep micro-organisms and their by-products out of the peri-apical region

How to do ?!

• Flap • Root apex or apeces removal • Cavity preparation • Application of root end filling material .• Suture for 1ry intension

Flap

Indications of endo surgery

• Periapical pathosis• Abscess drainage • Failed endo ttt• Anatomic variation e.g. dilacerations

Take care of …..

• Maxillary sinus outline .• Periodontal status of the patient • Patient medical history e.g. blood problems• Proximity to nerves e.g. mental & mandibular

nerves .

• Laser could be used in REF as follow : 1- for root resectioning … Er-YAG , Nd-YAG are

the best 2- for sterilization of prepared cavity and

resected apex … Er-YAG , Nd-YAG 3- improve sealing of root end material

following its … Er-YAG , Nd-YAG , CO2

Root end preparation

• Class-I cavity measuring a depth of 2-3mm along the longaxis of tooth

• An ultrasonic tip can be used to prepare a cavity withoutrisk of perforation

• Er-YAG , Nd-YAG , Ho-YAG LASER could be used for preparation and root apical resectioning ( Er-YAG produces cleaner resected suface with less thermal damage if compared to Ho-YAG )

• CO2 show rougher surface and less favourable marginal fit following CO2 laser treatment to

the use of continuous wave mode so it is not used in root resectioning

Advantages of laser • Improves the healing process• Reduces the post operative discomfort

#N.B : conventional root end filling is faster and not technique sensitive as in using laser for root end filling

• Valuable in controlling the bleeding during procedure .

• Sterilizes the resected root surface , so no smear layer or debris left on the resected root surfaces prepared using the Er:YAG laser for example .

Requirements of filling material • Seals all bacteria within the canal to prevent

leakage of bacteria & bacterial by products• Non-toxic Non-cariogenic• Biocompatible with the host tissue • Dimensionally stable & Insoluble in tissue

fluids• Easy to use• Unaffected by moisture during setting

• no material has been found that fulfills all or most of the properties for ideal retrograde filling material

Different root end filling materials

• Metals : such as gold-foil, silver posts, titanium screws, tin posts , amalgam (with and without bonding agent) and gallium alloy are some of the solid, commonly used retro-filling materials

• Cements and sealers : such as ZnOE Cement, Super EBA , Diadent BioAggregate (DBA), , zincpolycarboxylate , zinc phosphate and glass Ionomer cements, mineral trioxide aggregate (MTA ) , calcium phosphate cement and bone cement have also been employed for retro-filling

• Mineral trioxide aggregate (MTA),• Discovered by Mahmoud Torabenigad Prof of

advanced endodotics Loma Linda univ. California and produced by Dentsply .

• composed mainly of tricalcic silicate, tricalcic alluminate(*) , bismuth oxide, is a particular endodontic cement. It is made of hydrophilic fine particles that harden in the presence of dampness or blood. ( Set time 3 hrs new MTA set in 12-18 mins ) ( 50Mpa -15Mpa ) (3P:1L )

•DiaDent Bioaggregate

• (DBA) • Most biocompatible material • It is a ceramic nanoparticle material • Set time (4-72 hrs )

• SuperEBA™ is an all-purpose, alumina-fortified ZO material P( 70% ZO , 30% alumina ) L(62.5 % EBA, 37.5% Eu ) The fast set has a 10-15 minute slab set, but a faster in the mouth set of 4-8 minutes.

• An in vitro studies shows Significant difference of sealing ability was found among diff. cements and sealnts used for root end filling DBA followed by MTA and super EBA showed the highest sealing ability.

• Other commonly used materials : are composite resin (with and without bonding agent) and gutta-percha

Laser assisted root end filling studies revealed that ….

• the erbium laser, used for apicoectomy, results in a high success rate with considerable benefit in terms of clinical outcome and therapeutic success.

• that cavities prepared with Er:YAG laser have significantly lower microleakage for all tested root end filling materials.

• resected root apeces treated by laser are more sterile and have higher degree of sealing against micro organisms

Conclusion

• The endodontic surgeon should consider using materials, which have been biologically and clinically evaluated and which give evidence of long term success

• the best technical sequences among the ones• evaluated in this study to perform endodontic

surgeries: 1- apicoectomy with bur and treatment of apical

surface with Nd:YAG laser; 2- apicoectomy with bur, root-end cavity

preparation with ultrasound, filling with MTA, and treatment of apical surface with CO2 laser;

3- apicoectomy with Er:YAG laser and treatment of apical surface with Nd:YAG laser.

• Using Er-Yag laser in root end filling is very beneficial and increases the success rate of the procedure

• Er-YAG laser is superior to Nd-YAG , CO2 and Ho-YAG laser for root end fillings because of effecacy and less thermal damage

• Er-YAG laser could be used in all steps of REF

• Based on review of literature, it appears to date that the existing root-end filling materials do not possess ideal characteristics, but studies have revealed that MTA , Diadent BioAggregate (DBA) and Super EBA are superior to other retro-grade filling materials

Recommendations

• Boost the Er-YAG laser to be widely used root end filling procedures .

• further development of MTA to reduce the long setting time and difficulty in manipulation for use as a root-end filling material

• further researches about Diadent Bioaggregates .

THANK YOU