Root canal Filling Materials
Dr. Deepthi P.R.3rd Year MDSDept. of Conservative Dentistry & Endodontics
History
Amalgam Asbestos Balsam Bamboo Cement Cu, Fe, ZnOCl, Au or Sn foil, Ag points Pastes PoP Resin Rubber
Ideal reqmts: Grossman modified Brownlee’s criteria
Obturation of Root canal systems- Endodontics : Colleagues of Excellence, Fall 2009
2 basic groups Core filling materials Sealers
Core materials
Solid core : Ag pointsSemisolid core: Gutta perchaPaste : ZnO containing pastes
Solid core filling materials-Ag Points Jasper- 1933 1930s- 1960s Advantages DrawbacksSeltzer et al.Brady & Del RioGoldbergGuttirezKehoe
Newer solid core filling material: Resilon/ Real Seal Polycaprolactone core material
Resilon/ Real Seal
Bioactive glass Bi, Ba salts: fillers Pigments Resin sealer
Resilon/ Real Seal
“Monoblock”
Resilon/ Real Seal
Primer Sealer Synthetic polymer points/ pellets Lower temperatures than GPMiner et al.Nielsen & BaumgartnerShipper et al.
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
Semisolid core filling materials Gutta percha C- points
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
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
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
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
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
Gutta percha- Indigenous Sources Palaquium obavatum Palaquium polyanthum Palaquium ellipticum Palaquium gutta
Prakash et al. Gutta- percha: An untold story- ENDODONTOLOGY
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
Gutta percha- Chemistry
BUNN: 1942
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
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
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
Gutta percha- Compositions
Ingle’s Endodontics: 6th Edition
Gutta percha- Compositions ZnO: filler, mild antibacterial Waxes & resins: Plasticizers Metal sulfates:BaSO4-radiopacifier
Medicated GP
Iodoform Free iodine Protection No difference: regular GP points &
MGP- ability to delay microleakage of E. faecalis Martin et al. 1999
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.
Medicated GP
Activ Point (Roeko/Coltene/Whaledent): CHX
Better antibacterial than Ca(OH)2 containing GP: Lin et al.
Podbielski et al. GP + tetracycline
GP: Crystalline phases
Alpha Beta
Prakash et al. Gutta- percha: An untold story- ENDODONTOLOGY
GP: Commercial manufacture Coagulation Obach’s technique Aging: rejuvenation
Prakash et al. Gutta- percha: An untold story- ENDODONTOLOGY
Size availability
ISO sizes 0.04 & 0.06 taper Traditional sizes Pellets
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.
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
GP: Properties
ToxicitySjogren et al.Serene et al. Cross reactivityCosta et al. , Hamann et al.
Solubility
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
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
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)
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
Smart Seal Obturation System
EndoTechnologies, LLC
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
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
Smart Seal Obturation System Self sealing; dentin derived moisture Less dentin removal Avoids compaction forces
EndoTechnologies, LLC
Paste filling Materials
ZnO Russian Red Trailement SPAD MTA Paraformaldehyde
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
MTA
Conventional core filling materials cannot be used
Drawbacks: Somewhat difficult handling characteristics
Extended setting time of at least 3 hours or more
MTA
Sealing ability Marginal adaptation Leakage Cytotoxicity Repair & Regeneration Use of moist cotton Solubility
MTA
Whitworth J. Methods of Filling Root canls: Principles & Practices. Endo Topics. 2005, 12, 2- 24
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
Paraformaldehyde pastes Easier and faster to place Release HCHO Serious injuries to surrounding
tissues
Paraformaldehyde pastesBrewer D.L.Schwartze T. Position statement by AAE in 1991 No FDA approval Proponents: 1969- American
Endodontic SocietySargenti Opposition Society:
2008
Paraformaldehyde pastesEndomethasone: Powder: dexamethasone,
hydrocortisone acetate, thymol iodide, paraformaldehyde, & a radiopaque excipient
Liquid: eugenol, peppermint oil & Anise oil
Riebler’s pasteTrailement SPAD
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
SEALERS
Impervious seal Filler Antimicrobial Lubricant Adhesive properties
J.L. Gutmann. Root Canal Obturation: An Update. www.ineedce.com
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.
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
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)
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
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
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
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
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
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
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
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
Eugenol - Rickert’s formula - Grossman’s formula
Carrotte P. Endodntics- Part 5. British Dental Journnal 2004; 197: 455- 464
Non- eugenol Medicated : Corticosteroid +
paraformaldehyde
ZnO containing sealers
Paraformaldehyde, Rosin, Canada balsam
Procosol sealer
ZnO containing sealers
Roth’s 801 Sealer Bismuth subnitrate
Rickert’s formula Kerr’s Pulp Canal Sealer
Pulp Canal Sealer EWT- 6 hours
ZnO containing sealers
Tubli-SealZnO base paste: BaSO4 Mineral oil Cornstarch Lecithin
Catalyst tube: Polypale resin Eugenol Thymol iodide
ZnO containing sealers
Wach’s PastePowder: ZnO Bi subnitrate Bi subiodide MgO, Ca3(PO4)2
Liquid: Oil of cloves Eucalyptol Canada balsam Beechwood creosote
ZnO containing sealers
NogenolBase: ZnO BaSO4 Bi oxychloride Vegetable oil Catalyst Hydrogenated rosin Methyl abietate Lauric acid Chlorothymol Salicylic acid
ZnO containing sealers
Medicated Canal Sealer Martin Iodoform MGP GP- 10% CHI3
Ca(OH)2 Containing SealersSealapexBase: ZnO Ca(OH)2 Butyl benzene Sulfonamide Zn stearateCatalyst: BaSO4 TiO2 Proprietary resin Isobutyl salicylate Aerocil
Holland & De Souza
Ca(OH)2 Containing SealersApexit
www.ivoclarvivadent.in
Ca(OH)2 Containing SealersCalcibiotic Root Canal SealerSlow setting- 3 daysStable
Ca(OH)2 Containing SealersVitapex 40% iodoform Silicone oil
Beltes et al.Siquiera et al.
RESIN SEALERS AH 26 HCHO Advantages Disadvantages
AH Plus & Thermaseal Plus Advantages of AH 26 Epoxy- bisphenol resin:
adamantine WT & ST Other improvements
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
EPIPHANY/ REAL SEAL Sousa et al. Versiani et al. Solubility Dimensional stability ANSI/ ADA standards Ungor et al.
DIAKET Polyketone compound Vinyl polymers + ZnO & Bi3(PO4)2 PVC B- diketone Biocompatibility
Eldeniz et al. Shear bond strength
SILICONE BASED SEALERS Lee Endo-Fill, RoekoSeal Wu et al. Gutta Flow: - Silicone oil - Paraffin oil - Platin catalyst - ZrO2
-Nano-Ag: preservative, coloring agent
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.
ahrendental.com
Urethane methacrylate sealersEZ Fill Single GP; Bidirectional spiral
Urethane methacrylate sealersMetaSEAL Thinner version of 4- METABelli et al. Self- etching
Glass Ionomer Based Sealers Ketac- Endo Good biocompatibility Seal Solubility
Solvent- based sealers
Johnston & Callahan GP particles + CHCl3 Shrinkage & voids Chlorosin Chloropercha Kloropercha N-
Evaluation & ComparisonOrstavik ANSI/ ADA & ISO Flow, WT, ST Radiopacity Solubility & disintegration Dimensional change following setting Biologic tests, Usage tests ,
Antibacterial testing Clinical test
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.
Tissue tolerance
Miletic et al.Spangberg & PasconEconomides et al.Huumonen et al.
Flow
Orstavik Lacey et al.McMichen et alTagger et al.
Orstavik. Endodontic Topics 2005, 12, 25–38
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
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
Radiopacity
Minimum: 3mm Al Std. GP points: 6mm Al
Orstavik. Endodontic Topics 2005, 12, 25–38
Biological testing
Concern for untoward reaction Extreme situations Delay / prevent resolution
Orstavik. Endodontic Topics 2005, 12, 25–38
Usage testing
Expt. Animals Uninfected teethKatebzadeh et al. Induced apical
periodontitis
Orstavik. Endodontic Topics 2005, 12, 25–38
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
Intraorifice barriers
Composite resins Glass ionomers Cavit IRM Super EBA Dentin bonding agent
Temporary Filling MaterialsCavit: ZnO CaSO4 ZnSO4 Glycoacetate Polyvinylacetate resin PVC acetate Triethanolamine Red pigment
Temporary Filling MaterialsIRM:Polymer-resin-reinforced ZOE
TERM: UDMA polymers Inorganic radiopaque filler Pigments Initiators
Summary
Grossman’s requirements Long term RCTs Tissue regeneration
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