Endodontic materials BDS III lecture 2024- Dr Kisumbi (1).pdf

Dental endodontic materials.

1. Endodontic materials
Dr. BKK

2. OUTLINE
Introduction
Ideal properties
Classification
Rigid root filling materials
Sealer cements
Root end filling materials

3. Introduction
What is endodontic treatment?
When is it indicated?
What does it involve?
What is the role of endodontics material?

4. Identify the structure

5. Indications & biomaterials application

6. Cont..
Different materials have been used in
filling the root canal system
Pre-formed obturating points (rigid)
and
Root canal-sealing material.(flowable)

7. IDEAL PROPERTIES
Biocompatible
Be easily introduced into the root canal
system.
Seal the canal laterally as well as apically.
Not shrink after being inserted.
Be impervious to moisture.
Be bacteriostatic, or at least not
encourage bacterial growth.

8. Cont…
Be radiopaque.
Not stain tooth structure.
Not irritate periapical tissues.
Be sterile or easily and quickly sterilized
before insertion.
Be easily removed from the root canal if
necessary.

9. CLASSIFICATION
Example ofrRigidroot filling material
Sealer cements
... and introduced into the canal
with a gutta-percha point.

10. RIGID MATERIALS/ POINTS
Are prefabricated
GuttaPerchapoints most frequently used
Resiloncone
Titanium posts, Silver points used in the past (
historical)
Silver points not recommended due to insufficient
sealing capacity,
Due to Increased corrosion and toxicity

11. RIGID ROOT FILLING
MATERIALS

12. GUTTA-PERCHA
Natural product made of the bark of the gutta-percha tree
(Isonandra percha)
Chemically a polymer based on isoprene ( 1,4-polyisoprene)
Two types used in endodontics ;
α-gutta-percha, has a better flow behavior and relative volume
stability. But brittle at room temp.
Is preferred for injectable techniques,
β-gutta-percha, which is more flexible and is primarily used for
points in their solid state. Most GP cones are βphase.

13. GP polymer
β
α
. GP transitions from αto βwhen heated at 46
o
C.

14. Colour coding??
... and introduced into the canal
with a gutta-percha point.

15. Composition
Composition varies between different manufacturers
Gutta percha(20-30%
Zinc oxide –fillers (50-79%) –improves strength and
rigidity
Natural resins-plasticizers (1-4%)
Heavy metals-opacifiers1-17%)
Pigments (1.5-3.4%)
Attempts have been made to make GP more
antimicrobial -Iodoform chlorhexidine, tetracycline
Clinical effects of adding these antimicrobial agents
hasn’t been demonstrated.

16. Gutta-Percha Presentation
Rigid cones
2% taper
4%, 6% taper are available
Standardized GP sizes are designed to match the taper
of the SS and NiTi instruments

17. NiTi files –hand and rotary types
Used to prepare root canals to receive root filling

18. Gutta Percha brands
DiaDent
GAPADENT
META

19. Properties
Biocompatible
Thermoplastic
Easy to manipulate-by both warm and cold techniques
Can be compressed into irregularly shaped root canals using
either lateral or vertical compaction techniques
Radiopaque
Non-adhesive
Dissolves in some organic solvents-eucalyptus oil, alcohol,
acetone
Shrinks when exposed to heat/solvent

20. Properties
Brittle
Becomes more brittle and less elastic due to oxidation.
Should be stored in cool place, out of light to extend shelf life
Cannot be heat sterilized
Can be sterilized by pacing the cones in 5.25% NaOClfor 1 minute
(Siqueira et al 1998)

21. Allergic reactions to GP
One case of a suspected allergic reaction has been
documented
Gutta-percha was applied beyond the root apex in a
female patient who was allergic to latex.
The operator did not wear latex gloves.
Pain, lip swelling, and a diffuse urticaria occurred after
the endodontic treatment. The gutta-percha point was
removed 4 weeks later. There-after, the patient’s
symptoms disappeared

22. Manipulation
Cold lateral condensation technique,
Warm lateral condensation technique,
Warm vertical condensation technique,
Injection of either thermoplasticized or a cold fluid
matrix,
Thermomechanical techniques and carrier based
techniques.

23. Manipulation
Gutta-percha, is selected based on apical canal preparation
The cold lateral technique is considered gold standard
It is coated with sealer cement then inserted
Accessory GP cones are sequentially added until obturation
Excess GP is severed with a warm
Instrument

24. Resilon
Newest core filling material
Is a polycaprolactone polymer
Attempts to ensure continuity between the Root Canal
wall, sealer and the core obturating material

25. Presentation
1. Resiloncone
•which is a polycaprolactone polymer with
dimethacrylatemonomer (3-10%)
•a bioactive glass, bismuth oxychloride and
barium sulphatefillers-for radiopacity
2. Epiphany sealer -is dual-cure resin based
cement
3. Self etching primer.

26. Manipulation
Canal preparation
The smear layer is removed by conditioning with EDTA,
The canal is then primed
The sealer is placed into the canal.
The cone is inserted and the sealer is cured.
The coronal restoration is then placed.
The handling characteristics are similar to those of GP
therefore it can be manipulated using any of the
techniques used for GP.
It can also be softened by heat and dissolved by
chloroform.

27. Properties-Resilon
Physical properties resemble those of
gutta percha
Studies show that quality of obturation
that can be obtained is similar to that of
GP
Susceptible to degradation in the
presence of oral fluids
More expensive than GP

28. Advances in GP
Introduced into market with an
attempt to create a similar bond
between the canal wall and the
cone as in the resilonsystem
Examples
Active GP plus-
Cones coated with Glass Ionomer
Cement to be used with GI
sealer

29. SEALER CEMENTS
Are pastes that are mixed and set via a
chemical reaction
Dental cements
Used in combination with rigid root filling
materials
They ensure the canal is completely
sealed apically, laterally and coronally

30. SEALER CEMENTS

31. SEALER CEMENTS
Zinc oxide eugenol (ZOE) sealers
Calcium-hydroxide-based materials
Resin-based sealers
Mineral trioxide aggregate (MTA)
Silicone-based sealers

32. IDEAL PROPERTIES OF SEALER
CEMENT
Should be tacky when mixed so as to
provide good adhesion between the filler
cone and the canal wall when set.
They should be biocompatible.
The cements should provide a complete
seal apically, laterally and coronally.
They should be radiopaque
They should not undergo setting
shrinkage.

33. IDEAL PROPERTIES OF SEALER
CEMENT
They should be bacteriostatic.
They should set slowly for adequate
working time.
They should be insoluble in oral and
tissue fluids.
They should be soluble in common
solvents like chloroform for ease of
removal in case retreatment is required.

34. ZOE cements
One of the most widely used sealers.
A type of acid–base cement, and forms by
reaction of eugenol with zinc oxide powder.
The matrix of the cement is a chelate substance
consisting of zinc eugenolate.
The current sealers were developed through two
formulae-Rickert’s and Grossman’s formulations
Former cements presented as powder liquid.
Current cements presented as 2 paste systems

35. Formulation of original ZOE
based endodontic sealers

36. Current ZOE sealer cement

37. ZOE
Easy to manipulate,
Undergo no dimensional changes
Non-staining
Radiopaque,
Germicidal (eugenol)
Have ample working time.
Substantial degree of plastic character-are able to
provide a good seal at the root apex

38. ZOE
Disadvantages
Potential for cytotoxicity towards soft tissues-if
eugenol is leached
(Zinc oxide-eugenol is susceptible to hydrolysis,
which causes the material to decompose and release
eugenol.)
Are not resorbed if excess extrudes periapically
Irritate periapical tissues when extruded beyond the
tooth apex.

39. Manipulation
Equal lengths of base and catalyst pastes
are dispensed onto dry glass slab
Mixed using spatula to obtain
homogeneity
ST-5 minutes on glass slab, 20 minutes in
the RC
Final set in 1 hour

40. ZOE brand
Tubliseal.

41. Resin based sealers
Are based on either epoxy resin or polyvinyl resin.
Provide an acceptable seal with gutta percha
points
They initially cause a severe anti-inflammatory
response which subsides after a few weeks
Resistant to degradation in aqueous conditions
Leak more than other sealers (F. Paque et al,
2007)
Leakage due to polymerization shrinkage (V.A
Mahajan et al,2007)

42. AH26, AH26 PLUS:
AH26 Plus was modified from AH26 due to reports of allergenicity
and mutagenicity of AH26 (release of formaldehyde)
AH26 Plus has been shown to have reasonable anti-bacterial
properties
Epoxy resins set slowly (36-48hours) at body temperature
Are difficult to remove

43. Examples of epoxy resin sealers
AH Plus
Diaket

44. AH PLUS
Base paste Catalyst paste
Calcium tungstenate Bisphenol A-glycidyl ether
Adamantane amine, N,N’-
Dibenzoyl-5-oxanonane-
diamine-1,9-TCD-diamine
Calcium tungstenate
Zirconium dioxide Zirconium dioxide
Silicon dioxide Silicon dioxide
Poly(dimethyl) siloxane Pigment
PRESENTED AS 2 PASTES

45. DIAKET
Resin reinforced chelate of zinc oxide and
diketone
Presentation
Fine white powder and viscous liquid
Sets rapidly (6minutes)
Resistant to resorption
Slightly irritant to periapical tissues

46. Calcium hydroxide cements

47. Base Paste
Calcium hydroxide 46
Sulpharaide 38
ZnO 12
Zn. Slearate 2
Colloidal silica 2
Working time 2-5 hrs need humidity if not >>setting
time 10 hrs

48. Catalyst
%
Barium sulphate 39
Resin 33
Isabytyl saliylate 17
Colloidal silica 6
Titanium dioxide 4
Iron oxide < 1

49. Properties
Have an ability to induce apical closure, inhibit
root resorption,
Are able to create as good a seal as ZOE sealers
while eliciting less toxic effects
Disadvantages
They are very soluble
When exposed to tissue fluid for a long time,
calcium hydroxide will leach out hence
compromising on the quality of the seal.

50. Cont…
Calcium hydroxide has an antibacterial effect due to the high
pH (12.5)
Is able to stimulate bone healing and root formation.
Is radiopaque.
They are presented as two pastes
Set via a reaction between calcium hydroxide and a salicylate
ester-aldehyde.

51. Calcium Hydroxide sealers
Sealapex,
Apexit

52. APEXIT-COMPOSITION

53. MTA -Composition
Mixture of tricalcium silicate, tricalcium aluminate,
tricalcium oxide, and silicate oxide
Bismuth oxide is used as radiopacifying agent. It does not
participate in the setting reaction, but remains as an
essentially inert filler within the set MTA matrix.
Excellent biocompatibility with tissues of the root apex
The powder is mixed with water. To facilitate placement of
the material into the root canal
Mixing of the powder with water generates a colloidal gel
that sets within 3–4 h
Its relatively long setting time has been addressed in
products such as Biodentineby the inclusion of calcium
chloride as an accelerator.

54. MTA
The presence of calcium hydroxide within the set
MTA cement makes the material alkaline
Has an antimicrobial effect. However, this was
lower than with ZOE and CH formulations
(Tanomaru-Filho, 2007)
It is marketed in both white (WMTA) and grey
(GMTA) forms, with Al2O3, MgO, and FeO being
present in higher concentrations in the grey
material

55. Uses of MTA
MTA has a wide variety of clinical uses within endodontics.
A root-end filling material
Pulp capping, pulpotomy
In pulpotomies on deciduous teeth it has a higher
success rate than both formocresoland ZOE pastes
(Eidelman, 2001)
To repair lateral root perforations
Apexification

56. MTA-Disadvantages
Long setting time
Difficult to handle
Difficult to remove once set

57. MTA Brands
ProRoot MTA,
grey and white
Biodentine
MTA-Angelus

58. Silicone Based Sealers
Consist of two-paste systems comprising a base and a catalyst
paste.
The silicone components are a polydimethylsiloxane polymer
blended with paraffin oil and filled with finely divided zirconium
dioxide. (radiopacfier)
Insoluble materials with good dimensional stability
They undergo a slight expansion on setting,
Are biocompatible at the root apex
They lack anti-bacterial properties-They therefore rely on
providing a high-quality seal in order to prevent bacterial
colonization

59. Silicone Based Sealers
Roekoseal
Guttaflow

60. Roekoseal
It is dispensed onto a mixing pad and introduced into
the canal with a gutta-percha point. The working time
is 15-30 minutes, while setting takes place after 45-50
minutes.

61. Gutta Flow
Similar to Roekoseal,

62. Ingredients:
•Guttapercha
•Zinc oxide
•Barium sulfate
•Sealer
Polydimethylsiloxane
Silicone oil
Paraffin oil
Zircon dioxide (radiopacity)
Platinum catalyst
Color pigments
Nano-silver (conservation)

63. +
guttapercha powder sealer
< 30 µm
The first “Two in One” cold fluid filling system
+
=
=
patented
Cold fluid gutta percha

64. Dr. Matthias Roggendorf, University of Erlangen
Guttapercha-cone (4% Taper)
Guttapercha-powder
Sealer

65. GLASS IONOMER SEALER
CEMENT
Introduced with the aim to improve the seal during
obturation
May or may not require a GP cone
Disadvantages
short working time
difficulty to remove in case of retreatment

66. Glass ionomer sealer cements
–brand names
Ketac-endo
Endion

67. Epiphany and Endo-rez
Endo-rezand Epiphany are resin based sealer cements
with hydrophilic properties. Can therefore easily
penetrate the moist dentine walls.
Endo-rez, by Ultradent
Commonly used with resin coated GP cores.
Epiphany sealers
Commonly used with resiloncores

68. EndoREZ
Claimed to be hydrophilic. Automixing system.
UDMA based radiopaque material available in Kenya

69. Bioceramicsealers
Bioceramic-based sealers have only been available for
use in endodonticsfor the past 30 years
Calcium silicate-based sealers
Bioceramic-based root canal sealers show promising
results as root canal sealers.
However conflicting findings of their properties

70. Biological and physical
properties of bioceramics
It should be tacky when mixed to provide good adhesion
between it and the canal wall when set.
It should make a hermetic seal.
It should be radiopaque so that it can be visualized on
the radiograph.
The particles of powder should be very fine so that they
can mix easily with liquid.
It should not shrink upon setting.

71. It should not discolourtooth structure.
It should be bacteriostatic or at least not encourage
bacterial growth.
It should set slowly.
It should be insoluble in tissue fluids.
It should be well tolerated by the periapicaltissue.
It should be soluble in common solvents if it is necessary
to remove the root canal filling.

72. Examples of bioceramic
sealers
Al-Haddad et al 2016

75. Root end filling materials
Applied as a filling at apex
Indicated when conventional root obturation
approach is not feasible
apex exposed surgically in apicectomy
procedures

76. Root-end filling materials
Amalgam has been the most widely used
in the past.
It is now abandoned and no longer
recommended because of corrosion and
tissue agyria, persistence of apical
inflammation and poor long term success.

77. Materials used today are;
Reinforced GICs and.
Reinforced ZnOE cements e.g., IRM, super EBA
MTA
Biodentine
Composite resin

78. REFERENCES
http://dx.doi.org/10.1016/B978-0-08-100491-3.00010-6
G. Schmalz, 2009 biocompatibility of dental materials, chapter 7
pg. 187-220
Schürer, N.: Latex-Allergiein der Zahnheilkunde. Stellung-nahme
der DeutschenGesellschaft fürZahn-, Mund-und Kief-erheilkunde.
[Latex allergy in dentistry –a statement of the Ger-man Scientific
Dental Society (DGZMK)] DtschZahnärztlZ 54 (1999).
http://refhub.elsevier.com/B978-0-08-100491-3.00010-6/rf0100
http://refhub.elsevier.com/B978-0-08-100491-3.00010-6/rf0320
Al-Haddad, A., & CheAbAziz, Z. A. (2016). Bioceramic-Based Root
Canal Sealers: A Review.International journal of
biomaterials,2016, 9753210.
https://doi.org/10.1155/2016/9753210

79. Thank you