Retro grade filling

retrograde filling materials used during the endodontic surgical]procedures

1. ROOT END FILLING
MATERIALS
VISHNUJA V R NAIR
II MDS
DEPT OF CONSERVATIVE DENTISTRY &
ENDODONTICS

2. CONTENTS
•Introduction
•Purpose
•Indications
•Ideal requirements
•Root end resection
Classification
Metals / Non-metals
Dental cements
•ZincOxideEugenolBased
•GlassIonomerCement
•MineralTrioxideAggregate
•CalciumPhosphateCement
Resins
• Composite Resins
• Compomers
• Diaket
• Epoxy Resin Based Materials
• Polymethylmethacryate
• Bone Cement
Recent advances
•Castor Oil Polymer
•Ceramicrete
•Bio dentine
•Bio Aggregate
•Endosequenceroot repair material
•Cold ceramic
•iRootBP Plus
•EndoBinder
•GenerexA
•Capasio
•Viscosity enhanced root repair material
•Laser
Testingofmaterials
 Leakageassessment
 Marginaladaptation

3. CONTENTS
•Biocompatibility
a)cytotoxicitytest
b)implantationtest
c)usagetests
•Conclusion
•References

4. INTRODUCTION
•Themainobjectiveofallendodonticproceduresistoobtain
ahermeticsealbetweentheperiodontiumandrootcanal
system,sothatnobacteriaorbacterialbyproductscanenter
orleavefromthecanal.
•Apicalresectionorapicectomyfollowedbyrootend
(retrograde)fillingisacommontreatmentwhenconventional
rootcanaltreatmenthasfailed.

5. •Throughoutthedentalhistory,awidevarietyofrootendfilling
materialshavebeenevaluatedforbiocompatibility,
adhesiveness,dimensionalstability,solubility,leakageetc
inanattempttoidentifytheidealmaterial.
•Athoroughunderstandingoftheavailablematerialsisvery
importantforthesuccessofthetreatment.

6. PURPOSE
•Themainpurposeoftheroot-endfillingistoprovidefluidtight
sealoftherootcanal,toinhibitcoronalleakageofpathogens
andtheirproductsintotheperiradiculartissues,thuspromote
healingandformationofcementumonthecutdentinal
surface.
(Chong&PittFord,2005)

7. INDICATIONS
Treatmentoptioninvolvestheneedtosealcanalopeningapically
whentheycannotbesealedbythenonsurgicalcanalapproach
including:
Anatomic
•Non negotiable dilacerated or
curved roots.
•Extensive canal calcifications.
•Non negotiable parallel canals.
•Internal or external root
perforations.
•Accessory canals.
Iatrogenic
•Apicalmicroleakageispresentin
post&corecaseanditisdifficultto
remove.
•FailedRCTcaseswithdifficultyto
removefillingorobturating
material.
•Brokeninstrumentslodgedinthe
canalthatcannotbebypassed.

8. IDEAL REQUIREMENTS OF ROOT END
FILLING MATERIALS
They should be biocompatible to
periapical tissues
Should be insoluble in tissue fluid
They should adhere to the tooth
(Adhesion)
Should be bactericidal or bacteriostatic Dimensionally stable
Readily available and easy to handle
Materials used in dentistry S. MAHALAKSHMI
Non corrosive, should not stain teeth or
periradicular tissue
Radiopaque
Electrochemically inactive
Promote cementogenesis

9. Extent of
Resection
Instrumentation
Angle of Root
End Resection
Factors to be considered before
root end resection

10. Instrumentation
•Highspeedhandpiecewithsurgicallengthfissureburusuallyresults
insatisfactoryresection.Useofroundburmayresultingougingof
rootsurfacewhereascrosscutfissureburscanleadtounevenand
roughsurface.
•RecentlystudieshaveshowntheuseofEr:YAGlaserandHo:YAG
laserforrootendresectionbutamongtheseEr:YAGlaserisbetteras
itproducescleanandsmoothrootsurface.
Advantages of use of laser in periradicularsurgery over the
traditional methods include:
•Reductionofpostoperativepain.
•Improvedhemostasis.
•Reductionofpermeabilityofrootsurface.
•Potentialsterilizationoftherootsurface.
•Reductionofdiscomfort

11. EXTENT OF APICAL RESECTION ???
Apical Ramification: 52% 78% 98%
Lateral canals: 40% 86% 93%
> 3mm compromises tooth structure
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12. BEVEL ANGLE
•Earlier-45
o
:togainvisualandoperatingaccesstotheroottipforresection,
placementofretrofillingmaterialsandinspection.
•Present-90
o
perpendiculartothelongaxisofthetoothat0
o
degreebevel
Zerodegreebevel
exposelessof
dentinaltubulesto
oralenvironment
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13. CLASSIFICATION
Root canal filling materials can be broadly classified into two
types.
Orthograde
filling
materials
Retrograde
filling
materials.
•Orthogradefilling:materialsarethosewhichareusedtofilltherootcanal
duringnon-surgicalendodontictreatmentthroughthecanalorificesoftheroot.
•Retrogradefilling:materialsarethosewhichareusedduringsurgical
endodontictreatmenttoobtaingoodhermeticsealoftheapex.
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14. Retrograde filling materials can be classified as
Metals
•Amalgam
•Gold Foil
•Tin Foil
•Silver Cones
•Silver Points
•Lead Points
•Titanium Post
•Tin Post
•Gold Screws
Non-metals
•Zinc Eugenol cement
•Zinc Polycarboxylate cement
•Zinc Phosphate cement
•Glass Ionomer Cement
•Cavit
•IRM
•Super EBA
•Composite Resins
•Gutta-percha
•MTA
•Bio dentine
•Bio Aggregate
•Endosequenceroot repair material
•iRootBP Plus
•EndoBinder
•GenerexA
•Capasio
•Viscosity enhanced root repair material
•Laser etc.
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15. •It is the most extensively used retrofillingmaterial from past seven decades.
•Farrar (1884) first reported amalgam as a root end filling material.
AMALGAM
Jain A, Rawat AP, Ratre RK. Comparative Evaluation of the Sealing Efficacy of Zinc-Free High-Copper Amalgam and Mineral Trioxide
Aggregate used as Root-End Filling Material: An In Vitro Dye Penetration Study.
Concerns in the use of amalgam as a root end filling can be categorized under
the following factors
•Type of amalgam (high copper versus conventional, zinc versus non zinc).
•Leakage of amalgam root end fillings
•Tissue compatibility
•Preparation and manipulation of the amalgam.
•Electric potential –galvanic currents, corrosion and degradation
•Pigmentation or argariaof the surrounding tissue.

16. Zinc Vs Non-zinc
•Effectofmoistureonzincalloysiswellestablished,zinccauses
electrolyticdissociationofwaterintohydrogenandoxygen.
•Thepresenceofhydrogengascausesinternalpressuregreatenough
toexpandtheamalgamfromwithin,whichcancauserootend
expansion,orrootfractureandleakage.
•Thereforefromalltheabove:highcopperzincfreeamalgamis
preferredasrootendfillingmaterial.
Jain A, Rawat AP, Ratre RK. Comparative Evaluation of the Sealing Efficacy of Zinc-Free High-Copper Amalgam and Mineral Trioxide
Aggregate used as Root-End Filling Material: An In Vitro Dye Penetration Study.

17. •The conclusion drawn from various studies was root end
amalgam leak minimally adequate at first.
•The marginal adaptation as well as sealing improves as
amalgam ages ,due to formation of corrosion products.
•The use of amalgam bond, 4-META bonding agent with
amalgam significantly reduces the microleakage of
amalgam retrofillings. (Anderson et al)
•4-META monomer contains both hydrophobic and
hydrophilic ends, the hydrophobic end attached to
amalgam and the hydrophilic end helps bonding to dentin.
•This increases dentin sealing and improves resistance but
increase in retention form is not significant.
LEAKAGE OF AMALGAM
Markova K, Manchorova N, Pecheva A. Classification of dental materials for retrograde endodontic filling-an overview.

18. ELECTRIC POTENTIALS –GALVANIC CURRENTS
•Placementofrootendamalgaminatoothwhichhasametallicpostorcrown
restorationcouldcreateagalvaniccouple,whichhasthepotentialtogenerate
significantamountsofelectriccurrents.
•Currentsinexcessof50µAhavebeenshowntocause
•Tissuenecrosis.
•Electrochemicalcorrosion.
•Releasessignificantamountofzincintotheperiradiculartissue.
TibauAV, Grube BD, Velez BJ, Vega VM, Mutter J. Titanium exposure and human health. Oral Science International. 2019 Apr;16(1):15-24.

19. TISSUE STAINING –ARGYRIA
Staining of hard and soft tissue subsequent
to root end amalgam filling could be due
to the following :
•Amalgamscattered in the surgical site
during placement of the root end filling or
due to removal of failing root end
amalgam.
•Fractured or loosened amalgam root end
fills
•Galvanism and electrochemical corrosion
ErakovićM, DukaM, BekićM, MilanovićM, TomićS, VučevićD, ČolićM. Anti-inflammatory effect of amalgam on periapical lesion
cells in culture. Vojnosanitetskipregled. 2021 Mar 26;78(3).

20. GUIDELINES FOR AMALGAM
USAGE AS A ROOT END FILLING
Although amalgam is not the ideal material, the following concepts should be
considered when choosing amalgam as the root end filling material.
•Control of moisture in the surgical site is essential
•High copper alloys are the materials of choice at present
•Varnish or dentin bonding agents must be used prior to alloy placement
•When moisture cannot be controlled zinc free alloys should be considered
•Create a smooth surface of the finished alloy
•Prevent the dispersion of alloy particles in the surgical site

21. Advantages
•Easytomanipulate
•Readilyavailable
•Welltoleratedbysoft
tissues
•Radiopaque
•Initiallyprovidestight
apicalseal
Disadvantages
•Slowsetting
•Dimensionallyunstable
•Itshowsleakage
•Stainsoverlyingsoft
tissues,resultingin
formationoftattoo.
•Morecytotoxicthan
IRM,superEBAor
MTA

22. •Did not inhibit cell growth Fine pellet gold
•Inhibited up to 80% of the cellular
growth
New biofill& karat
Cytotoxicitystudieshaveindicatedvariationsintheinhibitionofcell
growthbasedontheformulationofgold.
WhencomparedtoIRM,compositeresin,amalgamandglass
ionomergoldfoilwasleasttoxic.
Schuster in 1913 & Lyons in 1920
GOLD FOIL
Markova K, Manchorova N, Pecheva A. Classification of dental materials for retrograde endodontic filling-an overview.

23. Advantages
•Due to its malleability and
ductility can be adapted at the
margins perfectly.
•Homogenous surface due to
cohesiveness
•No tarnish or corrosion
•Chemically inert and
biocompatible.
Disadvantages
•Needs a moisture free
environment
•Need for careful placement and
finishing
•Possibility of root fracture under
excessive condensation pressure.
•Need for surgeon expertise in
material management.
Markova K, Manchorova N, Pecheva A. Classification of dental materials for retrograde endodontic filling-an overview.

24. SILVER CONES
•Silverconeshavebeenusedtoobturatetherootcanalssincetheearly1930s.
•Theconewasinsertedintothecanalattheresectedrootendandcutoff,smoothed
orburnishedtoconfirmtheresectedrootsurface.
•Silverconescannotobscurethespaceoftherootcanalinthreedimensions,
especiallyintheapicalthirdoftheroot,wheretheresectionlinewillbeduring
endodonticsurgery.
•Anotherdisadvantageistheinabilitytopolishtheapicalpart.
Markova K, Manchorova N, Pecheva A. Classification of dental materials for retrograde endodontic filling-an overview.

25. ZINC OXIDE EUGENOL
•First described by Chisolm(1873)
•Nicholls(1962) used ZOE cements as a retrograde filling material. The cement
tended to be absorbed over time because of its high water solubility.
Composition
Powder Liquid
•Zinc oxide –70% Eugenol –85%
•Rosin –30% Olive oil –15%
•Zinc acetate –0.7%
•Zinc Stearate –1%
•Magnesium oxide
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26. •Zinc oxide cement + Water Zinc hydroxide and Eugenol.
•This reaction continues until all the ZOE in contact with the free water is
converted to zinc hydroxide.
Eugenol can
•Inhibition of prostaglandin
•Macrophage and fibroblast cytotoxicity
•Sensory nerve activity
•Mitochondrial respiration
•Depressed vasoconstrictor response
•Can be an allergen.
Zinc oxide cements were modifiedin an attempt to resolve these problems
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27. Modified Zinc Oxide EugenolCements
•IntermediateRestorativeMaterial(IRM)
•Cavit
•Ethoxybenziocacidmodified(SuperEBA)
Materials used in dentistry S. MAHALAKSHMI

28. INTERMEDIATE RESTORATIVE MATERIAL (IRM)
•It is a zinc oxide eugenol cement reinforced by
the addition of 20% polymethyl
mechacrylateby weight to the powder.
•Developed to over come some of the short
coming of zinc oxide eugenol cements.
•Composition
Powder Liquid
Zinc Oxide –80% Eugenol 99%
Polymethylmethacrylate-20% Acetic Acid –1%

29. •With reinforcement the problem of absorbability of ZOE cement is
eliminated.
•Tissue tolerance and biocompatibility -a mild to zero
inflammatory effect after 80 days,
•Addition of 10% and 20% of hydroxyl apatite produced
significantly
Better seal than amalgam,
Increased its disintegration rate
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30. ADVANTAGES
•Morebiocompatibleandhas
improvedtissuetolerancethan
conventionalZOE
•Thesealingabilityissignificantly
betterthanamalgam.
•Itdemonstratesantibacterial
property
•Costeffective,easytomixandeasy
tohandle
DISADVANTAGES
•Ithasnodentalhard-tissue
regenerativecapacity.
•Increaseddisintegrationrate

31. CAVIT
•ItisZincOxideEugenolbasedtemporaryfillingmaterial.
whenitisusedasretrogradefillingmaterialitundergoes
hygroscopicexpansionresultinginlinearexpansionof18%.
Materials used in dentistry S. MAHALAKSHMI

32. Advantages
•Duetoitssettingexpansionit
adaptswelltothecavitywallsand
sealsbetter.
Disadvantages
•SimilartoZOE,cavitexhibits
greatersolubilityandquickly
disintegratesintissuefluids.
•Cavitshown to exhibit greater
leakage than IRM
(Friedman S,ShaniJ, et alInt EndodJ. 2018)

33. SUPER EBA (Super Ethoxy benzoic acid)
•Itisazincoxideeugenolcementmodifiedwithethoxybenzoicacid
toalterthesettingtimeandincreasethestrengthofthemixture.
•Ithasmuchbetterphysicalpropertiesthanzincoxideeugenol
•Highcompressivestrength
•Hightensilestrength
•NeutralpH
•Lowsolubility
Adheretotoothstructureeveninmoistconditionandadherewell
itselfthereforeitcanbeaddedincrementally.
•SuperEBAprovidesbettersealthanwhencomparedwith
amalgam,GICandgutta-percha.
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34. •Biologically,Super-EBAiswelltoleratedintheperiradiculartissueswhen
usedasaroot-endfilling.
•However,ithasnocapacitytoregeneratecementum.
•Bonehealinghasbeendemonstratedat12weeks,withsomefibroustissue
persisting.
•Super-EBAroot-endfillingsshowabasophilic-stainedlineadjacenttothe
fillingmaterial,whichmayindicatehard-tissueformation.
•Super-EBAhaslimitedantibacterialeffect.
•ThecytotoxicityofSuper-EBAissimilartothatofamalgamandIRM.
•Incomparativestudiesinwhichamalgamwasalsousedasaroot-endfilling
material,useofSuper-EBAalwaysresultedinlesspersistentdisease
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35. ZINC PHOSPHATE CEMENTS
•Rhein in 1897 used zinc phosphate cement along with gutta-percha
to seal the root canal system prior to root end resection.
•Herbert in 1941 recommended zinc phosphate mixed with
powdered thymol as a root end filling material following root end
resection.
Markova K, Manchorova N, Pecheva A. Classification of dental materials for retrograde endodontic filling-an overview.
Presentlyzincphosphatecementnotindicatedbecauseofthematerials
•Solubility
•Leakage
•IrritatingtotissueandInhibithealing

36. POLYCARBOXYLATE CEMENTS
•IntroducedbySmithin1968
•Whenthecementmixed,thereactionoccursbetweenzincionandthe
carboxygroupsofthepolyacrylicacid,thefreecarboxygroupshavingthe
capacitytochelatecalcium.Thereforeadhesiontotoothstructureisa
significantphysicalproperty.
•pHofthecementisapproximately1.7anditbecomeneutralizedwhenthe
materialset,workingtimeofthecementis3-5mins.
Consist of powder and liquid
Powder contains
modified zinc oxide with fillers such as magnesium oxide and stannous fluoride.
Liquid contain
aqueous solution of polyacrylic acid.

37. LIMITATIONS
•Polycarboxylatesplacedinrootcanalsystemorbeyondthe
confinesofrootapexshowedinflammationof
periradiculartissue.
•Severalapicalleakagestudiesreportedthat
polycarboxylatesleakatlevelssignificantlygreaterthan
amalgamorguttapercha.
Markova K, Manchorova N, Pecheva A. Classification of dental materials for retrograde endodontic filling-an overview.

38. GLASS IONOMER CEMENT
It was developed by Wilson and Kent in 1972
•They are formed by the reaction of calcium aluminosilicate glass particles
with aqueous solutions of polyacrylic acid.
•The setting reaction is 2 phase.
•Initially the calcium ions binds to the polyacrylic acid that provides initial
adhesion to tooth structure,
•after than aluminiumpolycarboxylate are formed. During the initial setting
when calcium salts predominate glass ionomers are extremely sensitive to
moisture.
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39. Biocompatibility study
shown evidence of
initial cytotoxicity with
freshly prepared
samples, with
decreasing cytotoxicity
as setting occurs.
They have good
marginal
adaptation and
adhesion to tooth
structure
Newer glass ionomer cements containing glass
metal powder (Ketacsilver) showed promising
results as root end filling material with less leakage
and no pathological signs.
The sealing ability of
GIC adversely affected
when the root end
cavities contaminated
with moisture at the
time of placement.
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40. Advantages
•Donotinducetissueinflammatory
response
•Lowcytotoxicity
•Thecompatibilitywithboneallows
bonetogrowdirectlyovercement
withoutaninterfaceofgranulation
tissue
•Ithasanexcellentmarginalseal
•Actasbondedcapovertheresected
rootsurface
Disadvantages
•Slowsettingtime
•Glass-ionomer cements are
susceptibletoattackbymoisture
duringtheinitialsettingperiod,
resultinginincreasedsolubilityand
decreasedbondstrength.
•Contaminationwithmoistureand
bloodadverselyaffectedthe
outcomewhenGICwasusedasa
rootendfillingmaterial
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41. Metal –modified GIC
•Itcanbeusedasanalternativeretrogradefillingmaterial
ADVANTAGES
•Lesscytotoxicthanamalgam
DISADVANTAGES
•Corrosion
•Discolorationofsofttissues

42. Resin –modified GIC
•FirstdescribedbyAntonuccietalin1988.
•Theyweredevelopedtoimprovethephysicalandhandling
properties.
Materials used in dentistry S. MAHALAKSHMI
ADVANTAGES
•Improvemechanicaland
physicalproperties
•Lesssensitivetomoisture.
•The adaptation and sealing
ability of a resin modified
GIC is better than the
conventional GIC and silver
amalgam
DISADVANTAGES
•Inabilitytototallydryretrocavity
duringplacementofthecement,
whichiscrucialforbetter
adaptationofthematerialtothe
cavitywalls.

43. MTA (Mineral Trioxide Aggregate)
•Developed at Loma Linda university (1993) for use as root end filling material.
•Commercially available as Pro Root MTA.
•Composition
Tricalcium Silicate
Tricalcium Aluminate
Tricalcium Oxide
Silicate Oxide
Mineral Oxides in tracers bismuth oxides
•It is a powder consists of fine hydrophilic powder, that sets in the presence of
moisture. Hydration of powder results in colloidal gel.
•pH immediately after mixing is 10.2, rising to 12.5after 3 hours.
•Setting time is 4 hours,
•compressive strength –70MPa, comparable that of IRM and super EBA but
significantly less than amalgam.

44. •Hollandandcolleaguestheorizedthatthetricalciumoxidein
MTAreactswithtissuefluidstoformcalciumhydroxide,
resultinginhard-tissueformation.
•MTAappearstobeabletoinducecementoblasticcellstoproduce
hardtissue.
•CementogenesisinthepresenceofMTAhasbeenevaluatedby
assessmentoftheexpressionofosteocalcin(OCN),cellgrowth,
andthemorphologyofcementoblast-likecells
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45. SETTING REACTION
•MTAisatypeofhydrauliccementthatcansetinthepresence
ofwater.
•Powder/liquidratio3:1
•Thesettingoccursasahydrationreactionoftricalciumsilicate
anddicalciumsilicate.
SetMTAhas2phases
•Crystallinephase
•Amorphousphase

46. •Inastudycomparingthesettingtime,compressivestrength,
radiopacity,andsolubilityofMTAtothoseofamalgam,Super-EBA,
andIRM,MTAwasfoundtobelessradiopaquethanamalgambut
moreradiopaquethanSuper-EBAandIRM.
•MTAhadthelongestsettingtime(2hours,45minutes)andthelowest
compressivestrengthat24hoursaftermixing(40MPa),although
compressivestrengthincreasedto67MPaat21daysaftermixing.
•ThesolubilityofMTAaftersettingwassimilartothatofamalgam
andSuperEBA.
•MTAislesscytotoxicthanamalgam,Super-EBA,orIRMroot-end
fillings.
Torabinejad M, Hong CU, McDonald F, Pitt Ford TR: Physical and chemical properties of a new root-end filling
material, J Endod

47. Advantages
•Leasttoxicofallthefilling
material
•Sealingabilityissuperior
•Excellentbiocompatibility–when
MTAcomesintocontactwith
periradiculartissueregenerationof
newcementumoverMTAisa
uniquephenomenon,mechanismof
cementumformationisunclear.
Itcanbebytwomechanism,
Calcificationoffibrousconnective
orActivationofcementoblasts.
•Itishydrophilic
•Reasonableradiopaque
Disadvantages
•Difficult to manipulate
•Long setting time
•Thematerialcostishigh
•Itisdifficulttoremoveafter
setting
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48. Calcium Phosphate Cement (CPC)
•Developed by ADA-Paffenbarger
Dental Research Center at the United
States National
•CPC is a mixture of two calcium
phosphate compounds,
•one acidicand the other basic.
Commonly known as hydroxyapatite
cement,
•it is composed of tetracalcium
phosphate and dicalcium phosphate
reactants.
•The final set cement consists of nearly all
crystalline material
•It is as radio opaque as bone.
•When combined by dissolution in moisture,
even blood, CPC sets into hydroxyapatite.
•It demonstrates excellent biocompatibility,
does not cause a sustained inflammatory
response or toxic reaction.
•Its compressive strength is >60 MPa
+
WATER
form a solid implant
composed of
carbonated
hydroxyapatite.
Markova K, Manchorova N, Pecheva A. Classification of dental materials for retrograde endodontic filling-an overview.

49. Advantages
•Itsetsinthepresenceofmoistureevenintheblood
•Radiopaque
•Excellentbiocompatibility
Markova K, Manchorova N, Pecheva A. Classification of dental materials for retrograde endodontic filling-an overview.

50. COMPOSITE
RESIN
•Composite resin + dentin bonding agent showed good apical seal,
but a dry field is necessary for dentin bonding agent and composite
resin as root end filling because of moisture sensitivity.
Recently Wennerberg
reportedthatcompositeresin
bonded tightly to
apicoectomizedrootwith
bondingagentshowedtissue
regeneration including
cementogenesis.
All polymerizing resins
leave on uncured oxygen
inhibiting surface layer
that may interface with
initial healing and therefore
be removed with a cotton
swab before wound
closure.
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51. •Thehealingresponseoftheperiradiculartissuestocomposite
resinsingeneralappearstobeverydiverse,rangingfrompoorto
goodthismaydependonthetypeofmaterialused.
•Twocompositeresin–basedmaterials,havebeenadvocatedfor
useasroot-endfillingmaterials
Retroplast(RetroplastTrading,Rørvig,Denmark)
Geristore(Den-Mat,SantaMaria,CA)
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52. RETROPLAST
•Bis–GMA/TEGDMAbasedchemicallycuredresincomposite+dentinbonding
agent(GLUMA)hasbeendevelopedforrootendfillingduringendodonticsurgery
in1984
•Workingtime1.5-2mins
COMPOSITION
Paste A: Bis-GMA/TEGDMA 1:1
Benzoyl peroxide
N-di-(2-hydroxyethyl)-p-toluidine
Paste B: resin ytterbium trifluoride aerosil
ferric oxide
GLUMA based dentin bonding agent is
used to adhere material to root end
surface
•Limited information available on
physical and chemical properties
•Material is well tolerated and
promoted a good healing response
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53. Advantages
•Itcompletelysealthecutrootsurfaceincludingdentinal
tubules,isthmus,accessorycanalsandthemainrootcanals.
•An8yearclinicalstudyshowedcompletehealingin77%
casesradiographically.
•Techniquesensitive
•Cytotoxicity
Disadvantages
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54. Resin Ionomer suspension (Geristore)
•Combinationofvariouspropertiesofcompositeresins+GIC
•Requirelightactivationandresin–dentinbondingagentstoattach
•DualcuringpastecontainhydrophilicBis–GMAwithlongterm
fluoriderelease.
•InvitrostudyshowssuperiorresistancetoleakagethanIRM,
amalgam,orSuperEBA
•Recommendedbothasrootendfilling&useinrestoring
subgingivalsurfacedefects
•To restore subgingival surface defects
–root caries
-root resorption
-root perforations
-Subgingival oblique fractured roots
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55. -These materials are less sensitive to moisture than conventional glass-ionomer
cement; however, dry environments produce stronger bonds.
-The effect of blood contamination during the bonding phase in a clinical
scenario is unknown.
-Geristoreappears to have the potential to allow regeneration of the periradicular
tissue
Advantages
•Less sensitive to moisture
•Allow regeneration of periradiculartissues
•Technique sensitive
Disadvantages
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56. DIAKET
•Tetsch(1986)firstdocumentedtheuseofdiaketasrootcanal
fillingmaterial.
•Itisapolyvinylresin-reinforcedchelateformedbetween
ZincoxideandDiketone
•Forrootendfillingaslightlythickerconsistencyofdiaketthan
normalrootcanalsealer.
•StudiesshowedthatdiaketprovidedbetterapicalsealthanIRMor
superEBA.
•Biocompatibleandpromoteperiradiculartissueregeneration
PathwaysofthepulpbystephenCohen–10
th
editionCX

57. •Easytoplacethanmineraltrioxide
•Setsinashortperiod,afterwhichitcanbepolishedtothe
finerotaryinstrument.
•DiakethasmoreradiopacitythanMTA,GIC,compositecavit,
superEBA,IRMandlesscomparedtoamalgamandgutta
percha.
•Itisinsolubleintissuefluid
•Sealer–1:1powder/liquidratio
Rootendfilling-2:1Powder/liquidratio

58. •Histologically,auniquetissuebarrierhasbeenobservedto
formacrosstheDiaketattheresectedrootend,thenatureof
whichisunknown.
•Thistissueresemblesanosteoidorcementoidtypeofmatrix
withacloseapproximationofperiodontaltissuefibers,
suggestingaregenerativeresponsetotheroot-endfilling
material.
PathwaysofthepulpbystephenCohen–10
th
editionCX

59. GUTTA-PERCHA
•Gutta-perchaisthemostcommonlyusedmaterialforretrogradeandorthograde
obturationofrootcanals.Thepurposeishermeticsealingbothcoronaryand
apicaly.
•Inendodonticsurgery,gutta-perchacanbesmoothedwithbothcoldandhot
methods.
•Manystudiesadvocatedthatorthogradegutta-percharootcanalobturationcanbe
usedtosealtheapexoftherootafterapicectomywitheithercoldorhotburnisher
•AbdalandRetiefobservedthatheatsealedguttaperchaprovidesbettersealas
comparedtoamalgam,IRMandsuperEBA.
Markova K, ManchorovaN, PechevaA. Classification of dental materials for retrograde endodontic filling-an overview.

60. LIMITATIONS
Gutta-perchaareporousinnature,itabsorbsmoisturefrom
surroundingperiapicaltissueandexpandsinitiallywhichis
followedbycontractionatalaterstage.Thismayresultsinpoor
marginaladaptation.
Markova K, Manchorova N, Pecheva A. Classification of dental materials for retrograde endodontic filling-an overview.

61. Castor Oil Polymer
•The Castor oil polymer is a common tropical climate plant
(Riccinuscommunis)
•Itisabiopolymerconsistingofchainoffreefattyacidsand
hasahighinteractioncapacitywithhumancells
•Itschemicalcompositionconsistsofchainoffattyacidswhose
molecularstructuresarealsosimilartolipids,thebodydoesnot
recognizethiscementasaforeignbody.
J Appl Oral Sci.2019;17(3):220-3
RECENT ADVANCES

62. •Evaluatethesealingabilityofcastoroilpolymer(COP),mineral
trioxideaggregate(MTA)andglassionomercement(GIC)as
root-endfillingmaterials.
•Concludedthatcastoroilpolymerpresentedanefficientsealing
abilitywhenusedasroot-endfillingmaterialshowing
significantlybetterresultsthanMTAandGIC.
Martins GR, Carvalho CA, Valera MC, Oliveira LD, Buso L, Carvalho AS. Sealing ability of castor oil
polymer as a root-end filling material. Journal of Applied Oral Science. 2009;17:220-3.
Sealing ability of castor oil polymer as a root-end
filling material.

63. CERAMICRETE
•Ceramicreteisaninorganicphosphateceramicbindermaterial
usedtoencapsulateradioactiveandhazardouswastes.
•Itisaself-settingphosphateceramicthatsetsusinganacid-
basereactiontoformapotassiummagnesiumphosphate
hexahydrateceramicmatrixphase.
•Itsmechanicalpropertieswereimprovedbyaddingcalcium
silicatewhiskerstoproduceaphosphosilicateceramicmaterial
Journal of Dental Sciences and Research , 2019,vol.5, issue-2

64. Journal of Dental Sciences and Research,2019, vol.5, issue-2
A comparison of the root-end seal achieved using Ceramicrete,
Bioaggregateand White MTA was done to study the
prevention of glucose penetration.
Both Bioaggregateand Ceramicreteshowed similar sealing
ability to MTA, with Ceramicreteshowing significantly better
results than Bioaggregate

65. BIODENTINE
Uses
•Amaterialforcrownandrootdentin
repairtreatment
•Repairofperforations
•Apexification
•Resorptionrepair
•Root-endfilling.
Biodentine: Biodentine™ It is a calcium silicate based material introduced in
2010, developed by Septodont’sResearch Group
One of the most biocompatible of all the biomaterials in dentistry as
demonstrated according to all the ISO standard tests.
The working time of Biodentine™ is up to 6 minutes with a final set at around
10-12 minutes.
Composition
•Purifiedtricalciumsilicate
powder
•Smallamountsofdicalcium
silicate
•Calciumcarbonate
•Radioopaquer

66. Bioaggregate
•Bioaggregateisanewbioceramicrootrepairandroot-end
fillingmaterial.
COMPOSITION
POWDER
•Tricalciumsilicate
•Dicalciumsilicate
•Tantalumpentoxide
•Calciumphosphatemonobasic
•Amorphoussiliconoxide
LIQUID
deionized water.

67. Bioaggregate: Bio
Aggregate® Root Canal
Repair Filling Material is a
fine white hydraulic
powder cement mixture
It utilizes the advanced science
of nanotechnologyto produce
ceramic particles that, upon
reaction with water produce
biocompatible and aluminum
free ceramic biomaterial.
The working time of
BioAggregateis atleast5
minutes .

68. Endosequence
EndosequenceRootRepairMaterial(ERRM)isanewbioceramic
material
Composition
•calciumsilicates
•monobasiccalciumphosphate
•zirconiumoxide
Endosequenceroot repair material (Brassler, USA):
•It is available in putty and paste forms.
•It is a ready-to-use, premixed bioceramicmaterial for use as a root end filling
material.
•It can also be used for perforation repair and pulp capping.
•This material shows biocompatibility similar to MTA.

69. Cold ceramic
•Itisarecentlyintroducedceramicbasedrootendfillingmaterial
withthemaincomponentbeingcalciumhydroxide.
•Itisbiocompatible
•Hasgoodsealingability
•Settingtime–Initial10minutes
Final24hours
Markova K, Manchorova N, Pecheva A. Classification of dental materials for retrograde endodontic filling-an overview.

70. iRootBP Plus (Innovative BioCeramixInc., Canada):
It is a synthetic water-based bioceramiccement. It is available in ready to use
premixed form and has a biocompatibility similar to MTA .
Viscosity enhanced root repair material (VERRM):
This is a new retrograde filling material which is formulated using Portland cement as the
base material. Bismuth oxide and other compounds were added to improve the radio
opacity and handling characteristics. Hut Kheng et al showed that VERRM’s physical
properties are similar to MTA and is biocompatible with the periradiculartissues.
Markova K, Manchorova N, Pecheva A. Classification of dental materials for retrograde endodontic filling-an overview.

71. Laser: Clinical investigations into LASER, used for apicoectomy began with
the CO2 laser. Later Nd: YAG, Er: YAG lasers were used.
The most promising wavelength has been the Er: YAG at 2.94 micrometers.
The use of laser for apicectomy procedure has some merits, but it takes more
time to perform when compared to more conventional methods.
EndoBinder
•Itisanewcalciumaluminate–basedendodonticcement
•ItwasintroducedtoovercomethedisadvantagesofMTA.
•ItisdevoidofMgOandCaOthatcausedtheexpansionofthematerialandFe2O3
whichleadtodiscolorationofteeth.
EXPERIMENTAL CALCIUM ALUMINOSILICATE BASED MATERIALS
Markova K, Manchorova N, Pecheva A. Classification of dental materials for retrograde endodontic filling-an overview.

72. GENEREX A
GenerexA(Dentsply Tulsa dental, USA)
ItisacalciumsilicatebasedcementandissimilartoMTAbutthe
handlingpropertiesaredifferent.
Insteadofwaterthecementismixedwithaspecialgel.
ThefinalconsistencyissimilartoIRMlikedoughandeasyto
manipulate.
•ItissimilartoProRootMTAmixedwithauniquegel.
•Ithasgoodhandlingproperties
•Itistheonlynewgenerationendodonticmaterialwhichallows
osteoblasticgrowthascomparedtoMTA
Saxena P, Gupta SK, Newaskar V. Biocompatibility of root-end filling materials: recent update. Restorative dentistry & endodontics. 2013 Aug 1;38(3):119-27.

73. •Self-Adhesive -No need for retentive
cavity design.
• Saves chair time and tooth structure.
• Syringe delivery system -Easy and simple
to dispense
• Bonds to all surfaces including: enamel,
dentin
• Low polymerization shrinkage and low
coefficient of thermal expansion -excellent
marginal integrity
• Resistant to marginal leakage and
abrasion.
• Biocompatible -years of clinically proven
safety, especially subgingivally
• Radiopaque -highly distinguishable from
tooth structure in radiographs.
• Technical difficulty
of placing
• Requires light
activation and resin
bonding agent to
bond to tooth
surface.
A
D
V
A
N
T
A
G
E
S
D
I
S
A
D
V
A
N
T
A
G
E
S
Saxena P, Gupta SK, Newaskar V. Biocompatibility of root-end filling materials: recent update. Restorative dentistry & endodontics. 2013 Aug 1;38(3):119-27.Saxena P, Gupta SK, Newaskar V. Biocompatibility of root-end filling materials: recent update. Restorative dentistry & endodontics. 2013 Aug 1;38(3):119-27.

74. Capasio
•Studieshaveshownthatcapasiohasmineralizationcapacityandwhenusedas
rootendfillingmaterialwilllikelypenetratethedentinaltubules.
Capasio(Primus ,USA): It is a new material which contains
bismuth oxide, dental glass, and calcium alumino-silicate
with a silica and polyvinyl acetate-based gel.
According to a recent study, this material has
mineralization capacity similar to MTA in vivo.
It also has the capacity to penetrate dentinal tubules and
supports primary osteoblast growth.
Composition
•Bismuthoxide
•Dentalglass
•Calcium
aluminoslicate
•Polyvinyl acetate
based gel
Saxena P, Gupta SK, Newaskar V. Biocompatibility of root-end filling materials: recent update. Restorative dentistry & endodontics. 2013 Aug 1;38(3):119-27.

75. BONE CEMENT
Bone cement is common in the
practice of orthopedic surgery. The
cement exhibits low cytotoxicity.
High and Russell concluded that
Fibroblasts were completely
unaffected by the bone cement,
whereas amalgam caused cell
lysis.
•Bone cements deliver high
antibiotics locally but do not allow
high systemic concentrations.
•It has also been found to be more
effective than amalgam in inhibiting
bacterial growth.
•In addition, bone cement tolerates a
moist environment very well. Blood
contamination of bone cement
resulted in a slight decrease in shear
strength and no difference in
mechanical penetrationof the
cement interface.
These characteristics potentially make it a suitable desirable retrograde filling material.
Saxena P, Gupta SK, Newaskar V. Biocompatibility of root-end filling materials: recent update. Restorative dentistry & endodontics. 2013 Aug 1;38(3):119-27.

76. Testing of materials
Thesuitabilityofrootendfilingmaterialshasbeentestedby
•Leakageassessment
•Marginaladaptation
•Biocompatability
Cytotoxicitytest
Implantationtest
Usagetestsinexperimentalanimalsandhumanbeings.
Gutmann’s surgical endodontics

77. I.Leakageassessment
Thequalityofapicalsealobtainedbyrootendfilling
materialshasbeenassessedbydegreeofdye,
radioisotopeorbacterialpenetration,electrochemical
means&fluidfiltration
A.Particleleakage
B.Bacterialleakage
Gutmann’s surgical endodontics

78. IIMarginaladaptation
Thescanningelectronmicroscopehasbeenusedtoinvestigate
themarginaladaptationofrootendfillingmaterials.
SpecimenpreparationforexaminationwiththeSEMinvolves
severalsteps,eachcapableofinducingartificialchangesinthe
specimen.
Gutmann’s surgical endodontics

79. Initial test –provides general toxicity
profile of potential materials
Secondary tests –evaluate local
toxicity
usage tests –potential substances are
used in teeth of experimental animals
according to clinical protocols.
III Biocompatibility
Gutmann’s surgical endodontics

80. •1. Agar overlay technique
•2. Millipore filter method
•3. Radiochromiumrelease test
a) Cytotoxicity
tests
Gutmann’s surgical endodontics
B)Implantationtests
Subcutaneous & intraosseous
implantation techniques are
considered suitable secondary tests to
evaluate the biocompatibility.
The implantation method (Friend &
Browne) used Teflon tubes as a
vehicle to place small standardized
surfaces of fresh or set dental material
in contact with designated tissues.

81. C)Usagetests
performedinexperimentalanimals&clinicaltrialsinman.
Periradiculartissueresponsetorootendfillingmaterials
Therootcanalsofexperimentalanimalsareusuallycleaned,shaped,
obturated&afterrootendresectionandpreparationofrootendcavitiesthey
arefilledwithtestmaterials.
Theanimalsarethensacrificed&theirperiradiculartissuesareexamined
histologicallytodeterminethebiocompatibilityofthetestmaterials.
Saxena P, Gupta SK, Newaskar V. Biocompatibility of root-end filling materials: recent update.
Restorative dentistry & endodontics. 2013 Aug 1;38(3):119-27.

82. Clinicalusage
Invitrotests,implantation&usagetestsinexperimentalanimals
arescreeningmeanstoeliminatematerialswithleakage&high
levelsoftoxicity.Thesetestsareprerequisitesandarenot
substitutesforclinicalstudies.
clinicalcomparisonofrootendfillingmaterialsundersimilar
operativeandpostoperativeconditionsistheultimateandmost
reliablemethodforevaluationoftheirclinicalusefulness&their
longtermefficiency.
Saxena P, Gupta SK, Newaskar V. Biocompatibility of root-end filling materials: recent update.
Restorative dentistry & endodontics. 2013 Aug 1;38(3):119-27.

84. Saxena P, Gupta SK, Newaskar V. Biocompatibility of root-end filling materials: recent update. Restorative dentistry &
endodontics. 2013 Aug 1;38(3):119-27.

85. Manymaterialsadvocatedforuseasretrogradefillingmaterialsand
eachhasspecificadvantages&disadvantages.
Thoughretrogradefillingmaterialsnotmuchrecommendedinearlier
days,playsasignificantroleinthesuccessofendodonticsurgery.Endodontic
surgeonshouldconsidermaterialsthatareclinicallyandbiologicallyevaluated
togivelongtermsuccesstothetreatment.
CONCLUSION

86. REFERENCES
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th
edition
•EndodonticsbyJohnFIngle-5
th
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2020.
•Periapicaltissueresponseandcementumregenerationwithamalgam,super
EBA,andMTAasrootendfillingMaterial.BaeketalJOEvol31,no6jun
2018.
•OynickJ,OynickT:Astudyofanewmaterialforretrogradefilling.JEndod.
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•WennbergA,andHasselgrenA:Cytotoxicityevaluationoftemporaryfilling
material.IntEndodJ.201714:121-4.
•MarkovaK,ManchorovaN,PechevaA.Classificationofdentalmaterialsfor
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87. •BhargavaS,ChandraS,ChandraS:Acomparisonoftissuereactionstopotentialretrograde
rootfillingmaterials.Endodontology2017;11:8-13.
•Taggeretal,Astandardforradiopacityofrootendfillingmaterialsisurgentlyneeded,IEJ,
2018,37,260–264.
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Dental and Medical Sciences
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radioactiveanalysisofmicroleakageoffourdifferentretrograde.IntEndodJ.2015;25:183-
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•TorabinejadM,FalahR,KetteringJD,PittFordTR.Bacterialleakageofmineraltrioxide
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88. THANK YOU