Pediatric Endo Don Tic Materials

7/29/2019 Pediatric Endo Don Tic Materials

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1

Department of Pediatric & Preventive Dentistry

Presented By: Nilesh Deshpande,

Junior Resident-II.


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Introduction Definition

Different Obturating materials Recent advances Conclusion Bibliography

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The final of endodontic treatment is to fill the entire rootcanal system and all its complex anatomic pathwayscompletely and closely with non irritating hermatic sealing

agents.

Obturation of a root canal should result in a complete sealfrom the coronal aspect to the apex preventing the entry ofmicroorganisms and fluid

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Mathewson in 1995 defined it as the complete

removal of necrotic pulp from the root canals of

primary teeth and filling them with an inertrestorable material so as to maintain the tooth inthe dental arch.

Finn defines it as removal of all pulpal tissues fromthe coronal and radicular portions of the tooth.

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The material should resorb as the roots of primary

teeth resorbs. Should not irritate periapical tissues. Should not coagulate any organic remnants in the

canal. Should be able to adequately disinfect and seal the

canals. Should be non toxic. Should not get dissolve in oral fluids. If surplus material has been filled in periapical area

then it should be easily resorbed.

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Should have proper consistency on mixing so that itcan be adequately pushed into the canal.

It should not discolour the tooth. Should be radiopaque. Should be retrievable if required.

Should be harmless to the adjacent tooth bud.

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Primary Teeth Permanent Teeth

- Zinc oxide eugenol - Gutta percha- Ca(OH2) - Silver Cones- Iodoform paste - Stainless Steel File

method

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B. KRI paste: Iodoform 80% Camphor 4.86% Parachlorophenol 2.025% Menthol 1.215%

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A. Walkhoff Paste:ParachlorophenolCamphorPhenol

C. Vitapex / Metapex:Calcium HydroxideIodoformOily Additives

D. Endoflas:Barium SulphateCalcium HydroxideIodoformZnOE

E. Maisto Paste:ZnOIodoformThymolChlorophenolLenolin


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It is the most frequently used oburant. The filling material of choice is ZnOE without a

catalyst. Lack of catalyst gives adequate working time for

filling the canals.

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NOTE: The most popular of all root canal fillingmaterial for primary teeth are ZnO and eugenol(ZnOE), calcium hydroxide [Ca(OH)2] and iodoformpastes.

Both ZnOE & Metapex/ Vitapex have shownencouraging results.

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Few studies have reported that ZnOE sets into a harder

cement that resists resorption when extruded beyond theapices.

Investigation by Mani et al reported 67% of all overfilledcanals showed over-retained ZnOE at 6 months follow-up.

Flaitz et al 1964reported that 20% of the permanent teeth

showed deflection in case of overfilling of canals with ZnOE.

Eransqun & Munuzabul 1972 reported that ZnOE irritatesthe periapical tissue of rats and may produce necrosis ofbone and cementum.

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Months/years to resorb Grossman, 1974woods, 1984

Jevell & Ronk 1982 reported that premolar eruption wasarrested due to toxic effects of ZnOE.

According to Reddy et al 1985 lack of ZnOEs antibacterialproperties may aggravate residual infection of root canalinstead of promoting healing of infected tissue.

Coll et al 1992 reported it has no significant effect onexfoliation of primary teeth in any of the case.

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Goerig et al in their study reported that ZnOE when mixedwith other root canal filling materials like calcium hydroxide& iodoform has good antimicrobial activity and resorption

capabilities as when used alone.

In 1985 Coll reported that ZnOE could alter the path oferuption of succedneous teeth.

Wright KJ 1994 did a study on comparison and antimicrobialeffects of ZnOE & KRI paste (ZnOE+Iodoform). Resultssuggested that ZnOE has better antimicrobial activity thenKRI paste. It had lower cytotoxicity.

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Coll et al 1998in their study reported that gross own fillingwas related to failure of pulpectomy with ZnOE.

According to Sadiuan et al 2000 tooth overfilled with ZnOEand those filled up to the apex did not show resorption ascompared to those which were filled 1 mm or short of theapex.

Holan et al 2001 reported that 100% of the tooth filled to theapex with KRI paste and 85% of those filled with ZnOE weresuccessful and not statistically different.

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No difference was observed when the teeth were under filledwith ZnOE or KRI paste.

Overfilling of canals, however, resulted in a much highersuccess rate of KRI (75%) then ZnOE (41%), which wasstatistically significant difference.

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Easily available.

Radiopaque material.

Cheaper/ cost effective.

Effective antimicrobial agent.

Also less cytotoxic to cells in direct or indirect contact.

Good plasticity

Insoluble in tissue fluids

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Excessive filling - it leads to mild foreign body reaction.

Muruzabul found that ZnOE cement was highly irritatingto the periradicular tissues and caused necrosis of bone and

cementum.

Rate of resorption does not coincide with rate of resorptionof root ( a little slow).

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Coll and Sadrian reported that ZnOE retained material alterthe path of eruption of succedeneous teeth in 20% of cases.

(However it has been shown that optimally filled andoverfilled canals showed a statistically higher success rate

compared to underfilled root canals).

It has been found that Eugenol is not only cytotoxic but isneurotoxic also.

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Canals are said to be underfilled when the material is filled 2mm short of radiographic apex.

Lentulo-spiral if chosen for obturation then it should besmaller by 2 size from the last H/K file used and 1mm short ofworking length.

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Consists of: Powder: ZnO+ Staybelite resin+ Bismuth

subcarbonate + Sodium borate +

BaSO4 Liquid : Eugenol

Note: At the time of placement pH of cement is 7which potentially makes them as the least irritatingof all dental materials.

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It consists of powder containing ZnO and liquid

containing Eugenol.

Powder contains finely ground ZnO which enhancesflow of cement.

It has been shown that 1 mm of ZnO Eugenolcement has a radiopacity corresponding to 4.5 mmof Aluminum sheet, which is slightly lower than G.P.

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Resin acids (Monobasic carboxylic acids) whenmixed with ZnOE it renders it less soluble than

regular ZnOE cement.

Consistency of paste when used for filling should be

1 scoop powder : 1 drop liquid.

Consistency for temporary filling ZnOE cementshould be 2:1.

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Ca(OH)2 a colourless crystal or white powder.

Prepared by reacting Ca oxide (lime) with water, a

process called slaking and is also known ashydrated lime or slaked lime.

When heated above 5800C it dehydrates forming

the oxide.

Hermann introduced Ca(OH)2 in endodontics in1930.

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1)Antibacterial action

2)Heals peri apical lesions

3)Resorbs easily

4)Does not set intohard mass

5)No discoloration of teeth


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In 1938, Teuscher and Zander introduced the rationale that

Ca(OH)2 has ability to form reparative dentin.

Seltzer and Benden identified the osteogenic potential of

Ca(OH)2.

Tanburic et al summarized the mineralizing effects ofCa(OH)2 .

Estrela et al summarized the antibacterial properties ofCa(OH)2

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There was some controversy regarding the source ofCalcium ions in the dentin bridge repair at exposuresite:

Sciaky and Pisanti, Attalla and Norjaindemonstrated that Ca ions from capping materialswere not involved in bridge formation.

Stark and his colleagues, however believed that Ca

ions come from the blood circulation which theyhave shown by presence of radiolabelled Ca ions.

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Tuan T.J. in 1957, reported that Ca(OH)2 could inhibitmacrophage function and reduces inflammatory reaction inperiapical tissue or in pulp when it is used in pulpectomy or inDPC.

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Mechanism of Action of Calcium Hydroxide


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Base Paste Catalyst Paste Glycol salicylate (40%) - Ca(OH)2 (50% ) Ca(SO4)2

- ZnO (10%) Titanium dioxide (Inert filler) - Zn stearate (0.55%);accelerator

Calcium tungstate or Ba sulphate - Ethyl toluene(Provides radiopacity) - Sulphonamide (39.5%);

oily compound, acts as a

carrier

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Has got an antibacterial action (Initially bactericidal than

bacteriostatic) :

Hydrolyses bacterial cell wall lipopolysaccharides thus making them

incapable of producing biologic effects such as toxicity, pyrogenecityand complement activation.

Neutralizes bacterial endotoxins.

Reduces anaerobic organisms through CO2 absorption.

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Protection of pulp (If used in pulpotomy procedure) Is an ideal pulp protection agent. If used beneath acid containing bases/cements, it

neutralizes the acid due to its high alkalinity.

Should be used in a very thin layer over or nearpulp exposures.

Obliterating the canal space with Ca(OH)2 during

treatment may minimize the ingress of tissue fluidused as a nutrient by microorganisms.

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Blocks patent dentinal tubules, neutralizing attack of

inorganic acids and leached products from certain cementsand filling materials.

Promotes healing and repair.

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Pulp Obliteration:

Due to osteogenic potential, it is capable of inducingcalcific metamorphosis, resulting in obliteration of pulpchamber and root canals.

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Internal resorption:

Induces internal resorption in primary teeth.

However investigations have reported that mixture ofCa(OH)2 and iodoform (Metapex/vitapex) is easy to apply,resorbs at a slightly faster rate than roots and has no toxiceffects on the permanent successor and is radiopaquealso.

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Internal resorption results due to overstimulation ofUndifferentiated mesenchymal cells leading to formation ofodontoclasts. These odontoclasts then resorb the dentin.

Although it has been documented that internal resorptionoccurs due to Ca(OH)2 in primary teeth, it does not appear tobe a problem in permanent teeth.

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Lack of adhesion to hard tissue:

It is a major shortcoming of Ca(OH)2.

This leads to inadequate seal against microleakage.

Furthermore, Ca(OH)2 materials have been found to dissolve underrestorations where microleakage has occurred, resulting in bacterialaccess to the pulp.

Does not adhere to dentin or resin restoration.

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Review of Literature:

Castagnola and Urley in 1952 demonstrated that KRI pastegot resorbed with root at the same rate which was seen as asuccess.

It is bactericidal to microorganism in root canals and losesonly 20% of potency over a 10 year period.

Maisto in 1967 introduced a mixture of ZnOE and Iodoform(Maisto paste) as a RC filling material in permanent teeth,

but was used by Tagger and Sarnet in 1984 in primary teeth.

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Garcia Godoy in 1987 found that KRI paste is bactericidal inroot canals, resorbs from the apical tissues in one or twoweeks, is apparently harmless to tooth germs, is radiopaque,does not get to a hard mass and is easily inserted and

removed.

Mass in 1989 found Maistos paste to be successful intreating an infected primary posterior teeth. He reported

that iodoform containing pastes are easily resorbed from theperiradicular region and causes no foreign body reaction likeZnOE.

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Doninguez in 1989 reported that when iodoform andCa(OH)2 are combined excellent clinical, radiographic andhistological results were obtained.

Matsuzuki in 1996 reported that iodoform improved

antiseptic and radiographic effects.

Reddy and Fernandes in 1996 found Maisto paste to be100% successful. 93% should bone regeneration withcomplete healing of interradicular pathology and complete

resorption of excess material.

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Nucko and Godoy in 1999 evaluated effectiveness of vitapexCa(OH)2 +iodoform paste and found that it is radiopaque,does not set to a hard mass, resorbs from the apical tissues

in 1 week to 2 mos., apparently harmless to permanenttooth germ and can be easily inserted and removed.

Chawla HS in 2001 evaluated the effect of mixture of ZnOpowder, Ca(OH)2 paste and distilled water as a root canal

filling material. They found that material resorbed at thesame rate as the root.

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Fuks et al 2002 conducted a study using endoflas as fillingmaterial. After 52 months, overfilling led to a success rate of58%, underfilling showed a success rate of 83%. The pastealso got resorbed extra radicularly.

In a study conducted on 96 primary molars for clinical andradiographic evaluation of pupectomies using ZnOE andiodoform (RC fill), Ca(OH)2 and iodoform (vitapex), ZnOE+Ca(OH)2 +Iodoform (endoflas) in 72 children of age group 4-7

years, it was reported that success rate was:90.6% with Metapex84.7% with RCfill95.1% with Endoflas

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It is preparation of iodine.

Obtained by the action of chlorinated lime upon an alcoholic

solution of iodide of potassium heated at 1040 deg F.

The product being iodoform and iodate of lime.

Iodoform has no irritant action.

In small doses it relives pain, disinfectant having greatinfluence on the nervous system.

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Highly resorbable, bacteriocidal.

Iodoform 80% Parachlorophenol 2%, Camphor 5%, Menthol 1%.

Fuks et al 2000 found that1. Success rates of 84% with the Kri paste group versus

65% with the ZOE group.2. Overfills more successful (Kri paste 79% vs. ZOE

41%). The excess paste will resorb without causingany adverse side effects.

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Composition

1. Camphorated Parachlorophenol : 4-8%2. Eugenol: 24 to 22%3. Zinc oxide: 48 to 58%4. Di-iodothymol: 12 to 18%5. Menthol crystals: 1.40 to 2.90%

6. Silver powder: 0.70 to 1.45% approx.

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Antiseptic agent Dissolve albumins and which can therefore

progressively penetrate into the canaliculi of the

tooth.

Major disadvantage is its total resorption, whichoccurs both in the periapical area and in the canal areaof the tooth.

Even in the most favourable cases, there is no longerany trace of paste in the previously filled canals, oneyear after filling of the canals has taken place.

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To allay the pain arising from the near exposure of the pulps ofteeth

Also the pain of sensitive dentine

Also to arrest the hemorrhage and allay the pain of woundedpulps of teeth.

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Anodyne Antispasmodic Antiseptic

Menthol has given satisfaction as an external remedy infacial neuralgia, odontalgia, as an obtunder of sensitivedentine, and as a local anesthetic

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Endoflas is root canal sealer material

Composed of zinc oxide,barium sulfate,iodoform,calcium

hydroxide,eugenol and pentchlorophenol

One condition for success of endoflas is prevention ofmicroleakage.

A permanent restoration should be placed as soon as

possible after clinical signs and symptoms of inflammationare eliminated.


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PROPERTIES ZOE VITAPEX KRI PASTE

Rate of resorption Slower than that of toothroot

Slightly faster than that of toothroot

Faster than that of tooth root

Toxicity None None None

Overfill resorption Occurs Occurs Occurs

Antiseptic action Present Present Present

Application Easy

Adherence to canal wall Good Good Good

Removal Easy Easy

Radioopacity Radioopaque Radioopaque Radioopaque

Discoloration of tooth None None None


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Chawla H.S et al in 2008performed endodontictreatment on 25 pulpally involved mandibular primary

molars in 4-9 yrs old children, the root canals were

obturated with new root canal filling material consisting of

mixture ofcalcium hydroxide ,zinc oxide and 10%sodium fluoride solution.

All cases were clinically and radio graphically evaluated

after 3 months and 6 months.

It was observed that the rate of resorption of this new

root canal obturating mixture was quite similar to rate of

physiologic root resorption in primary teeth.


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NON-RESORBABLE OBTURATINGMATERIALS


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Introduced by Bownaan in 1867.

Chemically, gutta-percha is a polyterpene, a polymer ofisoprene, or polyisoprene, specifically (trans-1,4-

polyisoprene)

Gutta-percha (Palaquium) is a genus of tropical trees nativeto Southeast Asia

It is an inelastic natural latex produced from the sap of thesetrees, particularly from the species Palaquium gutta.

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http://en.wikipedia.org/wiki/Terpenehttp://en.wikipedia.org/wiki/Polymerhttp://en.wikipedia.org/wiki/Isoprenehttp://en.wikipedia.org/wiki/Polyisoprenehttp://en.wikipedia.org/wiki/Treehttp://en.wikipedia.org/wiki/Southeast_Asiahttp://en.wikipedia.org/wiki/Latexhttp://en.wikipedia.org/wiki/Saphttp://en.wikipedia.org/wiki/Saphttp://en.wikipedia.org/wiki/Latexhttp://en.wikipedia.org/wiki/Southeast_Asiahttp://en.wikipedia.org/wiki/Southeast_Asiahttp://en.wikipedia.org/wiki/Southeast_Asiahttp://en.wikipedia.org/wiki/Treehttp://en.wikipedia.org/wiki/Polyisoprenehttp://en.wikipedia.org/wiki/Isoprenehttp://en.wikipedia.org/wiki/Polymerhttp://en.wikipedia.org/wiki/Terpene


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As it is obtained from tree, gutta percha is white in color.

By the addition of dyes it may be turned to any color of therainbow.

For many years it was dyed pink or red for endodontic usebecause that was the color of the pulp, which it replaced.

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According to Friedman and associates:

- Gutta Percha (Matrix): 18 - 22 %- ZnO (filler) : 59 76 %.- Heavy metal sulfates (radiopacifiers):1 10 %- Waxes or resin (plasticizer): 1 4 %

Because of the poor sealing ability of GP, regardless oftechnique, it must be combined with a root canal cement or

sealer to ensure proper filling and sealing of the root canal.

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Guttapercha at room temperature is considered to be inthe beta phase. In this stage gutta-percha is solid,compatible and elongatible.

When heated to 42 to 49C it undergoes a phase changeto alpha phase. In this phase it is runny, tacky, sticky, non-compatible and non-elongatible.

The 3rd or gamma phase occurs when heating is raised to 56to 62C. The properties are similar to the 2nd phase.

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The materials expands when heated from the beta to thegamma or alpha phase from less than 1% to almost 3%when cooled down to the beta phase, a shrinkage takes

place, of similar percentiles, but the degree of shrinkagealmost always is greater than the degree of expansion andmay differ by as much as 2%.

That means if gutta-percha is heated above 42 to 49C and

then inserted into a prepared canal, a condensationprocedure should be applied / some method used to lesserthe problem of shrinkage.

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Guttapercha is available as:STANDARDIZED GUTTAPERCHA

They approximate the diameter and taper of root canal

instruments. Available as primary cones (No. 15 to 140)

NON-STANDARDIZED GUTTAPERCHA

More tapered in shape, hence used as auxiliary cones inlateral and vertical condensations.

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1. Compressibility or Compatibility:

2. Inertness:

- least reactive of all the materials.- Considerably less reactive than gold and silver.

3. Dimensional Stability:- undergoes almost no dimensional change after completionof condensation in the canal.

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4. Tissue tolerance:

5. Radiopacity:- It is radiopaque and therefore easily recognized on dentalfilm.

6. Becomes plastic when warmed :- When heated above 420 to 490C, some changes occur inGP.- According to Marchin and Schilder after heating, GP could be

packed with pluggers and its mass increases in volume.

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7. Has known solvent:- The most common being chloroform and Xylene.- It may be dissolved completely by chloroform allowing

retreatment if required.

8. Elongatable when fresh, brittle when old:- Fresh Gutta percha when stretched elongates.- Old GP breaks off when stretched indicating that old GP

would not be as compact as fresh one on obturation.

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9. Does not shrink after placement.

10. Is easily sterilized prior to insertion and does notallow bacterial growth.

11. Probably the least toxic and least irritating toperiapical tissues, of all the root canal filling materials.

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1. Lack of Rigidity:- Bends easily when subjected to lateral pressure.- Makes it difficult to use in smaller sizes (i.e. less than 30).

2. Lack of Length Control:- It permits vertical distortion by stretching, unless itmeets an obstruction i.e. it has little control over whatdepth it will reach.

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3. Inability to seal the canal apically unless it is combined witha root canal cement or a sealer.

4. It has got limited shelf life, becomes brittle with age(process hastened with warmth and delayed when

refrigerated).

Note:Soin and Oliet described a technique to rejuvenate the aged

brittle cone by momentary immersion in hot tap water (550C)followed by instant cooling in cold tap water.

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Guttapercha (beta-phase).

Compacted gutta-percha.

Injection moulded Obtura II, Ultrafil.

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When the canal has irregular walls and has a non-circularshape.

Whenever a condensation technique is utilized that requiresaflare preparation to size 30.

In cases where a lateral / or an auxiliary canal is anticipated /multiple apical foramen present.

Whenever there is a strong possibility of occurrence of anoverfilling (as semi-solid materials are well tolerated by

tissues). In cases ofinternal resorption. In cases where apical surgery has to be performed.

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Warm GP Technique.

Thermoplastic GP delivery system (Thermafil).

Compacted GP (Mc Spadden Compactor)

Injection molded techniques (e.g.. Obtura II, Ultrafil).

Chemically plasticized GP (Eucapercha and Chloropercha).

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Introduced in dentistry in 1930s.

It was pure silver molded in conical shape.

Was often used for the obturation of very narrow canals inwhich GP was difficult to insert (because of lack of stiffnessof GP).

Also the technique was less time consuming.

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Did not require much of canal enlargement.

In 1941 Jasper introduced silver wires later called as Ag

points/cones.

Most silver cones contain small amounts of other tracemetals (0.1- 0.2%) such as Cu and Ni along with Ag.

This adds to the cohesion of Ag cones (most common clinical

complication).

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Indicated in mature teeth with small or well confined round

tapered canals:1. Maxillary I premolars with 2 or 3 canals,2. Buccal roots of mature maxillary molars

3. Mesial roots of mandibular molars if they are straight.

Not indicated for filling anterior teeth, single canalpremolars or large single canals in molars.

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Seltzer and Colleagues have shown that if failed they

appear black when removed from the canals.

Kohoe reported a case of localized argyria of buccal gingival,a dark blue pigmented tattoo surrounded by a gray hole.

Guttieriez and his associates in Chile reported that corrosion

in cones appear due to canal irrigants.

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Silver has more rigidity then Gutta Percha hence can be

pushed into small and thin canals in which Gutta Percha isnearly impossible to insert up to apex of the tooth.

Indicated in a tooth if it has to be restored with post and coresince it difficulty in cutting the cone.

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They corrode because of microleakage.

Proper apical seal is not obtained.

Poor adaptation.

Difficult to retrieve retreatment difficult.

Lower success rate has been reported with silver cone ascompared to GP.

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Can be used to fill fine, tortuous canals.

Suggested by Sampeck, they have been used instead ofGutta percha.

Can be inserted into canal with greater ease as compared tosilver cones.

File is inserted into the canal and once it is inserted than thehandle of the file is cut off with high speed bur 3 to 4 mmbelow the occlusal surface to allow space for restoration.

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Fox and Colleagues have reported 6 7 % failure rate forroot canals filled with this method.

Timpawat and associates found that silver cones or SS fileswhen used with a sealer for obturation leaked less than GPand sealer, in severely curved canals.

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Mineral trioxide aggregate (MTA) was first described byM.Torabinejad et al in 1993 when it was used as a root endfilling material.

It was approved by U.S. Food and Drug Administration in1998.

Mineral trioxide aggregate is a powder that consists of finehydrophilic particles that set in the presence of moisture.

Hydration of the powder results in a colloidal gel thatsolidifies to a hard structure.

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ProRootTM MTA

COMPOSITION

Tricalcium Silicate

Dicalcium Silicate

Tricalcium Aluminate

Tetracalcium Aluminoferrite

Bismuth Oxide 20%

Calcium Sulfate Dihydrate (gypsum)

5%


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Available in open single pouch use entire content of water ampule

hydrate all the powder

add 1 to 2 drops of sterile water if too stiff 5 minute working time

4 to 6 hour set time

cover mixture with moist gauze pad to extend working time


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Tarabinejad and Pitt Ford (1937) histogically assured MTAwith amalgam and observed that a complete layer ofcementum is formed with MTA as a root end filling materialas compared to amalgam.

Tarabinejad and Talah (1955) evaluated the leakage abilityof MTA and other materials like amalgam and Intermediaterestorative material and reported that MTA leakedsignificantly less than other root end filling materials.

D.Arens and M.Tarabinejad (1956) showed the effectivenessof MTA in furcal closure (communication between pulpchamber and underlying periradicular tissue).

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Torabinejad and Hung (1960) evaluated the

cytotoxic effect of MTA and reported that it ispotentially a bio-compatible material.

Torabinejad and Watron (1993) showed that MTAas a root end filling material showed less leakage ascompared to amalgam.

Torabinejad and Dittford (1993) reported that MTAhas an antibacterial effect.

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Sluyk & Moun (1998) evaluated the retention character ofMTA when used as furcal repair material and found that:

MTA resist displacement at 72 hrs of placement significantly

greater than at 24 hrs. With slight displacement at 72 hrs it demonstrates the ability

to re-establish resistance to displacement from dentinalwalls.

Presence of moisture in perforation during placement was

advantageous as it aids in retention.

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Tarabinejad and N. Clivean (1999) concluded from theirstudy on MTA that it can be used successfully forapexification, pulp capping with reversible pulpitis, repair ofroot perforations non surgically and surgically.

Eidelman (2001) used MTA in place of formocresol inpulpotomized primary molars and found it to be a suitablereplacement material for formocresol.

M.Acinnehhi et al (2003) compared MTA with Ca(OH)2 whenused as a pulp capping material in human teeth andevaluated less inflammation, hyperemia, necrosis andthicker dentin bridge with MTA than with Ca(OH)2.

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It stimulates cytotoxin release from bone cells i.e. itactively promotes formation of biologic barrier.

It produces thicker dentinal bridge.

Produces less inflammation and pulpal necrosis ascompared to Ca(OH)2 .

It produces better asepsis of lesions because of highalkalinity of MTA (12.5).

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It activates alkaline phosphatase and also increases activityof calcium dependent pyrophosphatase thus achievingasepsis and initiating the process of bone healing.

The sealing ability and biocompatibility of MTA has beenattributed to the Ca ions revealed from MTA which reactswith phosphates in synthetic tissue fluid yieldinghydroxyapetite which helps in sealing. The crystal grow andfill the microscopic space between MTA and dentinal wall

when MTA gradually dissolves.

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MTA induces cytological and functional changes in pulpalcells, resulting in formation of fibro dentin and reparativedentin at the surface of mechanically exposed dental pulp,property useful for pulp capping procedure.

On Tissue Healing

(the test cells) were observed to have normal

morphology, and indeed they were observed to be growing inintimate contact with the MTA.

Koh, E. et all in1998

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In pulpal procedures:

- Pulp capping- Pulpotomy- Root end filling

Apexification.

Root perforation.

Furcation perforation

Extra-radicular perforation repair

Surgical root repair.

Internal resorption repair

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Furcation


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FurcationPerforation Repair

Procedures MTA

moist pellet

temp filling

complete RCT

perm filling

Radicular


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RadicularPerforation

Extra-radicular


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Extra-radicularPerforation Repair

A ifi ti


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Apexification

Indications

root end not developed

root end resorption

open apex

A ifi ti


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Apexification

Clinical Procedures

with apply MTA confirm with x-ray

moist pellet

4 hours setting time seal canal gutta-

percha

R t E d R i


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Root End Repair

flap

osteotomy

root-end resection

root-end preparation

control bleeding

lack of moisture control

makes MTA unmanageable

Root End Repair


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Root End Repair

Place MTA with small carrier

condense

moist pellet

do not rinse!

suture

I t l R ti


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Internal Resorption

Internal Resorption


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pRepair

Pulp Cap


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Pulp Cap

Pulp Cap


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Pulp Cap

Pulpotomy


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Pulpotomy

Indications

large pulp exposure

no symptoms

Pulpotomy


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Pulpotomy

Clinical Procedures

MTA

moist pellet

temp filling

1 week perm filling

check vitality every3 to 6 months


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MTA does not require compaction therefore there are always

less chance of extrusion of the material periapically.

It helps in one step obturation of teeth with open apexbecause of its property to form an immediate apical barrier.

Setting of MTA is not affected with water or blood.

MTA has proved beneficial to create an apical plug at the endof root canal system.

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MTA has got good antimicrobial effects.

It shows low solubility and has radiopacity more than that ofdentin.

Promotes guided tissue regeneration of original tissues.

It has found to regenerate periodontal ligaments efficiently.

It has the property to adhere to tooth surface.

Allows for overgrowth of cementum and formation of bone.

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Very long setting time about 4 hrs

It requires a wet medium for setting.

Has low compressive strength, hence cannot be placed infunctional areas.

It dissolve in acidic environment.

Material such as saline and anesthetic solution affects thephysical, chemical and biological properties of MTA.

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Pediatric Dentistry; Vol. 28, No.1, Jan/Feb. 2006; 39-48. Pediatric Dentistry; 27, Vol. 6, 2005; 470-477. Pediatric Dentistry; Vol. 2, No.1, 2006. Textbook of Pediatric Dentistry by Shobha Tandon: 1st Edi.

2001. Pediatric Dentistry; Infancy Through Adolescence by

Pinkham; 4th Edi. 2005. Pediatric Dentistry; A Clinical Approach by Koch; 1st Edi.

2001. Comprehensive Pediatric Dentistry by N. Marwaha; 1st Edi.

2006.

Endodontics by Ingle; 5th Edi. 2002. Pathways of Pulp by Cohen; 8th Edi. 2002. Endodontic Therapy by Weine; 6th Edi. 2004. Endodontic Practice by Grossman; 11th Edi. 1991.

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Pediatric Endo Don Tic Materials