Recent Materials in Endodontic

By
Dr. Fatima Sadeq Mohsin
The main goal of an endodontic treatment is complete removal of
bacteria, their byproducts, and pulpal remnants from infected root
canals and the complete sealing of disinfected root canals. A wide
range of Endodontic Materials can come into play when treating or
retreating the roots of a tooth. Whether cleaning a canal, obturating it
or sealing it following a successful root canal, there are options for the
type of material to use at each step of the treatment process.
Endodontic Materials include Calcium Hydroxide Materials, Intracanal
Solutions, Intracanal Lubricants, Refrigerant Sprays, Gutta Percha
Points, Paper Points, Endodontic Post Systems, Core Build-Up
Materials, Root Canal Sealers and Root Canal Repair Materials.
Irrigation Materials
Thorough irrigation of the canal system
during instrumentation is an essential part of
the process of rendering the canal system
free of tissue, bacteria and bacterial
products, and dentinal debris. This creates an
environment favorable to successful
obturation, and ultimately to clinical success
Sodium hypochlorite is used as an endodontic irrigant as it is an effective
antimicrobial and has tissue-dissolving capabilities. It has low viscosity allowing easy
introduction into the canal architecture, an acceptable shelf life, is easily available and
inexpensive. The toxicity of its action to vital tissues and corrosion are its main
disadvantages in dental use. The antibacterial and tissue dissolution action of
hypochlorite increases with its concentration, but this is accompanied by an increase in
toxicity. Concentrations used vary down from 5.25% depending on the dilution and
storage protocols of individual practitioners.
What precautions should be taken when
?using sodium hypochlorite
Avoid bodily contact with the material.
Contact lenses should not be worn while
working with this substance. Prevent skin/eye
contact through the use of impervious gloves,
clothing, boots, apron, and eye goggles or full
face shield. Avoid breathing vapors.
Normal Saline
Normal saline one of the solutions that used as irrigant in endodontics. It causes gross debridement
and lubrication of root canals .Since it very mild in action, it can be used as an adjunct to chemical
irrigant. It can also be used final rinse for root canals to remove any chemical irrigant left after root
. canal preparation .Normal saline as 0.9% W/V is commonly used
Ethylenediaminetetraacetic Acid (EDTA)
Complete cleaning of the root canal system requires the combined use of
organic and inorganic tissue-dissolving irrigation solutions. As NaOCl
effectively dissolves only organic tissue, other solutions should be used to
remove the smear layer and debris from the root canal system. The use of
demineralizing agents, such as EDTA as auxiliary solutions during root canal
treatment is recommended. In 1957, Nygaart-Ostby proposed the use of
chelating agents to aid in the preparation of narrow and calcified root
canals. The first recommended EDTA solution had a concentration of 15%
and a pH of 7.3 . EDTA is used most commonly as a 17% neutralized solution
Obturation materials
Obturation is described as the method used to fill and seal a
cleaned root canal, using root canal filling material and sealers to
complete a root canal procedure.
Endodontic paper points are used to eliminate moisture from
canals following preparation during root canal procedures. These
small pieces of paper should be highly absorbant and shaped to
easily fit into the canal. It is important for the paper points to be
sterile and sized according to the same protocols as endodontic
files so the entire canal can be dried. These points also should be
strong so they can easily be placed in and then removed from the
canal.
Gutta percha
Gutta percha is the most common root filling material in use today. This is
interesting, because it is one of the oldest dental materials currently
being used. The history of gutta percha goes back much earlier than its
introduction into dentistry in the late nineteenth century. Today, gutta-
percha is available in two types of point, standardized points and
accessory points (Fig. 10.2). The composition of the points may vary from
one manufacturer to the other, but generally they contain 60–70% zinc
oxide, up to 17% heavy metal salts, and 1–4% waxes, resins, ant oxidizing
agents . Chemically pure Gutta-percha exists in two distinctly different
crystalline forms: alpha and beta phase that can be converted into each
other .
Advantages
,It is bioinert -1
,Nonirritating to the periapical tissue -2
,Easily inserted and removed -3
,Dimensionally stable (shrinks only with the warm technique) -4
Radiopaque, impermeable to and unaffected by moisture, and -5
. Does not discolor the tooth -6

Disadvantages
1- lack of adhesion to dentin
2- a slight elasticity, which causes a rebound and pulling away from
the canal walls.
3- Warm Gutta-percha shrinks during cooling.
4- Gutta-percha mixed with solvents such as chloroform or eucalyptol
shrinks with evaporation of solvents.
new ProTaper Gutta-percha points are simple to use as all 3
available sizes of GP. points perfectly fit canals that have
been prepared with ProTaper-Finisher files, F1, F2 or F3.
They have been specifically formulated for cold and warm
obturation techniques.
Benefits
•Optimal coronal fit and perfect apical fit
•Easy to use.
•Time saving.
•Efficient mono cone obturation for rapid placement and
cost effectiveness.
Sealers
To provide a fluid-tight seal of the canal space, a sealer is required along with
the core obturating material. Because of this, the sealer has as much or more
importance than the core material in providing a successful clinical outcome.
Zinc Oxide Eugenol Sealer:- Early ZOE cement, developed by Rickert, has
been the standard of profession for years. It admirably met the requirements
set down by Grossman except for severe staining. The silver, added for
radiopacity, causes discoloration of the teeth, removing all cement from the
crowns of teeth would prevent these unfortunate incidents. All ZOE cements
have extended working time but set faster in the tooth than on the slab
because of increased body temperature and humidity. The properties of
cement are: its plasticity and slow setting time in the absence of moisture,
together with good sealing potential because of the small volumetric changes
on setting. It has a disadvantage of being decomposed by water through
surgical approach; it is slightly soluble in water. It is antiseptic. It is used in
endodontic therapy as an antimicrobial agent in higher concentration. The
main disadvantage of Zinc Oxide Euginol sealers is that: They gradually
dissolve in fluid, releasing eugenol, which Grossman, in 1981, pointed out “is
a phenolic compound and is irritating”. In a 2-year solubility study, it was
found that ZOE sealer completely dissolved away.
Endofill
Properties Endofill is a radiopaque preparation for permanent root canal
filling. Its composition is well tolerated by tissues and it provides anti-
inflammatory, antiseptic and germicidal actions. Before hardening, the paste
penetrates the narrowest fissures and maintains its therapeutic effects
throughout the treatment until completely set. The final obturation neither
retracts nor resorbs. Indications Permanent obturation of the root canal either
after pulpectomy or after treatment of infected 4th degree cavities, preferably
associated with endodontic points. Composition Powder Thymol Iodide 22.5%,
Polyoxymethylene 2.2%, Hydrocortisone Acetate 1.0%, Dexamethasone
Acetate 0.01%, excipient ad 100% Liquid Eugenol
Mineral trioxide aggregate, or MTA, is a new material developed for
endodontics that appears to be a significant improvement over other
materials for procedures in bone. It is the first restorative material that
consistently allows for the overgrowth of cementum, and it may facilitate the
regeneration of the periodontal ligament. The authors present five cases in
which MTA was used to manage clinical problems. These included vertical
root fracture, apexification, perforation repair and repair of a resorptive
defect. In each case, MTA allowed bone healing and elimination of clinical
symptoms. Materials such as zinc oxide eugenol cement and resin composite
have been used in the past to repair root defects, but their use resulted in
the formation of fibrous connective tissue adjacent to the bone. Because it
allows the overgrowth of cementum and periodontal ligament, MTA may be
an ideal material for certain endodontic procedures.
Intracanal Medicament:
Intracanal medicaments are used as an aid to improve the predictability
and prognosis of endodontic treatment. Nowadays, intracanal
medicaments are used to eliminate or to destroy the remaining
microorganisms in the pulp space after the chemo-mechanical
preparation of the canals. It may also be used to eliminate apical
exudates and may act as physical barrier during inter-appointment
dressings. Some of the most common sedatives used during root canals
include Oral Seditives and Nitrous Oxide. Oral sedatives are usually in pill
form, something like Valium. A dentist may ask you to take one before
the root canal begins.
Calcium hydroxide is most commonly used as an intracanal
medicament for disinfection of the root canal system . It is used in various
clinical situations such as to promote apexification, to repair perforation, to
enhance healing of periapical lesions, to control root resorption, and to
control exudation in teeth with persistent periapical inflammation.
Thank you for your interest